Richard F Ramsay
SOWK 379
Faculty of Social Work, University of Calgary
Distributed at the Joint International Conference on Social Work
Montreal, Canada
July 29 -August 2, 2000
Note: Original copy. Minor editing/reformatting was carried out.
Introduction
“The more I learn, the less I know.”
It seems that as my social work education progresses, I realize how much I still have to learn and the necessity of open-mindedness. As this semester ends, I feel pulled between the theory learned in course work and the demands of my practicum at Midcity Family Services. This paper provides the unique (somewhat daunting) opportunity to link theory and practice. During my first year of Social Work, I have come to appreciate the complex nature of our profession. I have begun to understand how the folding and unfolding of a simple tetrahedron can represent the interactions of many different systems inherent in the comprehensive framework of social work. Metaphorically, the unfolded tetrahedrons can be depicted as a diverse, deeply inter-related web, where each delicate thread is connected (See Appendix I). Pressure on any one thread influences all other threads. It is by starting with this metaphor that the true complexity of social work, and indeed life, can be understood. As we attempt understand the dynamics of each system within the web, we must remember the interdependence of the system as a whole.
Social work as a profession embraces a conceptual model, which includes the shared values of social work practitioners, recognition of the deep interrelatedness of all dimensions of life and a unified focus on the interactions between persons and their environments. This holistic, inclusive conceptual framework allows social workers in direct practice to remain conscious of the big picture and the importance of their contribution to the profession as a whole. Four tetrahedral dimensions can characterize the holistic comprehensive framework. Each dimension can be further unfolded to represent the unique dynamics within each subsystem. Each subsystem is a holon. This means the system is simultaneously a whole system and a part of a larger system (Miley, O’Melia and DuBois, 1998). The four dimensions used in this paper are Domain of Practice, Domain of the Practitioner, Paradigm of the Profession and Methods of Practice (Ramsay, 1999).
This comprehensive framework provides practitioners
with guidelines and a deeper understanding of their own practice (See Appendix
II). The framework reminds workers to remain conscious of the bigger picture
including the core values and beliefs of social work and the ultimate vision of
a just and civil society. The framework is an organizing tool that emphasizes
wholeness while still being applicable to direct practice. In this paper, I
will endeavor to apply this comprehensive framework to my direct practice with
special emphasis on the Methods of Practice dimension, using the three phases
of dialogue, discovery and development (Miley and DuBois, 1999).
Domain of
Practice
The first dimension in the comprehensive framework is the Domain of Practice. During this semester, I have begun to understand the implications of the person-interaction-environment concept (PIE). It is through fully understanding PIE that I can begin to see the invisible transactions between person and environment elements. PIE, as a concept, allows the practitioner to focus on relationships that are too often overlooked. The experience of looking with this new perspective in mind has influenced all areas of my life, as well as, my practice. I have seen deeply interconnected patterns where before there were simply gaps. The web of interrelatedness grows ever more complex when we open our minds to seeing the intangible connections which surround us every day. The unified focus provided by the concept of PIE gives social work a unique outlook on the world and once we begin to ‘see’ in new ways then we can work towards ‘changing’ in new ways. The concept of PIE frees us from the dominating influences of other professions, which are more prescriptive in nature and based on diagnosis. PIE allows us to fully understand our clients, to work with them in partnership, and see them as 'experts' in their own person-in-environment system.
In the 1970s, Bartlett identified three components, which contribute to the definition of the social work domain of practice (Ramsay, 1994):
1. A social functioning focus,
2. A broad based practice orientation,
3. A variety of intervention methods
Bartlett challenged the traditional dual-purpose focus, which emphasizes the person or the environment. She described the domain of social work as being the interaction between person and environment. PIE (person-in-environment) as a concept focused on how individual needs interact with environmental demands and vice versa. PIE utilizes ideas based on an ecological perspective (Garvin and Seabury, 1997). This perspective looks at the transactional interfaces between the individual and the environment. The underlying premise is that individual needs must be balanced by environmental resources, individual wants must be balanced by environmental opportunities, and individual skills and capacities must be balanced by environmental demands and expectations (Garvin and Seabury, 1997). The three elements: person, interaction, and environment are seen as a holistic unit. Interactions are the point at which individuals and their environmental elements converge. The social functioning result of the convergence is determined by how well persons function in their environments.
