Sie sind auf Seite 1von 17

Liliana Sousa, Claudia Ribeiro &

Sofia Rodrigues
INTERVENTION WITH MULTI-PROBLEM
POOR CLIENTS: TOWARDS A
STRENGTHS-FOCUSED PERSPECTIVE

Since multi-problem poor clients are mostly recognized by their problems, intervention is
developed from a problem-centered perspective, which has shown itself to be only modestly
effective. The strengths perspective, on the other hand, which assumes that every system
has competences, has been shown to be more effective. Nevertheless, incorporating the
strengths approach is difficult since the problem-centered view is embedded in our social,
cultural and professional context. This study aims to learn whether the strengths approach
is incorporated (or not) in practice involving multi-problem poor clients, thus allowing us
to perceive what obstacles and potentialities to such an approach emerge. An interview was
administered to both clients and practitioners, and the results confirm that the problem-
centered perspective is dominant and that a shift in perspectives is still in an incipient
stage.

Keywords multi-problem families; poverty; strength approach; problem-


centered perspective; families competencies; social intervention

Introduction
Multi-problem poor clients have been described mainly through their problems and
incapacities; consequently, intervention has been developed following a problem-
centered view which has shown itself to be only modestly effective and also
responsible for a variety of detrimental effects, such as the weakening of family
boundaries and cohesiveness.
In addition, the literature has produced evidence that, despite dysfunctional
clients being stuck in repetitive patterns that dont work well, every individual, family
and community has strengths, on which professionals must rely in order to help their
clients (re)gain control over their lives (De Shazer et al., 1986). Nevertheless,
problem-based practice is strongly incorporated in the habits and minds of
practitioners and clients, which obstructs the incorporation of a strengths-based
approach. The challenge is to incorporate the strengths perspective even in
settings where there is little recognition of it being relevant, which is the case for

Journal of Social Work Practice Vol. 20, No. 2, July 2006, pp. 189204
ISSN 0265-0533 print/ISSN 1465-3885 online 2006 GAPS
http://www.tandf.co.uk/journals DOI: 10.1080/02650530600776913
190 JOURNAL OF SOCIAL WORK PRACTICE

multi-problem poor clients who are often understood only by what is wrong with
them.
In this context, both participants points of view are important, since from the
strengths perspective, practitioners and clients form a partnership in defining
problems, goals, strategies and success. This study aims to understand whether multi-
problem poor clients and the practitioners that work with them are incorporating a
strengths-based approach. To achieve these objectives, an interview comprising three
open questions was administered to 28 heads of multi-problem poor families as well
as to the practitioners that each family identified as those who know us best.

Multi-problem poor families and problem-based intervention


Typically, multi-problem families are defined according to deficits, pathology,
fragility and incompetence. So they are characterized by: chaotic hierarchy, the
reduction of rules to a minimum, repeated ruptures and reconstitutions of
relationships and negative patterns of verbal and nonverbal communication
(Linares, 1997; Kaplan, 1986). Based on these descriptions, intervention has been
developed following the deficit perspective, which is organized in order to
compensate for the problems, that is: for each problem, a solution is sought which
will be developed by a specialist through compensatory work. In this context families
become agency families (Minuchin et al., 1998) since they are supported by several
social agencies and professionals.
This approach has been shown to have low effectiveness, resulting in
professionals frustration and families despair or apathy (cf. Linares, 1997; Imber-
Black, 1987; Madsen, 1999; Sousa & Eusebio, 2005). Furthermore, a variety of
detrimental effects have been documented: fragmentation and decontextualization,
which stigmatize patients and alienate them from their families (Elizur & Minuchin,
1989); a weakening of family boundaries and cohesiveness, dilution of the family
process and a greater dependency on social services (Colapinto, 1995; Imber-Black,
1987); and disempowerment and repression (Boyd-Franklin, 1989).
Intervention based on the deficit approach seems to fail to recognize that human
systems are autonomous and, consequently, evolution is a process where the effect of
the environment is minimal (Maturana & Varela, 1980). The assumption of the role of
problem solver by practitioners is an obstacle because it cannot be successful in the
context of autonomous human systems. Waters and Lawrence (1993) argue that one
of the great deficits of this approach is the lack of a pro-active vision of what people
need to move towards instead of a sense of what they need to move away from.

