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An Experiment with Case Notes: Bakhtin and the Polyphonic

What follows is an experimental essay I originally drafted in April 2013 applying Bakhtin’s exploration of the polyphonic to a standardized and simplified model of social work case notes. I lean on Timothy Lensmire’s interpretation of Bakhtin for use in teaching writing and Janis Fook’s exploration of radical case work.

The essay was originally titled “More than One Voice: Bakhtinian Casework and the Remaking of Case Notes and Plans.” I decided to change the title because I never fully completed the essay as intended.

INSTRUCTIONS (to be followed, not questioned)

As a profession, social work is interested in developing more collaborative models of working with clients, models that integrate their values, desires, and needs alongside those of the institutions and organizations serving them. Janis Fook’s work posits the need for a radical caseworker that integrates a structural, rather than individual, perspective into every aspect of their practice. In one case study example, she proposes seeing a socially disadvantaged background, rather than a biological failing, as reason for “developmental delays” in her client. She suggests an approach that will help her clients develop “critical awareness” rather than prescribing parent education classes (Fook, 1993, p. 137-139). While this sounds both helpful and ethical (it takes blame from the client and her family and places it on problematic social structures), even Fook’s practical advice leaves one wondering: what does it mean to develop critical awareness? The devil is in the details. Examining casework in particular, one of those details is the variety of texts produced in caseworker’s interactions with clients.

The following case notes contain a “diagnosis” of traditional casework. However, they build from a model suggested by Mikhail Bakhtin that he identifies as polyphonic, meaning “many voices”. Based loosely on Timothy Lensmire’s interpretation of Bakhtin for writing pedagogy, this approach suggests that, rather than the casework remaining in the hands of an expert worker, the client might begin to see their role in constructing the conversation, realizing their own agency in new ways (Lensmire, 2000).

In these notes, written as an inner dialogue between two voices in my own practice, I enact what I am proposing: the embodiment of two voices, tensions maintained and unresolved. This is a working out of two of my inner voices—that of a critic trying to co-construct case notes with their client and a traditional caseworker focused on important practicalities. The critic’s voice is nurtured through Fook’s work, the traditional response required no nurture as it has been nourished as common sense in my training and practice.  I follow a simplified case note model, and though this does not contain the voices of worker and client, I think it embodies the kind of conversation that could take place between those two parties in similar ways as the inner conversation below.

PERSON (read: “client”, “patient”, person deserving of our pity)[1]

The critic: The caseworker’s notes represent a single voice, that of the worker. In writing their notes, the worker’s perspective becomes entrenched in written symbols, becoming immutable, inscribed into a permanent bureaucratic reality. Over time, thoughts and beliefs—especially doubts, contradictions, but inclusive of hope and other emotions as well—that were alive at the time of writing begin to die out. All that is left are the words. They lose a personal, opinionated quality, taking on a tone of certainty and objectivity. Their reader might lose track of whether they were opinion, observation, or fact. Their writer may eventually lose track of the same. If the problems sounded less human, it might be difficult to tell whether a person or a car was being discussed. Certainly, the client’s voice disappears, at best subsumed into the voice of the worker; at worst, ignored in both conversation and inscription.

Yet, there are opportunities here too. What if the writing could remain alive, conversational, and open? What if the meanings of words might not get too settled or might be available to change? This could allow a human person to re-emerge. Perhaps case notes could write our client’s personhood into the bureaucratic machine, offering moments of humanity in a system bent on subsuming it. Such a writing would keep the client alive and open to change, would keep the worker open to the person in front of them, and could potentially open the broader institutional system to the voices and perspectives of its clients. These voices might call policies into question. Fook writes, “An analysis of agency procedure may reveal policies that support social inequalities” (1993, p. 92). The voice of the client will likely call these procedures into question, as the ways these procedures work and fail will be represented by the voice of the client as well as the worker, but cannot be subsumed only into the voice of the worker, who—unconsciously or consciously—is likely to protect the agency and themselves from critique.

