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02 Editorial

03 Jeae Marsh talks about the influence ofSharon Berlin on scholarship and practice

05 Frma Walsh looks at a family resilienceframework

15 Malclm Paye discusses complexity andsocial work theory and practice

21 Jerme Wakefield and Jdih Baer examinelevels of meaning and the case for theoretical

integration

29 Ssa Kemp looks at practicing place:everyday contexts in child and family welfare

38 James Clark discusses complex approaches towicked problems

49 Social Work Now aims

50 Information for contributors

Social Work Now is published three times a year by Child, Youth and Family.

Views expressed in the journal are not necessarily those of Child, Youth and Family. Material

may be reprinted in other publications only with prior written permission and provided the

material is used in context and credited to Social Work Now.

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SOCIAL WORK NOW: APRIL 2008

Professor Sharon Berlin:Social Work Theorist

Dr Marie Connolly

02

In 2007 a social work theorist of international

reputation retired from her position at the

University of Chicago. Professor Sharon Berlin,

as Jeanne Marsh will pay tribute to in the

foreword to this edition, has furthered social

work knowledge about cognitive behavioural

theory in ways that bridge the theory/

practice divide, guiding practice along the

interactive dimensions of personal meaning and

environmental realities.

Professor Berlin has periodically spent time

in New Zealand, contributing to the teachingand learning of theory, and through her work

has found a special place here. In May 2007 a

group of social work theorists from across the

world gathered at the University of Chicago for

a symposium to honour the work and career

of Professor Berlin. Given her connection with

New Zealand, we thought it would be fitting

to dedicate a special edition of Social Work

Now to social work theory, and in particular toher work. We were delighted to find that the

academics who presented at the symposium

were happy to share their work with us in this

special edition.

Theoretical explanations can help us to

understand and make sense of a complex

human world. In exploring ways of helping

clients, social workers can draw on a range

of theoretical perspectives in their work. In

this special edition we explore social work

theories for practice – theories that help us

to navigate our way through complex human

troubles. Some of the papers are challenging,

as they present complex conceptual territories.

Hopefully there will be something for everyone

as the papers encourage us to reflect on how

theory contributes to and influences our

practice.

Dr Marie Connolly is the Chief Social Worker at the

Ministry of Social Development.

EDITORIAL


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Sharon B. Berlin, steward ofthe discipline: her influenceon social work scholarship

and practiceDr Jeanne Marsh

Sharon B. Berlin, Helen Ross Professor in the

School of Social Service Administration, served

as a University of Chicago faculty member from

1985 through 2007. Her research and scholarship

during this period significantly shaped the

conceptualisation and practice of contemporary

social work. Her focus on

issues fundamental to the

practice of social work, to

the values, perspectives and

pragmatic concerns that

have shaped the profession

since its inception, serve

to advance the field while

keeping it grounded in defining concerns. In

this work, she has served as a “steward of the

discipline” according to social work scholar,

William Borden, (2007). As such, she is an

appropriate focus for the dedication of this

special issue of Social Work Now.

Her academic and professional background

include a bachelor’s degree from the College of

Idaho, masters and doctoral degrees from the

University of Washington, and a post-masters

programme in Community Mental Health at

the School of Social Welfare, University of

California, Berkeley. She served as staff social

worker at the Connecticut Child Study and

Treatment Center in New Haven. After her

return to Seattle, she joined a small group of

women in organising one of the first feminist

counselling centres in the

region. She was assistant

professor in the School of

Social Work at the University

of Wisconsin-Madison before

joining the faculty of the

School of Social Service

Administration in 1985. She

continued to work as a practitioner throughout

her academic career, most recently as voluntary

clinician for the Marjorie Kovler Center for the

Treatment of Survivors of Torture.

Sharon Berlin’s theoretical work has served

to advance cognitive models of practice in a

manner explicitly designed for social workers.

She understands that practitioners engage in

fundamental problem-solving processes as they

seek to understand and engage clients and

decide what to do that will be helpful. At the

FOREWORD

Sharon Berlin’s theoretical

work has served to advance

cognitive models of practice

in a manner explicitly

designed for social workers


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SOCIAL WORK NOW: APRIL 2008 04

practice wisdom through empirical findings.

Bringing knowledge of thinking and judgemental

processes to the context of practice, she

illuminates how practitioners and clients

acquire, retain, organise and extract different

kinds of information in the course of regular

encounters and how to make the best use of this

knowledge to address client goals. As renowned

social work scholar Laura Epstein (1993) has

written, Berlin’s work is a “jump-start toward an

advanced round of modernising clinical practice.

Future work will … contend with these new

ideas”.

R e f e R e n c e s

Bord, W. (2007) Programm ot: A symposium

to honor the work and career of Sharon B. Berlin,

Helen Ross Professor, The School of Social Service

Administration, The University of Chicago. chiago,

Illioi, May 11 2007.

epti, L. forword i Brli, s., & Marh, J. (1993)

Informing Practice Decisions. nw York: Mamilla.

Dr Jeanne Marsh is the Dean and George Herbert Jones

Professor in the School of Social Service Administration

at the University of Chicago. Her fields of special

interest include services for women and families, service

integration in service delivery, social programme and

policy evaluation, and knowledge utilisation in practice

and programme decision-making.

same time, she understands that all humans,

practitioners and clients alike solve problems

by relying on memory patterns that allow us to

interpret what is happening today. When these

memory patterns prevent us from recognising

that different circumstances require different

thinking, we can become stuck in old and

unhelpful ways of understanding. Nonetheless,

she also knows from her social work experience

that, for many clients, a therapeutic approach

solely focused on a patient’s thought patterns

is not sufficient. One of her great insights has

been to recognise that when someone’s life

situation is demoralising, truly effective help

incorporates opportunities for changes in that

life situation. In other words, assistance that

a social worker routinely provides – helping

a client prepare for a custody evaluation,

coaching her through a court hearing,

intervening on her behalf with a bureaucracy –

are not just tasks in addition to therapy. They

can explicitly be a part of therapy, because they

can spur new opportunities to learn and change.

Berlin’s inherent respect for each client is

evident throughout her writings. She is

unwilling to prescribe only one approach or

technique, because differing client circumstances

require different options. Her writing connects

a range of ideas, from neuroscience to social

psychology, from narrative studies to evidence-

based practice research. The breadth of ideas is

a testament to her understanding of the broadassortment of issues social workers are asked to

address, as well as her capacity to examine and

incorporate a range of disciplinary and practical

perspectives.

Berlin builds on nearly three decades of effort by

contemporary social work scholars to develop

an empirically-based practice that is consistent

with the humanistic values of social work. Her

work is part of a larger effort to elaborate


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Using theory to support afamily resilience framework

in practiceFroma Walsh, M.S.W., Ph.D.

Theory, research, and practice in social workare inescapably intertwined. Each can inform

and enrich the others. As a clinical scholar,

educator, and practitioner over the past three

decades, I have endeavoured to integrate

the three in the development of a family

resilience framework to guide intervention and

prevention efforts with families facing serious

life challenges. I have also found it essential

to bridge theory and research on ‘normal’

human development in the social sciences with

preoccupations in the field of mental health on

individual psychopathology and family deficits.

Early in my career I was drawn to the field

of family therapy, which was just flowering

in the late 1960s. It was refreshing to cast

off deterministic theories of early childhood,

maternal causality for individual problems. As

we have come to realise, views of normality,

health, and dysfunction are socially

constructed, permeating all research and clinical

transactions, assessments, and aims. Moreover,

with social and economic transformations of

recent decades, theory, research, and practice

must be relevant to the growing cultural

diversity and multiplicity of family kinship

arrangements.

