Autumn, 1997, Vol. 4, No. 1

TOO MANY HATS:
A Clinical Perspective of the Dual Role of Caseworker and Therapist

By Gina Fieramosca, SSA second-year clinical student

Central to the mission of many social service agencies is the belief that the primary role of the social worker is to empower the client. Through the provision of encouragement, resources, and a stable caring environment, the client receives the support necessary to make future-enhancing decisions. When services are provided around multiple objectives, the dynamics of agency structure often subordinates the therapy component of client services. Instead, the role of the caseworker becomes the primary component as greater emphasis is placed on implementing "client contracts" that focus on task completion.

For agencies serving adolescent populations, the intent of such contracts is to develop the client's skills and maturity necessary for independent living. However, limited resources often inhibit the ability to provide both individual therapy and case management services.

Instead, the roles are combined on the premise that caseworker and therapist share mutual and non-conflicting objectives. Yet the presumption that these objectives are interchangeable may be based more on agency structure and resource constraints than on optimal design. Can a therapeutic relationship be maintained with a client whose power has been minimized by the contract that the therapist is charged to enforce? Can one establish trust when the client's right to confidentiality is superseded by agency protocols?

In the dual role of caseworker and therapist, there is a constant struggle to find a balance between listening to a client disclose personal information, and running down a checklist of contractual goals. This creates constant tension between what needs to be done, according to the contract, and how the client assesses the situation. Clients often voice the fear that sharing their feelings in a therapeutic setting will be used against them in terms of the contract. This is particularly unsettling, as it is reasonable to believe that clients who have the most difficulty adhering to a contract may also be those who benefit most from therapy.

Granted, the purpose of a contract is to achieve the goal of self-sufficient and independent living through behavioral, task-oriented techniques. However, in the therapeutic context, the contract distorts the balance of power because the therapist is charged to implement negative consequences if a violation of the contract is revealed. The impact of having to continuously evaluate what can be shared affects the client's willingness to disclose information in a therapeutic session. The therapist shares this dilemma in constantly assessing what information upholds the contractual agreement.

More emphasis needs to be focused on sharing the "power" a worker with a dual role possesses, and finding realistic alternatives in the agency. In residential facilities for youth, parents or foster parents should be given the power to act on contract violations. This transfer may allow the worker to strengthen the foundation of the therapeutic relationship without undermining the trust of the client. Although agency power would change, a collaborative effort would be formed by which the therapist, parents or foster parents, and client work together. This approach will be more effective than the constant shifting of hats.

Gina Fieramosca is a second-year clinical student at SSA. Her placement is at Teen Living Agency

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