The emergence of the strengths perspective


Over the past few decades, there has been a shift in intervention focus towards greater
recognition and enhancement of family strengths and resources (Walsh, 1995). This
strengths-based approach shifts the emphasis of the intervention from what went
wrong to what can be done to enhance functionality, and builds on family strengths
and resources that enable mastery of lifes challenges and the healthy development of
INTERVENTION WITH MULTI-PROBLEM POOR CLIENTS 191

all family members. This is especially useful in work with multi-problem poor families
(Walsh, 1995), since intervention that is overly problem-focused can grimly replicate
the experience of family life, where problems are all-pervasive. These families are
among the most needy and difficult populations to work with, since they also deal
with poverty, which constitutes a factor that can force the healthiest family to buckle
under, especially when there are features that serve to maintain them in a position of
poverty and powerlessness (Hines, 1989). Research and community practice has
supported the importance of strengths-focusing as a powerful tool to address multi-
problem poor clients needs, engaging them in the intervention process and
promoting successful outcomes (Elizur, 1996; Henggeler, 1999; Rojano, 2004).
The strengths perspective has many kin (Saleebey, 2001; Lee, 2003): ideas about
healing, wholeness and wellness; empowerment and liberation movements; the
evolving resilience research and practice; asset-based community building approaches;
solution-focused and narrative approaches to therapy; research into hope, positive
expectations and possibility. Strengths-focused practice and thinking does not require
practitioners to ignore the problems of individuals/families or to ask clients to forget
their problems and pains. It means the realization that intervention is based on the
positive and possible goals rather than in deficiencies or problems (OHanlon &
Weiner-Davis, 1989; De Shazer & Berg, 1997). So, asking clients what is working in
their family life, what has worked best and what they have learned from their efforts
might be the best place to start in exploring solutions and positioning the client as
expert in his own life (Saleebey, 1997; Egan, 1998).
However, working from a strengths perspective raises the dilemma of maintaining
the designation of these families as multi-problem, since the term has assumed
connotations of serious family disturbance and causal attributions that tend to
overpathologize families. Nevertheless, all families are problem-solving entities, and
any existing family has solved thousands of problems, utilizing the resources of
individual members and the collective resources of family and friends (Imber-Black,
1987; Kaplan, 1986). So, any label should recognize the difficult realities of these
families lives, yet also be oriented towards the strengths, resources, and knowledge
that families possess in addressing those difficulties. Some authors have suggested
other denominations, such as multi-stressed (Madsen, 1999), multi-crisis (Minuchin,
1995) and families in perpetual crisis (Kagan & Schlosberg, 1989), which highlight the
persistent occurrence of expected and unexpected crises in these families. However,
the word multi-problem could still be used to refer to families encountering
multiple problems in their lives, while maintaining the idea that families are distinct
from their problems. The emphasis should shift towards an understanding of how
these families could survive and regenerate even in the midst of overwhelming stress,
adversity or life-altering transition (Kaplan, 1986).

Incorporating the strengths perspective into practice


The dominant language in our culture is deficit-based. Egan (1998) considered that
one of the major barriers to taking on this new perspective is that it can be difficult for
practitioners to make the shift from a traditional approach that focuses on the
192 JOURNAL OF SOCIAL WORK PRACTICE

problems of clients. De Jong and Berg (2001) warn that practitioners may feel it is
acceptable to support clients in talking about problems, but may feel uncomfortable
with aspects of positive challenging and positive goals, pointing out that practitioners
are oversupplied with techniques and perspectives that focus on problems rather than
solutions. So, in this process of transformation, it becomes important to understand
what practitioners are already doing from a strengths perspective and how they are
combining a strengths perspective with a problem-based approach.
The incorporation of a strengths-focused approach has become relevant in
intervention with multi-problem poor clients, but to make this shift in practice is a
considerable challenge for practitioners who have been educated and tutored in the
basic tenets of the professions knowledge base and practice methods. Whats more,
it is a substantial challenge for clients who are used to requesting solutions from
practitioners. Shifting mental frames is not an easy task; often, new ideas are
incorporated but only as attachments to older frames without altering the basic
frames of thinking and action (Blundo, 2001). In order to achieve this
transformation, it is necessary to understand whether multi-problem poor clients
and the professionals that work with them are thinking or able to think in a
strengths-focused way.

