GENERALIST PRACTICE IN SOCIAL WORK

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1 C h a p t e r

The Role of Theories in Social Work Practice

Chapter One Core Competencies

Competency 4: Practice-Informed Research and Research-Informed

Practice

• Students will understand the process of evidence-based decision making and learn the importance of thinking critically about theories.

Competency 6: Engagement

• Students will understand the importance of develop- ing therapeutic, professional relationships with clients regardless of the theoretical approach chosen.

• Students will be able to defi ne the common elements that are essential to a practice regardless of the theory that is used to inform practice.

Competency 8: Intervention

• Students will be able to identify various models used when integrating theories in practice.

• Students will be able to think critically about the advan- tages and disadvantages of taking an eclectic approach.

• Students will be able to defi ne basic and advanced micro- skills and understand how microskills are used to imple- ment interventions on micro-, mezzo-, and macrosystem practice levels.

Langer, C. L., & Lietz, C. (2014). Applying theory to generalist social work practice. ProQuest Ebook Central <a onclick=window.open('http://ebookcentral.proquest.com','_blank') href='http://ebookcentral.proquest.com' target='_blank' style='cursor: pointer;'>http://ebookcentral.proquest.com</a> Created from ncent-ebooks on 2021-02-11 14:38:34.

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8 Applying Theory to Generalist Social Work Practice

Introduction

The purpose of this book is to show a range of practice theories that inform social work practice. In the past, you may have taken a class regarding human behavior. If so, you have already been exposed to a variety of developmental theories that describe how humans progress through the life cycle. This book instead focuses on practice theories that affect the way social workers assess, plan, and intervene with children, adults, families, and communities. Although there may be some overlap between human behavior theories and those covered in this book, our intention here is to offer an array of theories that can guide social work practice. To get you started in this exploration of theoretical foundations to practice, this chapter defi nes what theory is, discusses how theory can be applied to social work practice, and closes with a review of approaches social workers can use when integrating multiple theories at one time.

What Is Theory?

A theory is an organized set of ideas that seek to explain a particular phe- nomenon (see Table 1.2). Theories are typically formulated when there is no empirical evidence, something that can be observed through the fi ve senses, to draw a defi nitive conclusion. A lack of observable evi- dence leads people to wonder about a particular experience, prompting the development of a theory or tentative conclusion. When possible, a theory is tested through the scientifi c method to determine the degree to which its assumptions are supported by observable evidence.

Considering recent technological advances, it is hard to imagine that people once believed the earth was fl at. Lacking the ability to per- ceive beyond what the eye could see, people developed this assumption because that was what they were capable of observing at that time. The idea that the earth is round was originally only a theory. This tentative conclusion was eventually proved through irrefutable physical evidence.

Theories are used in the natural sciences to explain various phenomena, including changes in weather patterns or causes of various diseases. Following a similar procedure, social scientists develop theo- ries to explain social phenomena, such as how patterns of violence get repeated across multiple generations or what factors lead to poverty. The challenge within the social sciences is that the ability to scientifi cally test theoretical assumptions through irrefutable physical evidence is limited because of their complexity and the considerations when conducting

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The Role of Theories in Social Work Practice 9

research on human subjects. Therefore, social scientists must be satisfi ed with evidence that lends support to their conclusions because there is little in the social sciences that can be discerned to the degree of knowing the earth is round.

As a result of the challenges facing social science researchers, the social work knowledge base is grounded in a multitude of theoretical ideas that come together to inform practice. There are varying levels of abstractions when considering theoretical material in social work (Coady & Lehman, 2008; Robbins, Chatterjee, & Canda, 2006). Some theoreti- cal ideas can be quite broad, as is the case with a theoretical perspective or framework. These practice perspectives offer general, widely appli- cable ideas. In contrast, Coady and Lehman (2008) describe midlevel practice theories as providing more specifi city. These theories provide more detail than perspectives, and they offer theoretical explanations regarding the nature of human behavior. Finally, practice models offer the greatest degree of direction. However, practice models may not be applicable across problems areas or populations. Table 1.1 provides a description of the strengths and limitations of each level of theoretical material informing social work practice.

Table 1.1 Levels of Theoretical Infl uences on Practice Level Strengths Limitations Examples

Practice Perspectives

- Applicable across multiple practice settings

- Diffi cult to measure - Diffi cult to implement consistently - Diffi cult to evaluate effectiveness

- Person-in- environment perspective - Problem- centered practice - Strengths perspective

Practice Theories

- More specifi c than larger perspectives, offering greater direction for practice - Easier to defi ne and measure than perspectives

- Perhaps not applicable across practice settings

- Cognitive theory - Behaviorism - Crisis theory

Practice Models

- Can foster the creation of a manual that supports consistent implementation and measurement - Easiest to evaluate the practice

- Can be narrowly focused to work with one population and/ or presenting problem - Typically not applicable across practice settings

- Solution-focused brief therapy - Motivational interviewing

Source: Coady & Lehman, 2008.

