Applying Macro and Micro Theories of Social Work

A Case Study

Structural approach is not a new method but rather is a way of thinking and acting at all levels of life. (Moreau 19990b, p. 34)

In everyone’s life there are critical moments, specific situations or crisis that can be identified. It is crucial in those situations, to get appropriate support. Every human being needs to share those experiences with other people. In order for them to solve their problems they must seek appropriated advices and help. Sharing problems and getting professional support is something relatively novel. In the past, people only had available the supportive listening of family, friends and in some cases their spiritual guides. However, in our modernity, with the complexity of everyday life, getting support to solve crisis has become more and more a professional demand. Nowadays people seek advices to solve their problems from organizations, looking for the expertise of counselors, social workers, therapists and a range of professionals specifically trained to give this support. Fortunately, individuals have available a broad range of services, such as individual, group and couple counseling programs. There is also available theories and researches, focused and developed on light of providing better support and intervention on that critical moments in ones’ individual life.

The aim of this paper is twofold; first it is intended to examine the theoretical approach of macro theory of social work using of Goldberg-Wood, Ruth Middleman and Maurice Moreau. This theory presents an analysis of the Structural Approach applied to direct practice in social work. Using a case study, it will be presented how these elements of macro theory have an impact in the problem. The importance of the work of Wood, Middleman and Moreau is that through different structural activities suggested by them, they seek to achieve the empowerment of the client that is a fundamental part of the solving of problems that demand the intervention of professional support. The second aim of this paper is the application of Micro theory of social work to the case study. In this part, I will be doing an analysis of the case under the light of ‘appropriate intervention skills’ thatmicro theory explains.

This paper will be divided in three sections. In the first section, the definition of Structural Approach to the direct practice in social work that suggested by Goldberg-Wood, Middleman and Moreau will be presented, followed by a brief explanation of the structural activities suggested by them. The second section contains the summary of the case study. In this summary the Partialization of the Problem and the initial assessment of the case will be done. It will be important in this section to identify the elements that macro theory of social work defines as environmental factors. These factors, according to the structural approach will affect or somehow will shape the clieInt’s problem. In the third section of this paper, skills of direct practice by applying appropriate intervention skillsto the specific case studywill be presented concluding with the summary of how the case is solved with the appropriate conselling intervention and the application of the principles of the Structural Approach.

Section 1: Structural Approach

Social work has developed over the years to meet specific needs in our society. The early roots of social work can be found in the volunteers who, at the beginning of the 1800s, started doing support by visiting the poor. At that time the approach of governments towards poverty was basically “laissez-faire”[1]. Poverty was seen as the result of personal failure and thus, to be poor was a matter of personal responsibility. By the mid of the nineteen seventies Maurice Moreau developed the structural approach in social work. In this approach Moreau contended that resources and opportunities were unequally distributed between the members of our society. Therefore, disadvantaged and oppressed people were in fact social victims; as such, they deserve to be empowered to get a fairer share of basic economic and social goods. As Moreau states, class, gender, race, age, ability/disability, and sexuality “have a significant social relation of advanced patriarchal capitalism.” (Moreau. M. & Leonard, L. 1989) He argues that while secondary structures, like personality, family, community and bureaucracy (including media, schools and government) are reproducing various forms of inequality, primary structures, like patriarchy, racism, capitalism, heterosexism, ageism, and ableism, have greater role on interweaving different forms of oppression that have an impact on secondary structures. While acknowledging the dominance of primary structures of oppression, the structural approach tries to eliminate these elements by using six major activities: Defense, Client-Worker Power, Unmasking structures, Personal Change, Collective Consciousness, and Political Change. (Carliol, B.1992) Goldberg-Wood and Middleman also suggest in their structural model six basic principles for social worker’s intervention in order to improve the quality of the relationship between people and their social environment. As it was explained by the proponents of the structural approach, social environment is the primary target of change. Social workers have to empower their clients in order for them to change or create different social structures. They suggest workers to apply the following principles: (Goldberg-Weed & Ruth Middlema1989)

Be adequate and be accountable person to the clients
Follow the demands of the client task.
Respect to the principle of least contest
Maximize the potential supports in the client’s environment.
Identify, reinforce and/or increase the client’s ability
Apply all those principles one after another.

