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 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.