Systems-oriented family process research hasprovided empirical grounding to assess healthy

family functioning (see Walsh, 2003b). Yet,

family patterns differing from the norm are too

often pathologised, particularly when distressed

families seek help. Moreover, family typologies

tend to be static and acontextual, offering a

snapshot of intra-familial patterns without

consideration of family challenges, resources,

and socio-cultural influences. I thought theconcept of resilience could be more relevant and

valuable for practice. By definition, it involves

strengths in the context of stress and is flexible

in relation to varied life conditions. Over the

past decade, I have developed a family resilience

framework, building on collaborative, strengths-

based practice approaches, that can take us to

another level by tapping into a family’s resources

and potential to master their life challenges.

The concept of resilience

Resilience can be defined as the ability to

withstand and rebound from disruptive life

challenges, strengthened and more resourceful.

Resilience involves dynamic processes that foster

positive adaptation in the context of significant

adversity (Luthar, Cicchetti, & Becker, 2000).

It is a common misconception that resilience


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personality traits for resilience, or hardiness,

reflecting the dominant cultural ethos of the

“rugged individual” (Walsh, 1996). Influenced

by psychoanalytic theory, resilience was

assumed to be due to innate traits, or character

armour, that made some children impervious

to the damage of parental pathology. ‘The

invulnerable child’ was likened to a ‘steel doll’

that would not break under stress (Anthony &

Cohler, 1987). Theory limited the view of the

family narrowly to the mother-child dyad. The

contributing – or counterbalancing – influence

of the father or other family members was

generally not assessed. In

cases where there was a

disturbed parent, scholars

and practitioners dismissed

the family as hopelessly

dysfunctional and sought

positive extra-familial

resources to counter the

negative impact. Thus,

families were seen to

contribute to risk but not toresilience.

The work of Sir Michael Rutter (1987) led

researchers toward a systemic perspective,

recognising the complex interaction between

nature and nurture in the emergence of

resilience over time. As studies were extended

to a wide range of adverse conditions – such

as growing up in impoverished circumstances,

dealing with chronic medical illness, being

severely abused or neglected, or recovering

from catastrophic life events, trauma, and

loss – resilience came to be viewed in terms

of an interplay of multiple risk and protective

processes over time, involving individual,

family, and larger socio-cultural influences.

Individual vulnerability or the impact of stressful

conditions could be outweighed by positive

mediating environmental influences.

means invulnerability; vulnerability is part of

the human condition. Nor is resilience simply

the ability to bounce back unscathed. Rather

resilience involves struggling well, effectively

working through and learning from adversity,

and integrating the experience into the fabric of

individual and shared life passage.

Resilience has become an important concept

in mental health theory and research over

the past two decades as studies challenged

the prevailing deterministic assumption

that traumatic experiences and prolonged

adversity, especially in childhood, are inevitably

damaging. Pioneering

research by Rutter (1987),

Werner (1993), and others

found that many children

who experienced multiple

risk factors for serious

dysfunction, such as parental

mental illness, traumatic loss,

or conditions of poverty,

defied expectations and

did remarkably well in life.

Although many lives were

shattered by adversity, others overcame similar

high-risk conditions, able to lead loving and

productive lives and to raise their children

well. Studies found, for instance, that most

abused children did not become abusive parents

(Kaufman & Ziegler, 1987).

Clinicians often work with individuals andfamilies who suffer from trauma who are

overwhelmed by daunting challenges, and whose

lives have been blocked from growth by multi-

stress conditions. What makes the difference for

those who rise above adversity?

Individual resilience in multi-systemic

perspective

To account for these differences, early studies

by child development scholars focused on

The work of Sir Michael

Rutter (1987) led researchers

toward a systemic

perspective, recognising

the complex interaction

between nature and

nurture in the emergence of

resilience over time


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not – nor to label and dismiss those who are

struggling at a particular time as ‘not resilient’.

This research affirms the potential throughout

life, for those who have suffered to gain

resilience and to turn their lives around.

Relational ‘lifelines’ for individual

resilience

In my survey of over two decades of

resilience research with varied populations

and methodologies, the crucial influence of

significant relationships stood out across studies.

The resilience of individuals was nurtured by

bonds with kin, intimate

partners, and mentors such

as coaches and teachers,

who supported their efforts,

believed in their potential,

and encouraged them to

make the most of their lives.

In the practice field, the

prevailing theoretical lens has

blinded many to the familyresources that can foster

resilience, even where a parent’s functioning

is seriously impaired. A family resilience

perspective recognises parental strengths and

potential alongside limitations. Furthermore,

grounded in a systemic orientation, it looks

beyond the parent-child dyad to consider

broader influences in the kin network, from

sibling bonds to couple relationships andextended family ties. An example of this

wider family empowerment is the use of family

decision-making processes in New Zealand child

protection legislation, The Children, Young

Persons and Their Families Act 1989. The family

group conference, the key mechanism of family

decision-making and empowerment within the

legislation, addresses and resolves care and

protection issues by bringing together and

utilising the knowledge, resources and support

In a remarkable longitudinal study of resilience,

Werner (1993; Werner & Smith, 1992) followed

the lives of nearly 700 multi-cultural children

of plantation workers living in poverty on the

Hawaiian island of Kauai. By age 18, about two-

thirds of the at-risk children had done poorly

as predicted, with early pregnancy, needs for

mental health services, or trouble in school or

with the law. However, one-third of those at

risk had developed into competent, caring, and

confident young adults, with the capacity ‘to

work well, play well, and love well’ as rated

on a variety of measures. A strong, mentoring

relationship, as with a coach

or teacher, was a significant

variable. In later follow-

up studies through middle

adulthood, almost all were

still living successful lives,

with stable relationships and

employment. When hurricane

Iniki devastated the island,

fewer were traumatised

compared to the generalpopulation, showing that

overcoming early life adversity made them

hardier, not more vulnerable, in the face of later

life challenges.

Of note, several individuals who had been

poorly functioning in adolescence turned

their lives around in adulthood, most often

crediting supportive relationships and

religious involvement. Such findings counter

deterministic assumptions that negative effects

of early life trauma are irreversible. Rather,

a developmental perspective is required,

recognising the potential, despite a troubled

childhood or adolescence, for human resilience

to emerge across the life course. There are

important implications for practice here. We

must be cautious not to frame resilience as a

static set of traits – some have it and others do

a developmental

perspective is required,

recognising the potential,

despite a troubled

childhood or adolescence,

for human resilience to

emerge across the life

course


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strengths and potential alongside vulnerabilities.

A multi-systemic view expands focus to tap

extended kin, community, and spiritual

resources.

The concept of family resilience

The concept of family resilience extends beyond

seeing individual family members as potential

resources for individual resilience. It focuses on

risk and resilience in the family as a functional

unit (Walsh, 1996; 2003a). A basic premise in

this systemic view is that serious crises and

persistent adversity have an

impact on the whole family.

In turn, key family processes

mediate the recovery – or

maladaptation – of all

members and the family unit.

The family response is crucial.

Major stresses can derail

the functioning of a family

system, with ripple effects

for all members and their

relationships. Key processes

in resilience enable the family

system to rally in times of

crisis, to buffer stress, reduce

the risk of dysfunction, and support optimal

adaptation.

Family stress, coping, and adaptation

The concept of family resilience extends

theory and research on family stress, coping,

and adaptation (McCubbin & Patterson, 1983;

McCubbin, H., McCubbin, M., McCubbin, A.,

& Futrell, 1998; McCubbin, H., McCubbin, M.,

Thompson & Fromer, 1998). It entails more

than managing stressful conditions, maintaining

competence, shouldering a burden, or surviving

an ordeal. It involves the potential for personal

and relational transformation and growth

that can be forged out of adversity. Tapping

of the wider family group. This approach

fundamentally alters the deficit-based lens

from viewing troubled parents and families as

damaged and beyond repair, to seeing them as

challenged by life’s adversities with potential

for fostering healing and growth in all members(Wolin & Wolin, 1993).