Section 2: Case Summary

Donald is a rural farmer, 61years old, who has been married for 40 years to Louis, 60 years old. They live in their farm located 30 miles away from Ottawa. Both, Donald and his wife, come from large Romanian families. Louis’s father was a minister of a Protestant church. They have three sons, ages 40, 38, and 33. All of them are married and working. They all are successful in their lives. Donald and Louis are proud of them, especially in terms of their athletic abilities and achievements. According to Donald, Louis was not the wife of his dreams. However, he recognizes that she has been a very caring, kind, and affectionate mother. Their children and grandchildren love her deeply. In spite his wife’s opposition, Donald has built a solid and close relationship with his siblings. He enjoys their support and companionship particularly over the past ten years. In contrast, Louis has kept her distance with her sibling and just maintains limited communication with her mother every other week. Louis distancing from her family comes from the fact that they rejected her because of her pregnancy out of marriage and they pressured her to marry Donald. After she got married, she devoted herself to her close family, husband and sons. From the beginning of their marriage, she has been responsible for daily chores such as laundry, cleaning the house, cooking, paying bills, puts the children to bed, and helping her children with their homework. In addition, she has been helping Donald with the work at the farm and managing their finances. So far, their financial situation has not been too bad. Donald explains that for the most part of the year they didn’t need to work out of the farm to get the necessary income for the family. However, as they become closer to their retirement time, they feel economically insecure and frightened. Donald suspects his wife is siphoning money from the joint account they have for their retirement. He thinks she is putting the money in her personal account. However, he has no evidence to proof this. According to Donald, their marriage has been difficult from the very beginning. The fact that they were forced to get married six weeks after their first child was born had an impact in their relationship. He blames Louis for this ‘incident’. However, both of them agreed that they were in love before the forced marriage happened. Donald expresses that their relationship has not been good since 40 years ago. He says they have remained together because of the well being of their children. However, he says, with the length of time shared, he had the hope to find in common on their relationship, something more than children. He is wondering if he has to remain in this relationship for his grandchildren as well. According to Donald, they never have had a good sexual relationship. Particularly in the last 15 years, they have had virtually no sexual contact. They have never talked about this subject. Few moths ago they started to sleep in separated beds.

Yesterday, he asked his wife to see a marriage counsellor. She rejected his suggestion strongly. He then, decided to see a counselor by himself without his wife’s knowledge. According to him, if she knew he was going to visit a counsellor, she would hide the car key. The main reasons for Donald to feel unhappy in his marriage and contemplate the idea of a divorce are, emotionally distance, not having an intimate relationship, or sexual intercourse for several years, and loosing trust in his wife. For him was really deceptive that she might be siphoning money from their joint account into her personal account, while she knows his concerns about the future of their financial situation. They have never before spoken about the difficulties in their relationship; nor have they brought their problem to third parties such as their sons, family or friends.

2.1: Initial assessment of the case by identifying environmental factors

Through the study of this case, based on a macrotheory perspective it can be said that environmental factors could put negative impact on the couple’s lives and their relationship. Social class is one of those factors. They are from the middle class whose lives are affected by societal class, financial status and education. Their access to some social advantages such as access to formal education, family counseling, community and recreational activities, among others, are very limited in comparison to those families with higher income, living in the inner city. As it can be notice, the couple in the case presented lives together in an unhappy relation for 40 years. Despite of the fact that there are so many activities, programs and services for helping couples and families to get the right direction in the enjoyment of their life, the couple in the present case has not received help nor have they benefited for any social or community service. If they were able to access those services and information sooner, probably they could fix the problems in their relation at the beginning of their marriage and would have enjoyed their life together. Accessing the right services might help them to decrease their frictions and improve their communication letting them to build a healthy relationship. However, most of those programs are available only to a limited group of society. Those in a good economic position and living in big cities are the more favored population in terms of receiving services. Social services are not distributed equally and fairly for every body. In the present case, these inequalities are present. For instance, Donald has to drive 30 miles to see a counselor. This service may not be affordable for him if he has to see his counsellour frequently. It would be difficult for him to enjoy this service. Another environmental factor that has to be considered as an element affecting his relationship is the prevalence of patriarchal structures in his environment, his gender beliefs and gender roles. As a matter of fact, power is distributed and expressed unequally between them. Cultural beliefs may have harmful effects on their relationship. In this case, due to the gender roles they have learned, daily routines are not fairly distributed. Louis has developed a feeling of great frustration over the years. The fact of being responsible of the majority of chores in their household affects their relationship considerably. As a result, her attitude toward Donald has become harsh. On the other hand, in terms of Louis’s pregnancy, even though both have had equal responsibility, Donald considered that the unexpected pregnancy was Louis’ fault. Not taking his own responsibility on that creates a huge emotionally distance between them from the very beginning of their life in common. We can also see the impact of moral issues on their relationship. The biases and rejection of children conceived out of wedlock by society were huge when this happened. Another structural factor that clearly affected the relationship in this case is ‘ageism’[2]. This prejudice brought many restrictions and limitation into their life. They are worry about their finances and shortage of economic resources during their retirement years. Due to their ages and the limitation of their physical abilities they may not have a good chance to get job off- farm to save more money for their retirement. The feeling of financial insecurity has a negative impact on their relationship. This is reflected in their emotional distancing from each other. This is clear from the fact that they suspect of and accuse to each other of stealing the money saved for their retirement.

