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Social workers: Fallen angels or mere mortals?

Article in Clinical Social Work Journal · September 1995

DOI: 10.1007/BF02191757

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Clinical Social Work J o u r n a l
Vol. 23, No. 3, Fall 1995

E S S A Y REVIEW

SOCIAL WORKERS: F A L L E N A N G E L S OR
MERE MORTALS?

U N F A I T H F U L A N G E L S : H O W S O C I A L W O R K HAS A B A N D O N E D
ITS M I S S I O N , H a r r y S p e c h t a n d M a r k C o u r t n e y , N e w York, N e w York:
T h e F r e e P r e s s . 1994, $22.95, 209 pp.

INTRODUCTION

The premise of this highly controversial treatise is that social work has
abandoned its long-standing mission of helping people to better use social re-
sources in order to solve their problems, and that the ascendancy of psycho-
therapy (and, in particular, clinical social work) has both contributed to and
become a symptom of this abandonment of social work's "mission to help the
poor and oppressed and to build communalitf' (p. 4). The authors believe that
psychotherapy cannot accomplish this social mission and therefore, to the extent
that social workers have left the public sector and become psychotherapists, we
have abandoned our commitment to serving the poor and improving their qual-
ity of life.
Specht and Courtney see the trend toward psychotherapy as both a cause
and an effect of this movement away from what they regard as traditional social
work values. They elaborate how the worship of psychotherapy today has re-
placed magic and religion as the ideal for alleviating emotional pain, and trace
this back to nineteenth century mind cures. The authors' thesis is that these
earlier movements, intended to deny and/or supersede material suffering, are
predicated on a belief that changing the individual, rather than social institu-
tions, is the most effective way to improve the quality of life. Psychotherapy
today rests on these same premises and attempts to serve the same fimctions in
response to human suffering. This is in direct conflict, for these authors, with
the goals and purposes of social work. The implication is that from a broad social
justice perspective, our current worship of psychotherapy is as ludicrous as the
nineteenth century mind cures now appear to us. Consistent with their position,
Specht and Courtney clearly idealize the nineteenth century social work pi-
oneers for their "angelic" qualities, and in fact dedicate the book to Jane Addams
and Mary Richmond, both of whom strongly believed in social philanthropism
and pre-dated the "psychologizing" of social work through its cross-fertilization
with psychoanalysis beginning in the 1920's and 1930's.

375 9 1995 Human Sciences Press, Inc.