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10 Applying Theory to Generalist Social Work Practice

The person-in-environment perspective, problem-centered prac- tice, and strengths perspective represent larger viewpoints that can be applied across social work practice. They are theoretical in that they offer an organized set of ideas that can be used to guide practice. How- ever, they are not as clearly defi ned as some lower level theories. These three perspectives are in many ways the foundation to social work practice. Whereas social workers choose theories to add on to these larger perspectives, person-in-environment perspective, problem- centered practice, and strengths perspective inform all parts of social work practice.

Theories, in contrast, are more clearly defi ned than these larger perspectives and lend themselves more readily to testing. Cognitive theory and family systems theory represent midlevel theories. Theories are more specifi c than perspectives and therefore offer more direction regarding social work practice. However, their increase in specifi city may leave them irrelevant for certain practice settings.

Finally, the most narrow and specifi ed theoretical guides to prac- tice are models. Practice models such as solution-focused brief therapy offer almost a how-to manual for social workers regarding what to say and do in specifi ed client situations. When these models are put into manual form, also known as manualized treatment, they are the easiest of the levels to implement and measure. However, treatment manuals are often set up to offer one intervention chosen to affect one identifi ed problem. Because social workers need to remain responsive to diverse client populations and specifi c cultural preferences, having one narrow model of practice is not always practical. Therefore, this chapter discusses strategies for integrating multiple theories, providing a range of practice interventions informed by theoretical perspectives, theories, and models chosen to fi t the particular cultural preferences of each client.

The Relevance of Studying Theory for Aspiring Social Workers

Even before pursuing a social work degree, most of us spent time in the process of theorizing. Theorizing is a natural part of our thought process that leads people to ask questions about why something is the way it is. Even a child may notice a change in behavior of a parent who seems particularly on edge one morning at the breakfast table. When one sibling looks at another and claims, “I think Dad didn’t sleep well

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The Role of Theories in Social Work Practice 11

last night,” that child is drawing a conclusion about the cause of this particular behavior. Theorizing is to some degree a natural part of the human experience.

Thinking about the causes of human behavior is important in that it helps us understand what is happening. Sometimes, understanding is all that is needed to resolve a situation. For example, if a child can understand a parent’s agitation is caused by a lack of sleep rather than some resentment toward the child, it is relatively easy to accept the behavior and move on. In this case, the simple act of understanding may resolve the problem. However, at times, people may want a situ- ation to change or improve. The child who theorizes that his father is cranky because he did not sleep well may offer a gentle suggestion that his parent not drink coffee in the afternoon. In this way, theorizing does more than simply lead to understanding; it also provides information regarding how to intervene to improve the situation.

If the process of theorizing is a natural part of the human condi- tion, you might wonder why a social work book needs to discuss the- ory. In this book, we want to emphasize social work as a profession that is grounded in a professional knowledge base. Essentially, our asser- tion is that we all engage in the process of theorizing. However, when theorizing is divorced from a knowledge base, the process for under- standing is based solely on our personal experiences, perspectives, and worldviews. Professional social workers need the ability to work with diverse populations who have experiences that are quite different from their own. Interacting with people who have different value systems in a respectful way can be diffi cult if the only frame of reference comes from a social worker’s past. As important as a social worker’s experi- ences are, many people would agree that these experiences are limited and may not offer direction for working with clients who have quite different experiences.

A professional knowledge base grounded in a rich history of theo- retical perspectives and empirical evidence can help you to go beyond a process of theorizing that is limited by your own experiences. Prac- tice theories can foster understanding because they explain the cause underlying a particular presenting problem. Practice theories can also describe the mechanism for change, the process through which posi- tive growth and adaptation can occur. Most important, a professional knowledge base is grounded in a history of observations and experi- ences based on years of social work practice offering a broader perspec- tive for social workers as they assess, plan, and intervene with complex social problems.

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12 Applying Theory to Generalist Social Work Practice

Case Example

Consider the case of Tamasi Sharma, an Indian American student who was conducting her fi eld placement at a U.S. elementary school serving a community of Sudanese refugees. A note was sent home request- ing permission for the third-grade students to view some television news shows for a unit on journalism in a history class. Despite multiple attempts, the school could not successfully get Ahmad, a new student from Sudan, to return the permission form to view the news shows. Tamasi was tasked with the responsibility of visiting the family at home to seek permission.

As Tamasi was driving to the home, she theorized about what might be happening. During this drive, she thought about the ten- sion she experienced as a child when her family emigrated from India. She remembered the confl ict that arose with her parents as she became more acculturated to the United States, leading her mother to fear she was losing touch with her family’s cultural beliefs and prac- tice. Because of these experiences, Tamasi began to wonder whether Ahmad’s parents may have similar concerns that led them to choose not to approve the school’s request.

