Handbook of

Clinical Sociology
Second Edition
 CLINICAL SOCIOLOGY
Research and Practice
SERIES EDITOR:
John G. Bruhn, New Mexico State University
Las Cruces, New Mexico

CLINICAL SOCIOLOGY: An Agenda for Action

John G. Bruhn and Howard M. Rebach

HANDBOOK OF CLINICAL SOCIOLOGY (Second Edition)

Edited by Howard M. Rebach and John G. Bruhn

THE LIMITS OF IDEALISM: When Good Intentions Go Bad

Melvyn L. Fein

THE PARTNERSHIP MODEL IN HUMAN SERVICES: Sociological

Foundations and Practices
Rosalyn Benjamin Darling

RACE AND MORALITY: How Good Intentions Undennine Social Justice and
Perpetuate Inequality
Melvyn L. Fein

A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume
immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact
the publisher.
 Handbook of
Clinical Sociology
Second Edition

EDITED BY

HOWARD M. REBACH
University of Maryland, Eastern Shore
Princess Anne, Maryland

AND

JOHN G. BRUHN
New Mexico State University
Las Cruces, New Mexico

Springer Science+Business Media, LLC

 Library of Congress Cataloging-in-Publication Data

Handbook of clinical sociology/edited by Howard M. Rebach and John G. Bruhn-2nd ed.

p. cm.-(Clinical sociology)
Includes bibliographical references and index.
ISBN 978-1-4613-5445-1 ISBN 978-1-4615-1217-2 (eBook)
DOI 10.1007/978-1-4615-1217-2
1. Clinical sociology-Handbooks, manuals, etc. 1. Rebach, Howard M. II. Burhn, John
G., 1934- III. Series.
[DNLM: 1. Social Medicine. 2. Sociology, Medical.]
HM585 .H35 2001
30l-dc21
2001029650

ISBN 978-1-4613-5445-1

© 200 I Springer Science+Business Media New York

Originally published by Kluwer Academic I Plenum Publishers, New York in 200 I
Soflcovcr rcprint ofthc hardcovcr 2nd cdition 2001

10 9 8 7 6 5 4 3 2
A C. LP. record for this book is available from the Library of Congress
AII rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form Of by any
means, electronic, mechanical, photocopying, microfilmmg, recording, or otherwise, without written permission
from the Publisher.
 To all my students and teachers with thanks
for all you have taught me.
HMR

To the faculties in sociology at the University of

Nebraska, Lincoln (1952-1958) and Yale University
(1958-1961), who were role models of excellence
in teaching, research, and service.
lGB
 Contributors

L. Jay Bishop, Department of Social Science, University of Maryland Eastern Shore, Princess
Anne, Maryland 21853

Sarah Brabant, Department of Sociology and Anthropology, University of Louisiana at

Lafayette, Lafayette, Louisiana 70504

John G. Bruhn, College of Health and Social Services, New Mexico State University, Las
Cruces, New Mexico 88003

Nathan Church, St. Cloud State University, St. Cloud, Minnesota 56301

Antoinette Coleman, School of Social Work, Norfolk State University, Norfolk, Virginia
23504

John F. Glass, Studio City, California 91604

Sue Hoppe, Department of Psychiatry, University of Texas Health Sciences Center, San
Antonio, Texas 78284

Joyce Miner Iutcovich, Keystone University Research Corporation, Erie, Pennsylvania

16502

Beverley Cuthbertson Johnson, Southern Desert Medical Center, Tempe, Arizona 85282

Ross Koppel, Social Research Corporation, Wyncote, Pennsylvania 19095

Bonnie L. Lewis, Department of Sociology and Criminal Justice, Southeastern Louisiana

University, Hammond, Louisiana 70402

Mildred A. Morton, Falls Church, Virginia 22044

F. Dale Parent, Department of Sociology and Criminal Justice, Southeastern Louisiana

University, Hammond, Louisiana 70402

Darlene L. Piiia, Department of Sociology, California State University at San Marcos, San
Marcos, California 92096
vii
viii CONTRffiUTORS

Howard M. Rebach, Department of Social Science, University of Maryland Eastern Shore,

Princess Anne, Maryland 21853

Bruce Saunders, College of Education, University of Washington, Seattle, Washington

98115*

Mary C. Sengstock, Department of Sociology, Wayne State University, Detroit, Michigan

48202

Barbara Sims, School of Public Affairs, Penn State Harrisburg, Middletown, Pennsylvania
17057

*Also a Senior Member of CSA, an international symposium of practicing social scientists

 Foreword

I am delighted that this book is coming out in a second edition a decade after its original
publication in 1991. There is a wealth of wisdom and experience reflected in these chapters, as
well as a wide variety of examples of sociology in action.
In the past decade there have been momentous changes in our society that cry out for
sociological insight useful for solving problems and creating change. The United States has
become far more racially and ethnically diverse. Our workplaces are facing the challenges of
the global economy, our healthcare system demands reform, and in many parts of the country
we are facing housing, education, and environmental challenges far more extensive and
complex than was the case a decade ago. We increasingly recognize that poverty, homeless-
ness, and drug abuse, for example, are not simply the individual derelictions of deviants, but
also reflect a disordered social system.
Clinical sociology is the application of social theory and a sociological perspective to
facilitate change. Clinical sociologists are primarily change agents who work with a client-
an individual, family, group, organization, or community. Good practice is informed and
guided by theory; it is a creative process involving feelings, intuition, risk taking, and prob-
lem solving as so many chapters in this book amply illustrate. I have always admired Kurt
Lewin's dictum "There is nothing so practical as a good theory." Lewin also believed that the
best way to understand something is to try to change it. Theory and practice are two sides of the
same coin.
Practitioners from other disciplines such as social work, psychology, public policy,
education, and management (to name a few), are visible and active in taking on social
intervention roles that necessitate consideration of the often dysfunctional social systems in
which their clients take part. But, sociologists are trained to look at society, social interaction,
and social issues from a social systems perspective and are the logical persons to facilitate
change. Clinical sociology can only flourish if its practitioners do good work, identify
themselves as sociologists, their work as sociological, and disseminate what they do to a larger
public.
Sociology itself is largely invisible: if you ask the average citizen what a sociologist is,
you will do well if the answer distinguishes sociologist from socialist or social worker. A
recent example of this invisibility is Bowling Alone (New York: Simon & Schuster, 2000),
Harvard Professor of Public Policy Robert Putnam's brilliant sociological analysis of the
decline of American community. His scholarly book is full of sociological insights and
suggestions for change, yet nowhere is the book identified as a work of sociology, nor are his
sociological collaborators identified as such.
Handbooks such as this are all too often only found on the shelves of professors and
libraries. That should not be the fate of this book with its mix of intervention techniques and
substantive areas for change. Hopefully it will find a wide audience among scholars and
ix
x FOREWORD

practitioners in sociology and allied fields, policymakers, and especially among introductory
and advanced sociology students to excite them about the challenges and opportunities of
sociological practice.

