Becoming

So, I promised at one point to share with some readers of a different blog I had about ways I have struggled with the SW code of ethics and how I am working through those struggles.  I have to admit that writing this makes me feel a bit vulnerable.  After all, by definition, I am about to tell you the ways that internally I have not always thought in ways completely in line with the values of our profession.  By definition, that is worthy of criticism according to the values of our profession.  All I can do is ask for your patience and forbearance if these struggles hit on points of the code that you find especially important personally or if you find aspects of my struggles offensive or objectionable.  Also, I can promise you that at no point in my struggling was I disrespectful in my treatment of others.  Treating others with disrespect is morally objectionable to me, no matter the situation.

So, we'll start with the one that has been most blatant for me.  I grew up in a conservative Christian context in which any sex outside of a male-female married relationship was considered sinful.  Unfortunately, for reasons that make little sense to me, sexual acts between two people of the same gender were considered especially objectionable.  Sorting out my beliefs about homosexuality has been one of the challenges of my time in this program.  There was one thing I came into the program clear about: everyone should be treated with dignity and respect, independent of their sexual orientation or practices.  But especially this semester, it became clear to me that I needed to sort out my perspective in more detail.  My church, which has been a very rich, warm and loving community for me, taught that it is not sinful to have homosexual attractions, but it is sinful to have sexual interaction with someone of your own gender.  The social work values of self-determination and nondiscrimination stated that in no way could such a view be allowed to influence how I interacted with people.  I struggled to reconcile these perspectives, both of which I appreciated to some extent.

This issue came to a head for me this semester as I started a field placement at a faith-based counseling center, and was surprised to discover that my supervisor had a large number of homosexual and transgender clients.  Thankfully, she was open to having extensive conversations about the topic.  Early on, she pointed out that I actually had two different issues to sort out: my personal beliefs on the issue, and how I would handle the issue with clients.  In some sense, the social work value of self-determination seemed to make my personal opinion a moot point when it came to interacting with clients.  But I was pretty sure it would not be that simple in practice.  Several of my professors have pointed out that the biggest tool a therapist brings to a client is themselves.  I knew that as long as I had confused emotions on the topic, I might do unintentional harm.  Most importantly, I was not clear what "harm" was.  Could I sit across the room from a homosexual client who was thinking seriously about celibacy and encourage them in what seemed like such an isolating decision?  Could I sit across the room from a homosexual client who changed sexual partners regularly and fully empathize with any struggles they were having?  The idea of a homosexual person with one partner to whom they were faithful was a little easier for me to swallow, but I was not sure it was Biblical.  Regardless, I needed to be able to support self-determination.  Was this issue important enough that it was worth being at odds with my church about?  At one point I even wondered whether I needed to leave a church that had been and continues to be an essential and wonderful support to my family.

In the context in which  I was doing my field placement, I had the option of simply not seeing clients who were homosexual, or who had belief systems that significantly diverged from mine.  However, this was not my preference.  I wanted to be able to serve a wide variety of clients from any and every belief system, and knew that for me to do so well I needed to sort out my own beliefs a little more clearly.

Thankfully my field supervisor really encouraged this quest.  In fact, she said that any field time I spent working through this issue, she considered time well spent.  I went after books and articles on the topic, I talked to my pastor, I talked to other close friends, I had multiple conversations with my field supervisor about the role of the therapist, what it means to be healthy, the challenges faced by different types of people, her own thinking in relation to this topic, and so forth.  Yay for the power of good supervision!  I also shadowed her as she did therapy with homosexual and transgender clients, as well as heterosexual clients.  I heard their stories and saw how she responded to the various issues they brought to therapy sessions.

Along with my interactions with my supervisor, one of the most important resources in this search for me was a book called Washed and Waiting.  The author, Wesley Hill, tells his story of discovering his homosexuality, coming to accept it, and, because of his religious beliefs, choosing celibacy.  He shares the challenges and riches that have come from this decision.  Part of my question was whether I could sit across the room from a homosexual client, and encourage them in this choice if it was what they wanted.  Wesley Hill convinced me both that this choice is incredibly difficult - I have never read a more poignant description of loneliness - and significantly rewarding, not just for the individual, but for the community.  Somehow, feeling more at peace with the possibility of that choice allowed me to also feel more at peace with self-determination generally.  If I have homosexual clients who are sexually active, that is only to be expected.  If I have homosexual clients who choose not to be, that is alright too.  Both choices have their pain and their riches, their challenges and their joys.  My role is to be with clients wherever they are at, and today I feel I can do that.  In fact I have found repeatedly that when I am at peace with my own beliefs, I can be open to client beliefs and lifestyles without feeling threatened, and more fully support self-determination.