The invention of the PIE framework gave new meaning to the profession of social work. PIE provides a common domain and a broad orientation that includes casework and group work, generalist models and specialist models, and work at both micro and macro levels. This broad orientation allows social workers to focus on any client system, any target system and use any action system depending on what is best for the client. The PIE concept requires a diverse repertoire of interventions to be offered by, or known to, all social work practitioners.
Furthermore, by unfolding PIE into more detail, we can look at the biopsychosociospiritual person and his/her environment (See Appendix II). The environment can be represented by three components: validator otherness (belief systems, laws, traditions), personal otherness (intimate relationships, family), and resource otherness (other opportunities, institutionalized resources) (Ramsay, 1997). This unfolded view of PIE aids the practitioner in fully understanding the client in a wholistic way. As I put this concept into practice, using the five-chair model (see Appendix III), I found myself being less person-centered and more relationship-centred, getting more information and insight into my client’s life.
My first session with ‘Mary’ was two hours, during this dialogue phase of our relationship, I was trying to connect with my client and form a basis of trust. Using warmth, empathy and genuiness I was able to connect with Mary on several issues. However, I felt my understanding of her was limited by the person-centered approach that is characteristic of a two-chair model of practice (See Appendix III). During the second hour, I used the conceptual five-chair model and began to ask Mary about her belief systems, relationships with family members and friends and about school and her previous experiences with counselors. This relationship-centred line of open-ended questions helped me to clearly see the transactions between Mary and her environment. For example, Mary does believe it is important to do well in school, however, she feels it is more important to be there for her friends. Understanding these two belief systems, allowed Mary and I to discuss how they sometimes conflict, and gave us new insight into possible solutions.
In this situation, it was clear to me how the expanded
concept of PIE could help me in direct practice by allowing Mary and I the
opportunity to discuss the invisible patterns and transactions in her life. We
continued down this path of forming a partnership, identifying challenges and
defining issues using the five-chair model to guide our discussions. Together,
we began to understand some of the main challenges facing Mary and how we could
work in partnership to improve the transactions in her life. An understanding
of the Domain of Practice allowed me to move from a person-centered approach
and to be more aware of environmental influences in Mary’s life. In life and in practice, it is easy to slip
into a problem-solving and rescuer role before truly understanding your client
in a larger context (this applies with friends and family too!!!). Using the
comprehensive framework and the PIE concept of social work's domain can guide
your practice by opening up new pathways to understanding by rendering the invisible,
visible.
Paradigm of
Profession
The second dimension of this comprehensive framework is the Paradigm of Profession. This component emphasizes the need for social workers to be unified in their practice, values, ethics, methods and practice options. Once again, the Paradigm of Profession requires social workers to be open-minded and keep in mind an awareness of the whole. Historically, defining the paradigm of social work has been a struggle. The debate about which activities fit with the values and purpose of social work continues today. Should we be specialists or generalists? Should we define ourselves by our field, the target population we serve, or the social problems we most often face? The profession of social work must address these confusing issues. When asked ‘what exactly do you do?’ The potential answers seem endless. In coming together to define the paradigm of our profession, we will be more comfortable in answering these issues both as individuals, and as a unique profession. The definition of the Paradigm of our Profession needs to be broadly based and inclusive of all different social workers. However, it must address the uniqueness of social work and the common activities that social workers utilize to meet the ultimate goals of social work. Clearly, this is a difficult, evolving and challenging task.
Once again, it is important to start with a minimum whole system of four elements and then unfold them to represent the complex paradigm of our profession. Using a generalist model and the work of Pincus and Minahan (1973) a four-element model of practice was developed. The four elements, change agent system, client system, action system and target system, can represent the practice options available to all social workers. This model is consistent with the Domain of Practice, the values and ethics inherent in social work and also allows practitioners a broad spectrum of potential methodologies that match with this practice option model. Understanding this model of practice activities allows practitioners to be aware of many different theories, practice methods and helps social workers to better serve their clients. This broad orientation of social work requires practitioners to utilize a vast array of knowledge from many different knowledge sources. This model requires social workers to look at the interconnectiveness of all dimensions of life and work with many different people, systems and theories. The four elements of the model can be further unfolded to identify traditional categories of social work including size of client group, types of target populations, different fields of practice, specified social problems, interagency partnerships and agency administration features. In this way, social workers can find a unified perspective that encompasses the diversity within our profession.