In the field of traumatology, researchers are

increasingly shifting attention from post-

traumatic stress disorder to better understand

the resilience and post-traumatic growth

experienced by many individuals in the

aftermath of trauma events

(Calhoun & Tedeschi, 2006;Tedeschi & Calhoun, 1996).

Van der Kolk and colleagues

have advanced a bio-psycho-

social understanding of

trauma, its treatment, and

its prevention, including

attention to variables that

influence vulnerability,

resilience, and the courseof post-traumatic reactions

(van der Kolk, McFarlane, and

Weisaeth, 1996). The effects

of trauma depend greatly

on whether those wounded can seek comfort,

reassurance, and safety with others. Strong

connections, with trust that others will be there

for them when needed, counteract feelings of

insecurity, helplessness, and meaninglessness.Despite the groundbreaking work of Figley

on the impact of catastrophic events on the

family (Figley & McCubbin, 1983), only recently

are approaches being developed to strengthen

family and community resilience in response to

major trauma (Walsh, 2007).

A family resilience orientation to practice seeks

out and builds relational lifelines for resilience

of the family unit and all members. It recognises

In the field oftraumatology, researchers

are increasingly shifting

attention from post-

traumatic stress disorder

to better understand

the resilience and post-

traumatic growth

experienced by manyindividuals in the aftermath

of trauma events


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conviction in their potential. Assessment and

intervention are redirected from how problems

were caused to how they can be solved,

identifying and amplifying existing and potential

competencies. Worker and clients work together

to find new possibilities in a problem-saturated

situation and overcome impasses to change.

This positive, future-oriented stance refocuses

from how families have failed to how they can

succeed.

A family resilience framework

is distinguished from a more

general family strengths

perspective by its focus on

strengths in the context of

adversity (Walsh, 2003a). It

links symptoms of distress

with stressful events and

conditions in the family

and wider environment.

Families most often come for help in crisis, but

often they do not initially connect presenting

problems with relevant stressors. A basic

premise guiding this approach is that crises and

persistent challenges impact the whole family

and, in turn, key family processes mediate the

adaptation of all members and relationships.

This family resilience framework can serve as a

valuable conceptual map to guide intervention

efforts to target and strengthen key processes as

presenting problems are addressed. As families

become more resourceful, risk and vulnerabilityare reduced and they are better able to meet

future challenges. Thus, building resilience is

also a preventive measure.

This conceptual approach shifts the prevalent

deficit-based lens from regarding parents and

families as damaged and beyond repair, to

seeing them as challenged by life’s adversities

with potential to foster healing and growth in

all members. Rather than rescuing so-called

into key processes for resilience, families that

have been struggling can emerge stronger and

more resourceful in meeting future challenges.

Members may develop new insights and abilities.

A crisis can be a wake-up call, heightening

attention to important matters. It can becomean opportunity for reappraisal of life priorities

and pursuits, stimulating greater investment in

meaningful relationships. In studies of strong

families, many report that through weathering a

crisis together their relationships were enriched

and became more loving than

they might otherwise have

been.

Utility of a family

resilience framework for

practice

As Werner has affirmed: 1)

resilience theory and research

offer a promising knowledge base for practice;

2) the findings of resilience research have many

potential applications; and 3) the building of

bridges between clinicians, researchers, and

policy makers is of utmost importance (Werner &

Johnson, 1999).

My efforts over more than a decade have

focused on the development of a family

resilience framework for clinical and community-

based intervention and prevention. This

resilience-oriented approach builds on

developments in the field of family therapy that

have refocused attention from family deficits to

family strengths (Walsh, 2003a). The therapeutic

relationship is collaborative and empowering of

client potential, with recognition that successful

interventions depend on tapping into family.

Our language and discourse are strengths-

oriented and empowering. Less centred on

therapist techniques, what matters more is the

therapist’s relationship and engagement with a

family, with compassion for their struggle and

A family resilience

framework is distinguished

from a more general family

strengths perspective by its

focus on strengths in the

context of adversity


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10SOCIAL WORK NOW: APRIL 2008

can be seen as nested contexts for nurturing

and reinforcing resilience. A multi-dimensional,

holistic assessment includes the varied contexts,

seeking to identify common elements in a

crisis situation and in family responses while

also taking into account each family’s unique

perspectives, resources, and challenges.

A developmental perspective is also essential

to understand and foster family resilience. (1)

Families navigate varied pathways in resilience

with emerging challenges over time. (2) A pile-

up of multiple stressors can

overwhelm family resources.

The impact of a crisis mayalso vary in relation to its

timing in individual and

family life cycle passage.

Past experiences and stories

of adversity and family response can generate

catastrophic expectations or can serve as models

in overcoming difficulties.

Varied adaptational pathways in resilience

Most major stressors are not simply a short-

term single event but rather a complex set

of changing conditions with a past history

and a future course (Rutter, 1987). Family

resilience involves varied adaptational pathways

over time, from the approach taken to a

threatening event on the horizon, through

disruptive transitions, subsequent shockwaves

in the immediate aftermath, and long-term

reorganisation. For instance, how a family

approaches an impending death, facilitates

emotional sharing and meaning making,

effectively reorganises, and fosters reinvestment

in life pursuits will influence the immediate and

long-term adaptation to loss for all members and

their relationships (Walsh & McGoldrick, 2004).

Given the complexity of life situations, no single

coping response is invariably most successful;

different strategies may prove useful in meeting

’survivors’ from ’dysfunctional families’, this

practice approach engages distressed families

with respect and compassion for their struggles,

affirms their reparative potential, and seeks to

bring out their best qualities. Efforts to foster

family resilience aim both to avert or reduce

dysfunction, and to enhance family functioning

and individual wellbeing (Luthar et al, 2000).

Such efforts have the potential to benefit all

family members as they fortify relational bonds

and strengthen the family unit.

Putting ecological

and developmental

perspectives into practice

This family resilience

framework combines

ecological and developmental

perspectives to understand

and strengthen family functioning in relation

to its broader socio-cultural context and multi-

generational life cycle passage.

Bio-psycho-social systems orientationFrom a bio-psycho-social systems orientation,

risk and resilience are viewed in light of multiple,

recursive influences involving individuals,

families, and larger social systems. Problems

can result from an interaction of individual,

family, or community vulnerability in the impact

of stressful life experiences. Symptoms may

be primarily biologically based, as in serious

illness, or largely influenced by socio-cultural

variables, such as barriers of poverty and

discrimination that render some families or

communities more at risk. Family distress may

result from unsuccessful attempts to cope with

an overwhelming situation. Symptoms may be

generated by a crisis event, such as traumatic

loss or suicide in the family, or by the wider

impact of a large-scale disaster (Walsh, 2007).

The family, peer group, community resources,

school or work settings, and other social systems

A developmental

perspective is also essentialto understand and foster

family resilience


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11 SOCIAL WORK NOW: APRIL 2008

reactivate painful memories and emotions

from the past, as in post-traumatic stress

reactions, or family histories of abuse, neglect

or violence. The convergence of developmental

and multi-generational strains increases the risk

for complications (Carter & McGoldrick, 1999).

Unresolved past losses can resurface with a

current or threatened loss (Walsh & McGoldrick,

2004). Family members may lose perspective and

conflate immediate situations with past events.

It is important to inquire about family stories of

past adversity and how they

influence future expectations,

from an optimistic outlook

to catastrophic fears.

Particularly noteworthy are

multi-generational anniversary

patterns.

In sum, symptoms of distress

are assessed in temporal

context as well as family and

social contexts. A family

timeline and a genogram

are essential tools for clinicians to schematise

relationship information, track systems patterns,

and guide intervention planning (McGoldrick,

Gerson, & Petry, 2008). Whereas genograms

are most often used to focus on problematic

family-of-origin patterns, a resilience-oriented

approach also searches for positive influences,

past, present, and potential. We inquire about

resourceful ways a family or an elder dealt

with past adversity, and models of resilience

in the kin network that might be drawn on to

inspire efforts to master current challenges. Key

principles of the practice framework are outlined

in tables one and two on page 12.