376

CLINICAL SOCIAL WORK JOURNAL

T H E D E B A T E OVER C L I N I C A L S O C I A L W O R K

Clearly, the issue of whether social work's goal should be narrowly defined
as only bringing about direct environmental change, or whether it should also be
conceptualized to include changing individuals and small groups (and thereby
empowering them vis-a-vis their environment) is a very old and probably unre-
solvable one. Interestingly, some social workers have always specialized in clini-
cal work and seen themselves as therapists,* even prior to the impact of Freud-
ian theory during the 1920's and 1930's. Beginning with Mary Richmond, one of
the two luminaries to whom this work is dedicated, there was an awareness that
the relationship with the caseworker served psychological functions for the client
(Richmond, 1917). Even before the full impact of Freud's theory, she recognized
that within the context of the relationship with the caseworker, a client could
take advantage of opportunities for improving his or her situation that were
psychologically too conflictual, or in some other way too threatening, prior to the
casework relationship. During the 1940's and 50's, many social workers had pri-
vate practices of their own, in addition to positions in agencies. Ironically,
Specht and Courtney even recount how Mary Richmond began doing private
practice herself, in a poignant story of a volunteer in the Baltimore Charity Or-
ganization Society asking Miss Richmond for help with a personal problem and
offering to pay her $3.00 for her services (pp. 107-108).
Parallel with a long history of social workers actually doing psychotherapy
is an equally long history of the argument that psychotherapy is not a legitimate
social work function, resting in part on the premise that social workers are ~an-
gels" whose activity is solely in the service of others with no element of personal
gain. According to Perlman, who reviews the history of the emergence of social
worker psychoanalysts and the responses they have received from the broader
social work community, psychoanalytic psychotherapy has long been attacked as
a legitimate social work specialty, beginning with a position paper by the Ameri-
can Association of Social Workers in 1926 and continuing through the 1960's and
70's (Perlman, 1994 a, pp. 70-71). He reviews the literature constituting this
rejection of psychotherapy within mainstream social work and concludes that
the primary motives for it lie in the argument that psychotherapy is generally
less available to and utilized by the disadvantaged, the very groups who a r e the
primary responsibility of the social work profession. Perlman also summarizes
the literature specifically written in response to this internal opposition toward
clinical social work, ~ . . . entailing the formulation of counter-arguments in sup-
port of psychotherapy as a flflly legitimate specialization in social work" (Perl-
man, 1994 a, p. 71).
One of the key arguments used to justify psychotherapy as a legitimate so-
cial work specialization has been the belief that social workers do clinical work
differently than do psychologists and psychiatrists, because of the sometimes
subtle yet potentially profound differences in the values and orientation of the
social worker, who has been trained to appreciate the importance of the recipro-
cal impact between the individual and the larger social environment. The Educa-
tion Committee of the National Federation of State Clinical Social Work Soci-
eties met in the early 1970's and developed an informal position paper stating
that clinical social work is indeed a legitimate specialization within social work.

* For the purposes of this discussion, the term "clinical social work" will be used
interchangeably with "psychotherapy ~ performed by a social worker, regardless of setting.
 377

ESSAY REVIEW

This platform has been supported by m a n y social workers since then. For exam-
ple, Pinkus et al (1977) explored the issue of social work education and con-
cluded t h a t clinical social work is different than psychotherapy done by psychol-
ogists and psychiatrists, stating that:

If one believes that the ego and thus other psychic structures are modified
either temporarily or permanently not only by an exclusive preoccupation
with the psyche in therapy but also because of shifts and changes within the
real world, then much of casework is psychotherapy. All psychotherapy is not
casework. The clinical social worker practices casework within the values of
the social work profession and with an integrated way of thinking about the
biopsychosocial process influencing the individual. It is the stress on the in-
teractianal processes between man and his environment, the person in situa-
tion, and the 'psycho-social' nature of the therapy, that distinguishes clinical
social work from the other therapeutic professions (Pinkus et al, 1977, p.
264).

Perlman makes a similar argument when he discusses the dual identity of the
social worker psychoanalyst, who is somehow subtly different from his analytic
collegues because of his social work identity (Perlman, 1994 b).
A further argument for the legitimacy of clinical social work as a specialty
had been offered by those social workers who look at the broader hmctions of the
social work profession and see clinical social work as not in conflict, but r a t h e r in
synchrony, with its broader goals. Wakefield, for example, defines the pursuit of
justice as the primary goal of social work, and says that "certain kinds of clinical
interventions are an integral part of the pursuit of justice, ~ which he defines as
not simply economic equality but also the equal opportunity for all individuals
and groups to feel a genuine sense of self-respect (Wakefield, 1988, p. 353). With
this expanded notion of social justice, therapy which is conceptualized as in-
tended to enhance the self-esteem of individuals, as distinct from a medical or
psychological model of therapy as leading to "wellness, ~ serves the broader aim
of social justice and is therefore not necessarily reactionary. The tension within
social work about whether psychotherapy is a legitimate specialty is unneces-
sary when the goals of social work are viewed more broadly. Implicit in Wake-
field's discussion is the earlier argument as well, namely, that the kind of ther-
apy done by social workers is different on a deep level from what is done by
practitioners in the other therapy disciplines. He feels there is a unique need for
this kind of help among m a n y individuals in our society, which only social work-
ers can fill, while at the same time remaining faithful to their social work iden-
tity in its truest sense (Wakefield, 1988).
Though this a r g u m e n t continues today, it is especially timely now, given
the reality that m a n y social problems do seem to be worsening and fewer social
workers are interested in-working in what was once called the "public sector ~
(Brown, 1990). The problem is also more relevant now because of intensified
competition for the m a n a g e d care m a r k e t among the various psychotherapy
disciplines, which would be radically affected were social workers, the largest
licensed profession providing psychotherapy, to be excluded from the mar-
ketplace.
Perhaps even more importantly, I feel that Specht and Courtney's book de-
serves careful consideration because of the professional honesty of reading a cri-
tique of what one does and therefore having to find a justification for one's pro-
fessional choices. What better way to truly believe in the meaningfulness and
value of our work than to have to defend it against a rather powerful critique!
378