The Paradigm of Profession component has strong implications in direct practice. Despite my limited experience and education in Social Work, I was able to access many different theories, styles and methods of practice. There are four social workers at Midcity Family Services; each with different theoretical orientations and each influenced by the nature of the agency itself. In working in the agency, I had to opportunity to observe the interactions among staff, with social workers and clients, and between employees and the agency. As a participant observer, I was able to see the interconnectiveness between the agency, staff and clients, and understand how each area was influenced by changes in other areas. In my own practice, I was able to enlist the support and help of the staff to increase my repertoire of methods and practice options. Seeing myself as the change agent system made me aware of my responsibility to my clients, and required me to continuously increase my knowledge base. For example, I consulted with my field instructor and other social workers for their suggestions regarding my clinical counseling and group work. To be consistent with the Paradigm of our Profession, social workers must continuously strive to broaden their knowledge, skills and methods of practice.
My work with Mary moved beyond the dialogue phase to
the discovery phase. We articulated her three primary challenges and agreed to
work towards her personal goals. The
discovery phase has a systemic and circular, or back and forth, pattern to it
that often involves returning to the dialogue phase with new pieces of
information and the opportunity to strengthen working relationships. Working
with Mary, I began to get a sense of the intricate web of her life and how she
experiences that web. As we explored her goals, we were confronted with new
challenges and therefore, the goals were constantly being changed and revised.
Together we emphasized Mary’s strengths and resilience, and reviewed her
previous problem-solving skills. We found that in addition to problem solving
skills Mary also had strong familial and personal resources. At one point, we
realized that we could not move any further in individual counseling without
addressing the outside influences in her life. We realized that the assistance
of her family (specifically her Mother) was essential to changing the
disruptive patterns in their relationship. Using the practice options model,
Mary’s Mother became the target system, and after asking for her assistance,
she became both a client system (working with my field instructor) and part of
the action system. Having a renewed focus on the relationship between Mary and
her Mother provided new intervention strategies, and removed the locus of the
problem from Mary to the relationship between Mary and her Mother. The
intervention strategy and process of discovery is further explored in the next
section Methods of Practice using the PIE assessment tool.
Methods of
Practice
The third dimension of the comprehensive framework is Methods of Practice. This dimension incorporates all the different skills and activities that practitioners use to aid and facilitate the change process. The focus of all methods of practice is person-in-environment problem solving or solution seeking, however, there are many paths that clients and practitioners can use to achieve these outcomes. The diversity of methodologies, practice skills and interventions is matched only by the diversity of the clients and their needs. Therefore, it is necessary to provide a framework to guide social workers in their practice to best meet the needs of the client. This dimension requires a systematic method of reciprocal decision-making that is inclusive of all the systemic and relationship type situations that clients may face. The method selected must be consistent with the values of social work, and therefore, incorporate our broad practice orientation, related practice options and person-in-environment understanding of the client's situation. Social workers have struggled to define a system, which is specific to our profession and its person-in-environment domain of practice. The result of our struggles has been rewarded in the creation of the PIE classification/assessment tool (Karls and Wandrei, 1994).
The creation of a useful tool based on the fundamental elements of our person-in-environment (p-I-e) domain was fundamental to the survival of our profession. As a professional tool, PIE, includes the p-I-e concepts in a classification system, which is holistic in nature. The PIE system does not attempt to look at a person in isolation, or separate a person from the environment influences around them. The PIE instrument allows for a variety of target systems and intervention approaches that are tailored specifically to the client's p-I-e situation. The current use of the DSM (Diagnostic and Statistical Manual of mental disorders) is not sufficient to fill the needs of the social work profession while holding true to the conceptual elements of its p-I-e domain. The DSM is a tool that emphasizes diagnosis specific to individual mental health functioning (DSM IV, 1994) and ultimately results in categorical labeling of the client. Labeling of this kind is contrary to a basic value in social work as the profession believes in the ability of the system to change and to learn to interact in ways that are mutually beneficial (Garvin and Seabury, 1997).
The DSM also fails to recognize the diversity of relationships between individuals and their environments. The DSM attempts to find or suggest a linear cause and effect and the locus of the problem is invariably individual-centred. Therefore, regardless of their particular or contextual circumstances, it is always the individual who must change. The DSM does not address the importance of the environment and the possibility of systemic or agency induced problems. The DSM is an important and useful tool when focused primarily on the diagnosis of particular mental functioning problems of the individual. However; it does not meet the needs of social work practitioners or the conceptual framework of a p-I-e domain. The creation of a comprehensive classification system for social work has proven to be a daunting task and several failed attempts resulted in the continued and wide spread use of the DSM by social work practitioners (Karls and Wandrei, 1992).