Practice principles and applications

Family resilience-oriented practice builds on

principles and techniques common among

strength-based collaborative approaches,

new challenges. Some approaches that are

functional in the short-term may rigidify and

become dysfunctional over time. Practitioners

work with families at various steps or transitions

along their journey, helping them to integrate

what has happened and to meet immediate and

future challenges.

Pile-up of stressors

Some families may do well with a short-term

crisis but buckle under the strains of persistent

or recurrent challenges, as

with prolonged joblessness or

a chronic illness. A pile-up of

internal and external stressorscan overwhelm the family,

heightening vulnerability

and risk for subsequent

problems. Reeling from

one crisis to the next, the

cumulative pressures can be

overwhelming for a family.

Family life cycle perspective

Functioning and symptoms of

distress are assessed in the context of the multi-

generational family system as it moves forward

across the life cycle (Carter & McGoldrick, 1999).

A family resilience practice approach focuses

on family adaptation around nodal events that

are stressful and disruptive. These include

complications with predictable, normative

transitions, such as parenthood and adolescence,

and those with unexpected, untimely events,

such as disabilities or death of a child.

Frequently, individual symptoms may coincide

with stressful transitions, such as parental

remarriage, that require boundary shifts and

redefinition of roles and relationships.

Legacies of the past

A multi-generational perspective is also required.

Distress is heightened when current stressors

Family resilience-oriented

practice builds on principles

and techniques common

among strength-based

collaborative approaches,

but attends more centrally

to links between presenting

symptoms and family

stressors


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• in family organisation, resilience is fostered

by: (1) flexible yet stable structure with

strong leadership, (2) connectedness, and (3)

kin, social, and community resources

• communication processes facilitate resilience

through: (1) information clarity, (2) open

expression of feelings and empathic response,

and (3) collaborative problem solving and

proactive approach to future challenges.

Offering a collaborative, non-pathologising

approach, a family resilience framework

has useful application in a range of adverse

situations (Walsh, 2002; 2006):

• healing from crisis, trauma, major disasters,

and loss

• navigating disruptive transitions (e.g.

separation, divorce, migration)

• mastering multi-stress challenges of chronic

conditions (e.g. illness, poverty)

but attends more centrally to links between

presenting symptoms and family stressors.

Interventions are directed to strengthen

relational bonds and tap resources that can

reduce vulnerability and support coping,

adaptation, and positive growth.

Synthesising findings in research on resilience

and well-functioning families, the Walsh

family resilience framework was designed to

guide practice assessment and intervention

by strengthening key processes for resilience

(Walsh, 2003a; 2006):

• family belief systems support resilience when

they help members: (1) make meaning of

crisis situations, (2) sustain a hopeful positive

outlook, and (3) draw on transcendent or

spiritual values and purpose, most often

through spiritual faith, practices, and

community (Walsh, 2008, in press)

Family resilience: conceptual

framework for practice

Resilience-oriented practice: facilitate family’s

ability to rebound from crises and overcome

persistent adversity, strengthened and moreresourceful.

Meta-framework for community-based services:

• relational view of human resilience

• shift from deficit view of families: challenged by

adversity

- potential for repair and growth• grounded in developmental and systemic theory

- bio-psycho-social-spiritual influences

- multi-systemic approach: family, community,

larger systems

• stressors impact family system, family responseinfluences

- recovery of all members, relationships, and

family unit

• contextual view of crisis, distress, and adaptation - family, larger systems, and socio-cultural

influences

- temporal influences

• timing of symptoms and family crisis

events • pile-up of stressors, persistent adversity

• multi-generational family life cycle

influences

• varied adaptational challenges andpathways in resilience.

Practice principles to strengthen

family resilience

• Convey conviction in potential to overcome

adversity

• Humanise and contextualise distress:- understandable, common in adverse situation,

extreme conditions

- depathologise; decrease stigma, shame, blame

• Provide safe haven, compassion for sharing

stories of suffering and struggle• Facilitate family communication, mutual support,

collaboration

• Identify and build strengths alongside

vulnerabilities

• Build ‘relational lifelines’, networks: - tap into kin, community, and spiritual

resources

• Seize opportunities to ‘master the possible:’

- learning, positive growth, and stronger bonds - shift focus from problems to possibilities,

creativity

- steps to attain future hopes and dreams

• Integrate adversity and resilience into individual

and relational life passage.

Table 1 Table 2


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• “bouncing forward”

to adapt to new life

challenges.

Resilience-oriented practice

may involve individual,

couple, family, and extended

kin sessions in a variety

of formats including brief

family consultations, psycho-

educational multi-family

groups, or more intensive

family therapy. Multi-systemic approaches may

also involve community agencies, or workplace,

school, healthcare, foster care, justice, and

other larger systems. Periodic, cost-effective

‘modules’ can be timed for critical phases of a

long-term adaptational process (Walsh, 2006).

Conclusion

The very flexibility of the concept of resilience

lends itself to many varied applications with

diverse populations. A family resilience

framework can be applied usefully with a widerange of crisis situations and persistent life

challenges. This approach affirms the varied

pathways that can be forged for resilience.

The need to strengthen family resilience has

never been more urgent, as families today are

buffeted by stresses and the uncertainties of

economic, political, social, and environmental

upheaval. With increasing family diversity,

no single model of family health fits all.

Yet, resilience theory and research support

clinical convictions that all families – even

the most troubled – have the potential for

adaptation, repair, and growth. A family

resilience orientation provides a positive and

pragmatic framework that guides interventions

to strengthen family processes for resilience as

presenting problems are addressed. Rather than

simply providing a set of techniques to treat or

change families, this strength-

based approach enables

workers, in collaboration with

family members, to draw out

the abilities and potential

in every family, and to

encourage the active process

of self-righting and growth.

For helping professionals,

the therapeutic process is

enriched as we bring out

the best in families and practice the art of the

possible.

R e f e R e n c e s

Athoy, e. J., & cohlr, B. J. (1987). The invulnerable

child . nw York: Guilord Pr.

calhou, L. G., & Tdhi, R. G. (ed.). (2006).

Handbook of Posttraumatic growth: Research and

practice. Mahwah, nJ: Lawr erlbaum.

cartr, B., & MGoldrik, M. (1999). The Expanded

Family Life Cycle: Individual, family, and social

perspectives. (3rd d.). ndham Hill: Ally & Bao.

fIgly, c., & Mcubbi, H. (ed.) (1983). Stress and the

family: Coping with catastrophe. nw York: Brur-

Mazl.

Kauma, J., & Ziglr, e. (1987). Do abud hildr

bom abuiv part? American Journal of

Orthopsychiatry, 57, 186-192.

Luthar, s. s., cihtti, D., & Bkr, B. (2000). Th

otrut o rili: A ritial valuatio ad

guidli or utur work. Child Development, 71,

543-562.

Mcubbi, H., Mcubbi, M., Mcubbi, A., &

futrll, J. (ed.). (1998). Resiliency in ethnic minority

families. Vol. 2. African-American families. Thouad

Oak: sag.

Mcubbi, H., Mcubbi, M., Thompo, e., &

fromr, J. (ed.). (1998). Resiliency in ethnic minority

families. Vol. 1. Native and immigrant families.

Thouad Oak: sag.

Mcubbi, H. & Pattro, J. M. (1983). Th

amily tr pro: Th Doubl ABcX modl o

adjutmt ad adaptatio. Marriage and Family

Review, 6 (1-2)s, 7-37.