CLINICAL SOCIAL WORK JOURNAL

D I S C U S S I O N O F UNFAITHFUL ANGELS

As members of the social work education community, the authors are in an

excellent position to observe the trends toward clinical work and private practice
among social workers, beginning as early as graduate school. Not only are they
concerned about the "psychotherapizing~ of social work, but they note that there
is a "big split in the field between social workers who are interested in social
welfare, social policy, and public programs, and those who are interested in clini-
cal practice s (p. 100). Because of this polarization, the twin dangers--that clini-
cal social work will lose its moorings in the social work field and that social
welfare practitioners will perform their tasks in a manner not informed by an in-
depth understanding of their clients--become even greater.
These social work professors are astute in their assessment of how the var-
ious social services administered by the United States Government constitute an
enormous and inefficient bureaucratic system, which has been increasingly ig-
nored by the profession of social work. As there are less professionals in these
huge agencies, there is a deprofessionalization of them and an antipathy toward
professional social work training and practice, which then makes it increasingly
more difficult to recruit new professionals into public agencies. Despite the au-
thors' strong critique of this trend, they do communicate their understanding of
why, given this current situation, social workers would rather choose to go into
private practice as psychotherapists than work in the public social welfare sec-
tor.
Unfaithful Angels is organized in seven chapters, which attempt to trace the
development of social work in relation to psychotherapy in the United States
since the nineteenth century. Though the authors state that their "primary in-
tention ~ is not ~to knock or champion either social work or psychotherapy~ (p. 3),
the book clearly does have the flavor of a diatribe and the authors are passion-
ately against what they see as the psychotherapizing of America and the selling
out of social work. Furthermore, they believe that the decline of social work's
value as a profession is related to political conservatism in this country, and that
society has always been ambivalent toward social work's mission of helping the
poor.
In the concluding section of chapter one, they present a brief historical over-
view of the origins and evolution of social work, seen through the lens of their
bias that psychiatry seduced social work away from its true ~mission." Chapters
two and three further develop the thesis that psychotherapy has replaced nine-
teenth century magic and faith healing, as well as elaborating on the idea that
social workers have been seduced into psychotherapy because it has a more pow-
erful and privileged social status than traditional social work practice and, in
particular, because it reinforces the naive, defensive American belief in the per-
fectability of the individual, rather than addressing and engaging in the difficult
and painful task of changing social institutions. The worship of psychotherapy
thereby represents a political threat to our most fimdamental social institutions,
even more so when practiced by social workers, the alleged guardians of social
justice!
In the fourth and fifth chapters, Specht and Courtney elaborate upon social
work's marriage to first psychiatry and then psychoanalysis, strongly emphasiz-
ing the consequences that this has had in moving social workers away from a
concern with the environment and toward a concern with the inner life of the
individual. Though clearly opposed to psychodynamic therapy, the authors do
make a point of underscoring that it is all psychotherapies that they find politi-
 379