JOHN F. GLASS
Studio City, California
 Preface

This book is an outgrowth of the reemergence of clinical sociology as a formally organized

subdiscipline. In the late 1970s, a group of sociologists met and formed the Clinical Sociology
Association. This organization was formed outside the mainstream of sociology, largely
because these individuals were actively engaged in intervention and social change but did not
find mainstream sociology supportive of their efforts. However, these individuals felt the need
to establish a community of interest and share information. They also felt that, by organizing,
they could increase awareness of sociological practice and be a catalyst for further developing
the discipline.
We feel that, after a decade, it is appropriate to assess our present status and suggest
directions for its further development and encourage sociologists and allied disciplines to join
in the progress of clinical sociology and sociological practice. Therefore, we submit this book
with samples of contributions from clinical sociologists over the past decade.

OBJECTIVES

In our selection of topics and chapters, we were guided by three principal objectives:
(1) to present a representative selection of current practice activities and issues; (2) to present a
broad spectrum of the field; and (3) to expose readers to a variety of perspectives, general
practice concerns, the practice of clinical sociology in specific settings, the work of clinical
sociologists with special populations, and to examine issues of identity and future directions of
clinical sociology.
The contributors to this volume are themselves actively engaged in the application of
sociological knowledge, methods, and theory to active intervention. They work as sociolo-
gists. Their contributions draw heavily on their own work in illustrating clinical sociology;
therefore, the Handbook provides a resource and a guide for sociologists and others on how
people have done clinical sociology.

ORGANIZATION

The book is organized around practice concerns, specific settings, and special populations
as frameworks. In addition, we have attempted to cover the social spectrum from the individ-
ual to small groups, organizations, and community settings. The parts in this book are
organized as follows:
Part I outlines the definition and history of clinical sociology.
Part II contains chapters that outline the common concerns of sociological practitioners.
xi
xii PREFACE

Part III portrays the practice of clinical sociology in several specific settings.
Part IV describes the work of clinical sociologists in mental health settings and with
ethnic minorities, women, the elderly, and substance abusers.
The Handbook is inteded for persons in a number of fields who are related to the practice
of clinical sociology. We hope the book will be useful to three target audiences. First, to upper-
level undergraduate and beginning graduate students, we offer it as an introduction to clinical
sociology and a resource for career decisions. Second, to our sociological colleagues, we offer
it in hope that they will appreciate a reemergence of the historic role of sociologists as working
for positive social change. We also offer the book to those who wish to develop courses and
curricula in clinical sociology, to sociology students, and to others who can benefit from seeing
sociology in action. Third, we offer the Handbook to our colleagues in other clinical disci-
plines, who explore tried and untried strategies to seek solutions to social problems. Finally, to
all our readers, our intent was to make this a practical handbook.
We are grateful to Paula L. Levine for her expertise in editing numerous drafts of
manuscripts and in the reading of the proofs.

HOWARD REBACH
JOHN G. BRUHN
 Preface to the Second Edition

It has been 10 years since we edited the first edition of the Handbook of Clinical Sociology.
During this time, a large number of sociologists and other social and behavioral scientists have
used the text in teaching applied and clinical sociology. Students today are interested in what
sociology (and other disciplines) can offer in preventing, reducing, or resolving the seemingly
overwhelming number of social problems that face the United States and the world. Certainly
social problems are not the exclusive territory of any single discipline.
Social problems have complex causes, histories, and life cycles; they elude easy solutions
and magic bullets. The speed and pervasiveness of social change and the erosion of social trust
and social capital have created a sense of helplessness among professional problem solvers
who wonder where to start. Political and media attention, like a butterfly among the flowers,
drifts from problem to problem focusing on the problem of the moment. We are not a society
that values prevention, preferring instead to marshal resources after a problem has been
defined as having reached crisis proportions, spend millions of dollars trying to uncover
causes, and put together politically acceptable programs to try to ameliorate the crisis. In
addition, the tendency has been to look at each problem as an isolated problem. There is a
critical need for scholars and students of human behavior to devote serious thought to the
analysis and change of unhealthy and deeply rooted behavior patterns and develop strategies
for intervention based on reality. We need leaders in the social and behavioral sciences to step
forward and help frame solid action plans to stop the erosion of our social fabric.
After slightly more than a decade, it is appropriate to take stock of the still developing
field of clinical sociology and sociological practice, reinforce the methods that practitioners
and clinicians have available to use in problem solving, and assess where we stand with respect
to some of the more pressing social problems. Finally, we would like to convince more stu-
dents in the social and behavioral sciences, and our colleagues in these areas that any
alleviation of our common social problems requires action on our part as experts and leaders in
our collective fields of human behavior. Whether thinkers or doers, we should exert our
responsibility as citizens and professionals in making our world safer, more livable, and more
humane. We hope the second edition of the Handbook is a contribution toward that goal.

OBJECTIVES

A handbook is a collection of the experiences, opinions, and data of experts in a defined

broad field. It is limited in inclusiveness by space and therefore we invited contributions from
authors who we regard as good analysts in their areas of expertise. We selected authors who
were personally involved in the teaching and the practice of clinical sociology. The Handbook,
therefore, is meant to be a practical resource for students and teachers of sociology and related
xiii
xiv PREFACE TO THE SECOND EDITION

disciplines. Our intent is to illustrate what has been done, what remains to be done, and the
tools by which to do it. Our primary objective in compiling the Handbook has been to convey
both the opportunities and the challenges that face sociology and the social and behavioral
sciences. We also want to create a sense of enthusiasm for becoming a part of the solution to
societal problems; we will be successful if we can stimulate readers' eagerness to apply their
education and training to address society's woes.

PLAN OF THE BOOK

The book is organized in five parts. In Part I, five chapters are devoted to discussing
general issues in clinical sociology: linking theory to practice; outlining what is meant by
intervention; presenting principles and guidelines that govern the professional-client relation-
ship; codifying the ethics of practice; and placing sociological practice into the context of
social change.
In Part II, five chapters discuss intervention at various levels of social organization, from
work with individuals to work with organizations. Part III includes four chapters that reflect
very specific kinds of sociological practice: conflict resolution, program evaluation, social
policy work, and preventive programming.
The chapters in Part IV take a detailed look at some contemporary social problems with
some attention to sociological analysis of the problems, as well as roles for clinical sociolo-
gists as change and intervention agents.
Finally, in Part V Bruhn has illustrated many different paths that clinical sociologists
have taken that led them to the field and the work they do today. This may serve to guide others
whom we hope we have influenced in preparing themselves for this work.
We have compiled the Handbook with the aim that it have broad appeal to our students
and colleagues not only in sociology but also in other social and policy sciences. We have tried
to make it practical, relatively free of jargon, and with frequent examples so that readers can
learn from both the successes and failures of various interventions. We think the Handbook
will be useful to both undergraduate and graduate students and as a companion to our text
Clinical Sociology: An Agenda for Action.