Resilience theory and

research support clinical

convictions that all

families – even the mosttroubled – have the

potential for adaptation,

repair, and growth


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Wrr, e. e. (1993). Rik, rili, ad rovry:

Prptiv rom th Kauai logitudial tudy.

Development and psychopathology, 5, 503-515.

Wrr, e. e., & Joho, J. L. (1999). ca w apply

rili? I M.D. Glatz ad J. L. Joho (ed.)

Resilience and development: Positive life adaptations.

(pp. 259-268). nw York: Aadmi/Plum Pub.

Wrr, e. e., & smith, R. (1992). Overcoming the

odds. Ithaa, nY: corll Uivrity Pr.

Woli, s., & Woli, s. (1993). The resilient self: How

survivors of troubled families rise above adversity .

nw York: Villard Book.

Froma Walsh is the Mose and Sylvia Firestone Professor in

the School of Social Service Administration and Professor

in the Department of Psychiatry, Pritzker School of

Medicine, at the University of Chicago. Her fields of

special interest include family systems and developmental

theory, family resilience practice applications, family

and couples therapy, end-of-life issues, recovery from

trauma and loss, and contemporary family diversity and

challenges.

MGoldrik, M., Gro, R., & Ptry, s. (2008).

Genograms: Assessment and intervention. (3rd. d.)

nw York, norto.

Ruttr, M. (1987). Pyhooial rili ad

prottiv mhaim. American Journal of

Orthopsychiatry, 57, 316-331.

Tdhi, R. G., & calhou, L. G. (1996). Th

Pottraumati Growth Ivtory: Maurig th

poitiv lgay o trauma. Journal of Traumatic

Stress, 9, 455-471.

Va dr Kolk, B. A., Mfarla, A. c., & Wiath,

L. (ed.) (1996). Traumatic stress: The effects of

overwhelming experience on mind, body, and society .

nw York: Guilord.

Walh, f. (1996). Th opt o amily rili:

crii ad hallg. Family Process, 35, 261-281.

Walh, f. (2002). A amily rili ramwork:Iovativ prati appliatio. Family Relations,

51(2), 130-137.

Walh, f. (2003a). family rili: A ramwork or

liial prati. Family Process, 42(1), 1-18.

Walh, f. (2003b). Normal family processes: Growing

diversity and complexity . (3rd d.) nw York:

Guilord Pr.

Walh, f. (2006). Strengthening family resilience. 2d

d. nw York: Guilord Pr.

Walh, f. (2007). Traumati lo ad major diatr:strgthig amily ad ommuity rili.

Family Process, 46, 207-227.

Walh, f. (ed.). (i pr). Spiritual resources in

family therapy . 2d ed. nw York: Guilord Pr.

Walh, f., & MGoldrik, M. (ed.). (2004). Living

beyond loss: Death in the family (2d d.). nw York:

norto.


17/56


Complexity and social worktheory and practice

Malcolm Payne

Most social workers, wherever they work, deal

with complex life situations in their practice. If

situations were not difficult in various ways orcomplex in their ramifications, people would

often manage them without calling on help

from a social worker. This paper focuses on the

implications of the complexity of the situations

that social workers deal with for the way in

which they use theory in

their practice. I argue that

social work theory does

not adequately guide socialworkers’ practice in such

complex situations. They

need to incorporate a range

of additional knowledge and skill to make good

use of practice theory.

Yvonne (16) and John (11), the children of

Catherine and Harry, are an example of the kind

of complexity that many social workers face in

their practice.

There were several break-ups between Catherine

and Harry after Yvonne was born, partly

caused by Harry’s violence. The final break-up

came just after her pregnancy with John was

confirmed. Harry eventually went to live with

another woman, whose children were considered

at risk and removed from the home because

of his violence. The local child protection

team continued to be involved, partly because

of continuing contact with Harry, who was

considered a risk.

Catherine brought up Yvonne and John largely

on her own, but three years ago was diagnosed

with cervical cancer. More recently, it became

clear that she had only a few months to live, and

arrangements for the children

after her death needed to

be planned. In law Harry

would be entitled to resume

parental responsibilities after

Catherine’s death, and he was

not considered a safe parent.

As Catherine became frailer, Yvonne remained at

home with her mother. John increasingly stayed

with Catherine’s sister, Louise, and his cousins.

The family’s plan was that he would move there

permanently when Catherine died, while Yvonne

would stay in Catherine’s home. During the last few weeks of Catherine’s life, Harry, who had

sporadic contact with the children, turned up

at Catherine’s home asking to see them. On two

occasions he was drunk and contact was refused,

but his attitude became more demanding as the

weeks went on.

On the weekend of Catherine’s death, Harry

called, drunk again, at Louise’s house in another

town to try to see John. He sat outside in the car,

Most social workers,

wherever they work, deal

with complex life situationsin their practice


18/56


was threatening and had to be asked to leave

by the police. Louise had no rights as a parent,

but she and her husband were concerned about

Harry visiting. The child protection responsibility

for John was to transfer to the authorities in

Louise’s hometown, and a meeting was set up

to transfer the case. However, Yvonne also

explained to the social worker that she felt the

need for protection if Harry visited the original

family home.

The various strands of this situation highlight

different aspects of social work practice. Among

these strands are:

• the children’s direct experience of marriagebreak-up and domestic

violence in their lives from

a young age

• John’s experience of

impending and actual

separation from his sister

and incorporation into

another family, which is

itself reforming to include

him

• John’s integration into a

new school at a time of

bereavement, and the consequences of this

for his school and other pupils

• the children’s recent experience of the death

of a parent, probably the first major death of

someone close to them in their lives

• the children’s experience of threat from their

father’s behaviour, and their perceptions and

understanding of these family dynamics

• Harry’s issues with alcohol, and his emotional

and social responses to parenthood in his two

families

• the legal complexities of parental rights and

responsibilities where children are protected

by removal from or separation from their

parents, and where family members take on

parental responsibilities

• the responsibility of the social workers

involved to assess and respond to the need

and risk affecting various participants on

behalf of the state

• the social work principle of engaging family

members and finding respectful, open ways todo this, especially in the face of hostility or

violence

• the complexity of trying to create safe

contact between children and their non-

custodial parent/s to maintain family

relationships, identity and belonging

• the delicate balance of a strengths-based

practice approach in child protection work

while at the same time considering risks,

needs, rights and wishes of all parties

• Yvonne taking on

independent responsibility

for her own living

arrangements and a house

at the age of sixteen

• the administrative

complexities of

transferring responsibility

for children at risk from

one public authority toanother

• the professional and administrative

responsibilities for liaison about a complex

family situation involving different public

authorities and responsibilities.

This list of issues is not exhaustive but it reminds

us that social workers deal both in making

practical arrangements, and in the emotional

and behavioural content of the situations. Theyare part of official and administrative systems

and have to make them work. They also have

to take into account the legal rights and duties

that they have as professionals and officials,

and those that their clients have as parents

and citizens. For example, there is an informal

arrangement between Catherine and her sister

for John’s care after her death that might be

fine in many families, although it would usually

This list of issues is not

exhaustive but it reminds

us that social workers deal

both in making practical

arrangements, and in the

emotional and behavioural

content of the situations


19/56


be better to confirm it through legal processes.

However, this is inadequate in dealing with the

complicated parental rights and behavioural

difficulties in this situation.

Unlike Catherine’s doctors and nurses, whomainly focused on her treatment and comfort as

she approached death, the focus of social work

is on the social systems of which individuals are

a part. So social workers were involved with

important social issues for several members of

the family, and were responsible for making a

variety of social systems work properly. For

example, a thoughtful social worker would

realise that John’s bereavement at a young agemight well have an emotional

impact on his classmates at

school that would need to be

managed.

The complexity is of different

kinds. Some of it arises

because there are several

individuals and family groups involved, some

because a variety of social and behavioural

issues are present, some because of a mixture of

agencies and legal and official responsibilities.