ESSAY REVIEW

cally dangerous, including even the humanistic psychology of Carl Rogers,

Abraham Maslow, and Fritz Pearls.
Specht and Courtney highlight the emergence of social casework in the
1940's, along with a growing interest in private practice, which they see as a
barometer of the degree to which social workers have abandoned their social
mission and instead pursued their interest in the inner world of the individual.
The authors make some relevant points concerning why m a n y social work stu,
dents are not only interested in becoming therapists, but specificallyin pursuing
careers in private practice, rather than doing clinical social work in agencies.
One hypothesis offered is that, unlike the so-called "ideals professions, such as
law and medicine, social work's traditional clientele was not middle-class and
could not pay for services provided by independent practitioners. Because of so-
cial workers' conflicts regarding working in the public sphere and engaging in
the kind of work about which (according to Specht and Courtney) our society is
highly ambivalent, it has become increasingly tempting to aim for full-time pri-
vate practice as a career goal.
Of particular interest to this reader was the history of the emergence of
private practice among social workers, as presented in their overview. Psychi-
atric social workers, in particullar,were the firstsocial workers to become inter-
ested in private practice, which the authors feel is consistent with the shii~ of
emphasis in psychiatric social work from manipulation of the environment to
manipulation of the individual, as well as increasing emphasis on the relation-
ship between the social worker and the client.They feel that the relative decline
of psychotherapy among social workers during the 1940's had to do with the
Great Depression and the subsequent decline of the middle class, who had be-
come the clientele of the private practitioners. After World W a r If, however,
private practice once again gained acceptance among social workers, partly be-
cause of the need for mental health services for returning veterans, as well as
because of the increasing value of mental health services among the middle
class. The authors conclude chapter five by once again elaborating upon their
premise that:

Although the aspirationof many socialworkers to have their own private

practice is consistentwith development in other professions,there is some-
thing quirky about this lust for autonomy and solo practicein a profession
whose traditionalfoundation and ethos liein its commitment to, and exper-
tise in, the creation of socialapproaches to solving the problems of individ-
uals and groups (p. 121).

Though they acknowledge that the private practice of psycho-therapy by social

workers in this country has been enormously successful, they genuinely believe
that this has been achieved at the expense of the public sector and particularly
represents a disservice to the chronically mentally ill,most of w h o m cannot af-
ford private practitioners.
It is to the credit of Specht and Courtney that they go beyond simply criticiz-
ing the existing situation and propose a vision for the twenty-first century which
is a blend of idealism and a sort of 1990's realism. Perhaps the idealisticflavor of
their model lies in its "communalistic approach to the solution of social prob-
lems ~ (p. 138), which undoubtedly appears idealisticto this reader precisely be-
cause she has in part internalized what the authors have described as a
uniquely American individualistic view of h u m a n behavior. Because of their
view of social work from a collectivistvantage point, the authors feel that social
workers have available to them a variety of interventions appropriate in differ-
380

CLINICAL SOCIAL WORK JOURNAL

ent situations, with psychotherapy being only one among many, and usually the
most expensive and least effective form of treatment, based on actual outcome
studies. They then propose how a community-based system of social care would
be structured, as well as how it would be attacked from both the left and the
right. Their conclusion is strikingly radical, in that they maintain that the fun-
damental beliefs underlying all forms of psychotherapy are inherently in conflict
with communally-based kinds of interventions, and therefore t h a t individual
psychotherapy cannot be integrated into a communally-based system of social
care.