Based on her theorizing, Tamasi feared Ahmad would become socially isolated, as she felt at times, if he was not allowed to participate in various education activities. Therefore, she prepared an argument regarding why it was important for Ahmad to be included in this unit and entered the home ready to convince the parents to consent to the school’s request.

When Tamasi arrived at the home, she was invited to sit at the kitchen table of a small one-bedroom apartment. Despite a substantial language barrier, she attempted to make her case regarding the impor- tance of granting Ahmad permission to participate in the journalism unit. Tamasi sensed some tension, believing the parents appeared distressed while speaking to each other in a language she could not understand. She chose to slow down and make her case again, yet the parents became increasingly agitated, and the father ultimately left the conversation and went into the bedroom. At this point, Tamasi decided this discussion was not helpful, so she thanked Ahmad’s mother for her time and began to make her way toward the door.

Before Tamasi could leave, Ahmad’s mother asked her to wait. Tamasi looked up and saw Ahmad’s father exiting the bedroom while carrying their one small TV. As the father approached Tamasi, he attempted to hand Tamasi the TV. She looked back at him puzzled, and

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The Role of Theories in Social Work Practice 13

the mother explained that although this was their only TV, they were willing to give it up so that their son could be educated.

At that moment, Tamasi realized the failure to sign the permission slip was not based on fears about acculturation, as she theorized, but was instead founded on a misunderstanding. In the Sudan, these par- ents were often pressured into giving up possessions of worth to people in power. When they received the permission slip that requested per- mission to view a TV show, they misunderstood the request and instead thought they were expected to give their TV, one of their only posses- sions, to the school. Once Tamasi understood what was happening, she was able to clarify the expectations and easily resolve the situation. As the parents understood the request, they were relieved and happy to give permission for Ahmad’s participation in the journalism unit.

In this case, Tamasi’s experiences, which were a great strength to her when working with many children and families, led to some assumptions about what was happening with Ahmad and his family that directed her intervention in a way that was not helpful. Although our experiences are a great asset in our work, a professional knowledge base helps broaden our thinking beyond our experiences, allowing us to better assess and intervene. This is not to say that a social worker’s history and experiences are not helpful in some ways. However, when social work decision making is divorced from a professional knowledge base and grounded solely in personal experiences, the practice lacks professionalism and can be unduly infl uenced by bias.

Evidence-Based Practice

As mentioned earlier, a theory is a set of organized ideas used to explain a phenomenon. Whether theorizing offers larger guiding frameworks that are applicable across settings, midlevel theories offering increased specifi city, or models that offer directive guides to specialized practice techniques, the professional knowledge base is grounded in theoretical material that guides assessment, planning, and intervention. Although social scientists are not able to offer irrefutable evidence to prove their theories, as can in some cases be accomplished in the natural sciences, social work is concerned with seeking evidence that lends support to claims that theoretically informed social work interventions are effective.

Over the past two decades, the fi eld of social work has become increasingly concerned that professional decision making is not just grounded in theory but also supported by empirical evidence (Gilgun,

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14 Applying Theory to Generalist Social Work Practice

2005). Evidence-based practice (EBP) is a movement in social work suggesting that, when possible, social work interventions should be chosen based on the best available evidence of effectiveness (Gambrill, 2007; Rubin, 2011). The concept of EBP is modeled after an approach in medicine that involves using research evidence to inform decisions regarding which medical treatments to choose for various health con- ditions (Adams, Matto, & LeCroy, 2009). EBP is essentially a process that involves searching for the best available evidence to support clinical decision making that also considers a social worker’s clinical judgment and professional ethics and the client’s personal and cultural prefer- ences (Thyer & Myers, 2011). Social work researchers have responded by designing and conducting a host of research studies to test whether a particular intervention is effective with a particular social problem. EBP for social workers involves working in conjunction with client prefer- ences to choose interventions based on this body of research that have demonstrated effectiveness.

To understand how evidence can be applied to support the use of a particular psychosocial treatment, we use cognitive-behavioral therapy (CBT) as example. CBT is commonly used to treat emotional problems such as anxiety and depression. CBT is grounded in an integration of cognitive theory and behaviorism, midlevel theories that offers direction regarding how to assess and treat mood disorders. The theories explain the mechanism for change, suggesting that depression is maintained through illogical thought patterns that foster hopelessness. By identifying and restructuring unhelpful thought patterns, CBT is expected to allevi- ate the symptoms of depression. Multiple research studies have imple- mented CBT and tested its effectiveness by establishing whether levels of depression were reduced after a client received CBT. Based on these studies, CBT has been shown to signifi cantly reduce depressive symp- toms for many participants in these studies, suggesting it is an empirically supported treatment for this target problem (Butler, Chapman, Forman, & Beck, 2006).