Objectives
This exploratory study aims to get a better understanding of one main question: are
multi-problem poor families and the practitioners that work with them thinking or
able to think in a strengths-focused way? Results will have an impact on the
identification of obstacles and/or potentialities that exist in relation to the
incorporation of a strengths-focused approach.
This study was developed in Portugal, but multi-problem poor families, as well as
intervention based on a deficit approach, involving the assistance of multi-agencies
have been described in many countries, such as: Spain (Linares, 1997), Israel (Sharlin
et al., 2000), Finland (Seikkula et al., 2003) and the United States of America (Imber-
Black, 1987; Minuchin et al., 1998).
Although this subject is not specific to our country, it assumes some specificity in
Portugal. Democracy was established in Portuguese society after the Revolution of 25
April 1974. Until this moment, Portugal had lived under a dictatorship which had
lasted for nearly half a century. The 1976 Constitution (the first after the revolution)
specified the States responsibility in implementing social policies to improve the
populations social and economic well-being. Social policies tended towards the
model traditionally called the welfare state. While in other European countries
the welfare state started during the post-Second World War period, in Portugal it
only really began to develop almost 30 years later.
The poverty rates in Portugal (Eurostat, 1999) are the highest in the European
Union: 26% of households and 24% of individuals live in poverty. Other countries,
such as Spain, Greece and Ireland also have poverty rates superior to 20%. At the
moment in Portugal, the main social and political preoccupations are centered on
poverty and unemployment.
INTERVENTION WITH MULTI-PROBLEM POOR CLIENTS 193

In our country, assistance to multi-problem poor families is provided both by


public and private organizations (these are usually financed by the Government),
based on a problem-centered approach. Moreover, social and health assistance are
separate, poorly articulated fields, promoting fragmentation in the intervention.
Recently, efforts have been made to improve articulation and partnership, mainly by
creating multi-disciplinary teams involving practitioners from several institutions.

Methods
Data were collected through an interview comprising three open questions designed
to challenge practitioners and multi-problem poor clients to think in a strengths-
focused way, that is, to concentrate on what works, what is functioning and what
goals to achieve (Table 1).

Sample
The sample was collected in the county of Aveiro, a small county (about 200 km2)
located on the west coast of Portugal, with about 75,000 inhabitants. In Portugal
policies have a national scope, so what has been said for Portugal is also valid for this
county. Although epidemiological studies on the incidence of multi-problem poor
families in the county of Aveiro are nonexistent (they are also not available in
Portugal), the Social Welfare Centre of the county estimate that these families
represent 6% of the total number of families who request support from social
services. However, they absorb about 50% of the services efforts and practitioners
and represent 75% of the failure cases.
The selection of the sample was performed in two phases: first, the families, who
then identified the practitioners that knew them best. The families were chosen
from a panel of 100 socially vulnerable families who collaborate in another research
study. At the beginning of this study these families had already been interviewed
twice, so by analyzing the collected data it was possible to identify 32 multi-problem
poor families who had been asked to collaborate and to ask their permission to
interview the professional who knew them best. Two of those families refused to
TABLE 1 Interview: questions and objectives

questions objectives

Identify positive aspects in the functioning To identify the practitioners and clients perception
and organization of the family? about what works in the family or what is not broken.
Which objectives would this family have to To recognize positive goals for the family to achieve as
reach to improve their life? this encourages clients to identify areas of
competence.
What happened in this familys life in the To identify what has worked best in the familys past,
past that helped them improve their life? since it allows understanding of what works in the
family.

Source: based on De Shazer et al. (1986) and Saleebey (1997).


194 JOURNAL OF SOCIAL WORK PRACTICE

collaborate, whereas the remaining families accepted and gave us the name and
institution where the practitioner was employed. Later, the practitioners indicated by
the families were contacted and two refused to collaborate on the grounds that they
did not know the families.
Some families identified the same practitioner; therefore 16 practitioners were
interviewed in relation to 28 multi-problem poor families. Among the 16
practitioners interviewed, 12 were social workers (11 were women) and four were
family doctors (two men). Their ages ranged from 26 to 61 years. One of the social
workers answered in relation to five families, one family doctor about four families,
two social workers about three families each, and another social worker spoke of two
families. The remaining 11 practitioners spoke only of one family each.
Concerning the families, the heads of family were interviewed (81.3% female).
Their average age was 47.7 years old (standard deviation: 16.3). In terms of residence:
urban 15.6%; peri-urban 53.1%; and rural 31.3%. In terms of education, the
most common level was primary school (75%), and regarding professional status, the
predominant categories were housewives (39.3%) and unemployed (32.1%).

Data analysis
All the interviews were taped, transcribed and submitted to content analysis, which
was carried out by four experienced research assistants (two psychologists and two
sociologists). The process comprised two stages: the definition of categories within
each question and the classification of answers into the previously defined categories.
The first phase aimed to create and test the categorization system. It was an
interactive process of successive refinement involving two independent coders. Each
of them read all of the interviews and developed a list of categories for each question.
Both coders then met in order to compare and discuss both proposals, until agreement
was reached. Subsequently, each coder categorized five interviews at random in order
to confirm that the categorization system fitted the answers.
In the second phase, two other coders categorized the answers independently.
They were given the list of categories, together with a definition and criteria for the
assignment; an example of an answer that would fit the category was also provided.
After each coder had analyzed all the answers, they met and registered their
agreements and disagreements. The inter-rater agreement score (this score was
reached by dividing the number of agreements by the total number of agreements plus
disagreements) was 93.1%; this reliability may be considered quite high (Miles &
Huberman, 1984). Finally, the two coders discussed the answers on which they
disagreed, and this discussion led to total agreement.