Using the momentum from Bartlett’s new ideas, and as a reaction to the third edition of the DSM in 1981, the National Association of Social Workers funded a two-year project to develop a system for classifying the problems of social functioning (Karls and Wandrei, 1994). The creation of PIE is the operationalization of a conceptual framework. PIE, as an instrument, uses person-in-environment as an organizing construct. It focuses on social functioning (by looking at roles), recognizing client strengths, and describing the environment of the client. PIE embraces the belief that people can change and strives not to categorically label or diagnose, but simply to describe (Garvin and Seabury, 1997). This tool allows the practitioner to target many different systems (not only the client) and to use a variety of action systems and interventions.
PIE is easy to use, has proven to be reliable and valid in studies thus far, and more research is being planned. PIE attains the goals set out by its creators, which are:
1. To provide social workers a common language to describe their clients problems,
2. To provide a tool for clearer communication among practitioners,
3. To provides a basis for gathering data and program design and evaluation (Karls and Wandrei, 1997).
PIE uses a four dimensional
holistic system. It is primarily descriptive in nature and although it has a
numerical component, the emphasis is on the social worker’s narrative. The
basic structure of PIE also makes it a good organizing tool: Factor I is
a description of social role problems, describing the role type and the
associated problem and has an index for severity, duration and coping
skills. Factor II is a
description of environmental problems, which also includes a severity and
duration index. Factor III
utilizes Axis I and II of the DSM-III-R to describe mental disorders and Factor
IV lists any physical disorders (based on the International Classification of Diseases) and the source of the
information (Barker, 1999). By using these four factors, PIE becomes an
integrative model that recognizes and encourages a multidisciplinary approach. Although
the first two factors are of the most importance to social workers, the third
and fourth factors recognize the importance of psychology and medicine in the
overall well-being of the client.
PIE Assessment (Mary)
Factor I: Social Functioning
Familial Roles
Child Role: Ambivalence, Dependency Type
Low Severity
Six Months to One Year
Inadequate
The primary problem in social functioning is Mary’s relationship with her parents, and more specifically her mother. Mary feels that she and her mother are constantly fighting and that things have been very tense over the last 8 months. Mary also feels her Mother controls her too much.
Sibling Role: Ambivalence, Other Type
Low Severity
One to Five Years
Somewhat Inadequate
A secondary problem for Mary is her relationship with her younger brother; they are always fighting. Mary also feels jealous of her brother’s relationship with their mother.
Friend Role: Responsibility Type
Low Severity
Six Months to One Year
Inadequate
A third problem in social functioning is the high level of responsibility that Mary feels to meet her friends’ needs. Including supporting them through their problems at the expense of her own relationships.
Safety/ Other: Unsafe School Conditions
Low Severity
More than five years
Mary and her friends are extremely frightened to go to high school because they believe they will be beaten up and ridiculed.
Education: Absence of Support service needed to access educational opportunities
Low Severity
Six Months to One Year
Discrimination: Geographical
Mary’s difficulty in school may be due to the lack of educational resources in rural areas, specifically, rural areas face a challenge of attracting and keeping qualified teachers.
Factor III: Mental Health
No reported or observed mental health issues
Factor IV: Physical Health
No reported or observed physical health issues
The PIE assessment helped use to move from the discovery phase to the development phase of our problem-solving/solution-seeking relationship. Mary suggested that her primary social functioning problem was with her Mother and that her goal was to improve their parent-daughter relationship. By focusing on Mary’s strengths and past problem-solving abilities, we found that we made some progress towards planning how to improve her relationship with her Mother. We set out several goals and practiced communications skills, emphasizing ‘I feel’ statements. We also made a plan for anger management in hopes of avoiding the frustration of constant fighting. Mary left with these tools and made an appointment for the following week.
The following session with Mary showed no real improvement in the relationship between Mary and her Mother. Mary felt that although she was trying very hard the patterns of communication were too difficult to break on her own. With Mary’s permission, we decided that Mary’s mother would be our next target system. When Mary’s mother, ‘Jane’ agreed to help us in the change process, she became part of the action system. Jane also became a client system when she began to meet with Barb, my field instructor.
The plan for the development phase is to have individual sessions and joint sessions with Mary, Jane, Barb and myself. During these sessions, we will use family therapy and focus on changing dysfunctional communication patterns between mother and daughter (CASW Task Force, 1999). On a macro level, the PIE tool made me aware of several social and environmental issues, each which is suggestive of different interventions. For example, targeting the educational system by advocating for student safety in high school or petitioning for better teachers in rural schools. The PIE tool provided me with a broader perspective and allowed me to see systemic problems within the educational system, which I may have missed in a person-centred approach.