I have come to some conclusions about my personal beliefs surrounding this issue.  However, now that I am at peace with my own views, what they are is not essential to my role as a social worker.  I am confident in my ability to serve people well, no matter their belief system.  And that is what I needed to be sure of.

If you have found this post dissatisfying, incomplete, or problematic, feel free to write me about it!  Believe me, this is an ongoing thought process and conversation for me, and I would love to engage with anyone who is open to doing that in ways that are thoughtful and respectful.  My email can be found here.

Social Work and Spirituality

According to my Generalist Social Work textbook:

"Spiritual beliefs may affect the client’s response to adversity, the coping methods employed, the sources of support available (e.g., the faith community may form a helpful social network), and the array of appropriate interventions available. Particularly when clients have experienced disaster or unimaginable traumas, the exploration of suffering, good and evil, shame and guilt, and forgiveness can be a central part of the change process. Social workers must be aware of their own spiritual journeys and understand the appropriate handling of spiritual content, depending on the setting, focus, and client population involved (Ellor et al., 1999)" (Hepworth et al, 2010, p. 241).

As I have been at my internship, I have been impressed with the way this issue was handled.  Spirituality came up in many conversations with clients, and the client's perspective was always treated with respect.  The therapists always engaged in a strengths-based perspective, in which they encouraged any ways that a person's spirituality seemed to help them cope with difficult situations.  They were never negative or disparaging about a spiritual belief in the client's presence, no matter what their private, personal perspective on that believe happened to be.  They asked good questions that made clients feel comfortable discussing their spiritual beliefs.

In many ways I appreciate this approach.  I would feel very uncomfortable if I went to a therapist and they were negative or critical of my spiritual beliefs.  In fact, I might have doubts about whether that person could be helpful in addressing my presenting issues.  However, what happens if spiritual beliefs seem to be harmful to a client?  How does a social worker make that determination?  I suppose the correct response would be simply to ask questions that would allow the client to determine whether that was the case.  However, even in the asking of questions, can we really deny that we sometimes have an agenda?  The questions we ask can cause a client to think in one direction or another.  Of course, the beauty of questions is that they do not force anything on a client.  But can our personal perspective really be so thoroughly removed from view?  If so, why do Hepworth et al say it is important for us to be aware of our own spiritual journeys?  Only so that we can keep them hidden? 

When it comes to issues of suffering, good and evil, shame and guilt, and forgiveness, things seem to get even more complicated.  Many religions have very strong perspectives on these issues, but those perspectives may or may not lead to positive change.  Within the religion I practice, Christianity, there are many different views on why suffering exists, and God's relation to it.  I have found some of these to be helpful in my own times of struggle, and others to be decidedly hurtful.  Is there any point in which, as social workers, it is appropriate we express an opinion to a client on something like the importance of forgiveness?  Is there any point that we share what has been valuable in our own lives on these topics?  Clearly, I have more questions than answers.

Works Cited:
Hepworth, D.H., Rooney, R.H., Rooney, G.D., Strom-Gottfield, K.  2010.  Direct Social Work Practice Theory and Skills (9th edition).  Delmont, CA: Brooks/Cole, Cengage Learning. 