Results

Identify positive aspects in the functioning and organization of this family


All interviewees, heads of multi-problem poor families and practitioners, mention at
least one positive aspect, although they showed some difficulty (Table 2). Among the
most mentioned positive aspects, three are common to both sub-samples: family
INTERVENTION WITH MULTI-PROBLEM POOR CLIENTS 195

TABLE 2 Positive aspects of family functioning and organization

categories families practitioners common*

Union and family support 19 21 11


Strong parent/child bond 19 13 12
Capacity for organizing and sharing of tasks 19 13 6
Capacity to solve problems 0 19 0
Keeping a steady job 1 9 1
To have good health 3 1 0
To have sufficient income 0 7 0
Good conjugal bond 4 5 1
Good social relationship (including the practitioners) 2 8 2
To have a house with adequate conditions 0 3 0
Adequate individual development 5 2 0
Total (N) 72 101 33

* Number of times that an aspect was referred to by interviewees of the two sub-samples in relation
to the same family unit.

union and support; the parent/child bond; and the capacity of family organization and
sharing of daily tasks. However, one aspect distinguishes the opinion given by the two
sub-samples: the practitioners point out the capacity of the family to solve problems,
whereas the families never refer to this aspect. It should be pointed out, though, that
practitioners do this in various ways: (a) believing (although the mother was a sick
person all her life she took care of children and earned some money); (b) disbelieving
(most of the time he is unemployed, but we notice that he is trying to find a job,
though when he finds one, he immediately has problems); (c) showing less correct
forms of doing so (he has a great capacity to solve economical problems, even if this
means doing things that put others at risk).
Despite both sub-samples being in general agreement on the positive aspects
mentioned, their opinion is formulated in different ways. Family union and support is
described by family members in an assertive way, while practitioners are ambiguous
about it and, in some cases, consider it harmful: they are united, but this has two
sides to it: it is not good because we cannot separate them, which would be
important; however they do support each other! The practitioners describe the
strong parent/child bond with some ambiguity: parents link to their children is
sometimes so strong that if it is necessary to take the children away, due to
negligence, it becomes very difficult. The capacity of sharing the daily tasks is
described by the family members in a clear manner and without restrictions. The
same does not occur in the view of the practitioners, who consider this organization
not very clear: I have the impression that they have some organization in terms of
support, but this is not always evident!
Although the following categories were mentioned with less frequency, it is
important to mention some elements.
196 JOURNAL OF SOCIAL WORK PRACTICE

(a) The practitioners indicated as positive the fact that family members have a steady
job and sufficient income, an aspect that is not indicated by family members.
Normally, because they do not regard the job as significant for their lives, neither
do they consider their income as sufficient.
(b) When mentioned by the families, a good conjugal relationship is described by the
absence of domestic violence (between us there is no violence). For
practitioners, it is a stable relationship between the spouses.
Although practitioners identified positive aspects in the functioning and organization
of the multi-problem poor families, they confessed that their main focus was on the
familys problems: We know more about the problems than about the good things
because when they come to us they come with problems!

Which objectives would this family need to achieve in order to improve their life?
The practitioners pointed out at least one objective that the families would need to
achieve in order to improve their quality of life. This trend was not observed among
family members, since six of them did not state any objectives, arguing that now,
nothing else can happen. In this situation we may highlight those families consisting of
old people or those where there are chronically sick dependent people.
The three objectives that were most referred by the two sub-samples are
(Table 3): obtaining a better housing situation; improving health status; and finding a
more stable and/or better remunerated job.

TABLE 3 Objectives families need to reach in order to improve their lives

categories families practitioners common*

To get a house with adequate conditions 11 13 7


To get a steady and/or better remunerated job 6 9 3
To have better health 8 6 1
To improve their income via their own means 4 2 1
To improve their relationship with their children 2 3 0
Greater capacity to solve problems 4 1 0
To increase the union and family support 2 4 0
To stabilize or breach the conjugal relationship 0 7 0
To obtain more formal support in money, assets and/or 0 4 0
services
To improve the social relationship (including the 2 1 0
practitioners)
Improvement of academic/professional 2 1 0
background(normally the children)
Total (N) 41 51 12

* Number of times that an aspect was referred to by interviewees of the two sub-samples in relation
to the same family unit.
INTERVENTION WITH MULTI-PROBLEM POOR CLIENTS 197