Some people believe that EBP is the future of social work. Estab- lishing evidence for the practice of social work lends credibility to what social workers do. In addition, ensuring our practices are effec- tive is relevant when considering our ethical responsibility to clients (Gambrill, 2007). In this way, theories and research evidence work together to form the social work knowledge base needed to inform professional decision making.

Although the notion that research informs social work practice is well accepted, it is important to acknowledge that there are substantial

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The Role of Theories in Social Work Practice 15

debates about how narrowly to interpret the concept of evidence and therefore how best to implement the process of EBP (Gilgun, 2005). Standards regarding what type of evidence is of value remain at ques- tion (Adams et al., 2009). Some social work scholars suggest the high- est level of evidentiary evidence comes from a systematic review of randomized controlled trials (RCTs).

Systematic reviews involve reviewing multiple research studies on the same topic to see whether similar studies report consistent fi ndings. RCTs are often included in systematic reviews, because they involve controlling for factors outside a study’s focus that may be affecting the outcome, increasing a researcher’s confi dence that the effects are truly a result of the intervention. RCTs are considered by many people to be the most rigorous form of intervention research (McNeece & Thyer, 2004). Because systematic reviews look at the effects of multiple RCTs, this offers a substantial amount of quality evidence regarding effective- ness. Essentially, this means that several well-done studies have consist- ently supported the hypothesis that the use of a particular intervention has led to reduced symptoms related to a particular problem. When a treatment has received this level of evidence, it is considered to have empirical support.

Despite the dramatic increase in intervention research, many inter- ventions and problem areas have not yet been researched to the degree that they have systematic reviews of RCTs. EBP suggests practitioners seek the best available evidence to support their clinical decision mak- ing. The term best available suggests there is a hierarchy regarding how different types of evidence are valued (Rubin, 2011). Thyer and Myers (2011) conclude the EBP process involves giving weight to the most rigorous studies, usually referring to RCTs, yet looking at other forms of evidence such as preexperimental designs and qualitative studies as also being of value. Although some scholars suggest that system- atic reviews of RCTs offer the highest level of support for a treatment, this does not mean that other studies are not helpful. Some scholars fi nd that studies examining practice within its context offer unique strengths that might be lost when controlling for variables in an experi- mental design (Gilgun, 2005). Debates regarding what is evidence and what value to place on different types of evidence are not yet resolved within the fi eld.

Despite the value in high standards for evidentiary evidence, not all treatments and problems can be defi ned in ways that lend themselves to this type of measurement. In addition, in practice, social workers rarely face one problem. A client who is facing depression may also be facing

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16 Applying Theory to Generalist Social Work Practice

fi nancial stress because of a lost job and subsequent marital distress. Social workers have to be prepared to face multiple, complex social problems. These situations do not always fi t the fi ndings of a narrowly designed research study. In addition, social work values highlight the importance of culturally responsive practice. Even if an intervention such as CBT has empirical evidence to support its usefulness with depression, it may not be the appropriate choice if this approach does not honor a client’s cul- tural preferences. Therefore, Rubin (2011) and Thyer and Myers (2011) highlight EBP as a process that involves engaging in practice that inte- grates research evidence with the clinical expertise of the social worker in collaboration with the client’s preferences.

In addition to seeking research evidence that demonstrates the effectiveness of an intervention, some scholars contend evidence of effectiveness can be established within the fi eld (Gilgun, 2005). Practice-informed evidence refers to a social worker’s observations regarding whether a client responds to a particular treatment. This perspective values evidence that stems from research just as it values evidence derived directly from practice. A commitment to EBP means social workers remain knowledgeable about current research studies regarding their area of practice (Gambrill, 2007). It also means social workers gather their own data to assess the degree to which their practice is helpful for the clients they serve.

Although some people are concerned that EBP deemphasizes the- ory, Rubin (2011) suggests that when evidence is not available, theory is often used to direct practice. In addition, because EBP is a process, he acknowledges that theory plays an important role in grounding the clinical expertise that is needed to integrate empirical evidence with the unique needs and preferences of each client. Therefore, theoretical knowledge is a critical part of the EBP process. We highlight this discus- sion of EBP here because the process of considering evidence of effec- tiveness works closely with the process of choosing and implementing theory.

In this book, we cover a set of perspectives, theories, and models offering a range of evidence. As mentioned earlier, larger perspectives such as the person-in-environment perspective are diffi cult to defi ne and measure. Therefore, these perspectives offer less empirical evi- dence but are applicable across settings and have been well established as useful within the larger social work knowledge base. In addition, we cover some midlevel theories such as cognitive theory that have achieved the highest level of evidentiary evidence. Our objective is to expose you to a range of theoretical material, allowing you to gather

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The Role of Theories in Social Work Practice 17

a large toolbox of interventions. By having multiple perspectives that lead to a range of useful interventions, we as social workers are better able to respond to the complex and diverse nature of the problems and populations we serve.