HOWARD M. REBACH
JOHN G. BRUHN
 Contents

PART I THE FIELD OF CLINICAL SOCIOLOGY 1

Chapter 1 • Theory, Practice, and Sociology 3

Howard M. Rebach and John G. Bruhn

Chapter 2 • Intervention in Clinical Sociology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Howard M. Rebach

Chapter 3 • Communication and Relationships with Clients .. . . . . . . . . . . . . . . . . . . 37

Howard M. Rebach

Chapter 4 • Ethics and Sociological Practice 53

Joyce Miller Iutcovich and Sue Hoppe

Chapter 5 • The Effects of Social Change on Clinical Practice 75

Nathan Church

PART II LEVELS OF INTERVENTION 89

Chapter 6 • Work with Individuals 91

Beverley Cuthbertson Johnson

Chapter 7 • Work with Families 113

Antoinette Coleman

Chapter 8 • Group Work 133

L. Jay Bishop

Chapter 9 • Sociological Work in Communities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Mary C. Sengstock

Chapter 10 • Intervention in Fonnal Organizations: Lessons from Interventions

in Public Schools 169
Bruce Saunders
xv
xvi CONTENTS

PART III TOOLS OF PRACTICE 195

Chapter 11 • Mediation and Alternative Dispute Resolution . . . . . . . . . . . . . . . . . . . . 197

Howard M. Rebach

Chapter 12 • Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 225

Ross Koppel

Chapter 13 • Social Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 251

Mildred A. Morton

Chapter 14 • Preventive Programming 267

John G. Bruhn

PART IV APPROACHES TO CONTEMPORARY SOCIAL PROBLEMS 291

Chapter 15 • Healthcare Equity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293

Bonnie L. Lewis and F Dale Parent

Chapter 16 • Domestic Violence 313

Barbara Sims

Chapter 17 • Racism and Diversity in U.S. Society: Issues for Clinical Sociologists 327
Darlene L. Piiia

Chapter 18 • Poverty, Social Welfare, and Public Policy 353

Antoinette Coleman and Howard M. Rebach

PART V IN CLOSING 393

Chapter 19 • On Becoming a Clinical Sociologist . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395

John G. Bruhn

Exhibit A • Discovering Clinical Sociology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 411

John F Glass

Exhibit B • How I Became a Clinical Sociologist 415

Sarah Brabant

Exhibit C • How I Became a Clinical Sociologist ... . . . . . . . . . . . . . . . . . . . . . . . .. 419

Beverley Cuthbertson Johnson

Index. .. . . . . .. . .. .. . .. .. . . . .. .. .. .. .. .. . .. .. . 423
 PART I

THE FIELD OF
CLINICAL SOCIOLOGY

Twenty years have passed since a small group of sociologists banded together, formed an
organization, and gave renewed currency to the term clinical sociology. These sociologists
were clearly outside the mainstream of the discipline. Their goal was to gain recognition for
sociologists applying the skills and knowledge base of sociology to solve problems in real
social systems.
One stimulus for the interest in the application of sociology has been the developing
evidence of the inadequacy of the "individual bias" in solving problems that have their origin
in, and are maintained, because of social arrangements. The term individual bias refers to a
perspective, deeply rooted in U.S. culture, that approaches the solution to social problems by
trying to change individuals' behaviors on a case-by-case basis. The individual is seen as
deviant, or unmotivated, or inadequate and needing to be "fixed" in order to solve the social
problem. What we call clinical sociology involves sociologists in direct intervention activities
operating from a sociological perspective that views behaviors-both normative and deviant-
as cultural expressions and views social problems as outgrowths of social arrangements.
The notion of a "clinical" sociology is not exactly a household phrase. But the idea of
joining the perspectives, knowledge, theory, and methods of sociology with active interven-
tion and problem solving dates back to the roots of sociology as a discipline and social science.
In this Handbook, we have tried to show the diversity of clinical sociology across the
sociological spectrum from the microlevel to the macrolevel. This reflects our belief in the
applicability of sociological knowledge to human problems; it also reflects what clinical
sociologists actually do.
The chapters in this first section cover topics that apply across the spectrum. The section
begins with an overview of clinical sociology as a subdiscipline and includes a developmental
review. The first chapter also calls attention to a major theme in the history of sociological
practice-the tension between application of sociological knowledge to address social prob-
lems and academic sociology that emphasizes theory construction. This is the tension between
"pure" and "applied" science and touches on the relationship between theory and practice. A
second theme in the opening chapter that reappears in subsequent chapters is the role of values
and ethical practice in clinical sociological work.
Chapter 2 continues the broad overview of clinical sociology and the theme of its
diversity. The chapter also identifies certain guiding themes that apply across levels of inter-
vention; these include the way that problems are defined and the way that the scientific method
is applied to intervention. The chapter discusses the process of intervention and offers a
general schema for understanding the stages of intervention. Finally, the themes of sociology
2 PART I

as the knowledge base and the issue of values round out a general discussion of sociologically
based intervention.
Chapter 3 emphasizes the fact that all clinical work involves communication and relation-
ships with clients. Effective intervention requires establishing effective working relationships
with clients and members of the client system. Ethical practice and humanistic values are the
basis for the suggestions that the chapter offers.
Clinical sociologists must pay attention both to ethical practice and, perhaps more than
other disciplines, to the effects of social change on practice. Codes of ethics serve a very prac-
tical function: they provide guidelines and support and offer direction in what are often
ambiguous situations. Chapter 4 deals with the code of ethics for sociological practice in
detail. Practice is about bringing about positive social change, but changes in the larger society
set the context for practice. Chapter 5 closes the section with a thoughtful discussion of the
effects of social changes on practice.
 CHAPTERl

Theory, Practice, and Sociology

HOWARD M. REBACH AND JOHN G. BRUHN

INTRODUCTION

During the course of the twentieth century, the population of the world increased from less
than 2 billion to about 6 billion people. With this increase has come increasing demands on the
world's resources, global warming and increasing pollution of our environment, and the
potential for shortages of food and fuel and fouling of air and water. The world carries into the
twenty-first century the social problems of the twentieth: ethnic conflict, the growth and
centralization of corporate power, an increasing gulf between the haves and have-nots, all
problems that threaten the existence of democratic institutions in both the developed part of
the world as well as the developing nations. If the world's citizens are to address these
problems, we will need a combination of scientific knowledge, wisdom, and activism. We
contend that well-trained sociological practitioners can and should take their place among
those working on solutions.
This book is about the application of sociology, the joining of sociological perspectives,
theory, knowledge, and skills with active intervention. In our previous work, we and others
have defined clinical sociology as the use and application of sociological theory, methods, and
findings to bring about social change at the individual, small group, organizational, commu-
nity, institutional, or social system level (Bruhn & Rebach, 1996; Kallen, 1995; Rebach &
Bruhn, 1991). We agree with Freedman (1989) who added that intervention knowledge and
skills also distinguish clinical sociology, especially as these are used to deal with emerging
social problems. The uniqueness of clinical sociology is its focus on active intervention for
change and problem solving. It is this focus that distinguishes clinical sociology from other
areas within the field of sociology. In this introductory chapter, we will give a brief develop-
mental history of clinical sociology and then a consideration of sociology as a field and what it
has to offer. We will then discuss the relationship between clinical and pure sociology.