The increment of the housing situation, either in terms of property (to be given a
social house, or to pay a lower rent), or in terms of conditions (for example, to have a
bathroom) is the aspect with greatest consensus (common to seven families). The
intention to find a steady job is associated with the improvement of the economic
situation, by both sub-samples, and integration in society only by the practitioners.
The improvement in health status is associated with: treatment of the alcoholism/drug
addiction of the husband and/or the children; chronic illnesses or situations of
dependency (resulting from illnesses or car/work accidents). This objective is allied
to the possibility of finding a job and, thus, of improving the economic situation.
Concerning the remaining objectives, some points deserve consideration: (a) the two
multi-problem poor families who indicated the improvement of the parent/child bond
refer to having their children back (the children had been taken by the social
services); in the practitioners case, they indicated situations where the children are
not interested in their parents (normally elderly people) or parents who maintain a
relationship of conflict with their children; (b) the improvement of the conjugal bond
(only mentioned by the practitioners) is related either with the breaking-up of the
relationship by the wife (three cases of domestic violence) or with harmony in the
relationship (three cases); (c) one of the objectives drawn by the practitioners (in four
cases) is the attainment by the families of more formal support (money, assets or
services) which is not mentioned by the families.
The way in which the objectives were formulated also requires some comment:
(a) The practitioners have a tendency to elaborate them in individual terms (Mrs X
needs to have a steady boyfriend, the son needs to go to school and the father to
quit drinking), whereas the families were more global in their statements (if my
husband could work everything would be better).
(b) On the practitioners side, a feeling of impotence is revealed (the world fell
upon this family); on the families side, opinions were divided; some consider
that there was nothing else to be done, whereas others were less pessimistic
(the important thing is that my husband quits drinking, after that everything will
be alright).
(c) The practitioners have a tendency to define utopian objectives (the objective
would be to find a job, but for this they would need to be slightly younger); on
the other hand, the family members tend to be more realistic (a little house,
where I could bring up my child properly, would be enough for me).
(d) The practitioners stated several times that these multi-problem poor families
content themselves with very little, that is, with some form of economic
improvement; the families wished for an improvement of their economic
conditions, but for them this is not little (if had a job, everything would be
different in my life).

What happened in this familys past that helped it to improve their way of life?
Concerning this question, five heads of families were not able to identify anything in
the past that had contributed to an improvement of their way of life, because they
could not remember (two cases) or because nothing happened (three cases). At the
198 JOURNAL OF SOCIAL WORK PRACTICE

same time, concerning another five families, the practitioners did not indicate any past
situation that had helped to improve the families lives: three had only known the
family for a short time and did not possess past information; one considered that
nothing positive had occurred (things have become more and more degraded);
another considered that it has always been the same. The interviewers mentioned
that this question was understood as an evaluation of the practitioners work, thus,
even after having explained the underlying objective, some revealed apprehension.
Among the aspects most cited by the sub-samples, three are common (Table 4):
obtaining formal support; having found a better job; and improvement of their health
status. Only one of the most cited aspects differs: practitioners pointed out an
improvement in the parent/children relationship and families indicated a greater
capacity to solve problems.
The attainment of formal support was one of the strategies that functioned in the
past as a trampoline for the improvement of the familys life. The practitioners consider
these families as those who were able to use support without becoming subsidy-
dependent. The families consider that the help was given at the right moment,
allowing them the opportunity to overcome a more difficult phase. Having found a
stable and/or better remunerated job was recognized as important since it gave the
families a higher and more stable income. The improvement of the health status was
mainly related to institutional support, via orientation towards disintoxication
programs and provision of more adequate medical support that led to recovery from
some illnesses.
The families indicate that they acquired a greater capacity to solve problems,
although they were not very explicit (we became more capable of solving things).
The practitioners underline the improvement of the parent/children relationship,
normally because, by leaving their parents home in order to live in reasonable

TABLE 4 Events in the familys past that have helped to improve their lives

categories families practitioners common*

Getting formal support in money, assets and/or services 7 13 3


Improvements to their state of health (includes 5 10 2
alcoholism treatments)
Finding a steady and/or better remunerated job 7 6 2
Greater capacity to solve problems 6 4 0
Improvement in the relationship parentschildren 2 6 0
Improvement in family support 0 4 0
Improvement in the housing situation 2 3 0
Improvement of income by their own means 2 2 0
Stabilization in conjugal relation 1 3 1
Rupture of the conjugal bond 0 4 0
Total 32 56 8

* Number of times that an aspect was referred to by interviewees of the two sub-samples in relation
to the same family unit.
INTERVENTION WITH MULTI-PROBLEM POOR CLIENTS 199

housing conditions and to form a family, they made their parents very proud and, at
the same time, the parents were relieved of financial expenses.