Further Debates

In addition to understanding debates within the fi eld regarding the- ory and the process of EBP, it is important to understand that theories come from varying philosophical understandings of our world. Much of our discussion thus far has focused on a modern perspective within the social sciences. Theorists coming from a modern standpoint assert an objective reality can be understood through testing according to the scientifi c method. Leaders in this area value evidence-based decision making as a way of bringing objectivity and evidence to social work decision making. Some material covered in this book, such as cognitive theory and behaviorism discussed in Chapter 7, are grounded in the scientifi c tradition.

Postmodern thinkers challenge the notion that social experiences can be objectively measured. Whereas modernism focuses on identi- fying an objective reality, postmodernism suggests much of what we understand about the world is based on our interpretation of our expe- riences. Is a plant truly green, or did we as a society create the concept of green and assign socially defi ned characteristics as to what green is? Even if we created a category known as green, some people interpret color differently such that to one person a paint color might be sea foam green, whereas to another it might interpreted as moss blue. Postmod- ern perspectives challenge the notion that there is one objective reality that can be measured using the scientifi c method.

Social construction is the idea that all social interaction is defi ned through the process of interpretation. This philosophy challenges us to think about whether social problems such as attention defi cit disorder are true, objective disorders that can be measured or whether a society has created this label to defi ne a set of behaviors that are uncomfortable for the effi cient functioning of social service delivery systems such as our primary educational system. This greatly affects the profession of social work because some social workers draw on theories like cognitive the- ory and behaviorism that seek to measure the frequency, duration, and severity of problems. Modern thinkers commonly label problems and seek practices based on empirical support that could help reduce social

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18 Applying Theory to Generalist Social Work Practice

problems. But does one treatment always work the same for everyone? What about individuality and differences? Does labeling problems make them real? Some postmodern perspectives, such as critical theory and feminism as discussed in Chapter 12, challenge the idea that there is one reality. They also question the ways hierarchy in a society can infl u- ence the research enterprise. They instead offer theories that highlight how social structures can inhibit the potential of certain groups trying to offer an alternative perspective of what reality is. These theories are not EBPs because they speak less about measuring change in problems identifi ed with the functioning of an individual and focus instead on the ways social structures, which include social policies and programs, can both help and hinder the potential of members of a society.

In this book, we cover a range of modern and postmodern theoreti- cal positions to offer an array of perspectives that have varied applica- tion for social work practice that occurs with individuals, families, and communities on the micro, mezzo, and macro levels. At times, we offer case examples that focus on micro practice when a particular theory offers an explanation for how to understand individual functioning. At other times, we offer macro practice examples, often associated with postmodern perspectives, that provide explanations regarding the role society plays in issues of relevance to social work. When we use the phrase social work practice, we are speaking broadly about generalist prac- tice, which encompasses the varied roles social workers serve, including but not limited to counselors, crisis intervention workers, case man- agers, program developers, policy analysts, advocates, and community organizers.

Table 1.2 Key Concepts Theory An organized set of ideas that seek to explain a

particular phenomenon

Empirical Evidence Evidence based on what can be observed through the fi ve senses

Mechanism for Change An explanation regarding the process for making positive improvements regarding a particular problem

Evidence-Based Practice A process of choosing an intervention based on the best available research evidence, a social worker’s judgment, and a client’s personal and cultural preferences

Microskills Elements in communication such as asking ques- tions or refl ecting feelings that help a professional to facilitate a social work interview

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The Role of Theories in Social Work Practice 19

Theoretical Integration

Throughout the book, each chapter covers a different theoretical per- spective, theory, or model for the purpose of understanding, criti- quing, and applying these distinct sets of organized ideas. This approach increases the clarity about each theory, allowing us to compare and con- trast the ideas among the theories covered. Although it is helpful to learn theories in this way, in practice, theories are commonly integrated, and we draw from multiple perspectives when seeking to assess, plan, and intervene. Although combining theories is a common practice, this is not an activity to take lightly. Therefore, we cover four approaches, summarized in Table 1.3, regarding how to implement theory.

The Expert Approach

When social work practitioners choose to use one theory to guide their practice, this is considered the expert approach. The advantage to drawing interventions from one theory is that social workers can spend all of their continuing education time reading, researching, and attending

Table 1.3 Approaches to Theory Application and Integration Approach Strengths Limitations

Expert Approach

- Develops advanced skills in one area

- Knows a lot about one theory but little about others - Limits fl exibility and responsiveness to client preferences

Eclectic Approach

- Offers a lot of fl exibility - Can be responsive to client preferences

- Can water down application of theories - May not end up developing advanced skills

Selective Borrowing

- Offers a compromise wherein expertise is developed but additional skills can be used

- Requires more education and experience to develop expertise in one theory yet the social worker can be knowledgeable enough about other theories to integrate interventions grounded in other theories

- Combination of Two Theories

- Broadens the theoretical perspective while maintaining expertise

- Requires expertise in two theories and the ability to combine theories coherently

Source: Nichols, 2011.