The caseworker: Case notes are only one part of the caseworkers tasks. Caseworkers do try to work collaboratively with clients, often allowing clients to guide the identification of problems in their own lives. By focusing on case notes the worker will miss opportunities to generate meaningful interactions and relationships with clients, one of our most essential roles and commitments. Taking up case notes during meetings are also, essentially, a mediator between client and worker, introducing precisely what this polyphonic model is seeking to overcome. While it would certainly be valuable to call reflexive attention to the ways we interact with our clients, this method of drawing attention is a distraction from the relationship that matters. Finally, while it is valuable to call attention to social inequities in institutional policy, meetings with clients are not appropriate places to do so. Clients need our focus to remain on them and their needs, not to turn to institutions, which may even make them feel more helpless.

PROBLEM (read: diagnosis) and PROCEDURE (read: what I’m going to do to you)

The critic: One problem with traditional casework is that it fails to recognize that structural and individual change[2] needs to take place in concert. By structural change, I mean that, “personal problems are primarily structurally based” (Fook, 1993, p. 74). This means that we need to understand the structural causes of personal problems, which allows us to both more generously and helpfully work with our clients and also challenge oppressive structures. By individual change, I refer not only to the client, but to the worker. Both have positions and narratives that are limiting and most likely aligned with broader oppressive societal narratives (Kamler, 2001).  This includes the belief that persons meeting with social workers are at fault for the problems they are encountering. Writing case notes as dialogue with clients causes us both to reflect on the ways we are framing each other and the problems we are working on together. It is likely that the caseworker is not the only one blaming the client for their problems; society has trained us to believe that we are mostly at fault for our own problems (Tuck, 2009). Writing the notes of our meeting together calls attention to these limited framings, giving us the opportunity to re-write them, in turn allowing us to re-write the futures that potentially follow. Rather than serve as a mediator to our relationship, this calls attention to a relationship where to buy doxycycline legally? pharmacy support group cialis: best place to buy generic cialis Buy Viagra over the counter! always already mediated by our personal biases and judgments. In developing a critical awareness of our framing narratives, we can choose different narratives, which far from esoteric, is deeply practical, as it enables us to drive toward solutions that may have been unavailable to us earlier. Additionally, it repositions responsibility and choice away from the caseworker, instead focusing on the relationships the client has to the narratives they tell and have been told about their lives, giving new agency and choice to the client in terms of choosing how to move forward.

The caseworker: This turn away from seeing our clients as the problems our clients face sounds appealing and humanizing. However, our clients do have real problems that do need to be addressed. Take, for example, the case of a client with post-traumatic stress disorder (PTSD). This is not a narrative we tell about their lives: they are diagnosed with a disorder that requires treatment. What will this perspective call attention to that is otherwise missing? Perhaps the danger is in identifying the challenge this person faces with a name, a disorder. Maybe a better approach would be to recognize the challenges they are facing in their life, and try to trace those challenges back to structural causes. This might help them take blame off themselves for the problems that PTSD is causing in their life. I can imagine that this is a valuable realignment, but it will not change the fact that they have PTSD needing treatment.

PLACE (read: helping / oppressive institution)

The critic: It may not change the fact that the client is with the worker and desires help changing parts of their life that are causing them suffering. On the other hand, the label is necessary to justifying the use of funds to provide a client with assistance. However, the label can become a source of bureaucratic oppression, trailing an individual from institution to institution. There is a risk that these labels become the client. When we return later to our case notes (or another worker picks up our case), we may forget that these labels and diagnoses came about reluctantly, through negotiation, in order to justify funding for services. Case notes in dialogue maintain both voices, allowing uncertainties, overcertainties, contradictions, mistakes, and missed messages to re-emerge and be questioned. It prevents case notes from being read too quickly, requiring prolonged engagement with two or more voices to fully trace a client’s history in order to determine “appropriate” bureaucratic responses.

The caseworker: One of the things that making new workers and organizations re-read these dialogues allows is at least a limited reconstruction of the way the previous worker interacted with the client. This can be helpful to understanding clients’ desires, narratives, and resistances. However, it may also open the opportunity for organizations to transfer blame from organizational policies to individual workers. The worker, whether they are aware of it or not, is likely to be practicing at least in part from institutional policies that get written into notes as the workers beliefs or practices. This might be dangerous for the worker, when in fact it should be an opportunity to question the institutional policies of the worker’s organization.