Section 3: Direct Intervention into Donald’s Case

In terms of direct intervention, the skills that a counsellor has to apply have been influenced by a Feminist approach in relation to the behavioral tradition and from a psychoanalytic perspective. Based on feminism approach, the therapist has to be sensitive to the distribution of power in relationships. Feminist therapists must assess how power and responsibility are distributed, even in the little aspects of daily routines. It is believed that inequality in power prevents the problem from being solved. Therefore, it is the responsibility of a feminist therapist to empower the female client. This empowerment will allow the woman to claim her rights in the relationship. It is also important for the therapist to encourage men to recognize his power. By doing that, he will be able to give up some degree of this power in order to have a balance in the relationship. The therapist has to give them proper explanation in order for them to have a clear understanding of gender differences and power imbalance. In fact, the most important concern in feminist therapy is to reach an equal relationship between couples. Intervention skills also have to be focused on four main points: first, it has to focuses on ‘cognitive behavioral therapy’, as it was developed by D. Burns (1999); second, it has to use the ‘problem- centered’ model developed by W. M. Pinsof (1995); the third focus has to be in ‘resilience’ perspective developed by Lawrence Shulman (2006) and fourth, the ‘metaframeworks’ approach developed by Doug Breunlin, Dick Schwartz and Betty MacKune Karrer(1992) has to be applied. However, in these approaches, therapist use client’s past life to gather information.

For an effective counselling, the information gathering has to be concentrated on their client’s present situation. In fact, the therapist must focus her conversation with the client on the present problem. She also has to examine the problem from a behavioral and systemic perspective. The therapist must assume that the client is pathologically healthy, while he/she may not be able to solve his/her problems by using the skills and beliefs that he/she currently holds. When this inability to solve the problem due to his/her limited skills and/or beliefs is detected, the therapist has to move her analysis of the case into a more historical and psychoanalytical perspective. Both, Metaframeworks perspective and Resilience theory are notions that influence the use of intervention skills in the following case. The analysis of the problem from these perspectives has to be done using six different factors: a) organization b) sequences c) internal processes of family d) development, e) gender, and f) culture. These six factors impose limitations and affect the problem. Each of those factors or a combination of them may create a web of constraints. The complexity of this interrelation of factors will determine how difficult it will be to solve the problem. The theory of constraint offers an integrative approach to therapy while honoring the complexity of human systems.

Contracting in the First Session:

At the first session of therapy, while the therapist assured Donald that she really wants to help him, she tried to make him to realize that in a couple relations, like in any other relationship, both parties have equal right to decide whether or not they want to stay or leave the relationship. The therapist also tried to present the option of repairing the relationship together instead of terminating it. In this session, she did not try to get too much information, although Donald seemed to be in a good mood to talk. In a couple therapy gathering information from both sides, is really important in order to help to get a best and fairer outcome. The therapist offered him to contact Louis and ask her to join them at the next session. He looked a bit nervous and unsure that Louis would accept to attend; however, he accepted the suggestion happily. The therapist got Donald’s home phone number and talked to Louis. When the therapist introduced herself she explained the reason why she was calling her. The therapist also mentioned that her husband is now in her office. They talked a little bit about the organization that she was working for and assure her that the services of the organization were based on respecting their client’s confidentiality. She explained the situation to her and told her that she understood how difficult may be for both of them to talk about something such private to a stranger. She also told Louis that she understand their position about not having their sons involved in their marital problems. However, if they both feel unhappy and unsatisfied about their relationship, it was wise to do something to solve their problems and getting professional advice was one option to do that. The therapist offered her the opportunity to join to her husband in the next session. Louis was shocked when she knew that her husband was in a social work office. She was silent and took for her some minutes to reply. She firmly responded that she did not have any problem in her marriage; therefore, she did not need to talk about it to anybody. Louis mentioned that she was not interested in this matter and she would not be present at next meeting. With a calmed tone, she added “nobody can help me in this matter. I have had this life for 40 years and nobody can change it. This is my destiny.” The therapist understood her indirect massage. She tried to show Louise her empathy and support. The therapist told her: “I know how frustrating should be your situation. Pretending in front of your sons and in front to the community that everything is fine is hard when both, your husband and you feel unhappy and both have a deep emotional pain.” The therapist also added: “I know you have a lot to say to me and to your husband that you have not had the chance to tell before”. Then, her voice was getting a little bit gentler. Louise indicated that the office is so far from their farm, and it will take time to get there. She excused herself arguing that she has lots of chores to do and she was not able to postpone. For her, she said it was a waste of time.