Discussion

Are multi-problem poor families and the professionals that work with them thinking or
able to think in a strengths-focused way?
Findings suggest that the heads of multi-problem poor families and the practitioners
who work with them are capable of identifying positive aspects in the functioning and
organization of the family, describing objectives that could improve the families lives
and indicating aspects that have worked in the past. Moreover, for all questions, both
samples generally tend to mention the same aspects. However, they differed in the
way they formulated them: families are more assertive, demonstrating conviction; the
professionals are ambiguous, demonstrating reluctance to believe in the families
capacity to use or to exert such capacities.
In fact, when practitioners think in an ambiguous way, they come to forget the
families competences, since the incompetences and/or the problems conceal the
competences. One possible strategy for facilitating the integration of a strengths
approach in practice would be the separate identification by the practitioners of
problems and competences, followed by reflection on how families competences may
help to overcome some problems. Thinking separately about problems and strengths
also has other advantages: incompetence will not conceal competence, so it is less
probable that disbelief in the families strengths will arise; in this way, practitioners
will be in accordance with social expectations, but will also be reinforcing the self-
esteem of families and their members and engendering positive dialogue.
As practitioners interact with clients, their actions have certain effects on them.
These effects may be empowering (ways of thinking and acting that acknowledge,
support and amplify clients participation and influence in developing the lives they
prefer) or inadvertently disempowering (ways of thinking and acting that may
disqualify, constrain or supplant clients participation and influence in their lives)
(Madsen, 1999). The way of thinking revealed by practitioners (and families) suggests
a disempowering effect on families. For example, concerning past events that helped
families improve their quality of life, the formal support resources were highlighted
by both sub-samples. In this way, the practitioners competences are better valued
than those of the families, promoting the families dependency on the social agencies.
So, practitioners and families are assuming that practitioners resources have been the
best answer to improve the families lives; furthermore, they are not assuming a
partnership role and families are not being empowered. It is useful to draw a
distinction between the intention behind actions and the effect of those actions:
helpers generally attempt to act in empowering ways, but their actions may have
inadvertent disempowering effects on the client.
In this context it is pertinent to discuss whether, despite the fact that families
identified strengths in the way their families worked, those strengths will be adequate,
how they are used and what for. The results indicate that practitioners attribute to
families the capacity to try to solve their problems; however, the families do not
200 JOURNAL OF SOCIAL WORK PRACTICE

recognize this capacity, probably because the effort is directed towards unsuitable
objectives or because the context is very vulnerable. In any case, this effort could be
redirected, but should not be devalued.
Thus, the importance of contextual factors (employment, housing, health and
income) which are valued by those interviewed emerges, as objectives to be reached
and as past aspects which have improved the lives of the families. Since poverty is the
overarching cause of many of the other structural and functional family factors, it
seems appropriate to concentrate the objectives in this area (Rojano, 2004). Actually,
these factors, which are often outside the control of family members, may contribute
to family disruption, stress, and depression. It can be suggested that improvement of
the contextual aspects will allow the families to make better use of their relational
competences.
Clients and practitioners seem to cling to what has gone wrong and to be blind to
what has worked in the life of the family. It is important to think about how people
have survived until this moment (certainly not without a struggle) given the
difficulties they face (Saleebey, 1997).

What obstacles and/or potentialities might emerge to thinking in a strengths-focused


way?
The major obstacles that emerge concerning the shift from a problem-centered
perspective to one which is strengths-centered are: the reluctance professionals reveal
to identify the families positive aspects; impotence and incredulity of both the
participants at the possibility of the families improving their lifestyle; concentrating on
formal means as the main resources for families to improve their lifestyle.
The ambiguity showed by practitioners means that they identify competences, but
do not recognize or believe in them, and, above all they dont rely on them in order
to help the family. Thus, practitioners assume the traditional role of expert, defining
objectives and strategies without taking advantage of the families competences. From
a strengths-focused perspective, the ability of practitioners to motivate clients by
expressing a positive regard for their competences and capacities is powerful, and
sometimes, though not always, enough to redirect clients towards a more positive
coping approach to their life.
This ambiguity can have perverse effects on the clientpractitioner relationship:
(a) it introduces doubt in the intervention system, and one of the parties (the client)
feels that the other (the practitioner) does not believe in his capacities, which may lead
to conflict (they do not value us) or apathy (they do not understand us, therefore it
is pointless); (b) the family does not believe in its capacities and becomes dependent
on the practitioner, who feels that he/she should not have to assume this role. Vital to
the process of family change is the familys ability to maintain an element of hope; that
is, the family must have wishes or desires that are accompanied by a confident
expectation of their fulfillment (McCubbin, 1989). Hope can be reinforced or
become weaker according to the expectations shown by practitioners; in this case, it
seems that hope is frail because both participants do not share it.
The impotence and incredulity of both participants regarding the capacity of
families to improve their lifestyle is a way of denying that skills and strengths exist in
INTERVENTION WITH MULTI-PROBLEM POOR CLIENTS 201