PROFESSIONAL REPRESENTATIVE (read: the person who will do the process to you)

The critic: Fook writes that, “The main difference between a traditional and a radical casework relationship is that the latter places emphasis on equality and sharing, rather than the often unbalanced paternalistic style of many traditional workers” (Fook, 1993, p. 103). I argue that writing case notes in dialogue helps us, over time, scaffold our clients’ participation in the casework process. Rather than the casework remaining in the hands of an expert worker, the client might begin to see their role in constructing the conversation, realizing their agency in new ways. They may not only become critically aware of the narratives guiding their lives, they might also realize they have the opportunity to edit and reshape them (Kamler, 2001).

One of the things this also gives us as social workers is a more realistic record of our work, the movement we are making as we go, and the relationship we develop with our clients. Historically, these are aspects of our work are most difficult to measure, and therefore are traditionally not included in funding models. This model provides documentation of the evolution of our relationships over time, capturing the efforts that we and our clients make to work together.

The caseworker: I do not believe that my style is paternalistic or unbalanced. Often, clients come to me looking for help or assistance. They are not looking at me to be an equal, instead desiring that I provide them a service and let them go on their merry way.

There is also a danger in explicitly documenting the development of our relationships with clients. It is a well-known truth that social workers regularly defy institutional policies regarding how time spent with clients is supposed to be spent. Most of us spend significantly more time developing our relationships with clients than we indicate on our case notes. Writing this time into our case notes may actually decrease funders interests in supporting our work, choosing instead workers more “focused on the task at hand.”

ADDENDUM (conclusion)

If I have been successful here, we should be stuck trying to argue for both sides, wanting to inquire further, and wanting to engage the conversation ourselves. The value, I think, of including multiple voices in the case notes is precisely this: we will become absorbed with people, rather than diagnoses, just as we’ve become absorbed and defensive of both the critic and the caseworker, focused on them in all of their complexity, rather than as characterizations or caricatures. Notice that these separate voices diverge, but also merge, respond and weave together. Two perspectives are not always completely contrasting, just as they do not always reach perfect synthesis. Instead, these voices are more dynamic, alive, and open to change. We might also introduce more than two perspectives. The social worker’s institution and client’s work, family, and friends may also have important stories to work through.

It is also important to note that the Introduction and Addendum to these notes are written in a unitary voice. I think it is important to remember that there will always be framing voices, whether our own or the broader frame of our institutions. My suggestion is that labeling the voices we use makes them explicit, reducing the danger that they will be read as the Truth.

Whether this polyphonic model is more ethical and productive in the way it generates and reads case notes is, for me, settled. However, the question of whether it belongs in social work practice needs to remain open. As the critic and caseworker have proven here, the caseworker is balancing many important practical considerations. We are left, as we should be, with few easy answers, and a great deal more open questions.

References

Fook, J. (1993). Radical casework: A theory of practice. St. Leonards, Australia: Allen & Unwin.

Kamler, B. (2001). Relocating the personal: A critical writing pedagogy. New York, NY: State University of New York Press.

Lensmire, T. J. (2000). Powerful writing, responsible teaching. New York, NY: Teachers College Press.

Tuck, E. (2009). Suspending damage: A letter to communities. Harvard Educational Review, 79(3), 409-427.


[1] I model this paper on a simplified, but relatively standard, model of casework notes. I’ve combined the radical caseworker and a Bakhtinian caseworker here, but were there space, it would be valuable to explore the interactions between all three. For sake of brevity, I believe that the Bakhtinian caseworker is an extension and modification of a radical caseworker, so this combination seems justifiable.

[2] I do not actually think Fook’s radical casework would agree with this, but I think that the Bakhtinian perspective offers opportunities for self-reflexivity.

 

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Extending Brené Brown: Vulnerability, Shame, and the Social Order

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Shame by Christian, Image Source

I began this post on Yom Kippur of last year–and glad I started it then, because I have a tendency to forget these moments of insight if I don’t write them down. Thoughts on this subject have been percolating ever since. Actually, it may be more accurate to say that this essay has been percolating–the thoughts were clear to me the moment they arrived in a burst of insight. I’ve only been looking for the words since. At Yom Kippur services, I underlined a statement by Franz Kafka’s biographer, Reiner Stach. Stach was commenting on the underlying intensity of Kafka’s famous letter to his father in which he writes: “To identify deliberately with characteristics that the community regards as strange, insane, or anti-social requires a high degree of reflectiveness.” I’d like to suggest that this in fact is the political origin of shame, and that Brené Brown’s analysis of Vulnerability and Shame requires the addition of this idea to be understood in an ecological, rather than individual, manner.