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20 Applying Theory to Generalist Social Work Practice

trainings on this one theory. Students cover a range of theories in their programs, so taking an expert approach means that new social workers explore all options relevant for the population with whom they work and the problems they expect to address. This choice then leads to ongoing postdegree development in becoming an expert in the technical applica- tion of that theory. The strength of this approach is that the social worker has the opportunity to develop advanced skills within one theory. This can increase confi dence and skill level.

Despite these potential advantages, social workers rarely have jobs focused on one problem area. Even if they fi nd such a position, there is variability within any population and within any problem area. Having only one theory to draw from may limit the number of interventions available to the social worker. This may hinder the worker’s ability to remain responsive to complicating factors within the case. The expert approach may also limit culturally sensitive treatment because it prior- itizes the clinical preferences of the practitioner over those of the client. Therefore, most social workers choose to integrate multiple theories into their approach to practice.

The Eclectic Approach

The eclectic approach to theory integration involves having a long list of theoretically informed interventions from which the social worker can draw (Coady & Lehman, 2008; Nichols, 2011). In this case, the social worker may not be an expert in one theory or model but instead may have reasonable competence in many theories. Social workers are able to draw from multiple perspectives, allowing them to remain more responsive to the cultural preferences of clients and to be better prepared to address multiproblem cases. The benefi t to this approach is its breadth and fl exibility. The disadvantage is that it requires social workers to know a lot of theories. In addition, some people are con- cerned that a truly eclectic approach can water down the application of theory, creating an inconsistent, atheoretical approach. If a social worker chooses the eclectic approach, it is essential that core competencies are developed within each theory that is applied.

Selective Borrowing

Selective borrowing involves choosing one primary theory that is then supplemented with interventions from other theories as needed (Nichols, 2011). This approach represents a compromise between the expert and the eclectic approaches. The social worker ascribes to one

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The Role of Theories in Social Work Practice 21

primary theory that represents the best fi t for the population and the problem areas addressed by that worker. This practitioner is responsible for developing expert knowledge regarding this theory and how it is applied in practice. Once social workers achieve competence with the primary theory, they then search for a multitude of additional interven- tions grounded in varying theories that complement the primary theory.

Combining Two Theories

Combining two theories involves choosing two primary theories that are integrated to guide practice (Nichols, 2011). Choosing two theories that supplement each other by making up for the limita- tions present in the other theory can be a useful way of developing advanced skills and expertise while creating some fl exibility. CBT is a treatment approach discussed earlier in this chapter that represents a good example of combining two theories. In this case, theorists inte- grated the theoretical principles of behaviorism with cognitive theory, two approaches that were philosophically aligned. By combining these two theories, the approach became stronger because each theory made up for limitations of the other. In a similar way, social workers may choose to identify two theories that best fi t the population and the problem areas they serve. The integration of two approaches broadens the theoretical understanding that informs assessment, planning, and intervention.

Some Final Thoughts About Integration

There are benefi ts to synthesizing theoretical perspectives. Integration increases the breadth of understanding and explanation when consid- ering various social problems. Integration leads to an expansive list of interventions available to a social worker, increasing fl exibility. This fl exibility can enhance the degree to which social workers are able to remain responsive to a client’s cultural and personal preferences. How- ever, some caution is worthwhile. Combining theories to the degree that the theoretical underpinnings become unrecognizable can interfere with competent implementation of theories in practice. The integration of multiple theories is an important, serious effort that requires some thoughtful decisions about which theories to choose, how to go about integrating them, and fi nally, how to apply the approach professionally and competently. Finally, as mentioned earlier, person-in-environment and strengths perspectives are frameworks that are foundational and inform all social work practice.

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22 Applying Theory to Generalist Social Work Practice

Common Elements

In addition to considering the benefi ts of theory integration, research has compared social work practice theories to identify the elements com- mon within multiple practices that are helpful. The common elements approach is a transtheoretical model that identifi es the most effective aspects of social work practice (Cameron & Keenan, 2010; Drisko, 2004). By understanding what is helpful across multiple theories, social work- ers can highlight these aspects regardless of which theory they choose.

When discussing common elements of practice, many scholars identify as critical the professional relationship that is formed between the social workers and the children, adults, families, and communi- ties they serve. Lambert (1992) found that when clients perceive their social workers as empathic and supportive, an effective therapeutic rela- tionship can be formed. When professionals can demonstrate care and respect for people who have been oppressed, judged, hurt, or trauma- tized, the forming of this relationship is in itself healing (Frank, 1982). When social workers demonstrate genuineness, show empathy, and are emotionally grounded, the potential for positive effects is enhanced. Essentially, the importance of developing a collaborative therapeutic relationship has been consistently linked to positive outcomes (Orlinsky, Grawe, & Parks, 1994).