Social workers have to deal simultaneously with

each of these different aspects of complexity.

Weaknesses in social work theory and

knowledge

The assumptions of the theory and knowledge

bases of social work do not fit complexity of

this kind, even though it is commonplace in

practice. This is one of the reasons that social

workers often comment that the theory that

they are taught on their courses is sometimes

unhelpful when they reach full-scale practice.

In education, while writing essays about the

application of theory to practice, and in practice

placements, it is possible to limit the range of

factors that a practitioner deals with. There

are no such luxuries in full-time professional

practice.

Practice theory is an aspect of social work

theory concerned with how to do social work,

in which ideas are developed to prescribeparticular models of practice or ways of

practising (Payne, 2005a). Practice theory

tries to make sense of the work social workers

actually do, and includes formal and informal

sets of ideas. Formal practice theory is written,

usually published, evidence and analysis worked

out in a rational structured form. It offers

general ideas that may be applied deductively to

particular practice situations; that is, the ideasare applied to the situation

rather than the situation

generating ideas.

Informal practice theory

draws on ideas and

experience gained in life

and practice. It is applied

inductively, that is, the theory derives from

particular situations and is generalised to

other relevant practice situations. This

requires decisions about similarities and

differences between situations to decide if the

generalisation is relevant. Practice theory is not

the only form of social work theory: there are

also theories about what social work is and of

psychological and social knowledge about the

client’s world (Sibeon, 1990).

The assumption of evidence-based or research-

aware practice is that fairly clear prescriptions

for action can be identified from research, but

this does not consider how these are mediated

by official or legal responsibilities or agency

function (Webb, 2001). Practice theory generally

prescribes actions that take place with one

client or family. Many practice theories such as

task-centred practice, solution-focused work or

cognitive behavioural practice presume a precise

Informal practice theory

draws on ideas and

experience gained in life

and practice


20/56


targeting of specific behaviours (Payne, 2005a).

These systems of thought may give us ideas

about a situation and organise a response that

people can understand and accept. For example,

task-centred practice helps practitioners and

clients identify a series of tasks to be shared.

Solution-focused work generalises successes

in clients’ lives to other issues where they are

having difficulty. In both sets of ideas, this helps

practitioners and clients.

While such theories may be helpful as part of

practice, the situations practitioners work with

are not the main focus of much social work

practice theory. Because it defines the ideas

that should be applied to a situation, it does not

make provision for ideas to

emerge from the situation

that practitioners are dealing

with. Therefore, it does not

allow clients and others in

the family system to develop

and act on ideas about

how they might be dealt

with. Complex relationships

between different family

groups, all with a legitimate

call on some aspects of

social welfare provision,

and the provision of packages of caring services

lie outside most practice theory prescriptions.

Practice theory also does not deal with working

across several organisations with different roles

and legal and administrative mandates.

Bringing knowledge and understanding

together

Social workers therefore need more than

practice theory to deal with complex situations.

They need to bring the ideas and techniques

that come from practice theory together

with other aspects of social work knowledge

and understanding to incorporate a range

of knowledge about the services and social

environments in which they work. Pawson et

al’s (2003) work refers to:

• organisational knowledge, about government

and agency organisation and regulation

• practitioner knowledge, drawn from

experience of practice, which tends to be

tacit, personal and context-specific

• user knowledge, drawn from users’ knowledge

of their lives, situation and use of services,

including the views of children and young

people

• research knowledge, drawn from systematic

investigation disseminated in reports

• policy community

knowledge, drawn from

administrators, official

documentation and analysis

of policy research.

Moreover, social workers

bring this knowledge together

to practice in ways that

respond to their personal

style of relating to people

and forms of response

determined by their agency

and colleagues as appropriate

to their roles. Among the less

well-specified elements of practice that may be

relevant are:

• caring, which brings together two elements:

a receptiveness and openness to clients’

needs and interests and a proactive response

to the understanding thus gained about

clients and their situation, so that clients’

personal development and control of their

circumstances is enhanced (Mayeroff, 1971;

Noddings, 1984; Payne, 2008)

• enhancing resilience, improving the capacity

of individuals and families to respond to

the social issues that they face in their life

(Oliviere and Monroe, 2007; Walsh, 2006)

Complex relationships

between different family

groups, all with a legitimate

call on some aspects of

social welfare provision,

and the provision ofpackages of caring services

lie outside most practice

theory prescriptions


21/56


• emotional labour and intelligence,

responding in a way that is acceptable to the

participants to their feelings and improving

the participants’ capacity to deal with the

emotional stresses of their situation (James,

1993; Morrison, 2007)

• support, being prepared to stand alongside

people as they work through what is

happening to them (Sheppard, 2004)

• process, as a way of understanding the

trajectory of events (Payne, 2005b).

Practice frameworks provide further

opportunities to collate theory, research and

knowledge types into conceptual guides for

practice (Healy, 2005; Connolly, 2006). Socialwork supervision also provides an important

mechanism for the

exploration of these issues so

that practice is informed in

ways that strengthen good

outcomes for children and

their families.

Looking again at Yvonne and

John’s situation, the various

social workers involved

would need a great deal

of organisational and practitioner knowledge

about how the agencies and organisations need

to be contacted, chased and supported to deal

with the various problems the children face.

Intervening in this situation would require

active pursuit of the links to ensure that John

and Yvonne were safe. The responsibility is

splintered so much that practitioners could not

assume that the cases would transfer between

authorities cleanly; that Yvonne would be

helped to deal with her bereavement in her new

fairly isolated position, or that the police would

intervene effectively to protect Yvonne in her

mother’s home; or that the school would be able

to understand and deal with John’s emotional

difficulties arising from his bereavement and his

change of placement.

The family situation is so complex that

practitioners would rely on family members to

interpret behaviour and understand what wouldwork in the various relationships. They could

not solely rely on over-simplified assumptions

about family or human development, although

of course this knowledge would help them know

what kinds of issues to raise questions about.

Understanding the process of what is happening

for Yvonne and John in their bereavement and

various losses would also be important. In this

way, practitioners could work out how concerns

would mount at the time of loss, and when

extra effort to help would

be required. It would be

important to be prepared to

listen to the different concerns

of the participants: John and

Yvonne’s losses and fears;

Louise’s anxieties about the

impact of the bereavement and

taking John into her family;

and also Harry, since his

behaviour may reflect rising

stresses and provide opportunity to facilitate some

intervention to help him and secure relationships

for Yvonne and John. Being prepared to act

to help resolve particular issues as they arise is

supportive because it means standing alongside

people at a difficult time.

Conclusion

I have argued that dealing with complexity

requires more of social workers than following

prescriptions of practice theory that may be too

oversimplified to be useful in complex situations.

Practice theory may be applicable to particular

aspects of situations within the complexity of

Practice frameworks

provide further

opportunities to collate

theory, research and

knowledge types into

conceptual guides forpractice


22/56


people’s lives. It may offer ideas about how to

see the situation that clients are dealing with.

However, social workers also need to call on a

range of sources of knowledge and respond to

the complexity in many of the situations that

they deal with by analysing and understanding

the process and trajectory of issues as they have

arisen in clients’ lives. They need to use that

knowledge and theory in a caring, emotionally

intelligent and supportive way with the aim of

disentangling the various elements of a complex

system and enhancing the resilience both of the

people involved and the social and organisational

systems that they are entwined with.

R e f e R e n c e s

coolly, M. (2006). Prati ramwork:

coptual map to guid prati i hild wlar.

BJsW Adva A publihd oli o Ju 16,

2006, British Journal of Social Work, doi: 10.1093/

bjw/b1049.

Haly, K. (2005). Social work theories in context:

Creating frameworks for practice. nw York:

Palgrav.