But first, a note about my choice of language. I want to “extend” Brené Brown rather than critique her. I think her work is great, I’ve used it in my own life, and I know it has been very meaningful and helpful to others. In the humanities and social sciences, we tend to “critique,” but I think this choice of language implies that something is done, complete, finished. And then when it doesn’t do everything we hoped it would and more, we critique it as being only half true, or incorrect, or something of the sort. Ironically, rather than creating rigorous conversation, I think this attitude generally closes down real conversation in favor of arguments, debates, and anger. All of this is a topic for another post, but I wanted to note here that I’m choosing the language “extend” intentionally and beginning to try to figure out how to make it operative.

Brown, a social worker at the University of Texas, builds off the work of others to define shame quite simply, and in relationship to guilt. Guilt is stated, “I did something bad,” while shame moves this from a an objective to a subjective: “I am bad” or “I am not enough.” I first confronted these ideas intellectually in a text by Cheri Huber, There is Nothing Wrong With You. Brown elaborates on how shame works, how it operates in our lives (and yes, she does use a general “our” without much cultural, economic, or social differentiation),  and about how the antidote to shame is choosing vulnerability. She elicits a connection to her reader’s personal experiences by sharing personally moving examples of shame. Indeed, her popular fame is derived from two TED talks she gave The Power of Vulnerability and Listening to Shame, both based on personal narratives. Her book Daring Greatly is the most popular of her works, though she outlines similar ideas in several other volumes.

Brown’s work is ultimately personal and individual. She is looking for strategic authenticity – a choice to sometimes be vulnerable, to move beyond our feelings of shame with a moment of courage in which we strive to share something with another person, even though we feel as though we will be judged as being a bad person. She writes, “Choosing authenticity means cultivating the courage to be emotionally honest, to set boundaries, and to allow ourselves to be vulnerable; exercising the compassion that comes from knowing that we are all made of strength and struggle and connected to each other through a loving and resilient human spirit; nurturing the connection and sense of belonging that can only happen when we let go of what we are supposed to be and embrace who we are” (www.brenebrown.com). I certainly appreciate these ideas, and on a personal and interpersonal level, they have a great deal of positive potential.

In my own life, Brown’s work has colluded with several others and a few major life experiences that have transformed me. I’m a strategic person by nature. I remember playing chess and risk with my cousin who lived down the street and was my best friend as a child. We played together almost every day. But we played in really different ways. He was competitive, and when we played a game like chess or risk, he almost always won. I’m not deeply competitive at board games, but I don’t like to lose. And I also don’t like to hurt people or feel distant from people – often a feeling I experience when in direct competition. And I’m not good at that type of strategy. So we almost never played in direct competition. I think of that as my strategy: when playing a competitive game didn’t work for me, I’d manipulate the social situation to make sure I didn’t have to compete.

I strategize everywhere. Sometimes it serves me well. Being strategic isn’t always manipulative in a mean way – I have many close friendships and I think they grew that way in part because my friends and I are able to be strategically vulnerable with each other. But when it came to sharing information that would threaten the closeness of my relationship with someone, I was usually terrible at sharing it. I kept it to myself, thinking, “I’ll wait until the right moment” or “that will be so hurtful to share, maybe they don’t really want to know.” Any sort of rationalization helped me minimize the importance of the information. Strategically, I could work around it, bury it, hide it. Keep it out of sight. I even got so good at it I could sometimes keep it out of mind. On a basic level, it worked, and often I would get what I wanted (sort of). But I had a problem: this never actually brought me closer to people.

Through a combination of loving friends, therapy, and some challenging experiences, I’ve learned to try to go head first into situations and share of myself as much as possible. This still isn’t easy for me. It involves a conscious choice every time. It involves courage and a risk of failing and fear. And it involves the deep conviction that I am good enough and that I am loved. Without these ideas, I’m not sure I could do it even as much as I do.

