Clinical vs. Macro Practice

I have been advising some students lately who are contemplating whether to pursue the clinical or administrative ‘tracks’ during their graduate social work education. For any non-social workers reading this, you are likely confused. That’s kind of part of my point–these distinctions that we agonize over within the profession are rather meaningless beyond it, which, I would argue, suggests that our focus is a bit misplaced.

The logic behind tracking students into either clinical practice (where they focus on therapy that uses similar methodologies to some other helping professionals to pursue intrapersonal change on the individual, group, or family level) or social work advocacy/administration (SWAAP, for short) is that students who intend to do one of these different kinds of social work or the other need specialized training unique to their intended practice. Since the two academic years outlined for graduate social work education are too short to accomplish all of our learning objectives anyway, there is a need for greater specialization in order to fit more in. So, before they begin their second year (or immediately, in the case of advanced standing students who skip most of their first year), students have to choose whether they intend to ‘be’ clinical or administrative in their practice. Not all schools of social work conceptualize these distinctions exactly the same, and there are problematic elements within most of the alternatives as well, but the divisions persist among students and within our profession, and I find it disturbing, counterproductive, and, in some cases, even destructive.

As a social worker who probably wouldn’t have pursued social work had I not had the ability to tailor my education towards the kind of macro practice that really interests me, though, I certainly appreciate the importance of having a big enough tent, so to speak, for professionals with very different ideas of the kind of social work they want to practice to all fit underneath. Surely, though, there is a way to encourage social workers to pursue their passions within the profession while not perpetuating what is really a largely false divide. I know that I wish, now, that I had more of an understanding of narrative therapy, because I see how powerful it is for people to tell their stories in an advocacy context, and there were certainly many occasions while lobbying when it would have been helpful to have a stronger foundation in human behavior! And without policy and advocacy content, I can’t see how any social worker can practice ethically, according to our Code, which requires social workers to engage in advocacy and to only practice within their areas of competence, two mandates that would seem mutually exclusive without proper preparation.

My goal here is not to contribute to the debate already (at times) raging within our profession, although I do assign sections of Unfaithful Angels in both of my core classes. Instead, I want to offer some of my initial thoughts on how we might begin to close this divide within my School of Social Welfare and as a profession more broadly. I am actively working to introduce some of these ideas with my students and my colleagues, and I know that many of them share the same commitment. Taken as a whole, social work has something very powerful, and rather unique, to offer the world, including in the advocacy arena. We can attend to people’s immediate needs while working towards a society that will not create so much need. We can fight for a product that will respect vulnerable people without resorting to processes that make people feel more vulnerable. We can integrate our traditions of social care and social change in a way that has profound implications for society’s future. If we can pull it all together.

  • We advocacy-minded social workers need to start, I think, by recognizing our need for core social work skills, of connecting with people and building relationships, as central components of our advocacy practice. Too often, the ‘need to bring the two sides of the profession together’ argument is really code for ‘clinical social workers need to do more advocacy,’ but that’s really only half of it.
  • Field education is at the heart of our professional preparation, so we need to build field education experiences that include both macro and micro content, and that cross populations, to help people see themselves as ‘social workers’ rather than as ‘therapists’, ‘hospital social workers’, ‘lobbyists’, etc… This is hard, of course, when many field instructors are much more regimented than this in their practice, but it needs to be a goal.
  • We need mentors that provide bridges to macro practice opportunities for clinical social workers, and those of us who specialize in advocacy practice need to be willing to serve in these roles.
  • Our academic content, including the stipulations of the Council on Social Work Education, needs to allow for clinical students to take policy and advocacy courses and for macro students to take classes in direct practice. Initially, this crossover probably needs to be required, in order to force students to stretch beyond what they think they want to study. Ideally, this is the first step towards moving away from these tracks and towards a more integrated social work.
  • Licensure laws need to recognize the importance of protecting social work’s unique perspective. While I recognize the need for clinical licensure as demanded by third-party payers (I don’t agree with it, necessarily, but I recognize the need), we need to at least examine renewal policies that require content in diagnosis and treatment but nothing on advocacy or macro practice.
  • Social work needs a good public relations campaign that would help to clarify to the public who we are as a profession and what people should expect from us. Going to a social worker for help with a problem should deliver different assistance than going to a counselor or psychologist, and a social work lobbyist should conduct him/herself differently than a lobbyist without our ethical framework, but this isn’t always the case. The people with whom we work need to expect, and demand, this.