Thoughts on Applying What I'm Learning to Brazilian Culture

Over Thanksgiving, I went back to my home city of Sao Paulo, Brazil.  I was full of what I had been learning during my first semester of grad school.  In Sao Paulo, I realized anew that different methods might be needed in different contexts.  One example of this was in the area of listening.  In the US, it seems people feel someone is listening well if the person sits quietly while they are talking and asks good questions.  In Brazil, that did not seem to go over as well.  When I tried to quietly listen, it seemed I was not as engaged in the life issue as others who were more verbal in their response.  When I asked the kind of questions I would naturally ask here, people were sometimes a little taken aback.  For example, when I asked questions to check my assumptions, it came across as if I lacked intuitive understanding of what they were sharing.  It was expected that conversation would happen more fluidly and less formally, and perhaps even that I would have strong opinions and express them.  This was in an informal friendship-based context, but my experience with the counseling professions in Brazil gives me the impression that a strong sense of the "right" direction, of having the answer, is expected from the counselor, also. 

As I have spent more time thinking about my interactions in Sao Paulo, I have wondered what kind of counseling approach I should take if I moved back to Sao Paulo as a therapist.  Could American listening methods be useful, and even liberating, if people were told what to expect from the beginning?  In other words, if a person came in for counseling and I told them that I would not give them advice, but instead was there only to ask clarifying questions that would help them make their own decisions, would that create a greater sense of empowerment?  Or would it simply create estrangement?  Could I adapt to a style more normal in the Brazilian environment without doing harm through foolish advice or jumping to conclusions?  I believe I would have to spend more time in a Brazilian context to reach satisfactory conclusions on these questions. 

Even more challenging, in some ways, in Brazil, was thinking about how to respond to physical needs.  In my current internship in Pittsburgh, although part of the goal has to do with mental health, a significant piece of is to make sure they have the basic resources they need to live stable lives.  On the most immediate level, this includes adequate housing, food, and clothing.  On a longer-term level, it includes goals in employment, education, and healthier relationships.  In every area, except perhaps the last, meeting these goals is more challenging in Brazil.  There is no government food stamps program and food is more expensive relative to an average working class salary.  As far as I know, there is no social security, SSI, or unemployment benefits that can provide an income to people who are not working.  In terms of housing, although there are a few high rise housing projects, I have never heard of anything like HUD or Section 8.  Almost all help in these areas come from the community, non-profits, and religious groups, not from the government. 

So how do I apply Mazlow's hierarchy of needs in that context?  Or should I even try?  In a Brazilian context, sometimes the hierarchy seems to work backwards: encouraging self-actualization (the pursuit of dreams) leads to better esteem and relationships, which in turn provide the necessary community tools for safety and meeting physiological needs.  Once again, these thoughts require further pondering within a Brazilian community. 

Where I Stand on the Cultural Adjustment Spectrum

I finished the last blog by saying that I would express where I stand within the Cultural Adjustment Spectrum (assimilation - acculturation without assimilation - ambivalence - opposition/rejection) in this one.  However, given that this is a topic my own life experience has led me to think about in-depth, this is still only an initial overview of my thoughts.  

Intuitively, due to my own cross-cultural experience living as an American in Brazil for 16 years, and as a semi-Brazilian in the US for 11, I tend toward the second option (acculturation without assimilation), while recognizing that a certain amount of ambivalence may be inevitable for those who move between worlds.  I believe there is great richness lost in mere assimilation, even if it is easiest for the receiving country.  On the other extreme, the terms "opposition" and "rejection" do not sit easily with me.  This does not mean, however, that I am always opposed to immigrant or minority groups bringing social change.  

I deeply admire, among others, people like the Settlement House workers, the women suffragists, and peaceful participants in the civil rights movement of the 1960s.  I admire their refusal to use violence, despite the intense frustration of their causes.  Instead of bringing destruction, they helped us to live more fully into the ideals on which this nation was founded.  Those ideals - of justice, liberty, equality, freedom of speech, freedom of religion, and so on - are, to this day, part of the reason immigrants want to come to the United States.  I think immigrant populations have and can continue to help us live out those ideals more fully.  

Unlike many, I do not think that change in and of itself is a bad thing - be it change in culture, in social systems, or in the political forces at work in our country.  We have always been a nation of immigrants, and every new wave has brought its own set of changes.  The realities that some conservative groups now so vocally seek to defend are not the realities that existed here a few decades ago, but the realities that were created by interactions between our culture and the groups of immigrants of each time period.  We are a continually changing nation, and hopefully an ever improving one. 

