Therapists need to understand not just how to use, but why to use a variety of clinical perspectives
by Chelan David
While many social workers come to characterize their clinical approach as eclectic, the SSA clinical curriculum is unusual in that it is designed to encourage students to think critically about differing theoretical perspectives, empirical findings, and technical procedures over the course of intervention.
William Borden, a senior lecturer at SSA, explores comparative perspectives and integrative approaches in social work practice in two forthcoming books, Contemporary Psychodynamic Theory and Practice and The Play and Place of Theory in Social Work: Comparative Perspectives in Contemporary Practice, an edited work that explores a range of theoretical perspectives in social work practice.
"As social workers try to strengthen the empirical foundations of practice and negotiate the demands of an applied profession, theoretical concerns receive surprisingly little consideration in the broader literature of the field," he explains. "Theory is increasingly marginalized in social work education in light of perceived conflicts with the practical concerns of the profession, the emergence of skills-based courses of study, and the growing emphasis on evidence-based practice."
Borden argues that comparative approaches to clinical theory and mastery of the foundational schools of thought strengthen eclectic, integrative psychosocial intervention. In the comparative point of view, social workers regard theories as tools for critical thinking and decision-making as they carry out their practice. The clinician learns multiple theories, therapeutic languages, and modes of intervention, and, depending on the specifics of the clinical situation, can draw on a variety of perspectives. Borden emphasizes the need for ongoing dialogue across the therapeutic traditions to clarify differences and integrate ideas in pragmatic approaches to intervention.
In his books, Borden provides a series of case studies that illustrate how pluralist points of view help a practitioner use differing perspectives over the course of treatment, broadening the range of theories, empirical findings, and technical procedures applied in the clinical situation. One account describes the psychotherapy of a young adult who developed post-traumatic stress disorder following his return from military service in Iraq. He described fluctuating periods of numbing detachment and intrusive recollections of traumatic events, and experienced a pervasive sense of dread that limited ways of being, relating, and living.
The practitioner's understanding of psychodynamic, cognitive, behavioral, humanistic, and existential perspectives provided the theoretical underpinnings that allowed him to use differing approaches over the course of intervention. For example, he drew on cognitive and behavioral approaches to help the client manage intrusive recollections of traumatic events and humanistic and existential perspectives facilitated exploration of the meaning and implications of the traumatic events. Movement from one orientation to another was guided by the nature of the specific problems in functioning, the focal concerns of intervention, and the client's capacities to make use of differing strategies. The validity of differing strategies was determined by the effectiveness in the clinical situation
"Pluralist perspectives emphasize the limits of human understanding and assume that no single theory captures the variety and complexity of actual experience in the real world. No single perspective—however encompassing it may seem—can possibly meet all of our needs over the course of intervention. Every theory carries the potential to help us out in certain ways but will inevitably fail us in other respects," he explains.
A growing number of graduate social work programs have established generalist, atheoretical, skills-based courses of study, Borden says. "They don't provide opportunities for students to develop the critical analytic capacities they need. If you've learned a template—when you encounter this, then do that—then you aren't prepared to negotiate the particularities, complexities, and irreducible ambiguities of clinical practice." While students learn how to implement technical procedures in these programs, he argues, they do not develop the conceptual foundations needed to carry out individualized approaches to intervention.
"The ethos of the social work tradition urges us to approach the person as an individual—in the words of Oliver Sacks, 'as a human being first and last,' engaging the 'experiencing, acting, living I,''' Borden says.