    Social workers, if you specialize in clinical practice, how do you integrate advocacy into your work? If you specialize in macro practice, how do you keep yourself connected to social work, and on which social work skills do you regularly rely? How well did your social work education prepare you for your work? What else do you wish you would have learned? Do you see a need for greater integration as a profession? How do you propose that we move towards this?

  • 13 responses to “Clinical vs. Macro Practice

    1. I post so often on here, I think I may need my own blog. But the conversation is so much fun!

      So, this time, I’m posting not just as a Social Work professional, but as a client who was inspired to pursue SW, as a profession.

      And that’s the true beauty of SW, I think: These very black-and-white lines established by other clinical professions (“You can either be an advocate or a therapist, not both,” for instance) discount not only the environment that precipitates the client’s need for change, but also discount the client’s ability to change that environment. And if change is too slow to come (as is usually the case), at least the client is exposed to the idea that she/he alone is not completely to blame for whatever ailment caused them to seek a professional, to begin with AND that there are others with similar problems to connect with, to advocate with, etc.

      My point is this: The line between client and professional is a bit blurry. Shouldn’t the line between clinical and administrative social work be just as blurry? Or not present?

      My clinical recovery from a Postpartum Depression–that nearly took my life–started, in earnest, the day I [a Journalism teacher, at the time] took a typo-filled, Microsoft Word-produced brochure with no graphics, edited it up and down, returned it to my “clinical” social work professional, and said, “If you want this Postpartum Resource Center thing to work, like I do, we’re gonna need to make some changes.” My healing required clinical intervention, yes. But–for lack of a better term–“coming into my own” required advocating. Both were brought to me by a wonderful social worker, who understood that maintaining strict boundaries–in this situation–would just be binding me…and maybe even her organization.

    2. melindaklewis

      First, I would totally read your blog if you had one! But you’re more than welcome to share your thoughts here any time.

      I can think of so many people with whom I worked who, far from feeling overburdened with advocacy and organizing roles as part of their own journey to peace, or out of poverty, or to safety, or wherever it is that they’re going, felt, instead, that having a larger role to take on is what gave their lives meaning and hope during a time of great struggle–just as you relate from your own life.

      I 100% believe that we do our clients a disservice when we artificially present ourselves as clinicians or as advocates or as organizers, rather than as complex, integrated professionals (and human beings) who bring interpersonal skills, political analysis, and a passion for justice to our work, on the micro, mezzo, and macro levels. Furthermore, we do our profession a tremendous disservice by bifurcating it this way, and we sever part of our whole selves, which is destructive to our well-being too. It’s kind of madness, really, yet somehow our innate desire for categorization and order push us towards these false boxes in which we seek to work and practice. We need new ways of organizing ourselves as social workers, of talking about what we do, and, as you so powerfully share, of inviting clients to work alongside us–it’s smart social work and potentially transformative, revolutionary practice, too. For you and for all those you now serve, I’m so, so, so glad that you found a clinical social worker who gets it, and that she invited you in.

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    5. Hello beautiful people,

      Forgive me if this is the wrong place to ask this question, but I’m a bit desperate and am running out of time to make such a difficult decision.

      I am a long-time social justice activist who has recently decided to change my career from law to social work or counseling because I saw the infighting in the powerful Occupy Movement as a big part (the biggest part perhaps) of what tore us apart.

      I am about to start grad school in the fall, and although I’ve talked to many people now, I am still struggling to make a decision about where exactly I’d like to focus in school – macro or micro, community organizing or clinical social work – as I don’t think I can do both since my local schools don’t offer that it seems, as much as I would LOVE to.