the family. Therefore, the practitioners assume a focus on problems and on the deficit
perspective, which the members of the families have already incorporated. The feeling
of impotence on the part of practitioners implies that professionals saturated by
problems cannot see solutions, transforming them into frustrators of change instead of
facilitators. Perhaps it would be more effective if practitioners and families could
assume the perspective proposed by Madsen (1999): it can be presumed that clients
who have been dealing with difficult life circumstances have inevitably learnt many
skills in managing the challenging aspects of their lives.
Concentrating on the formal means as the main resources for families to improve
their lifestyle reinforces the idea that the practitioners competences are the resource
to improve the families lives. A strengths perspective will not work if the practitioner
hides behind expert roles, and distances him/herself from the client.
The potentialities that emerge are centered on the fact that both practitioners and
service users are capable of identifying positive aspects, drawing positive objectives
and identifying some aspects that have functioned in the familys past. At the same
time, the families seem to have a supplementary potential: they believe in their
capacities. This is a first, but nevertheless, a very important step towards the
incorporation of a strengths perspective into practice.
The main limitations of this study are found in the small size of the sample and in
the fact that some practitioners responded in relation to more than one family. It is
felt that the interview used to collect the data would have been enriched by the
inclusion of more questions and that some standardized instruments could have been
used to complement the qualitative information (for example: the Family Functioning
Style Scale Deal et al., 1988; or the Family Resource Scale Dunst & Leet,
1987).
Concerning perspectives for future research, we verified that the families studied
in this research are families where intervention has not been successful and, therefore,
the connection to the services still remains. It would be interesting to reconstruct
successful cases and to analyze whether in these cases a strengths focus existed.

Conclusions
Findings suggest that multi-problem poor families and the practitioners that work
with them are mostly thinking and acting from a deficit-based perspective, despite
being able to identify multi-problem poor families strengths and competences. It is
important to underline that the deficit perspective is shared by all involved: users,
practitioners, policy-makers, institutional leaders and, in general, all the citizens. So,
practitioners are expected to solve multi-problem poor families problems.
The incorporation of a perspective based on competences seems to be hindered
by a dilemma: how to believe in the resources and competences of families where
there are so many problems? The field of family intervention has increasingly
embraced a commitment to the belief that all families are resourceful and have the
capacity to grow, learn and change. In contrasting a narrative of pathology and a
narrative of resourcefulness, it is important to avoid polarization in which clients are
seen as simply dysfunctional or simply resourceful.
202 JOURNAL OF SOCIAL WORK PRACTICE

It seems we are still at the beginning of the process of shifting perspectives.


Professionals are still problem-focused which can make of them frustrators of client
change, instead of facilitators, especially because they are saturated with problems and
parched of solutions. In addition, multi-problem poor clients seem to have
interiorized the deficit view, which can only be countered by their confidence in the
positive aspects of their family.
In practice, the transformation may have to stem from understanding and using
both perspectives (problem-centered and strengths-centered) as complementary
and not as different and incompatible. McMillen et al. (2004) consider that problem-
focused and capacity-focused approaches are not dichotomous categories but need
each other and may work well together.

Acknowledgments
The authors wish to thank Susana Pires and Tania Costa for their participation in the
data collection and analysis. This study was funded by the FCT (Foundation for
Science and Technology) Project Nu 39644/SOC/2001.

References
Blundo, R. (2001) Learning strengths-based practice: challenging our personal and
professional frames, Families in Society, vol. 82, no. 3, pp. 296304.
Boyd-Franklin, N. (1989) Black Families in Therapy: A Multisystems Approach, Guilford Press,
New York.
Colapinto, J. (1995) Dilution of family process in social services, Family Process, vol. 34,
pp. 5974.
De Jong, P. & Berg, I. (2001) Co-constructing cooperation with mandated clients, Social
Work, vol. 46, pp. 361374.
De Shazer, S. & Berg, I. (1997) What works? Remarks on research aspects of solution-
focused brief therapy, Journal of Family Therapy, vol. 19, no. 2, pp. 121124.
De Shazer, S., Berg, F., Lipchik, E., Nunnaly, E., Molnar, A., Gingerich, W. & Weiner-
Davis, M. (1986) Brief therapy, Family Process, vol. 25, pp. 207221.
Deal, A., Trivette, C. & Dunst, C. (1988) Family Functioning Style Scale, in Enabling
and Empowering Families, eds C. Dunst, C. Trivette & A. Deal, Brookline Books,
Cambridge, pp. 175184.
Dunst, C. & Leet, H. (1987) Measuring the adequacy of resources in households with
young children, Child: Care, Health and Development, vol. 13, pp. 111125.
Egan, G. (1998) The Skilled Helper, Brooks/Cole, Pacific Grove.
Elizur, Y. (1996) Involvement, collaboration, and empowerment: a model for
consultation with human-service agencies and the development of family-oriented
care, Family Process, vol. 35, pp. 191210.
Elizur, Y. & Minuchin, S. (1989) Institutionalizing Madness: Families, Therapy and Society,
Basic Books, New York.
Eurostat (2000) European Social Statistics: Income, Poverty and Social Exclusion, Eurostat,
Luxembourg.
INTERVENTION WITH MULTI-PROBLEM POOR CLIENTS 203