HOWARD M. REBACH • Department of Social Science, University of Maryland Eastern Shore, Princess Anne,
Maryland 21853. JOHN G. BRUHN' College of Health and Social Services, New Mexico State University, Las
Cruces, New Mexico 88003.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. KIuwer
Academic/Plenum Publishers, New York, 2001.

3
4 HOWARD M. REBACH AND JOHN G. BRUHN

CLINICAL SOCIOLOGY: A DEVELOPMENTAL REVIEW

Sociology emerged as a discipline in the late nineteenth century in response to the rapid
social changes brought on by urbanization, industrialization, and the scientific and technologi-
cal advances that hastened the passing of agrarian society and raised the curtain for complex
modem society. It had its roots in European philosophy, economics, and political science.
Nineteenth-century thinkers and writers such as Auguste Comte, Karl Marx, Herbert Spencer,
Emile Durkheim, and Max Weber all contributed theories to sociology that are still studied
today.
The first references to clinical sociology came in 1930 and 1931 when Yale University
proposed establishing a Department of Clinical Sociology (Kallen, 1995). About the same
time, Wirth (1931/1982) described the role of clinical sociologists in child guidance clinics.
Community development also emerged as a major theme. Saul Alinsky, a leader of this effort,
involved local people in an early war on poverty (Alinsky, 1934/1984). Before and after World
War II, sociologists who were also members of minority groups, such as W. E. B. Du Bois,
were both scholars and activists and made significant contributions to the understanding of and
change in race relations in the United States. Other sociologists, such as Gunnar Myrdal, with
his now-classic book, An American Dilemma, helped raise people's consciousness about the
damaging effects of racial discrimination in the United States. Robin Williams codified
existing sociological knowledge to help in reducing hostility and tension between groups.
William Foote Whyte was concerned with the application of sociological relationships to
human problems. And Nelson Foote was instrumental in applying what sociologists knew
about families to help agencies work with their clients. In 1949 and 1950, a four-volume work,
Studies in Social Psychology in World War II described the U.S. Army's application of scien-
tific evidence to deal with human behavior and to develop a system for deciding who would be
discharged (Kallen, 1995). Through the 1960s and 1970s sociologists maintained an interest in
the application of sociology which continues to the present.
In the United States, as in Europe, early sociology was characterized by debate over
whether or not sociology can or should adopt a "pure science" stance and be "value neutral,"
as the physical and natural sciences were perceived to be, or should sociology be directly
involved in reform and social action. Thus, the beginnings of clinical sociology became
enmeshed in the controversies associated with the beginnings of sociology. The post-World
War II era saw a growth in sociology aided by grants from major government agencies, the GI
Bill for returning veterans, and the growth of new programs and projects in universities. As
part of this growth, new specialties developed in the field, for example, criminal justice, family
studies, and therapy. The development of these subfields often had the effect of segregating the
theoretical and applied interests of sociologists. Those who were more "applied" were seen as
"atheoretical" and different from their more theoretically oriented colleagues. Indeed, soci-
ology paralleled the specialist model of other disciplines such as psychology and anthropol-
ogy. As Lee (1984) has noted, the barriers to clinical sociology that existed to some degree in
sociology's early history seemed to grow stronger in the 1950s and 1960s and they persist
today.
Actual participation in social action is viewed by some sociologists as a violation of the
"value neutral" stance of the discipline thus creating a further division within the discipline
between "pure" and "applied." The proliferation of specialties within sociology has also led
to a gap between sociologists who want to apply their knowledge and skills in practical
problem solving and those who regard such colleagues as "clinicians" who disregard socio-
logical theory (Turner, 1998). The formation of separate organizations has helped formalize
this perceived gap.
THEORY, PRACTICE, AND SOCIOLOGY 5

In the last decade, the viability and utility of sociology itself have come under scrutiny
(Howerth, 1985; Couch, 1995; Snow, 1999). This scrutiny has given rise to questions: What
makes sociology unique? Is it a science? Let us tum briefly to a consideration of sociology
keeping in mind the questions: Of what value is sociology? What does it have to offer?

SOCIOLOGY

Sociology is one of many fields and disciplines that study human behavior. Each has its
perspectives and paradigms but there is no royal road to truth. The perspective of sociology
offers a way of studying behavior that distinguishes it, somewhat, from other approaches to
the study of human behavior. This perspective begins with the most basic fact that human life
is social life. The concern is with the development, functioning, and change of sociocultural
systems, the familiar groups we encounter in our daily lives, and individuals and how each of
these levels affects and is affected by the others. It is a broad perspective that encompasses the
continuum from the macrosocial to the individual.
A fundamental notion in sociology is that large components of individuals' lives as well
as those things labeled as social problems can be traced to what are referred to as "social
arrangements," the organization of the social system, its norms, shared beliefs, values, status
structure, and so on. Social arrangements limit individuals' options, shape their predisposi-
tions, and channel most people's range of possible choices into a few of the more probable.
Goals are prescribed as are the acceptable means for their achievement.
A society's members' "inherit" social arrangements; that is, each of us is born into a
preexisting society and language community complete with its technology, its history, shared
meanings and ways of doing things-all the material and nonmaterial aspects of a culture. A
society's members are socialized, that is, taught, within a particular niche characterized by
time and place and other factors. For example, no social system rewards its members equally
nor gives them equal access to the opportunity structure. Yet all members must play the hand
they're dealt according to rules they did not make. They choose actions that they feel will meet
their needs as they have been taught to define them. Their actions are a reflection of what they
have learned within their social niche.
The perspective of sociology notes that both normative behavior and those things labeled
as social problems are a reflection of social arrangements. For example, in the United States,
from competition within a global economy to the economic pressures on families as well as
other social changes in the latter half of the twentieth century, most parents in most households
have to be in the work force. Social critics of all stripes who bemoan the decay of "family
values" may (perhaps outside of their own awareness) be harking back to an agrarian epoch in
which children and youth worked alongside their family members on a daily basis and
absorbed their teachings through daily contact. But the economic and social changes that have
led to parents' employment away from home leave children without adult supervision for
much of the time. This may be related to alcohol and drug experimentation, early sexual
experience, teen and single parenthood as well as various forms of delinquency. Social prob-
lems are interlinked with and arise from and are maintained by existing social arrangements.
Whether behavior patterns are acceptable or problematic is yet another reflection of
social arrangements. The definition of some condition as a social problem rests with those with
the power to label the condition as a problem, bring it to public attention, and make their label
stick. Consider the history of race relations in the United States. For example, in Plessy v.
Ferguson, the courts established that discrimination was acceptable with the doctrine of
separate but equal. Fifty-six years later, in Brown v. Board ofEducation, Topeka, separate but
6 HOWARD M. REBACH AND JOHN G. BRUHN