The therapist offered her to see them at their farm if they both feel more comfortable. She was still reluctant to participate in the session, but she finally accepted. She asked if Donald was also fine with this decision.

The Second session was held on their residence, where they have lived for 40 years. The session started with a brief introduction about the therapist and the services she provides. The therapist also talked about the services that her organization provides. The therapist reassured them that she will try to do her best to help them to take the best decision to enjoy the rest of their life. She talked about the importance of a join effort in order for them to achieve this goal. In addition in order to empower them, the counsellor explained that in theses sessions they will have a mutual relationship, “I will learn, the therapist said, many life lessons from you, and you will also to learn from me and from the counselling I will provide for you”. She asked them to clarify their goals and wishes. It was important for the counselor to take from them what they expected to achieve from these sessions. In fact she started the preliminary phase of intervention by contracting with the couple in order to establish a commitment. She opened the session with a general invitation to sharing their concerns with her, in order to define the primary conflict. The counselor was looking for themes such as closeness or distance, responsibility, and so forth. Louis started blaming Donald for spending most of his time with his siblings rather than taking any responsibility for the tasks that need to be done at home. She complained about the lack of attention from Donald to his sons and their own relationship. She complained that Donald used to behave like that since they got married. Things went worst after she gave birth to their first child. She indicated that, he used to blame her from the beginning of their marriage for the unwanted pregnancy that was the reason why they got married. She believed that the unwanted pregnancy was not her fault. However, she felt guilty since then all the time. This made her to feel upset and took a big deal of her energy. She also mentioned that, since then, she has never feel that Donald might love her or care about her. She mentioned that she always was afraid of loosing him. All these years, she claims, she has felt like a slave. She thought she has full responsibility for taking care of every thing, raising the children, doing house work, helping in the farm, managing the income and many other things. She complained that Donald has never listened to her or initiate a conversation with her. ‘He never has taken my ideas seriously’, she added, even thought I was the one taking care of the family all these years. She remarked “I am tired and lonely.” She added that she has some ideas about her own responsibility in their problem and recognized that she tended to be a controlling person. This might be a factor to make their marriage hard. However, as she explained, it has been the only way to survive and manage her life while Donald completely ignored her and avoid his responsibilities as a husband. She expressed that this controlling behaviour has its roots back into her primary family, because it was the experience she had from her parents and siblings. The therapist brought Donald into the discussion asking him how he felt about Louis’ concerns and what he wanted to add or argue about what she has said. At this point, he started to talk very slowly. He was in the middle of his second sentence when Louis interrupted him trying to explain the therapist what he was telling. Surprisingly, Donald did not resist and went back into a listening mood. After this had happened several times, the therapist described the negative interaction pattern by obtaining a clear picture of behavioral sequence. The counsellor suggested Louis to do the specific task of being more patient. While Donald is talking you have to wait for him to finish his word instead of jumping in and doing it for him, the therapist requested. She also explained that this difference in the way of talking and communicating would probably reflect gender differences. She mentioned that during arguments, men often talk more slowly than women; men also generally have a smaller affective vocabulary than women, which make conversations about their feelings more boring. (Bergman, 1991) In addition, most women show their involvement in a conversation by jumping into it and trying to finish the sentences. They show their interest and sometimes even their agreement about the subject. After this explanation, Donald answered the last question and expressed his feeling about their marriage. He mentioned that he also has not been happy with their relationship from the beginning of their marriage. However, he confessed that, during these forty years Louis has put a lot into their life. He still blamed Louis for their forced marriage. It was Louis’ father (because of his religious beliefs) who pushed them to marry. He thought that if this had not happened, they would have had a better chance to find a right person in their lives. He indicated that he does not like to be controlled by his wife in every single thing that he wants to do. He also mentioned about his suspect that Louis is siphoning their retirement saving from their share account to her own personal account. These doubts make him even more unhappy and insecure in their relationship. At this time, Louis angrily jumped in and explained about this subject. While she was crying, she mentioned that several times she tried to explain her plan for their retirement to Donald but he just ignored her and did not pay attention to her and her idea. Because of that, she decided to run her idea by herself, just like other issues in their relationship. She described her retirement plan step by step.