Henggeler, S. (1999) Multisystemic therapy, Child Psychology & Psychiatry Review, vol. 4,
pp. 214.
Hines, P. (1989) The family life cycle of poor black families, in The Changing Family Life
Cycle, eds B. Carter & M. McGoldrick, Allyn and Bacon, Boston, pp. 513544.
Imber-Black, E. (1987) Families and Larger Systems, The Guilford Press, New York.
Kagan, R. & Schlosberg, S. (1989) Families in Perpetual Crisis, Norton, New York.
Kaplan, L. (1986) Working with Multi-problem Families, Simon & Schuster, New York.
Lee, M. (2003) A solution-focused approach to cross-cultural clinical social work
practice: utilizing cultural strengths, Families in Society, vol. 84, no. 3, pp. 385395.
Linares, J. (1997) Modelo sistemico y familia multiproblematica, in La intervencion
sistemica en los servicios sociales ante la familia multiproblematica, eds M. Coletti &
J. Linares, Paidos, Barcelona, pp. 2344.
Madsen, W. (1999) Collaborative Therapy with Multi-stressed Families, Guilford Press,
London.
Maturana, H. & Varela, F. (1980) Autopoesis and Cognition, Reidel, Boston.
McCubbin, M. (1989) Family stress and family strengths, Research in Nursing and Health,
vol. 12, no. 2, pp. 101110.
McMillen, J., Morris, L. & Sherraden, M. (2004) Ending social works grudge match:
problems versus strengths, Families in Society: The Journal of Contemporary Social
Services, vol. 85, no. 3, pp. 317325.
Miles, M. & Huberman, A. (1984) Qualitative Data Analysis, Sage, Beverly Hills.
Minuchin, P. (1995) Children and family therapy: mainstream approaches and the special
case of multicrisis poor, in Integrating Family Therapy, eds R. Mikesell,
D. Lusterman & S. McDaniel, APA, Washington, pp. 113123.
Minuchin, P., Colapinto, J. & Minuchin, S. (1998) Working with Families of the Poor, The
Guilford Press, New York.
OHanlon, W. & Weiner-Davis, M. (1989) En busca de soluciones, Paidos, Barcelona.
Rojano, R. (2004) The practice of community family therapy, Family Process, vol. 43,
pp. 5977.
Saleebey, D. (1997) The Strengths Perspective in Social Work Practice, Longman, White Plains.
Saleebey, D. (2001) The diagnostic strengths manual?, Social Work, vol. 46, no. 2,
pp. 183187.
Seikkula, J., Arnkil, T. & Erikson, E. (2003) Postmodern society and social networks:
open and anticipation dialogues in network meetings, Family Process, vol. 42,
pp. 185203.
Sharlin, S., Shamai, M. & Sharlin, S. (2000) Therapeutic Intervention with Poor Unorganized
Families: From Distress to Hope, Haworth Press, London.
Sousa, L. & Eusebio, C. (2005) When multi-problem poor individuals values meet
practitioners values!, Journal of Community & Applied Social Psychology, vol. 15,
pp. 353367.
Walsh, F. (1995) From family damage to family change, in Integrating Family Therapy, eds
R. Mikesell, D. Lusterman & S. McDaniel, APA, Washington, pp. 587606.
Waters, D. & Lawrence, E. (1993) Competence Courage and Change, Norton, New
York.

Liliana Sousa is Auxiliary Professor at the University of Aveiro. Address: Department


of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal. [email: lilianax@
cs.ua.pt]
204 JOURNAL OF SOCIAL WORK PRACTICE

Claudia Ribeiro is a Psychologist, Research Assistant at the University of Aveiro.


Address: Department of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal

Sofia Rodrigues is a Psychologist, Research Assistant at the University of Aveiro.


Address: Department of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal