James Donnelly, DSW, LCSW

On June 12th, I participated on a panel at the annual colloquium of the Jarvie Commonweal Service. The theme was “Lift every voice: coming together to meet the challenges of change for older people.” Myself and three other social workers, Helen Hamlin, Pat Brownell and Ann Burack-Weiss, from the NASW Pioneers were asked to form a panel addressing what we have learned from all our years of experience that may contribute to facing the challenges of these times. Ann was the moderator for the panel. Helen and Pat presented their work at the UN and NASW regarding human rights, policy and advocacy for older persons. I was asked to present from a clinical stand point. The following was my contribution.

Stating the question. Starting with the conclusion.

The question to us as Pioneers was:

What have we learned having lived through the experiences of change we are discussing today?

Let me start with some conclusions that have profoundly influenced my psychotherapy practice  and then take us through the story of these changes in my experience as a social worker in health care that lead me to them. So, here they are in compressed form:

* Happiness is not something to be obtained. Happiness is a side effect of how we proceed.

* A serious consideration of time in term of past, present and future.

Time is a function of our narratives. It is our individual and communal consciousness constituting itself as a story through the multiplicity of our experiences together. As such it is as variable and as fluid as our stories are fixed or open to revision. Within this frame of time, past is the story as we remember it; future, or what we call future, is the  projection ‘ahead’ of our past.

What I have learned through my experience of these changes is that the actual or ‘real’ future is outside of time.

The real future is not so many moments, days or years ahead of us. The actual future is our allowance, discovery and realization of a new and different possibility between us in the present.

Once we imagine this new possibility, it becomes part of our story and our past. In fact, this actual future revises both our past narratives and projections on to the unknown we face.

* Implications for the balance of procedure and out come.

We are, I think, in an overheated ‘outcome’ focused climate throughout this time of ‘change’. In the dialectic of where we’re going and how we get there, outcome must always be open to transformation and revision by the values of how we proceed. There is a primacy of procedure to transform projected outcomes.

*Hope defined:

Hope is the realization that we are not trapped by experience. Hope lives in the ‘actual’ future and is a release from the tyranny of our narratives.

*We are all, in our disparate ways, in the business of hope; of striving to contribute to the creation of conditions wherein the experience of hope and meaning is possible.

The story of the torn fabric.

Under the pressure of the rapid changes in health care and the constant redefinition of the health care organization (from a professional organization to an instrument of efficient delivery of ‘products’) I was thrown back upon myself to rediscover a solid foundation for the uniqueness and meaning of my profession of social work. I believe all the professions were challenged in the same way.

I looked for that foundation in the human and historical realities that evoked the profession of social work in the first place.

Social work was evoked out of the massive disruption in the lives of people and communities imposed by the accelerated and brutal realities of industrialization, immigration, war and the loss or weakening of the traditionally experienced structures of value in people’s lives. Social work was a response not only to the material lacks and hardships they were experiencing, but more fundamentally, to the challenge these disruptions posed to a sense of meaning in their lives.

Social workers were called to be with people, families, and communities in a place where their lives no longer made sense – and to be and work with them in their efforts to reconstruct meaningful lives under the impact of these new and hard realities.

I captured this frame for myself in an image:

the image of the torn fabric –  where the patterns of the fabric represented the habits, rituals, routines of meaning in peoples lives; patterns that held for them their sense of who the are and what they meant in their families, communities and society.

These fabrics were torn asunder by circumstances beyond their control. I called this tear, this ripped open hole, the ‘in-between’ place; an awful undefined place between life as it once meant and meaning yet once again to be realized in completely new circumstances.

Fundamentally, essentially and at its foundation, social work was not about doing things or providing things. Social work was about being with people in this awful place of challenge; the challenge to recover what it means to be a human being. It is from that, the myriad things we do precede.

The requirement for a social worker to be in this ‘in-between’ space with clients (to be where the client is) is to allow oneself to also experience  the challenge of meaninglessness — without a preconceived fix or answer … and be present. It requires the allowance of genuinely being placed in question by the challenge of these harsh and disruptive realities.

Working with this image of the torn fabric over the years has led me to an understanding of therapeutic space that has continuously guided me in my practice of psychotherapy and my years of social work in health care.

The in-between space of disruption has the potential to become therapeutic if the discomfort and challenge of meaninglessness is genuinely shared with another human being. In this terrible and, I believe, holy place, lies the possibility for ‘actual’ futures and the realization of hope to occur.

Actually, when you think about it, all of our professions can be seen to have been evoked by the many challenges to meaning in life. Our professions are a communal response to life’s challenges to meaning.

Ethics and the foundation of our professions

This leads me to the fundamentally ethical core of all our professions.

The major threat to our professions today is the erosion and/or compromise of that core. It is the danger we all feel of being swept up with ’where we’re going’ without sufficient concern for the values of ’how we get there’.

How we get there for me is anchored in three values at the core of ethics.

The first is:

The intrinsic worth of each person.

The second is:

The intrinsic worth of all persons.

These two values are the polarities that form the field of our existence with each other. They create a field of human experience characterized by both tension and ambiguity.

The ethical way of negotiating ‘how we get there’ in this field of living with each other, is to hold to this truth:

That neither of these two values can be maintained at the expense of the other.

There is an inherent paradox at the heart of our existence together that cannot be ignored and cannot be completely resolved. In real life together, ethics does not deal with perfections. It is the force of this paradox-maintained that transforms our envisioned outcomes.

The third value is the engine of this transformation. This third value is:

Compassion.

Compassion is not a feeling. It is not empathy; it is the condition for empathy. Compassion is a stance towards life and cannot be turned on and off in the face of selected difference or suffering.

Compassion is the allowance of the different reality of the other to place you in question. The suffering endured in compassion is the suffering of striving towards the genuine meeting of the other.

Compassion is the commitment to step into that undefined and meaning-challenged space between us;  a commitment that allows our ‘pasts‘to be placed in question and transformed by the discovery of a new possibility between us.

Compassion is what allows the tears and holes of disruption to be transformed into therapeutic spaces. Compassion is the fire of transformation required for establishing conditions of hope.

We bring it into our meeting with those who support us and those who oppose; those who need us and those whom we need; those to whom we answer and those who answer to us; those who nurture us and those whom we nurture.

Compassion is the universal condition for the discovery of value and meaning between us regardless of circumstance and the habits of our narratives thus far.

Going forward.

In this effort to give “how we get there” the primacy and transformative power over “where we are going”, there are three procedural values:

Compassion. Compassion is the condition for authentically mutual dialogue and a sense of genuine participation.

Courage. It takes courage to step in to the in-between without the armor of certitude. However, there is no discovery of a new possibility without risk.

Collaboration.  The whole point, whatever the circumstance of practice and whomever our partners in care, we are in this together. Collaboration is an ethical mandate of our practice.

There are, however, two aspects to collaboration.

First is the need to seek out and collaborate with those who ‘get it’; whose values reflect this understanding. We must seek them out regardless of station or place; hi or low, they are our partners.

Secondly, we must actively seek opportunities of collaboration with those ‘who seem to ‘not get it’ and who seem to oppose us. The value of compassion does not rule out the mandate to engage.

Our professions are built on the power of relationship. As long as there is a willingness to step into the ‘in between space’ between us, hope is always possible.

Mentors

In addition to the great mentors of our profession: Richmond, Garret, Robinson, Taft, Hamilton, Smalley, Reynolds, Perlman, Hollis, to mention just a few, there has been three guiding lights for me from other fields as well:

From philosophy: Martin Buber.

From object-relations and psychoanalytic theory: Donald Winnicott.

From political philosophy: Hannah Arendt.

All three, from different venues, have struggled to face and make sense out of the major disruptions of our times.

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READINGS

Arendt, Hannah. (1958). The Human Condition. Chicago: University ofChicago Press

Baehr, Peter (ed.) (2000). The Portable Hannah Arendt. New York: Penguin Books.

Buber, M. (1958). I and Thou. Translated by Ronald Gregor Smith. New York: Charles Scribner’s Sons.

__________. (1965). Between Man and Man. Translated by Ronald Gregor Smith. New York: Macmillan.

___________. (1965). The Knowledge of Man. Translated by Maurice Friedman and Gregor Smith. New York: Harper & Row.

Canovan, Margaret (1994). Hannah Arendt: A reinterpretation of herpolitical thought. New York: Cambridge University Press.

Donnelly, James (1999). Love and Knowledge: The quest for personal meaning. New York: South Garden Press.

______________ (2009). Ramifications: A social work exploration of therapeutic space. New York: South Garden Press.

______________ (2009). Soundings: Exploration of social work in a changing health care environment. New York: South Garden  Press.

Phillips, Adam (1988). Winnicott. Cambridge: Harvard University Press.

Richmond, M. (1917). Social Diagnosis. New York: Russell SageFoundation.

Roberts, Robert W. & Nee, Robert N. (ed.) (1970). Theories of SocialCasework. Chicago: University of Chicago Press.

Turner, Frances J. (ed.) (1986). Social Work Treatment: Interlocking theoretical approaches. Third edition. New York: The Free Press.

Winnicott, D. W. (1965). The Maturational Process and the FacilitatingEnvironment. New York: International University Press.

_________. (1971). Playing and Reality. London: Tavistock Publications.

________ . (1986). Holding and Interpretation: Fragment of an Analysis.London: Hogarth Press.

_________. (1988). Human Nature. New York: Brunner/Mazel.

For thoughts and comments, please send to: jdonnellydsw@gmail.com

© 2009 James Donnelly, DSW.LCSW

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South Garden Press, New York