A Spectrum of Cultural Adjustment

In class last Monday, we discussed paradigms for understanding cultural adjustment to a new culture.  The professor specifically laid out four, along a spectrum:
1. Assimilation (completely taking on the new culture and abandoning your own)
2. Accommodation without assimilation (adjusting to all aspects of the new culture necessary to positive interaction with it, while maintaining your own culture internally and in your own home, as well as in interactions with others from that same culture)
3. Ambivalence (mixed feelings about your identity, as it comprises an uncomfortable and uncertain mix of the two cultures)
4. Opposition/rejection (maintaining your culture of origin as a social or political statement against the new culture)

We discussed this specifically in the context of assessment - the formal exploration of the current reality experienced/faced by the consumer or community.  The point in this context was, I believe, that when responding to people from outside the mainstream culture, it is important to understand which of these approaches they are taking as part of understanding their worldview.  But what then?  Do we simply note their perspective in passing, or do we have an ideal toward which we would like to move our clients?

American culture has sometimes held up one or the other of these positions as an ideal.  Today, there are a wide variety of perspectives.  For many Americans, assimilation is still the preference.  We continue to hear rhetoric from some of our politicians and from many Americans about how immigrants are dangerously bringing new values into our country and failing to take on a fully American identity as they should.

Others feel strongly that every culture is precious and valuable, and that it enriches our country to have cultural enclaves within it, where we have slightly greater contact with immigrant cultures, and where they can feel at home.  The third option, ambivalence, would probably not be the word chosen by any who hold an intermediate view between acculturation and opposition.  Perhaps some might instead say that forming a new synthesis from two opposing thesis (cultures) would result in yet a stronger community.  However, "ambivalence" does express the complexity and uncertainty often inherent in the experience of people trying to move between cultures.

Finally, mainly among those who feel unjustly treated by those in power, we have movements of outright opposition to our current system.  These movements often idealize the cultures from which they came and use them to build a communal consensus against the "enemy" of mainstream culture/power.  Some of these groups tried for decades or centuries to live peacefully in American culture, but continual discrimination, oppression and segregation eventually led to more definitive attempts at transformative political action, whether pacifist or violent.

Social workers at times have been the agents of mainstream culture in attempting to help immigrants assimilate or adjust as seamlessly as possible into our current reality.  At other times, social workers have been voices for change and social reform, specifically because of the abuses against impoverished or underrepresented (often minority or immigrant) groups in out system.  The social work code of ethics speaks always for letting clients/consumers decide for themselves what attitude they should take.  However, that does not allow us, as social workers, to simply brush our hands of the dilemma.  Consciously or unconsciously, our opinion will make a difference in our relationships, and it is important to be aware of these interactions within ourselves.  Furthermore, we often DO try to influence our clients/consumers in one way or another

As therapists, we want to see our consumers become as healthy as possible, and that includes having a picture of what health looks like toward which we hope to move them.  As advocates, it is unlikely we will be effective if we do not see the justice of our clients cause.  As community organizers, we seek to move an entire community.  As policy makers, we seek to influence the direction of an organization, state or nation.  Inevitably, our opinion on this debate will influence our practice.  The larger our sphere of influence, the more obvious this becomes.

So where do I stand?  For a response to that, you will have to see the next blog.

Self-Determination? Are you sure?

One of the primary values of Social Work is self-determination.  We provide clients with information, resources and pathways, but the final choices are theirs.  We are, we proudly say, about empowerment, not paternalism.

As an American, I whole-heartedly agree with this policy.  After all, I am an independent adult and therefore expect the full right to make my own choices the way I think is best.  In fact, I react viscerally to the idea of anyone making decisions about my life for me.  As a result, it only seems fair that I would give my clients the same rights and respect I desire.  And yet, the more I think about it, the more self-determination seems far from a simple concept.  After all, as adult human beings, do we really always know and choose what is best for us?  Without the strong intervention of loved ones, there are times I would have plunged down some very problematic paths.  This question becomes even more complicated, however, when placed in the picture of the addictions and mental illnesses with which many of our clients suffer, forces often directly opposed to wise decision-making.