Another common element that has been identifi ed is the setting of intervention (Frank, 1982). When a social worker is able to create a sense of safety in a professional space, this activity gives validity to the helping process. Drisko (2004) identifi es extratherapeutic factors such as the agency context as relevant. Social work practice is affected by knowledge of services and the location of the agency, making oppor- tunities for psychosocial intervention accessible (Lambert, 1992). This factor highlights the importance of agency-level factors that are needed to foster the creation of positive helping relationships. Additional extra- therapeutic factors that have been found to affect outcomes include the benefi t of social support for the client outside of the therapeutic rela- tionship and client characteristics, including motivation and investment in the change process (Cameron & Keenan, 2010; Drisko, 2004).

The fi nal key common element involves the specifi c interventions that are employed within the context of the helping relationship. Frank and Frank (1991) found that therapeutic procedures, such as helping clients to process emotions and creating opportunity to practice what they have learned, foster the healing process. Activities such as providing feedback, modeling new skills and behaviors, and developing increased insight are relevant to all theoretical approaches. These activities seem

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The Role of Theories in Social Work Practice 23

to support the change process (Cameron & Keenan, 2010). Although there may be some differences regarding what types of interventions are chosen as a result of the theoretical orientation of the social worker (Drisko, 2004), the technical application is a factor that infl uences the success of the helping process. In other words, it is not just what you do but also how you do it that may matter most.

Implementation of Theory: The Role of Microskills

Although this chapter has focused on what theory is and why study- ing theory is important for social work, the discussion of implementa- tion has been limited to our discussion of integration. Each subsequent chapter spends time discussing how to apply each theory covered in the book. However, before moving forward, we believe it is important to discuss microskills, because these generalist interviewing skills allow a social worker to implement theoretical principles competently.

Microskills are the “communication skill units” used to facilitate a professional interview (Ivey, Ivey, & Zalaquett, 2010, p. 14). The basic interviewing techniques are focused on active listening and seek to draw out a client’s story to foster understanding. These communication skills are needed to conduct any social work interview. The basic micro- skills, as summarized in Table 1.4, include orientation, attending, asking open- and closed-ended questions, refl ection of feelings or content, and summarization (Boyle, Hull, Mather, Smith, & Farley, 2009; Ivey et al., 2010; Shulman, 2009).

When conducting a professional interview, social workers use these basic skills interchangeably in the process of structuring the interview. For example, a social worker employed in a hospital may be meeting with an older adult and her adult children regarding whether the patient needs skilled nursing care. The interview may start with an orientation, which involves the worker explaining the purpose of their meeting and the role of the social worker. The worker may then use an open-ended question to ask the patient about what she would like to accomplish. By looking and speaking to the patient fi rst, the social worker is attend- ing to the patient, empowering her self-determination, and demonstrat- ing respect for her. As the patient responds to the open-ended question, the social worker may use refl ection of feeling and refl ection of con- tent to draw out the patient’s perspective. Once the patient has given a full response to the initial question, the social work may summarize what the patient said to highlight the key points and then turn to the adult children, asking for their impressions. The interview is structured

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24 Applying Theory to Generalist Social Work Practice

according to its purpose using microskills to facilitate a discussion that leads to decision making.

In addition to basic microskills, social workers use advanced com- munication skills when needed. These advanced microskills are used not simply to foster a conversation that prompts understanding but instead to prompt thinking and ultimately behavior change. Advanced interviewing skills, also identifi ed in Table 1.4, include confrontation, communication of feelings and immediacy, interpretation, infor- mation sharing, and use of self (Ivey et al., 2010). Social workers use the infl uencing skills in accordance with the theoretical perspective they have adopted. More detail is provided in each chapter about how to apply theoretical principles in practice. The overview of these microskills sets the tone for this objective moving forward.

Table 1.4 Overview of Microskills Basic Microskills

Orientation Clarify the role of the social worker and the purpose of the social work interview.

Attending Use eye contact, body language, and verbal tracking to provide encouragement and understanding.

Open- and Closed-Ended Questions

Use open-ended questions to draw out the client’s story. Use closed-ended questions to seek detail and to increase the structure of the interview.

Refl ection of Feelings Briefl y restate the emotions expressed by client to vali- date the feelings and to demonstrate active listening.

Refl ection of Content (Paraphrase)

Briefl y restate the content discussed by client to validate the story and to demonstrate active listening.

Summarization Organize a section of content by synthesizing the content and moving the interview forward.

Advanced Microskills

Confrontation Observe and point out contradictions within the interview to increase understanding.

Communication of Feelings and Immediacy

Share with the client the social worker’s concerns about the situation and the direction of the case.

Interpretation Share a tentative observation with the client about what the social worker is seeing in the case.

Information Sharing Provide information to the client to facilitate a referral, increase understanding, or develop a new skill.

Use of Self Use the professional relationship to prompt change in thinking and behavior, possibly including professional use of self-disclosure.

Source: Boyle et al., 2009; Ivey et al., 2010; Shulman, 2009.