PIE allows several target systems for change and it does not prescribe any specific action system; the intervention can be tailored to suit the client’s specific needs. PIE provides a problem solving/solution seeking focus by organizing the problems and allowing the practitioner to find the best fit between the problem and the intervention. As a tool, it can be used for organization of data and dissemination of knowledge. It remains the responsibility of the practitioner in partnership with the client to determine the best intervention. It is possible that PIE is too simplistic and does not provide enough guidance for social workers. However, the current version of PIE is a first version, and in time, it can be revised and extended to include relevant interventions. One example of a revision is the inclusion of three environmental components (validator, personal and resource) making the PIE tool more comprehensive (Ramsay, 1994).
PIE is an important step in the evolution of our profession and helps us to define social work by providing the classification system, which is necessary to pass society’s test of what constitutes a profession. As a tool, PIE will continue to help clarify our unique domain and the area in which social workers have special skills. It will facilitate research and evaluation of programs, and therefore, the efficacy of social work as an occupation. Most importantly, PIE allows social workers to conceptualize and describe client’s problems in the language of social work, and therefore, helps us to help our clients (Ramsay, 1994).
The fourth and final dimension of the comprehensive framework is the Domain of the Practitioner. This dimension focuses on the practitioner as the 'agent of change', and therefore, necessitates the social worker to look at his/her own PIE system. Through recognizing your own strengths and limitations, you can increase your self-awareness and effective use of self in the helping process. We must each reflect on the unique influences in our life and how they affect our practice. I felt connected with Mary because of personal struggles with my family as I was growing up. The agency, Midcity Family Services, and their directive towards family preservation also influenced me. Other environmental influences were from my co-workers in the agency, specifically, my field instructor. I related to her Methods of practice and saw her work with client reflected in my direct practice. In reviewing my own PIE system, I also discovered some barriers to my work with Mary. The main barrier was that I tried to equate my personal struggles with my mother to Mary's unique situation. In recognizing this process, I found that I had to return to the dialogue phase of our relationship and focus on how different Mary’s life experience was from my own. Use of self in the client worker relationship is a powerful tool, however, without self-awareness it can be detrimental to both the client and the worker. My self-awareness gave me insight into my motivations in working with Mary. It provided me with the opportunity to review my practice and makes appropriate changes to better serve my client.
The Domain of Practitioner is
essential to the comprehensive framework because it recognizes the possible
biases in the client-worker relationship. Increased self-awareness force social
workers to constantly evaluate and better their practice. Knowing your personal PIE system can help you
overcome the barriers you may face when working with clients. We cannot
separate our personal self from our working self (Witkin, 1999). However, we can find balance in our practice
by considering various theories, practice options and interventions.
Through the process of writing this paper, I have
gained insight into the necessity of a comprehensive framework for social work.
Each of the four dimensions has contributed to my own practice. I have begun to
see how the dimensions are interconnected and how they influence the system as
a whole. Each dimension can be further unfolded to represent deeper and more
complex interactions. Awareness of a comprehensive framework can guide practice
and information gathering; it can unify our profession and allow social workers
to meet the ultimate goals of a just and civil society. The PIE assessment tool
gives social workers the opportunity to move beyond a person centered approach
and see the detrimental systemic problems within our society. It is this
insight that may bring about change on a broader level and benefit the world
community.
Social workers have always recognized the importance of a holistic model and with the emerging focus on the holistic model within all helping professions; it is likely that social work will find a leading role. It is through our modeling and use of the comprehensive framework and PIE that our profession will gain a better understanding of the deep interrelatedness of all life systems. The comprehensive framework provides social workers with a way of understanding and organizing the diverse and complex web of life. As a profession, social work is sensitive to the constant changes in society; the PIE assessment tool provides us with a way to guide and organize information, and to see transactions and patterns, which are intangible. Furthermore, the comprehensive framework of social work (involving Domain of Practice, Paradigm of Profession, Methods of Practice and Domain of the Practitioner) gives us a whole system, which can be unfolded, stretched and redefined in response to the needs in society. The continuous evolution of the comprehensive framework is representative of the complex, and deeply interrelated systems of society. Ultimately, an understanding of the holistic comprehensive framework of social work will enable all social workers) (and me to better serve my clients.
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