Today was the first day of my internship.  I shadowed a mobile therapist for a mental health agency that works with people who have been homeless, but now live in apartments partially paid for by the government.  Many of these people have drug and alcohol addictions, mental illnesses, or both.  The first man we went to see was drinking, although it was only 10:00 in the morning.  His whole apartment reeked of alcohol.  He was watching tv, and made comments about spending most of his time in front of the tube.  Nonetheless, he complained vociferously against his landlord for not cleaning up the black mold in his kitchen, for giving him a terrible fridge in desperate need of defrosting, for the bad condition of the wooden steps leading down to his front door, and the list went on.  Some of these things were certainly problems on the landlord's end.  Others seemed fixable with a little bit of concentrated effort on his part.  Reasonable or not, right or not, I confess to a desire to shake the man.  This was probably partly due to the fact that I am currently in school full-time, working part-time and doing a two-day internship, so time to sit and watch a favorite tv show is at a premium for me.  The good news is, no shaking occurred.  Instead I listened politely, nodding and agreeing when necessary and eventually followed the mobile therapist out the door.  She explained to me that this man had not yet recognized that his alcohol addiction was a problem.  He was in the first of four stages through which they hoped to guide their clients, something along the lines of approach, persuasion, gaining health and preventing relapse.

With a little bit of time to calm down, I was able to see that shaking the man would not have been a good idea.  It makes sense that building a trust relationship is an essential first step, before anything else.  The therapist could not simply say, "make different choices," and expect the problems to disappear: addictions do not work that way.  Until the man recognizes the destruction caused in his own life by his own alcoholism, the therapist's hands are tied, except for in helping him with practical things essential to physical survival.  Throughout the day I met other people much further along in the process, many of whom were, frankly, delightful.  I came away admitting to myself that self-determination is not as simple as it initially seemed, but newly committed to trying to practice it.  People do need to be respected, and need as much of a voice as possible in their own choices.

Theological Follow-up

This blog is not for a class assignment.  I just felt compelled to present what I left out of my last post: the spiritual perspective that I did not mention in "A voice for change or a voice for the status quo?"  In Christian circles, we speak of the Kingdom of God as the coming of all good things: a world without suffering, violence, sickness, hatred, oppression, pain, etc.  The Kingdom of God, the Bible says, is both already among us, and yet still coming.  We see it continuously as we see relationships healed, forgiveness rendered, transformation for the good occurring.  On the other hand, we will never see it completely in this life.  This world is tragically marred, and will only be fully fixed when God makes the world new.  This perspective fuels my impetus for change: I have a profound belief that positive change can occur in the world around me; simultaneously, I have no expectation that it will happen easily, immediately, or in all cases.  Thus, my belief in God produces patience and perseverance.  Despite the difficulties of bringing about positive change, I still believe it is worth pursuing.

Today in class we had a special presentation from PFLAG: Parents, Family and Friends of Lesbians and Gays.  It was an excellent presentation, from which I learned a lot.  However, at times the word "sinful" got thrown around as an entirely negative, oppressive, judgmental word.  I can certainly understand why, as calling any group of human beings "sinful" over and against any other group of human beings is both hurtful and bad theology (the Bible teaches that we are ALL sinful, none more or less than any other).  But to put "sinfulness" in a different light, I openly say that the concept has been very helpful to me in reaching out to other human beings.  In truth, the recognition of my own sinfulness has been essential to forming a functional, resilient interaction with the world around me.

By admitting to myself that I am no better than human beings who have committed the acts with which I find it hardest to come to terms, such as the genocide in Rwanda, or the holocaust - by recognizing that my essence is no different than theirs, I find that, though horrified by their acts, I am no longer surprised by them.  In fact, I can reach out in compassion and understanding to these fellow human beings - if I had been in their circumstances, I may have responded the same way.  By not expecting human beings to be better than we are - by recognizing my own sinfulness and our common sinfulness - I find that I can admit the reality of darkness, but not lose hope, for the change - or, to be more precise, the change agent - I have seen in my own life is continually at work all around me.

My theology frees me not to get lost in a world of despair, but instead to pursue the positive difference I can make, trusting that a bigger power has the bigger picture in God's hands.  I forget this sometimes, when life just feels too out of control, too big, too problematic.  But as I turn to God, He restores sense, restores balance, restores perspective, restores sobriety.