But there was one more element to this as well, something that Brown doesn’t really mention with much seriousness. The closest I’ve seen her get is where she writes, “Daring Greatly is not about winning or losing. It’s about courage. In a world where scarcity and shame dominate and feeling afraid has become second nature, vulnerability is subversive. Uncomfortable. It’s even a little dangerous at times. And, without question, putting ourselves out there means there’s a far greater risk of feeling hurt. But as I look back on my own life and what Daring Greatly has meant to me, I can honestly say nothing is as uncomfortable, dangerous, and hurtful as believing that I’m standing on the outside of my life looking in and wondering what it would be like if I had the courage to show up and let myself be seen” (www.brenebrown.com). What she begins to allude to here is the subversive element of vulnerability. And subversive happens only in relation to authority or structured power.

I believe there is a powerful social and structural dynamic to shame, one that extends beyond the individual and interpersonal nature of Brown’s focus. Read from a societal frame, shame has a social purpose, and that is social cohesion. Brown articulates our need for a sense of belonging. Shame allows us to separate who belongs–who is “good”–from who should be excluded–by definition “bad.” Shame operates on an everyday level. It is not an abstract concept, nor is it something we do to ourselves (at least not at first). Shame operates as a way of defining where we belong, and is therefore perpetrated on us from the moment we are born. Most moral frameworks are structured on shame. Don’t do this, or you’ll be naughty. You’ll be bad. You’ll be a sinner. In a less dramatic form, these play themselves out in phrases like, “don’t cry,” “be a man,” “don’t be a quitter,” “you ought to be ashamed of yourself.” But they operate in more subtle forms too, “I can’t believe you did that!” “Why did you do that?” They operate through our body language, our facial cues. It is our way of saying, “if you do this in this way then you’ll belong. If you don’t…”

The Reverend Thandeka traces the operation of shame as the primary psychological structure reproducing race/racism. In her book Learning to be White, Thandeka discusses the ways that whites in the United States experience a primary moment of shame in their early childhood as they relate to people of other races. A small facial expression on the face of mom when the black neighbor kid comes to a birthday party. Subtle statements that begin with, “those people“. Or, “X racial group! Of course that’s why they are a bad driver.” The implicit statement is, “you don’t want to be like them,” which extends to, “you don’t want to be caught with them.”

Whether or not this is the primary origin of racist dynamics, Thandeka makes a powerful argument that shame plays a role in the reproduction of race relations. And it is broader than that too. Shame is used to enforce gender performance, racial performance, age performance, ability performance, etc. It can and often does operate as the instrument of social and cultural reproduction.  It’s purpose is to bring you into the fold, to keep you in line, and ultimately, to maintain the current social order.

So Brown is right when she says that vulnerability is subversive. It is a choice against the status quo, against the social order, against the Moral Authority. I’d argue that it can be so difficult to choose vulnerability because we are surrounded by the purveyors of shame, shame’s agents, the foot soldiers of society’s Moral Authority. To look someone in the eye and to be vulnerable with them is to directly challenge the Moral Authority, within yourself and with the person across from you. There’s the risk that they’ll take up the position of the Moral Authority. It’s a decent risk indeed – it is a culturally and socially supported/rewarded decision to make. It’s much easier to be an instrument/spokesperson for the Moral Authority than it is to resist it. But that’s what shame is: the Moral Authority internalized. This is why shame is so powerful. Vulnerability cracks this – it leans on the power of our relationships with others to reject otherwise titanic social force.

To be judgmental, then, is not simply to be mean to someone else. Usually, the force and weight of our judgment stems from the Moral Authority. So our judgment is an amplification of the voice of the Moral Authority, not our voice alone. It combines the power of the Moral Authority’s broad social message with the weight of our relationship. Moral Authority to the power of the Strength of  our Relationship is the equation that establishes the force of a judgment on another. Judgment in this sense is all the more terrible because it conveys to the judged what they already well know: they have erred against the world, and worse, the world inside themselves.