equal was found inherently unequal. Through the early part of the twentieth century, few
would have defined racism, segregation, and discrimination as a social problem. By the latter
half of the twentieth century, few would deny that race relations were clearly a problem for the
society as a whole as well as a problem for individuals and families.
Institutional racism remains a social problem. No doubt there are prejudiced individuals
and individuals who discriminate against others on the basis ofrace/ethnicity (or gender, age,
sexual orientation, religion, and the like). A sociological perspective might prompt us to ask
how they came to be that way. They had to be socialized-taught and reinforced within their
social niche for these ways of defining people and situations and for ways of acting.
The same might be said for domestic violence and abuse of women. The activities that
these labels refer to are hardly new to social life and domestic relations. Social rules that gave
husbands virtual ownership of their wives and families were supported by custom, law, and
religion and still are in many parts of the world. The vestiges of patriarchal ideologies still
exert influence today. The emergence of domestic violence and abuse of women as social
problems has come about through social changes, some of which have been associated with
the feminist movement. As with racism, activists raised people's consciousness about the
issues leading to a redefinition of what is appropriate behavior.
As we have attempted to illustrate briefly here, the sociological perspective is one way of
looking at and understanding human behavior and factors that influence it. In addition to the
sociological perspective, the discipline has a scientific base and scientific values regarding the
production of knowledge. Any reasonable discussion of what sociology is includes a set of
explanations of social life and the process of social change; especially the latter. The construc-
tion of theory supported and tested empirically constitutes the scientific work of the academic
discipline of sociology. Over time, the field has developed an array of empirical methods and
analytical techniques to aid in the development and testing of knowledge claims.
The terms academic discipline and social science have as their referent the work of soci-
ologists interested in "basic" research, the development of methodology and theory. "Pure"
research applies to activities designed to expand knowledge which may, in tum, eventually
contribute to theory development. As in all scientific fields, the goal of theory development in
sociology is to provide general explanations of phenomena addressed by the discipline.
By "general explanations" we refer to a theory as a set oflogically consistent statements
that explain relationships between antecedent conditions and consequences that are not tied to
specific times or places. For example, it may be possible to describe and explain events that led
to conflict and ethnic cleansing in Kosovo in the 1990s. This is ideographic explanation-the
explanation of a specific historical event. However, scientific theory strives for nomothetic
explanation. A successful theory of ethnic conflict, for example, would provide explanatory
principles not tied to time or place. The theory would be applicable to understanding of the
Spanish response to Jews in the fifteenth century, the French response to Huguenots in the
seventeenth century, racism in the United States as well as ethnic conflict in Northern Ireland,
Rwanda, Ethiopia, Bosnia, Kosovo, and all the other places in today's news.
But theory construction is not simply an armchair activity. The scientific work includes
the research effort that may eventually lead to theory development as well as research designed
to test the validity of the theory by testing, attempting to verify, specific predictions derived
from the theory. The more such predictions are verified, the greater the confidence we have in
the validity of the theory.
All of this comes under the heading of "academic" or "basic" or "pure" research. It is
knowledge production for the sake of knowledge production, that is, the production of
knowledge is itself valued. It is in this context that a closely related value emerges: the idea
THEORY, PRACTICE, AND SOCIOLOGY 7

that scholars can and should and must pursue knowledge wherever such pursuit takes them.
That is, they must remain "value free," unencumbered by established, accepted, or revealed
"truth." (Of course, this is, in itself, a "value" but we can put aside that discussion for another
day.) "Value free" also refers to the application of the scientific method with its decision rules
for the acceptance or rejection of hypotheses along with the idea that investigators must accept
the empirical evidence regardless of their own values and predispositions.
Theory development can have useful practical consequences for problem solving. A
theory is an explanation; when fully developed a theory about some phenomenon explains
why the phenomenon occurs, how certain antecedent conditions lead to certain observed
outcomes and what factors keep those outcomes in place or alter them. Sociological theory
development is directed toward human behavior and social life. As Collins (1988:119) wrote,
theory is directed at fundamental questions: "why are things as they are, what conditions
produce them, and what conditions change them into something else? If we have such a theory,
we will at last be in a position to know what we really can do about the shape of our society."
For example, a complete theory of ethnic conflict not only might suggest the causes of such
conflict but might also direct attention to the factors that need to be addressed to reduce or
eliminate it. Such a theory would also address how to manipulate these factors to achieve
desirable social changes.
In sum, then, sociology directs our attention to the study of human behavior, and directs
our attention to the development of social structure, its change, and its consequences. It
includes the application of the scientific method for the development, testing, and refinement
of theory. What it has to offer that is useful is a way of understanding social life and problems
within it and answering questions and solving problems that involves theory and careful
systematic analysis supported by empirical data. Its value goes beyond understanding. It can
be of value as understanding is applied to decision making and solving human problems.

CLINICAL SOCIOLOGY IS SOCIOLOGY

Of interest to those of us who call ourselves "clinical sociologists," another question has
been raised: Why do sociologists who are interested in applying the theories, principles,
concepts, and methods of the field have to be marginalized by their peers (Turner, 1998)? As
Turner (1998:250) pointed out, "the early founders of sociology all had a vision of using
sociology." Straus (1985) is another who held that sociology is eminently practical. Straus
asked, if sociology is not to be used to make sense out of life, what is its purpose? Why, then,
"do sociologists debate who is and who is not a real sociologist, dismissing those who apply or
practice sociology as clinicians without accepted credentials and theoretical rules of thumb"
(Turner, 1988:252; Babbie et aI., 1998).
Babbie (1994) pointed out that sociology involves the study of human beings. More
specifically, it is the study of the interactions and relations among human beings. Society is a
living laboratory. Sociology provides the opportunity to study the constant process of social
change and its continuous effects on human behavior; a moving picture that never stops. Some
sociologists have prided themselves as being observers and social critics who remain value
free and noninvolved with their subjects. But of what use is it to observe, document, and
discuss human issues and problems? Of what use is it to seek to develop theory, if one never
acts to apply principles, concepts, and research findings to guide change to achieve positive
outcomes? Bystanders are criticized for not being involved. It might appear that they do not
care to take on the risks of involvement. As the world becomes smaller and more complex,
8 HOWARD M. REBACH AND JOHN G. BRUHN