During the conversation and through their explanation about themselves and their family backgrounds the counsellor realized that there were many family differences from were they came from that may also be the cause of the problem for both of them. Donald comes from a very close family, in which their members try to minimize even small differences in order to protect solidarity among them. He is very close to both of his siblings and he enjoys being part of such a close family. He appreciated the fact of getting support from them. On the contrary, Louis came from a family that was almost the opposite of Donald’s family. Among Louis relatives, there was a low sense of solidarity and even low level of conflict was considered high. Louis’s family was part of a very conservative religious group. The structure of the family was rigidly hierarchical. Children and their mother have to follow the rules that their father has impose on them. After she got pregnant, she was rejected by her family and forced to get marry with the father of her child. She ends living with Donald and with her baby in isolation. Since then she has not received any support from her family. Her feeling of isolation increased when she realized that she had to raise her baby by herself. After then, she rarely visited her mother and her contact with other family members was reduced to a few times a year. The counsellor was trying to find the answer for questions about certain situations that occurred in that relationship. One of the most important questions was how couple life should be in order to get satisfaction and what is needed to be done to improve the relationship. Louis blames Donald for not taking responsibility in their life and their relationship and he complains that Louis would like to have every thing done on her own way. He said that even if he took the initiative to do something, he was always criticized by his wife. Over the years, this situation made him extremely reluctant to initiate anything in their relationship.

At the end of the second session, based on the counsellor’s observations and the information the couple told her, the counsellor based her assessment and recommendations on CBFT (Cognitive Behavioral Family Therapy). She had by then a definition of their primary conflict (Shulman, L. 2006) that allowed her to develop an assessment of the problem. She observed that gender imbalance has obviously negative impact on their relationship, particularly around issues of harmony and leadership. On the other hand, from a feminist perspective, the couple was surrounded in their interaction by some stereotypes, which made both of them to feel unhappy. ( Goldner, V. 1985) Louis, as a woman was trained from early childhood to be the family caregiver, especially for her husband. On the other hand, Donald, as a man did not receive the same training. She, as a woman has learned how to respond to other people’s needs without the others even expressing and/or asking for means to fulfill these needs. She expected her unspoken needs to be understood and recognized by others. The problems arose when nobody appreciated her efforts and they took for granted what she has done for them. In this case, Louis was emotionally and practically maintaining the family together, while Donald was emotionally withdrawn and took little responsibility for their daily lives. Miscommunication is obviously one of the major problems in their relationship. They definitely need some help to develop communication skills. The therapist has described the negative interaction patterns (Shulman, L. 2006)that can be identified in their relationship. She gave to them three major suggestions to repair that pattern ( Shulman, L. 2006) and asked them to accomplish some tasks for the next session. Her first suggestion was asking them to get back to one bed and share their bedroom in order to achieve closer physical contact. The counsellor explained that getting closer physically will open a door for them to be emotionally close as well. It will give them a chance to spend more time together. Physical contact will allow them focus their minds in their relationship and share more their spare time. Second, she asked each of them to make a list of minimum of 10 particular things that they would be pleased if the other person does it. Then exchange their list, choose only one or two items from the list to begin trying to accomplish. This will initiate a positive cycle between them. By completing this task, they will learn how to point their needs out and have a voice to let other person knows their expectations. By doing these tasks they also will practice to have a good communication. Improving their communication involves self-expression and listening, instead of denying their own feelings and acting them out indirectly. (Burns, D. 1999) The third task they were requested to do was an intervention to increase marital intimacy. The counsellor asked them to allocate 15-20 minutes together at least four times in the next week. During these periods of time, they must not answer the phone, watch TV or allow any interruption or situation that may interfere with their privacy. They should try to talk and listen to each other about anything that is in their minds. During this sharing time, they must try to do their best to not interrupt each other. If for any reason they need to interrupt, they should have a pen and paper at hand and write down a key word. (Dattilio, F. M. 1996) When any of them takes a turn to express an opinion, give a clear explanation and let the other know exactly what he or she means by that. The therapist also asked them to recall as many good memories as they have about the time when their children were living at home. Look old pictures that might help them to remember those happy events, like birthdays, wedding, graduation and so forth. Something that brings them happy memories will help them to focus more on the positive side of their marriage and strength their relationship. In fact, the counsellour asked them to gather some evidence that does not support their negative thoughts regarding their marriage and their relationship. (Greenberger, D. & Padesky, C.A. 1995). The tasks given will help them to focus more on positive experiences of their relationship that miscommunication has destroyed over the years. The third Session began with their report about the completion of the tasks over the last week. Even though the tasks given were not all completed satisfactorily, things went a little better. They came back to the same bed, which made both of them to feel better and closer. Louis explained that this task helped them to have conversations they did not have for many years. Donald had not been initiating any conversation yet. He still likes to spend most evenings with his own family of origin. Louis started to accuse him again of being irresponsible and careless about her emotional and physical needs. Donald responded to those accusations slowly and weakly. His slow reaction made Louis angrier and made her to reinforce her belief that “Donald does not care about me.” The more Louis got angrier and yelling at him, the more Donald shows his weakness and takes the silence mood. His responses were more slowly. His perception of her as a controlling person became stronger. The counsellor tried again to encourage Donald to speak up for himself and not to allow that the intensity of Louis’s communication silence him.

The therapist repeatedly explained the importance of voicing their needs and expressing their feelings in a relationship. At the same time, she was careful to validate Louis’s essential and rational demand from her husband to be more caring. Through all the sessions, the therapist was also trying to keep her ally attitude with both of them. This was particularly important with Louis, who still seems a little bit doubtful about the therapist work as an ally. At this session therapist and couple were more focused on the lists the couple made and already exchanged in order to use behavioral contracting. (Shulman, L. 2006). The therapist asked them prioritized their demands, and take three of them which they considered were more important. She asked them to read their choices very smooth, kind and loudly in the session in order to engage the other person who is willing to fill those demands. You may need to talk about it clearly, in order to get an agreement about your needs. She suggested that during the following week both of them have the responsibility to do those three tasks as the best of their abilities. They have to record the different tasks that the other part is doing for them. In addition, each time that they feel satisfied and feel good about that behavior have to mention it and appreciate it. Then, the person who received the appreciation should mark it down. The therapist also suggested continuing the previous tasks of being in a same bed and having at least 15 to 20 minutes of quality time together. This time she suggested they can talk about some issues that had bothered them all those years without blaming each other. Then she gave them an example of how they could go through the root of their problem helping each other. She also provided them with some reading about communication skills and asked them to read and discuss together during the week.

The forth session started. They both were smiling and welcome the counsellor at their home. During the last week, they had more chance to talk about their relationship. Louis was happy about Donald’s understanding in terms of their sexual relationship. She mentioned “last week when he asked me to have sex, instead of ignoring him or yelling at him, I asked him to help me to find out the reason that turn me down. Then we went through our life and found that, I had a very bitter experience since my first sexual relationship, which was ended up with the unwanted pregnancy and the forced marriage. Since then, I have never had a good feeling about my body and about having sex”. “I always feel guilty” she continued, because of that incident, and Donald was reinforced this feeling over the years”. “I looked at myself as a slave, who is supposed to take care of everything including providing sex. It gives me a very bad feeling. I did not enjoy the sex” she said, because “I was thinking that this was a job that I have to do it, and not something I desired to have”. “I saw sex, she continued, as somebody else need or as if it was part of the whole service I have to provide for my master”. “Although, I used to provide it even when my menopause happened, around 15 years ago” she remarked, since then, “I felt a very strong power pulling me back and no more sex desire remained”. “I had no feelings or desires, either physically or emotionally” she concluded. This time, Donald jumped in, looked at her and he added, “And during those days, I did not realized her real concern, so I did not do anything to help her.” Louis immediately took her pen and paper and gave one credit to Donald for his understanding and he consider this as an appreciation by her. After this discussion the counsellor realized that they found how to reframe their thoughts and their judgment about each other by using communication skills and find a solution for their problem. They added that they have decided to stay in the same bed closely until Louis feels ready to have a sexual relationship. During last week, Donald took responsibility to do some house work, like cooking the dinner and washing the dishes once, which was followed by Louis’s great appreciation. On the other hand, Louis initiated to visit Donald’s sister with him and they invited her for dinner. They stayed there for few hours and according to Louis’s words, she enjoyed that evening and after so many years she felt the sense of belonging to her husband’s family. She mentioned that after this visit, she perceived that Donald was kinder with her and more caring about her.

In the next session, the therapist suggested them to continue doing the previous tasks, as well as increasing the quality of talking time. In their conversations they should apply communication skills and try to not hurt each other by blaming, despising, making comparison or insulting each other. In order to get the couple more involved in their relationship, the therapist asked them if they have had any wish during their life together. Louis mentioned that she always wished to arrange a trip for a few days. Louis wished they both be responsible for organizing the trip. The therapist suggested them to make a list of every thing that they need to have done for the trip and then let every one takes the tasks he or she prefers to do; write their names in a check list for trip preparation items and have their names written in front of the task they might chose.

The last session, based on their request, it was hold in the counsellor’s office. They sat next to each other and waited for the counsellor to begin the session. Both had a nice smile on their face. The therapist started by asking them about their experiences during that week. They pointed out that there were some issues in their relationship that still they need to work on. However, they declared, “there is also a hope to regain the love that we lost over those years of miscommunication”. “I am so glad to hear that” the counsellour said. They are trying to love each other and build their relationship just for themselves and not for the children as it was before. “We do not care now about prejudices or looking good in front of our community” they stated. “We want to do it for our own sake” both said. The counsellour assured them: “you will be able to make this huge difference on you life. Your relationship will improve by looking at your problems as a team and applying the skills you already have learned”. The therapist explained that her job with the agency has finished and that she was going to refer them to another worker to follow up their progress. They got shocked, and asked her if she can continue to see them out of the agency responsibility. They mentioned that it would be difficult for them to not to have her as their social worker. They were afraid of loosing the path that they have already found after these many years of sessions. She explained that for her would be hard not to witness the progress they may continue having in their relationship. However she said, “I am sure that you are capable enough to make this happen with me or without me”. She also suggested them to attend the couple group therapy and communication skill class both being provided by the agency. She gave them plenty of information regarding those groups and classes. In order to maximize potential supports in their environment, the counsellour informed them that from now the agency will mail all educational pamphlets in this matter to them. She makes the compromise of letting them know when a work shop on these topics takes place. She indicated that if they could gather more than 5 people who are interested to receive that information, the agency will hold the work shop on their residential area in order to be more accessible for every body that lives there and have problem to get to the city. They appreciated that and told her that they prefer to join the classes and receive those services, rather than visiting the new social worker in a regular base. She also, after getting their consent, made an appointment for them with a financial adviser that would help them in terms of their financial concerns.

Conclusion

In the first part of this paper the case study has been addressed using macro theory levels and applying the Structural Approach in social work. In this part it was explored the negative impact of environmental factors, such as social class, age, and gender on the client’s life. Six major elements of structural social work, from Maurice Moreau, being them defense, client-worker power, unmasking structures, personal changes, collective consciousness and political changes, has been indicated. And then the six basic principles of the Structural Approach from Goldberg-Weed and Ruth Middleman have been indicated. In addition, it was presented an assessment of the case by identifying specific environmental factors that had impact on our client’s life and his relationship with his wife. In the second part of this paper, using “micro theory levels”, skills of direct practice to help the client for immediate relief and long term changes were incorporated. In micro theory levels, intervention skills have been borrowed from that micro theory. They are based on cognitive behavioral therapy along with feminist approach. It is also influenced by resilience perspective and problem- centre model. During the intervention, all structural principles that were presented on the first part of the paper were applied in order to get the best result.

Annotated Bibliography

Bergman, S. (1991). Men’s psychological development: A relational perspective (work in progress No. 48). Wellesley, MA: Stone Center Working Paper Series.

Burns, D. (1999). The Feeling Good Handbook. New York: plume printing, p.364- 375.

Breunlin, D. C., Schwartz, R. C., & MacKune-Karrer, B. (1992). Metaframeworks: Transcending the models of family therapy. San Francisco: Jossey- Bass.