      As an activist, I have done a decent amount of advocacy. I see the need for massive, transformative, revolutionary change in so many areas. I have always found myself drawn to such change. Recently, I’ve been working on a campaign in Atlanta, GA to create a pre-booking diversion program or solutions, not punishments in dealing with low level prostitution and drug offenses, and I love to make processes and systems more efficient and work for more people. I am a visionary and I want to see great alternatives to capitalism, patriarchy, white supremacy, etc. If I was working within a flawed system or saw macro-level problems that could be tweaked or re-designed, I would want to help do that.

      I also would be very excited to be able to help people through conversation and listening, and help individuals heal and find help and hope on a more intimate basis like clinical seems to offer. I know that my many organizations, relationships, working relationships with activists, and the many people we serve would be well-served by a deep knowledge of counseling techniques. If I were doing advocacy, I would feel frustrated if I couldn’t speak to people in a way that promoted healing and power, as I expect the more clinical track of social work to teach. I think internal healing and work is crucial to revolutionary, large-scale change as well! I am a big promoter of positive affirmations and confidence, especially in women, and I’d like to uplift my clients in this way.

      So again, as usual for me in life, my problem is wanting to do both at once, as you all seem to argue here is important anyway and academia should move in that direction. But in the meantime, I do believe I will have to choose a focus and so I’m hoping you lovely people can give me some advice as to how I should make this choice, or how I can have my cake and eat it, too 😉

      Thanks so much for the beautiful work you do, and for making social work even more amazing. I’m proud to be entering into this tradition.

      • So great to hear from you, Misty! I would never pretend to have all the answers for your personal career journey, but I do want to reflect that I think you’re asking all the right questions, and to affirm that this is a struggle for many students who find that the bifurcated approach to graduate social work doesn’t fit well with their desire for an integrated social work practice. Your background sounds really rich, and I am so excited that you have chosen to join our profession! I think one thing that might help is a more precise definition of ‘clinical’ practice, which really means therapy. There is certainly an assumption and expectation that all social workers–working in any field and on any scale–interact with people in affirming and ‘healing’ ways…it’s one of the things (along with our ethical obligations) that distinguishes macro practice social workers from others engaged in lobbying and community organizing, but not from a social work perspective. I know this sounds like a non-answer, but I think you can absolutely have a transformative practice as a radically-informed direct practitioner (‘clinical’ or otherwise), or as a sensitive and empowering macro practitioner, attuned to the healing power of engaging in collaborative social action. The right fit may lie somewhere in between, or in a sort of seesaw back and forth…or in something unique that you carve out for yourself, alongside your clients. There is important work to be done on many levels, in many venues, with many populations, and, ideally, your social work education should equip you for ethical, competent practice within always-changing contexts. I wish you all the best and hope you’ll keep us posted as your career progresses. Anyone else, please weigh in with thoughts about this micro/macro divide!

    6. Thanks a lot!

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    11. Thank you for your informative post (and responses!) I feel great comfort knowing that I am not the only person who is confused and conflicted when considering their path within the social work field! As someone in a situation similar to Misty’s, I am finding it hard to choose one graduate track over the other, because I feel that my strengths and personal goals will always straddle the line between macro and micro. In many direct service positions I have held, I (and my students/clients) have felt “trapped” within broken or inefficient systems, but without the access/professional ability to make systemic changes. I’ve found that one of my dominant skills is the ability to recognize ways of make broken systems more efficient and effective, and so I find that being in direct service positions where helping to fix the system is “not in my job description” can be very frustrating. However, if I were take the macro track, and ended up in a position that was removed from the more human interactions of direct service, I think I would feel a bit empty. Ideally, I am searching for ways to become involved in making direct service style changes (i.e., profoundly, positively affecting individual lives),but on a mass/macro/community scale. I’m not sure how to even define a position like that, or if it actually exists. I think you hit the nail on the head, Melinda, when you said, “The right fit may lie somewhere in between, or in a sort of seesaw back and forth…or in something unique that you carve out for yourself, alongside your clients.” I expect I will ultimately have to settle on one track to follow academically, but professionally I will always be focused on carving out a unique niche for myself in the middle!

      • And maybe, by carving out such a niche, you can be part of reshaping the channels through which social workers pass, so that there are more opportunities for those who want to be transformative practitioners, or hands-on advocates…or both. Thank you for your comment, and best to you in your career!

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