problems multiply. The intertwining of cultures, values, and behaviors increases the chances
of conflict and decreases the predictability of human behavior. This would seem to be a superb
natural laboratory for sociologists to develop and test theories, gather new facts, refine
methodologies, as well as evaluate the impact of interventions. Indeed, rather than question the
value, viability, and usefulness of sociology, it should be gaining preeminence and sociolo-
gists should be increasingly called on to be active practitioners. However, there appears to be
an inverse relationship between the increase in social problems and mainstream sociology's
involvement in them.
Many years ago, Street and Weinstein (1975:65) expressed the view that for sociology to
be of any use to publics besides other sociologists, it must "contribute sufficiently to our
understanding of how social institutions come into being, operate, change, and affect the
people who deal with them." They contended that "sociological knowledge is too important to
be monopolized by professors," that it is not for an elite but should genuinely serve the human
condition.
Clinical sociology is sociology. Clinical sociologists do the same things that other soci-
ologists do-they theorize, conceptualize, observe, test, evaluate, teach, do research, and
become involved in professional and community service. What clinical sociologists do that
other sociologists do not we call intervention, active involvement in various social systems
with the goal of positive social change. When they intervene, clinical sociologists are referred
to by their colleagues as clinicians, and seen as therapists much like psychologists and social
workers. Indeed, some clinical sociologists do have additional credentials as mediators,
marriage and family therapists or counselors, organizational or management consultants,
policy experts, and so on. These additional credentials do not detract from their sociological
training, but build on it. In-depth interviewing, focus group techniques, case histories, biogra-
phies and autobiographies, and the like are all techniques that can be added to the usual
sociological armamentarium. Clinical sociologists become involved in problems firsthand, but
remain well aware of the ethics of involvement and the limits of their intervention. The clinical
sociologist also is ready to work with other disciplines as it becomes apparent that most prob-
lems are more complex than the knowledge base of any single discipline. As Wirth (1931/1982)
held, "any single scientific viewpoint was inadequate to solve behavioral problems" (Larson,
1990). Thus, clinical sociologists put their sociological knowledge and skills into action. They
become involved in society's problems as professionals and as citizens.
A variety of pressures from outside sociology have also encouraged the activities of
applied and clinical practitioners, especially the growing intensity of social problems, the
downsizing of applied programs in general in universities, and declining enrollments in
sociology. Sociology is finding it difficult to compete as a career choice in a high-salaried,
hands-on job market. By the same token, clinical sociology is undergoing its own develop-
mental transitions (Robinette, 1992). As scholars of social change, sociologists are now
challenged to deal with social change in their own discipline; in particular, how to plan and
direct change to maximize its positive benefits.

THE MATURITY OF CLINICAL SOCIOLOGY

Foote (1996) pointed to certain "frontiers" or new directions for development in socio-
logical practice. One of these new directions is for clinical sociologists to convince our
sociological colleagues as well as others that clinical sociology is not fixed at the microlevel.
This is what Church (1991) meant when he noted that clinical sociology should not be just
THEORY, PRACTICE, AND SOCIOLOGY 9

another mental health profession. Not all interventions require "fixing" a person or situation.
As Foote stated, individuals who have been downsized or otherwise lose their job do not need
therapy, they need a job, a livelihood! Foote went on to note that it is the reciprocal
relationships between people that should be the focus of clinical sociological interventions.
That is not to say that individually focused interventions are unnecessary, but clinical soci-
ology is not just "fixing" individuals who are in trouble.
Another frontier concerns the perception that clinical sociology deals with qualitative and
descriptive data. For some reason clinical sociologists are perceived by some sociologists as
using (and perhaps overusing) the interview or case approach. In this way clinical sociology
has become stereotyped as a helping specialty much like social work, clinical psychology, and
counseling. The implication here is that descriptive data are less rigorous or less scientific. One
of the assets of sociology is its variety of methodologies. It is rare that sociologists focus all of
their efforts around one method, but rather calion a combination of skills as a situation
warrants. It is rare, even among clinical sociologists in full-time practice in an area like
marriage and family, that only one approach is used. Clinical sociologists also make use of
survey data, archival data, and the full range of quantitative techniques. It is the responsibility
of clinical sociologists to help to minimize the perceptions of the polarization of the meth-
odologies and levels of their practice.
A third frontier is that of identity and status. As specializations in sociology and new
organizations have been formed-and often shunned by mainstream sociologists-there are
concerns of how specialists will be perceived and treated. One of the ways to control
membership in organizations is to have strict rules of entry. Certification is one such rule.
Clinical sociologists have established certification as an important credential to provide
identity and status. Certification can serve useful purposes and enhance professionalization.
On the other hand, certification can exclude possible valuable colleagues who, for various
reasons, do not wish to undergo the steps leading to certification. Clinical sociology needs to
guard against becoming an exclusive club thereby alienating fellow sociologists and other
colleagues in related disciplines. Clinical sociology should not compete with other profes-
sionals by one-upping credentials for membership. Indeed, the societal problems of today call
for more collaboration rather than elitism.
A fourth frontier for clinical sociology is to establish more effective means of sharing
experiences and results of interventions with others in and outside of the field. Academicians
have annual meetings, journals, newsletters, interest groups, and the like, to provide for
information exchange and collegial bonding. Clinical sociologists do too. However, the
majority of clinical sociologists are not in academic positions and their rewards do not come
from writing papers to obtain tenure, so there is little incentive to write and see the results of
one's work disseminated. The work of clinical sociologists often yields a report that in tum
might lead to a policy or an organizational innovation. Sharing the process of how change
came about is often more useful than the outcome itself. Clinical sociologists need to be more
creative in finding ways to share what they do with peers and colleagues.
A fifth, and final, frontier is that sociologists need to do a better job of integrating knowl-
edge and practice. Typically in sociology programs graduates are imbued with theory and
often cannot see or are not given the opportunity to experience its applications. Wang Yang-
ming (1472-1529) put it succinctly when he said
knowledge is the beginning of practice; doing is the completion of knowing.
Men of the present, however, make knowledge and action two different
things and go not forth to practice, because they hold that one must
first have knowledge before one is able to practice.
10 HOWARD M. REBACH AND JOHN G. BRUHN

Perhaps this is where sociology could follow the teaching model of many professions, namely,
providing real opportunities to apply the theory that is taught in the classroom.
Thus, we ask the question: Why a "clinical" sociology? Why promote an emphasis on
application and sociological practice? In our opinion, it is good for the discipline and there is a
societal need. The discipline benefits from a healthy and visible clinical sociology. This
touches on the need for and benefit of a societal referent. Biology and chemistry as pure
sciences have societal referents in closely allied practice professions: medicine, pharmacol-
ogy, sanitation, engineering, and so on. Ultimately, for sociology to grow and prosper, for the
store of knowledge to grow, society-and its various decision makers-must support soci-
ology. For this to take place, sociology has to be seen as useful; that it has something practical
to offer society.
Also, as a practical matter, any discipline remains viable if it regularly attracts new
entrants who can see a recognized and accepted, interesting and rewarding career path before
them. It must attract talented young people who seek meaningful work, with an accepted role
in society, and they can grow and develop and make a living. As van de Vall (1992) noted, in
discussing sociological practice, "In the cost-benefit world of modem Academe, university
departments are required to attract minimal numbers of students. Today's freshmen are less
attracted by abstract notions of scholarship, however, than by the concrete perspective of a
professional career." The opportunity for sociological practice with the chance to address real
social problems presents a challenge that can attract young people. van de Vall wrote that in
Holland graduates trained in sociological practice have career options in policy work, organi-
zational consultation, or a host of general applications.
Indeed, a common query from undergraduates is, "What can I do with a degree in
sociology?" Classically, graduate education and on to teaching sociology was seen as the
primary career path. But as Dotzler and Koppel (1999) reported, while this model may still be
the perception, it may no longer give an accurate picture of what sociologists do:
Recent data from the NSF survey of Ph.D. sociologists, however, reveal that ... less than one-half of all
sociologists-45.8%-teach sociology. The majority of our colleagues spend their days managing and
administering, conducting applied or basic research, ... and engaging in a wide range of tasks that are
divergent from the traditional image.