Jam, n. (1993). Divio o motioal labour:

dilour ad ar. I Robb, M., Barrtt, s.,

Komaromy, c., ad Rogr, A. (2004) Communication,

Relationships and Care: A Reader . Lodo:

Routldg, 259-69.

Mayro, M. (1971). On Caring . nw York: Harpr

ad Row.

Morrio, T. (2007). emotioal Itllig:

motio ad oial work: otxt, haratriti,

ompliatio ad otributio. British Journal of

Social Work, 37(2), 245-63.noddig, n. (1984). Caring: A Feminine Approach to

Ethics and Moral Education, Brkly. Uivrity o

calioria Pr.

Olivir, D. ad Moro, B., (d) (2007). Resilience

in Palliative Care, Oxord: Oxord Uivrity Pr

Pawo, R., Boaz, A., Grayo, L., Log, A., ad

Bar, c. (2003). Types and Quality of Knowledge in

Social Care, Lodo: scIe.

Pay, M. (2005a). Modern Social Work Theory . (3rd

d). Baigtok: Palgrav Mamilla.

Pay, M. (2005b). soial work pro. I Adam,

R., Domilli, L ad Pay, M. (d). Social Work

Futures: Crossing Boundaries, Transforming Practice.

Baigtok: Palgrav Mamilla, 21-35.

Pay, M. (2008). Social Care Practice in Context.

Baigtok: Palgrav Mamilla.

shppard, M. (2004). A valuatio o oial upport

itrvtio with dprd mothr i hild ad

amily ar. British Journal of Social Work, 34,

939-60.

sibo, R. (1990). commt o th trutur ad

orm o oial work kowldg. Social Work and

Social Sciences Review, 1(1), 29-44.

Walh, f. (2006). Strengthening Family Resilience.

(2d d). nw York: Guilord.

Wbb, s. A. (2001). som oidratio o th

validity o vid-bad prati i oial work.British Journal of Social Work, 31(1), 57-79.

Malcolm Payne is Director, Psycho-social and Spiritual

Care, St Christopher's Hospice and Honorary Professor,

Kingston University/St George's Medical School, London. He

has worked in UK probation, social services, and national

and local voluntary organisations. He is author of 'Modern

Social Work Theory' (3rd ed, Palgrave Macmillan, 2005)

and more than 250 other publications.


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Levels of meaning andthe case for theoretical

integration Jerome C. Wakefield and Judith C. Baer

Cognitive therapy tends to focus on how theclient’s thoughts distort reality and lead to

anxiety and depression. But what if reality

contains stresses that might cause anyone

anxiety or depression? Sharon Berlin (2002)

in her book, Clinical Social Work Practice: A

Cognitive-Integrative Perspective, emphasised

the need to integrate into cognitive-behavioural

assessment and treatment traditional social work

person-in-environment concerns about the realchallenges of the environment of the client.

The point is fundamental: the very notion

that an individual’s cognition is ‘distorted’ or

‘irrational’ depends on a prior assessment of the

real environment and whether the individual is

reacting normally to it, so cognitive assessment

makes no sense without bringing in the

individual’s relationship to the environment.

The problem of lack of attention to

environmental context goes well beyond

cognitive-behavioural theory. One of us

(Wakefield), in a recent book with sociologist

Allan Horwitz titled The Loss of Sadness:

How Psychiatry Transformed Normal Sorrow

into Depressive Disorder (2007), argued that

the current fourth edition of the American

Psychiatric Association’s Diagnostic and

Statistical Manual of Mental Disorders (DSM;

2000) failed to consider the context of depressivesymptoms. It thus failed to distinguish normal

sadness due to environmental stressors from

genuine depressive disorders in which something

has gone wrong with an individual’s emotional

functioning and the individual is ‘stuck’ in

a pathologically deep or prolonged state of

sadness and associated symptoms.

Because sadness is biologically designed to be

an emotion experienced in response to certain

kinds of losses and other environmental stresses,

one cannot infer that there is a biological or

other internal dysfunction without evaluating

the relationship between the environment and

the individual’s response to it. Misdiagnosis

of normal responses to distress as depressive

disorder may be the reason, for example, why

in the Dunedin longitudinal study of health

outcomes in youth, fully 17% of a New Zealand

sample of 26-year-old Caucasian young adults

qualified for having major depressive disorder

in that very year. This is a level that seems

implausible for true disorder, but may reflect

normal reactions to stress and loss.

The realisation that cognitive-behavioural theory

must be expanded to include assessment of

environmental variables leads to the question:


24/56


are there other limitations in the cognitive-

behavioural perspective that unnecessarily

constrain the worker’s understanding of

and response to the client’s problem? We

believe the answer is that, perhaps with

cognitive-behavioural theory as a base, today’s

practitioner must be an integrationist about

theory and incorporate defensible insights from

a variety of theoretical perspectives into the

basic cognitive-behavioural repertoire.

Reasons for integration of

psychotherapy theories

There are persuasive scientific

and moral arguments for the

integration of clinical ideas

in social work education

and practice. The scientific

argument for an integrationist

view of psychotherapy theory

is simple: each of the major

theories focuses on one piece

of the truth about human

nature and each of the major

theories does get at part of

the truth. There are several

levels of meaning at which

individuals operate, and all

of these levels are potentially involved in a

psychosocial problem and in its treatment, but

each theory treats mostly one level.

Briefly, levels of meaning processing include at

least the following:

(1) Although not strictly in itself a level of

meaning, people’s meaning systems are rooted in

biological structures that support the generation

of meaning in the brain.

(2) People are instrumentally conditioned

by contingent reinforcers and classically

conditioned as well. We know this not only from

a vast empirical literature on learning but also

from recent neuro-scientific discoveries that

reveal the anatomy of learning; so people really

do have conditioned behaviours subject to the

principles of learning.

(3) People have cognitive/representational

mental contents including conscious beliefs and

desires, sometimes irrational, that motivate

and guide their actions. We know this not only

from our commonsense understanding of our

own and others’ minds, but

also from the remarkable

effectiveness of ‘folk

psychology’ (i.e. the intuitiveunderstanding of people in

terms of beliefs and desires

that cause their actions)

that we use to interact with

others in our everyday lives.

For example, how is it that

all the articles from around

the world comprising this

special section convergedin New Zealand at the right

moment for publication?

The only answer is that

the various writers had

certain beliefs about the deadline and what was

required, and certain desires such as to have

their article included, and thus their actions

led to the convergence of the articles. There

is nothing in behavioural or psychodynamic

theory that would begin to enable one to

predict such events. Cognitive explanation in

terms of beliefs and desires is firmly anchored

in this folk-psychological understanding,

which may itself be a biologically rooted way

we have of interpreting one another. But

beyond folk psychology, this level of conscious

representations is also supported by a vast

cognitive science empirical research tradition.

The realisation that

cognitive-behavioural

theory must be expanded

to include assessment of

environmental variables

leads to the question: are

there other limitations in

the cognitive-behavioural

perspective that

unnecessarily constrain the

worker’s understanding of

and response to the client’s

problem


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demonstrates that no one treatment works for

everyone. To serve all clients the practitioner

must be prepared to be flexible and offer a

change of treatment strategy when warranted

by the client’s lack of response or incomplete

response to the initial intervention strategy.

Moreover, because each individual is operating

at all the meaning levels noted above, different

sorts of interventions are often required in the

course of treatment to get

at aspects of the very same

problem. The different levels

are so interconnected that,

except for the biological level

(which arguably requires an

entirely different training to

directly evaluate and treat,

although all the levels are

influencing and are influenced

by biology), a worker must

be prepared to utilise any

of them with a given client,

so referring out seems a

cumbersome and inadequateprocess.

Why researchers need integration and

cooperation, not competition

For most practitioners, theory – even cognitive-

behavioural theory – is a means to clinical goals,

not an end in itself. Yet practitioners often

become wedded to one theoretical approach in a

way that can constrain clinical decision making.