Caroniol, B. (1992). “Structural Social Work: Maurice Moreau’s Challenge to Social Work Practice.” Journal of Progressive Human Services. 3(1), pp. 1-20

According to Maurice Moreau, workers can empower clients, only if apply all of the following six activities:

Defense: Social workers have to respond to the client’s need strongly, and involve the client to join them in seeking the required resources, so that support and validate their own efforts to defend themselves against oppression and injustice.
Client-Worker Power: In structural approach, workers acting to share decision-making power with clients and to demystify professional techniques, if so feminist approach. Workers try to reduce the distance between themselves and clients by using different ways and making a relationship based on mutual dialogue which there is no place for top-down interaction. Worker also will share all the information with client and no records would be hidden from them.
Unmasking structures: Unlike mainstream and conventional theories, structural approach tends to unmask the primary structural sources of oppressions which have impact upon the client’s situation. Workers carrying this approach are focusing on the roots cause the oppression that grounded in systemic inequalities, rather than blaming clients as psychologically defective.
Personal Change: Moreau suggested that workers must work simultaneously on changing and liberating society as well as the clients in order to have a liberate society. However, in this approach agree that primary structural sources make oppression, it does not mean that people are not responsible for whatever they do and therefore they would be allow to blame the system. On the contrary, personal change is also central to the structural approach in order to empower the clients by taking responsibility for feeling, behavior and thoughts that might be destructive to self or to others.
Collective Consciousness: In fact this element is related to the previous one which is personal change. Clients can not make changes on themselves unless to reject the individualism which isolates them and recognize the others common experiences. In contrast to conventional social work, structural worker encourage the clients to join social movement and share similar experiences with them.
Political Change: It could not happen unless the personal changes has been done already or happen both personally and politically at the same time. Political change is an on-going process. Structural workers empower the clients politically and personally in order to be more involved in political movements by becoming activists.

Dattilio, F. M. (1996). Cognitive therapy with couples: The initial phase of treatment. [Videotape]. Sarasota, FL: Professional Resource Exchange.

Greenberger D., Padesky, C. A., (1995). Mind over Mood. New York: The Guilford Press.

Goldberg- Wood and Ruth Middleman (1989) Chp. 3 “Basic Principles of the Structural Approach”, The Structural Approach to Direct Practice in Social Work. New York: Columbia Press.

Goldberg- Wood and Ruth Middleman introduced six basic principles that Structural Approach is based on them:

The worker should be accountable and adequate person to the clients. Based on structural approach the workers’ tasks would be defined by the definition of clients’ pressures and needs. Worker is supposed to adapt specific way(s) to remove those pressures upon clients. Workers tasks that will be developed at the beginning of the worker-client relationship by non written contractual agreement should be clearly understood by workers and clients. However, the workers’ tasks could be changed in the process of the work, workers and clients have to be aware of those changes and jointly agree on them or any alternative tasks. In fact, based on structural approach, the client and the worker, work together as partners from the beginning to the end of the relationship.
The worker should follow the demands of the client task. To respect to this principle, the worker should consistently look beyond the client to see if others are facing the same task as well as using different sets of behaviors at different times, depending on the nature of the task and the situation in order to accomplish the defined task.
The worker should maximize the potential supports in the client’s environment. Based on this principal, social worker should change the social structures that make limitation for clients and instead he/she should create new structures, so that client meet as much as possible his/her needs, while in this new structures, social worker is not the centre of the helping process.
To respect to the principle of least contest, worker should ranks the interventions along a power dimension and raise the issues slowly from the less powerful intervention to more powerful intervention.
The worker should identify, reinforce and/or increase the client’s ability to use behaviors that minimize pain and maximize positive outcomes and satisfaction.
The self principle directs social workers to apply all those principles one after another.

Goldner, V. (1985). Feminist and family therapy. Family Process, 24(1), 31-48

Moreau, M. & Leonard, L. (1989). Empowerment through a structural approach to social work: A report from practice. Montreal and Ottawa: Eecole de service sociale. Universite de Montreal and Carleton University School of Social Work.

Moreau, M. (1990b). Practice implications of a structural approach to social work. Unpublished previous draft for this journal. Montreal.

Pinsof, W. M. (1995). Integrative Problem-centered therapy. New York: Basic Books.

Shulman, L (2006 ). The skills of helping individuals, families, groups, and communities. Buffalo, New York: Brooks/Cole, Cengage Learning.

[1] Laissez-faire is an economic philosophy that supports little or no state intervention on economic issues, which implies free markets, minimal taxes, minimal regulations and private ownership of property. They support certain kinds of negative liberty as opposed to positive liberties, such as wealth redistribution.

http://en.wikipedia.org/wiki/Laissez_faire#The_laissez-faire_economic_philosophy

[2] ageism is understood as discrimination or prejudice against people of specific ages, especially in employment. (English Encarta Dictionary)