The data showed that about 27% (3300) of sociologists do not work for educational insti-
tutions, about 20% of whom are self-employed. Another 17% are employed as "sociologist"-
researchers, policy experts, planners, and the like (Dotzler & Koppel, 1999). Moreover, as the
data showed, a large proportion of academic sociologists spend a significant part of their time
also doing sociological work dealing with clients in applied research, advising on policy and
programs, and so on. In other fields such as economics, biology, physics, and psychology,
"practice" is valued. Entrants and students are taught and encouraged to take roles where they
apply the knowledge base and skills of the field. To quote Dotzler and Koppel again,
"Sociology appears to be special in its adherence to a traditional image, despite its destroying
and ultimately disempowering effects."
We agree with Dotzler and Koppel that disparaging practice is not good for the discipline
of sociology. We also note that others-criminal justice, social workers, management an-
alysts, policy scientists, public and private administrators, and evenjoumalists-are "doing"
sociology but often do not have the depth and rigor of sociological grounding that goes with
graduate education in sociology.
Sociological practice, wrote van de Vall (1992), depends on the theoretical and meth-
odological developments of basic work in the field. But, he argued, basic sociology benefits in
at least three ways from an active practice component. Citing Rossi (1986), van de Vall wrote:
THEORY, PRACTICE, AND SOCIOLOGY 11

1. Its [sociological practice's] orientation toward diagnosing and reducing concrete policy problems
will prevent basic sociology from becoming a scholastic discipline by providing important tools for
empirical research (Rossi, 1986).
2. The client system of sociological practice ... provides financial resources for empirical research that
ultimately stimulates new developments (Rossi, 1986).
3. Sociological practice offers professional career paths in social policy research and organizational
consulting that constitute a valuable asset in the increasing competition for graduate students among
the various social sciences.

We also believe, quite strongly, that a vigorous clinical sociology advances sociological
knowledge. Application is the true test of theory. The scientific sociology can only gain from
an active interchange among researchers, theorists, and clinical workers involved in trying to
produce positive social change in ongoing social systems. As social change agents, clinical
sociologists turn to theory and previous findings to inform and direct their problem solving.
Through systematic repeated application, we find out what works and what does not work.
Practice includes ongoing evaluation of intervention, which soon reveals the validity and
explanatory power as well as the limitations of existing research and theory and can provide
additional material for theory development as well as fertile avenues for further research.
There is no inherent contradiction between "science" and "practice." The goal of
science is theory development, the abstract and general. The workplace of the clinician and
practitioner is with specific social systems and problem situations. The abstract and general
emerges, inductively, from the specific. And theory is tested, deductively, as the abstract and
general is put to the test in specific situations. Clinical experience can play an important role in
theory development and verification.
Larson (1990) has discussed the relationship between pure or basic sociological theory
and applied or practical sociological theory at length including a review of earlier authors' take
on the subject. Larson noted that applied theory is seldom discussed and opinions vary on the
difference between pure and applied theory or whether theory is present or relevant to applied
sociology. The author also noted "an absence of consensus on the difference between pure and
applied sociology and what is and what is not applied sociology." One opinion holds that
applied sociology "is not primarily concerned with aims and values such as objectivity and
prediction." That is, it is client oriented rather than discipline oriented. Another view was that
of Rossi and his co-workers, that applied work attempts to solve some real-world problem
while basic research aims to enhance the body of knowledge of the discipline. However, this
distinction may not always apply, and it may not always be simple to differentiate pure and
applied since they are "inextricably intertwined" (Rossi et ai., 1978). They share common
methods and theoretical base. While applied sociologists seek the action-relevant implications
of the data they collect, "applied sociology has a third and overriding task, to contribute to the
disciplinary goal of knowledge accumulation."
"Basic Sociological theory influences the work of applied sociologists, and the work of
applied sociologists most certainly has implications for basic Sociological theory." Larson
cites Hawkins's (1978) view that applied work can bring a closer awareness of the relationship
between theory and research, as well as exposing unexamined assumptions about social
structure. Finally, "applied social research contributes to the ongoing process of the formula-
tion and reformulation of theory by putting it to a practical test." Hawkins's point is to
emphasize the mutual interdependence between pure and applied sociology.
Larson also cited the work of Ward who "was convinced that a mature science must have
both pure and applied branches." To Ward, "the object of pure sociology is the acquisition of
the exact knowledge needed to predict; the object of applied sociology is the application of
predictions to the effort to ameliorate the human condition." Ward insists that "without the
12 HOWARD M. REBACH AND JOHN G. BRUHN

pure stage all attempts at application must be wholly random," and that pure science per se is
"useless" (Ward, 1883:247).
Thus, Larson concluded, "Although first generation American sociologists such as
Lester Ward thought of applied sociology as an extension of pure sociology, it is not apparent
that most contemporary sociologists share this view." Theoretical knowledge is vital in the
assessment and problem solution when working with clients. Though theory needed to address
such problems may differ from theory in pure sociology, Larson asks, "is it of any less
importance to build scientifically relevant theory from sociology's applied side than its pure
side. "
This is not just a call for limiting sociological inquiry to practical problems. It is more a
call to have a complete sociology. The physical and natural sciences certainly recognize the
need for basic research and theory development the purpose of which is to expand the fund of
knowledge and increase understanding. But these fields also have well-developed and valued
applied sides. A complete sociology should do no less. However, as van de Vall (1992)
remarked, the terms applied and utilization often carry a negative connotation among main-
stream sociologists and practice-oriented curricula have been slow to develop and are often
resisted.
Many of those critical of an applied sociology point to it as a departure from and a
violation of value neutrality. Setting aside for now the question of whether it is ever possible
for a man or woman to be entirely value neutral, we assert that there are social issues that
reasonable people can agree on. Poverty is bad. So are hunger and starvation. Spousal and
child abuse are bad. So are violence and killing; racism and ethnic cleansing. And so on. The
development of theoretically sound, well-designed, and carefully monitored programs that
make use of sociological findings applied to prevention and amelioration of these and other
social problems seems superior to poorly conceived policy or programming based on what
might be currently fashionable, politically popular, or someone's pet idea (e.g., combating
drug use with a program of "just say no" or narrowly focused such as reducing poverty and
welfare dependency by improving individuals' self-esteem). To repeat what we have often
said above, a complete sociology provides knowledge that can be useful in dealing with social
life.
But other concerns remain: First, certainly a spectrum of ideologies exists, from right to
left, from conservative to liberal, and from acceptance of the status quo to radical criticism.
Each practitioner has a value orientation. For example, what Street and Weinstein (1975)
called radical sociology refers to the sociologist who is so politicized that all institutions
represent exploitation and dominance and stability and consensus are ignored. Even the
clients' wishes may be ignored in an attempt to benefit other groups seen as oppressed by such
an observer.
Second, in work with clients the fact that a client presents a problem to be solved makes
the work relevant to values. Closely related is the concern that for many types of sociological
work, clients represent elites who can afford to engage a clinical sociologist. For example, a
corporate client may seek a way to cool out environmental protests or workers' legitimate
complaints. Or a school administration may seek ways to impose some new policy strongly
resisted by faculty or seek ways to avoid instituting special programs for children with special
needs.
These types of situations involve values. The clinical sociologist and clients bring their
values to the task and these situations present challenges to value neutrality. But there are some
checks and balances. First, to a large extent, the application of the scientific method has the
potential to control a lot of the subjectivity. For many of us, the scientific method represents a
THEORY, PRACTICE, AND SOCIOLOGY 13