There are reasons the Moral Authority remains strongly moored to our sense of self, to our beliefs about right and wrong, to our social structures. First, it maintains social cohesion and the current relations of power. If we began to lift shame and shaming, we’d have different views about black youth who are involved in gangs; about Native Americans, who socially have been stereotyped in every way imaginable, about homosexuality, about transgender folks, about drug users. The social structure and media could no longer associated their human being-ness with “bad” and not belonging. And it would reach in a different direction too. We wouldn’t feel as though we had to relate to each other in the same types of ways. Our entrapment in binaries of gender, race, age, class, and ability would lift, and so too would our attachment to particular forms of economic relations, social groupings, hierarchies of power. We’d feel less of an obligation to build a family and get a good job as a way of continuing to “be good” or “do things right.” It isn’t that we might not still make these choices, just that they’d come from a very different place.

So vulnerability in the face of shame isn’t just subversive, I think it’s revolutionary. One interpretation of French philosopher Gilles Deleuze and psychoanalyst Felix Guattari’s seminal text Anti-Oedipus names this in a very different way. Part of the goal of their work is to shift the responsibility for psychological disorder to social disorder. This would mean a shift away from “I am bad” to a belief that society–the Moral Authority–had given me particular definitions of good and bad and that I was operating out of those. Deleuze and Guattari’s notion of desire, a very complex theorization I can’t possibly do justice to here, in part recognizes that what term as psychological ills are often actually manifestations of societal ills, how they’ve caused us to be, to see ourselves, and how we are seen. Michael White and David Epston built from these ideas (and those of another French philosopher, Michel Foucault) to create Narrative Therapy. A very basic idea behind this therapeutic model is that we operate from stories we tell ourselves about who we are and what we are supposed to be/do. Often these stories aren’t fully conscious. The role of narrative therapy is to make these stories conscious, to name them, and then to name other alternative stories that have been present in our lives at other points in time. This offers choices between stories, and validates these alternatives, rather than enforcing a particular social/moral position. When we allow alternative stories to surface and quit repressing especially the ones about which we feel ashamed, we have the opportunity to throw away the burden of the Moral Authority.

Of course, the Moral Authority will not easily allow this. I think Brown should also be extended a bit here. The Moral Authority requires obedience, because straying from its narrow paths endangers its very existence. Demonstrations of other possible ways of living threaten to ripple outward, allowing other people to also live more as themselves outwardly and less under the performance or guise of the Moral Authority. The Moral Authority doesn’t have to care what we think about inside, as long as we operate under its guidance. I think this is the pushback, for example, to gay marriage or to anti-bullying laws. They threaten the Moral Authority’s ability to censor, punish, and bring into line of the dichotomies, divisions, and definitions that exist and reproduce it. The anti-bullying laws in particular force the Moral Authority to withdraw its foot soldiers from its strongest institutions: schools.

I suggest authenticity, “be who you are,” while cliche and trite (and also very modernist) is a politically subversive and dangerous act. But perhaps just as, or even more dangerous, is to let others be who they are, to draw out their vulnerabilities, and to listen to their shame and acknowledge it not as theirs, but as deriving from a broader social world that needs to control them in order to survive. This is a war for our selves and for each other, and to win, we need to be prepared to listen to shame and then to put it within a historical and social context, thus cutting its force. I think, therefore, that Brené Brown’s work has bigger societal implications, going beyond what it does for individuals and families and friendships. I think it has the potential to radically restructure society. And I think, for those of us who aren’t quite satisfied with the way things have long been organized, that practicing this work — as hard as it is — invites others into practicing it as well.

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The Risk and Resilience of Risk and Resilience

This weekend, I read several papers by Ann Masten and colleagues (see references below) on the topic of Risk and Resilience. Risk is defined as anything which endangers positive and healthy development–trauma, war, violence, abuse, and so forth. Resilience is the “ordinary magic” that helps “people overcome risk or adversity to succeed in life” (Masten, 2009). What’s great about a framework of risk and resilience is that it believes resilience is everywhere, that it is positive, and that it comes from relationships. I especially love the way that it offers actions everyone can take to promote resiliency. It has a wealth of research behind it that also offers a broad range of possible interventions to those who care about fostering resilience.

However, as I tweeted last night, I’m worried about the frame of risk and resilience:

Continue Reading The Risk and Resilience of Risk and Resilience