DISCUSSION

Despite the rather repetitious and even polemical tone of this book, it does
indeed resonate with my own concerns about social workers entering private
practice as soon a f a r graduate school as the licensing laws allow, or even going
to graduate school in social work specifically as a means of relatively quickly
becoming a psychotherapist. I have become increasingly aware of what appears
to be a different mentality among social workers completing their education, a
mentality based much more on their individual career aspirations than on a
p r i m a r y commitment to social justice and social change. Such a commitment, in
m y opinion, overrides whether one works in the private or the public sector, and
whether one primarily does psychotherapy, provides direct social services, or
works for social change more broadly. Though some social workers entered pri-
vate practice in the 1940's, unlike m a n y social work therapists today they had
considerable agency and supervisory experience. They were firmly grounded in
their identities as promoters of social change and defenders of the rights of op-
pressed minorities. I agree with those authors already cited that it is our atti-
tudes and values, not only what we do but how we do it, t h a t define us as social
workers and differentiate clinical social workers from the other psychotherapy
disciplines. No matter how psychoanalytic we m a y be, we are and should be
"different ~ from our non-social work analytic colleagues in how we work with our
patients, different because of"who we are. ~
These issues have been powerfully addressed in a recent paper by Seiz and
Schwab (1992). Their study compared the values of agency practitioners, private
practitioners, and ~combination practitioners ~ (who worked both in agencies and
part-time in private practice) along a series of four value orientations t h a t in-
cluded the value of social welfare/ch'ange and the value of psychotherapy. The
study found t h a t the values of the three social work groups were significantly
different on all scales, and that in general combination practitioners were mid-
way between the two other groups on the four value orientations. Though this
finding was to be expected, what was less predictable was t h a t all three groups,
regardless of their settings, seemed to increasingly value private practice,
whether or not they performed it. A similar study by Smaller (1987) found t h a t
89.6% of the social workers surveyed viewed private practice "favorably.~
The Perlman study, mentioned earlier, though focused on looking at the
professional interests of social workers who have pursued formal analytic train-
ing, also found t h a t social workers in general seem to be less interested in the
values of social justice t h a n they were in earlier decades, and t h a t m a n y social
workers primarily want to be therapists, rather than social workers, but see
getting the M.S.W. or D.S.W. as a route to achieve this goal (Perlman, 1994 a, p.
80). Such studies clearly lend some credibility to Specht and Courtney's position
 381

ESSAY REVIEW

regarding the worship of psychotherapy in our culture, even among the tradi-
tional staunch defenders of the values of social justice and social change.
Equally, if not more, noteworthy was Seiz and Schwab's finding t h a t there
was little difference among the three social worker groups regarding the value of
promoting social justice (Seiz and Schwab, 1992). A similar finding was reached
by two other studies. Borenzweig (1981) found a lack of involvement by all social
work practitioners in social action activities. Barker (1983) actually found that
social workers in private practice were as or more involved in social change at
the community level than agency social workers (though there were probably
some practical reasons for this, based on lesser risk of adverse career conse-
quences of social action by those who were self-employed). Such research sug-
gests that whether a social worker values social welfare and social change may
have little to do with private practice versus agency practice. This supports my
belief that therapy m a y not be the culprit, but rather the values that social work
students as individuals bring to the social work profession and the values with
which they are imbued during their professional training.
One further corollary of the Seiz and Schwab study is that not all social
workers in private practice have values diametrically opposed to those who work
in agencies. Unlike Specht and Courtney's characterization, social workers in
private practice do not represent a homogeneous group in terms of values, and
m a n y have highly developed social concerns similar to those who work solely in
agencies. As a member of this "combination" group, I feel that my decision to
review this book, rather than a clinical book (with which I am generally more at
home), reflects my interest in both treatment and the larger social issues, my
commitment to the disadvantaged and poor, as well as to my more middle-class
clientele. It is because of my concern with social values that these trends among
social workers entering the profession are so disturbing to me.
I essentially agree with Specht and Courtney that psycho-therapy has be-
come a "religion ~ of our day, and that there are political underpinnings for and
ramifications of this phenomenon. The powers that be obviously prefer t h a t indi-
viduals change and adapt to social conditions, rather than changing social insti-
tutions, analogous to the media encouraging individuals to stop smoking at the
same time as large corporations continue to make huge profits while polluting
the environment. However, I see the worship of psychotherapy as more a symp-
tom t h a n a cause of our society's (including social workers') lack of p r i m a r y con-
cern for social justice. Consequently, it is my belief that the solution to the prob-
lem is not totally eliminating psychotherapy or redefining social work to exclude
clinical social work as a legitimate specialty. Furthermore, I do agree with the
argument t h a t for some individuals and families, therapy can help them to rec-
ognize and more effectively respond to social injustices. And for some people
with major psychological problems, their own individual problems do signifi-
cantly contribute to their unhappiness and lack of self-actualization, over and
above socioeconomic and political factors. For these people, social workers may
make the best therapists, precisely because of our historical awareness of envi-
ronmental factors (on all levels) and our reluctance to completely pathologize the
individual's problems. Incidentally, I believe that this is a primary reason why
self psychology has been so attractive to social workers--like social work, it
views the inner self of the person as constantly affected by and in turn affecting
the outside environment, rather than as a closed system.
What concerns me most is the polarization between the public and the pri-
vate social work sectors, and between psychotherapy and more traditionally "so-
cial work" values of either changing the social system or providing concrete so-
cial services. Students should care about social values as a requirement for
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CLINICAL SOCIAL WORK JOURNAL