One common idea in support of theoretical

exclusivity is that it is more scientific and

intellectually assertive if there are multiple,

competing, strongly defended theories, so

integration is a bad, even scientifically flaccid,

idea. It is true that scientific progress is best

derived and truth best revealed from the

vigorous clash of opposed ideas. But when it

(4) People are also influenced by an extensive

network of mental representations that are

outside their awareness. We know this not

only from everyday experience but from a

vast research literature in cognitive science

that demonstrate the unconscious activation

of meanings, as well as from some reliable

elements of the psychodynamic literature.

These unconscious meanings can interact with

conscious meanings in ways

we are not aware of.

(5) People are shaped in ways

they may not be aware of

by cultural and family rulesand other interpersonal

processes that form the

context and background for

their actions and provide

implicit rules that may be

followed without awareness.

For example, when having

a conversation, people

from different cultures feel

comfortable standing at

different distances, some

closer, some further away

(at international conferences, this becomes

apparent as people adjust themselves to others’

comfort levels).

The moral case for integration is simply that it

is in effect a form of malpractice to approach

the client within one theoretical perspective

when it is scientifically known that the truth

is more complex and the therapeutic options

available are broader than those encompassed

by any one theory. Informed consent requires

that theoretically divergent intervention options

be presented to the client, and that treatment

not be limited by the worker’s theoretical

persuasion. The moral argument is based on the

scientific argument. It is, first, that research

The moral case for

integration is simply that

it is in effect a form of

malpractice to approachthe client within one

theoretical perspective

when it is scientifically

known that the truth

is more complex and

the therapeutic options

available are broader than

those encompassed by anyone theory


26/56


comes to theories of practice, this proposal is

based on an anachronistic picture of theory in

the mental health field. It harks back to the

‘psychotherapy wars’ in which universal claims

were made by each theory as to its truth and

therapeutic efficacy, and each theory competed

with all the others. It seems fair to say that this

strategy has not led to a scientific resolution

in favour of one or another theory and has

not yielded much progress. The reason for this

failure is that the competition was based on

a misconstrual of the relationship among the

various theories. They were framed as mutually

exclusive universal theories,

but their relationship turned

out to be complementary.

If one open-mindedly

considers the evidence from

research, clinical experience,

and everyday life, it seems

apparent that all the major

theories of psychopathology

have important elementsof truth. The processes

described by behaviourists, cognitivists,

psychodynamicists, systems theorists, and

biological researchers all shape behaviour and

are all necessary to explain disorder in some

contexts. Moreover, a process may be useful

in treating a disorder even when the etiology

lies elsewhere. In other words, on the basis of

the overall evidence available at this time, ifthere is any theory of etiology and treatment in

which it is rational to believe, it is some version

of integrationism. From this perspective, all

the traditional theories, if framed as universal,

exclusive alternatives, are pseudoscientific;

their unjustifiably inflated claims are based on

ideology rather than evidence.

For example, the many theories of depression

– behavioural, biological, systems-theoretic,

cognitive, and psychodynamic – appear each

to capture some possible cases and thus to be

about specific etiologic pathways rather than

universal theories of etiology. These theories are

not logically in competition – or at least to the

extent they are formulated in a way that they

are, the formulations are needlessly inflated and

ignore reality. Rather, each theory attempts to

capture one possible causal pathway that can,

by itself or in conjunction with the others, lead

someone to become disordered. Consequently,

what is called for is not competition but

cooperation to identify etiologically pure

patients and to identify the

role of each explanatoryhypothesis in hybrid cases. In

a multiple-etiology reality, a

competition between single-

etiology nosologies is not

progressive and cannot yield

a valid diagnostic manual.

There is much to criticise in

the DSM’s operationalised

definitions of various mental

disorders (Wakefield, 1996, 1997). However, one

of the great contributions of the DSM has been

to provide theory-neutral criteria that do not

cite any etiology and, because they are based on

manifest symptoms, can be used by adherents

to all theoretical schools to identify individuals

with a certain disorder. The DSM enabled the

different schools to talk to one another and

compare their theories in a way that had not

happened before. This subtle but historically

important and beneficial contribution of the

DSM to providing the conceptual infrastructure

for theory integration has not been adequately

recognised.

Types of integration

Traditionally there are four forms of

psychotherapy integration (Gold, 1996);

If one open-mindedlyconsiders the evidence

from research, clinical

experience, and everyday

life, it seems apparent

that all the major theories

of psychopathology have

important elements of truth


27/56


technical eclecticism, the common-factors

approach, theoretical integration, and

assimilative integration, all of which combine

theory and technique. Technical eclecticism

has been considered the most clinical and

technically oriented form of psychotherapy

integration; however, it is the least conceptually

or theoretically integrated (Stricker & Gold,

2003). In technical eclecticism, clinical strategies

and techniques from two or more therapies

are applied sequentially or in combination.

Techniques are chosen based on clinical

match to the needs of the patient without

any systematic theoretical

rationale, based on clinical

skill and intuition as well as

patient preference.

Common factor integration

is based on the idea that

groups of therapies share

similar change processes and

techniques (Rosenzweig, 1936). Additionally, all

therapies share commonalities such as sociallysanctioned rituals, the provision of hope, and

encouragement to the client (Frank, 1961).

When using the common factors approach,

the therapist attempts to identify which of

the common factors will be most important in

interventions for specific cases; then a review of

the relevant intervention and psychotherapeutic

interactions is conducted to determine those

that best fit the client’s situation. The goal is toprovide the client with the best possible unique

combination of known therapeutic factors to

ameliorate his or her problems.

Common factors integration often combines

insight, new relational learning and experiences,

as well as hope by way of the therapeutic

relationship. The therapeutic relationship is now

believed to be the most potent common factor.

Theoretical integration consists of a synthesis

of central elements from two or more theories,

potentially including the theories’ models of

personality, psychopathology etiology, and

mechanisms of psychological change. By

forming one consistent theoretical system

incorporating different models, there is a logical

coherence to theoretical integration lacking in

the other approaches. This allows the therapist

to approach a case in a more systematic fashion.

Different theoretical assumptions are placed

within one overarching theory, so the therapist

can make principled judgments.

Safran and Messer (1997)

argue from a postmodernistposition that different

theories have such different

ontological assumptions

that in principle they can

never be theoretically or

technically integrated. This

seems a dubious argument, if

we are right that the theories capture different

levels of the meaning system that in fact does

exist in human beings and that the different

levels do interact in overall functioning. This

is because the parts of the theories that reflect

reality do interact and are part of one larger

reality that a future theory ought to be able

to capture. The postmodernist view seems

a dead end intellectually that freezes us in a

state of therapeutic ideology. The theories

as currently stated are incompatible in part

because they each claim to have the exclusive

truth and apply to all possible situations,

which is false, and in part because each of the

theories is just incorrect on many points. The

point of theoretical integration is to evaluate

which components of each theory deserve to

be retained, to moderate the claims of each

so they can be placed within a larger system,

and to hypothesise how the overall system

of interacting levels of meaning works so

Common factor integrationis based on the idea that

groups of therapies share

similar change processes

and techniques


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that intervention strategies can be devised

accordingly.

However, there has as yet been no successful

super-ordinate integration that includes

personality, psychopathology, worldview, meta-theoretical and epistemological assumptions, or

a theoretically coherent and adequate technical

eclecticism (Safran & Messer, 1997). One

answer, other than awaiting a future theoretical

integration, has been to embrace theoretical

pluralism. The pluralistic tradition falls within

postmodernism, and holds that one theory

cannot pre-empt an alternative organisation

of the evidence; therefore,the best way to approximate

truth is to have multiple

theories competing by way

of evidence (Safran & Messer,

1997; Borden, 2008).

Pluralist points of view

emph

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