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The Role of Theories in Social Work Practice 25

Conclusion

Theories are a set of organized ideas that explain and predict human experiences. Practice theories are those ideas that inform assessment, planning, and intervention in social work. There are varying levels of abstraction when reviewing theories, such as perspectives, midlevel theories, and models. These various organizing frameworks provide either general, widely applicable ideas or specifi ed directions for unique practice situations. As social workers choose which theory or model to use, the EBP movement suggests they consider the research evidence demonstrating the effectiveness of their approach along with their clini- cal expertise and the preferences of the client when making these deci- sions. As social workers implement theory in practice, there are various options for integrating theories. Regardless of the theory chosen, com- mon elements such as the infl uence of a positive, collaborative rela- tionship seem to be crucial. Finally, when implementing all of these decisions, basic and advanced interviewing skills provide the technical format through which this work is done.

Resources for Students

The Role of Theory in Practice

• http://swscmedia.wordpress.com/2012/01/30/do-theories-have- any-relevance-for-social-work-practice-a-case-example-opinion- piece-by-dr-nancy-smyth/

• http://www.theguardian.com/social-care-network/social-life- blog/2012/aug/03/using-theory-social-work-practice

• http://www.slideshare.net/srengasamy/theories-of-social-work

Defi nitions of Evidence-Based Practice

• http://depts.washington.edu/ebpi/ • http://www.socialworkpolicy.org/research/evidence-based-

practice-2.html • http://www.socialworkers.org/practice/adolescent_health/shift/

case.asp

Searching for Evidence-Based Practices

• http://www.samhsa.gov/ebpwebguide/index.asp • http://www.socialworkpolicy.org/research/evidence-based-

practice-2.html

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26 Applying Theory to Generalist Social Work Practice

Adams, K. B., Matto, H. C., & LeCroy, C. W. (2009). Limitations of evidence-based practice for social work education: Unpacking the complexity. Journal of Social Work Education, 45(2), 165–186.

Boyle, S. W., Hull, G. H., Mather, J. H., Smith, L. L., & Farley, O. W. (2009). Direct practice in social work (2nd ed.). New York: Pearson/Allyn & Bacon.

Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empir- ical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31.

Cameron, M. & Keenan, E.K. (2010). The common factors model: Implications for transtheoretical clinical social work practice. Social Work, 55(1), 63–73.

Coady, N., & Lehman, P. (2008). Theoreti- cal perspectives for direct social work prac- tice. New York: Springer.

Drisko, J. (2004). Common factors in psy- chotherapy outcome: Meta-analytic fi ndings and their implications for practice and research. Families in Soci- ety, 85(1), 81–90.

Frank, J. D. (1982). Therapeutic com- ponents shared by all psychothera- pies. In J. H. Harvey & M. M. Parks (Eds.), The master lecture series: Psycho- therapy research and behavior change (pp. 9–37). Washington, DC: Ameri- can Psychological Association.

Frank, J. D., & Frank, J. B. (1991). Per- suasion and healing: A comparative study of psychotherapy (3rd ed.) Baltimore: Johns Hopkins University Press.

Gambrill, E. (2007). Views of evidence- based practice: Social workers’ code of ethics and accreditation standards as guides for choice. Journal of Social Work Education, 43(3), 447–462.

Gilgun, J. F. (2005). The four cornerstones of evidence-based practice in social

work. Research on Social Work Practice, 15(1), 52–60.

Ivey, A., Ivey, M., & Zalaquett, C. (2010). Essentials of intentional interviewing: Counseling in a multicultural world (2nd ed.). Belmont, CA: Brooks/ Cole.

Lambert, M. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94–129). New York: Basic Books.

McNeece, C. A., & Thyer, B. A. (2004). Evidence-based practice and social work. Journal of Evidence-Based Social Work, 1(1), 7–25.

Nichols, M. (2011). The essentials of fam- ily therapy (5th ed.). Boston: Allyn & Bacon.

Orlinsky, D., Grawe, K., & Parks, B. (1994). Process and outcome in psychother- apy: Noch einmal. In A. Bergin & S. Garfi eld. (Eds.), Handbook of psycho- therapy and behavior change: An empiri- cal analysis (4th ed., pp. 152–209). New York: Wiley.

Robbins, S. P., Chatterjee, P., & Canda, E. R. (2006). Contemporary human behavior theory: A critical perspective for social work. Boston: Pearson/Allyn & Bacon.

Rubin, A. (2011). Teaching EBP in social work: Retrospective and prospective. Journal of Social Work, 11(1), 64–79.

Shulman, L. (2009). The skills of helping individuals, families, groups, and com- munities (6th ed.). Belmont, CA: Thomson/Brooks/Cole.

Thyer, B. A., & Myers, L. L. (2011). The quest for evidence-based practice: A view from the United States. Journal of Social Work, 11(1), 8–25.

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