acceptance into graduate schools of social work, which should teach these values
as well as individual and family psychodynamics and therapeutic skills. As a
result, perhaps more social workers will be interested in agency or combined
practice, and those who do go into private practice exclusively will think more
broadly and not be totally influenced by or emulate psychiatry and clinical psy-
chology. Furthermore, comprehensive social work education addressing both so-
cial and psychological issues would reduce the polarization by enabling social
workers in the public sector to understand their clients more deeply and thereby
be more helpful to them. To accomplish this goal, we m u s t not only more care-
fully select students for graduate social work education, but also work toward
changing social values so that social work can have more status in the broader
society relative to psychotherapy.
In conclusion, though I disagree with Specht and Courtney's diatribe
against psychotherapy, which is seen as the culprit in the current lack of pas-
sionate commitment to traditional social work values, I do feel t h a t they raise
some significant issues which should be of concern to a l l social workers, regard-
less of the nature of their practice. Unfaithful Angels is a provocative book,
which succeeds in stimulating the reader to think through these issues of great
concern and proposes a new model of "community-based~ social care t h a t m a y
have an impact on social welfare policy in the near future. As such, it is highly
recommended for all who are participating in and]or affected by current social
movements, which hopefully includes all of us in the social work profession,
whether ~angels ~ or mere mortals.

REFERENCES

Barker, R. L. (1983). Private practice primer for social work. NASW News, 28, 9.
Borenzweig, J. (1981). Agency vs. private practice: Similarities and differences. Social
Work, 26, 239-244.
Brown, P. (1990). Social Workers in Private Practice: What Are They Really Doing? Clini-
cal Social Work Journal, 18, 4, 407-421.
Perlman, F. T. (1994 a). The professional identity of the social work - psychoanalyst: The
genesis of professional identity. Journal of Analytic Social Work, 2, 1, 67-98.
Perhnan, F. T. (1994 b). The professional identity of the social work - psychoanalyst: Pro-
fessional activities. Journal of Analytic Social Work, 2, 2, 25-55.
Pinkus. H., Hating J., Lieberman, F., Mishne, J., and Pollock, J. (1977). Education for the
practice of clinical social work at the Master's level: A position paper. Clinical Social
Work Journal, 5, 4, 253-268.
Richmond, M. (1917). Social diagnosis. New York: Russell Sage Foundation.
Richmond, M. (1922). What is social casework? New York: Russell Sage Foundation.
Seiz, R. C. and Schwab, A. J. (1992). Value orientations of clinical social work practi-
tioners. Clinical Social Work Journal, 20, 3, 323-335.
Smaller, M. (1987). Attitudes toward private practice in social work: Examining profes-
sional commitment. Journal of Independent Social Work, 1, 7-18.
Wakefield, J. C. (1988). Psychotherapy, distributive justice, and social work. Part 2: Psy-
chotherapy and the pursuit of justice. Social Service Review, 62, 353-381.

Linda A. Chernus, L.I.S.W., B.C.D.

4416 H o m e r A v e .
Cincinnati, Ohio 4 5 2 2 7

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