superordinate value. The fact that assessment, problem definition, and program monitoring
and evaluation are all based on careful and systematic analysis of data means that, to some
extent, the method takes over reducing a large measure of subjectivity.
Another rein on subjectivity and the intrusion of the workers' values are the guidelines
for ethical practice, some of which emphasize openness with clients, informed consent, and
maintaining respect for clients' autonomy and the right to choose and control of all decision
making. Indeed, the participation of members of the client system, in addition to the ethical
aspect, is also good practice.
Finally, when working with clients, it is they who determine what problem they want
solved. The decision on whether or not to become involved with a particular client and/or the
terms of involvement can act as a brake on becoming involved in questionable activities or
working toward goals deemed antisocial. Simply put, the clinical sociologist does not have to
take a case that she or he feels is ethically questionable. The basic ethical requirement is "do
no harm." When clients' objectives are deemed exploitative or otherwise questionable, it may
be best to p:'lss.
An alternative concerns the nature of the relationship regotiated with clients. If clients are
helped to understand the empirical base and its relationship to problem diagnosis as well as to
planning and implementing interventions, and if clients can accept these terms, then submis-
sion to clients' preconceived notions may be averted. Street and Weinstein (1975) referred to
an "enlightenment model" of sociological practice in which "it is assumed that whatever
sociological research is done will be placed in context by sociologists, whose task it is to
enlighten the decision makers in as broad a way as possible." While the client may hire the
clinical sociologist, Street and Weinstein reminded us that "the communications to the elites
are not the sole product; they would be coupled with enlightening communications to relevant
publics and to the society at large."
The emergence and persistence of clinical sociology and sociological practice attest that
many of us see the relevance of sociology and feel a strong need to apply the tools and
perspectives of the field in the public arena.
We recall Albion Small's (1896/1985) challenge:
I would have American scholars, especially in the social sciences, declare their independence of do-
nothing traditions. I would have them repeal the law of custom which bars marriage of thought and
action. I would have them become more profoundly and sympathetically scholarly by enriching the
wisdom which comes fmm knowing with the larger wisdom which comes from doing. I would have
them advance from knowledge of facts to knowledge of forces, and from knowledge of forces to
control of forces in the interest of more complete social and personal life.

An active clinical sociology can also serve society. When people-and decision
makers-see others acting in a particular way, the tendency is to attribute that action to some
characteristics of the individual without reference to the social context. The tendency of many
observers is to attribute social problems to bad or flawed individuals. One important role we
can play is to elaborate a social structural and cultural view. We contend that application of
sociological perspectives, theory, research findings, and skills for problem solving and posi-
tive social change takes us back to the beginnings of sociology.

REFERENCES
Alinsky, S. (1934/1984). A sociological technique in clinical criminology. Proceedings of the sixty-fourth congress of
corrections. Houston, Texas. Reprinted in Clinical Sociology Review, 2, 12-24.
14 HOWARD M. REBACH AND JOHN G. BRUHN

Alinsky, S. (1984). Community analysis and organization. American Journal ofSociology, 46, 797-808. Reprinted in
Clinical Sociology Review, 2. 25-34.
Babbie, E. (1994). The sociological spirit (2nd ed.). Belmont, CA: Wadsworth.
Babbie, E., Cicourel, A., & Perlstadt, H. (1998). Commentary on Turner. Sociological Perspectives, 41(2), 259-271.
Bruhn, J. G. & Rebach, H. M. (1996). Clinical sociology: An agenda for action. New York: Plenum Press.
Church, N. (1991). The effects of social change on clinical practice. In H. M. Rebach and 1. G. Bruhn (Eds.), Handbook
of clinical sociology (pp. 125-139). New York: Plenum Press.
Collins, R. (1988). Theoretical sociology. New York: Harcourt Brace Jovanovich.
Couch, C. J. (1995). Presidential Address: Let us rekindle the passion by constructing a robust science of the social.
Sociological Perspectives, 36, 1-14.
Dotzler, R. J., & Koppel, R. (1999) What sociologists do and where they do it-the NSF survey on sociologists' work
activities and workplaces. Sociological Practice: A Journal of Clinical and Applied Sociology, 1, 71-84.
Foot, N. N. (1996). Frontiers in sociological practice. Clinical Sociology Review, 14, 1-13.
Freedman, 1. A. (1989). Defining clinical sociology. Clinical Sociology Review, 7, 53-56.
Hawkins, D. F. (1978). Applied research and social theory. Evaluation Quarterly, 2, 141-152.
Howerth, J. W. (1985). Present condition of sociology in the United States. Clinical Sociology Review, 3, 16-24.
Kallen, D. J. (1995). Some history of clinical sociology and sociological practice, Part I. Clinical Sociology Review,
13, 1-23.
Larson, C. J. (1990). Applied/practical sociological theory: Problems and issues. Sociological Practice Review, 1,
8-18
Lee, A. M. (1984). Overcoming barriers to clinical sociology. Clinical Sociology Review, 2, 42-50.
Rebach, H. M., & Bruhn, J. G. (Eds.). (1991). Handbook of clinical sociology. New York: Plenum Press.
Robinette, P. D. (1992). Sociological practice's mid-life crisis. Clinical Sociology Review, 10, 21-36.
Rossi, P. H. (1986). How applied sociology can save basic sociology. Journal of Applied Sociology, 3, 1-6.
Rossi, P. H., Wright, J. D., & Wright, S. R. (1978). The theory and practice of applied social research. Evaluation
Quarterly, 2, 171-191.
Small, A. (1896/1985). Scholarship and social agitation. The American Journal o/Sociology, 1, 564-582. Reprinted in
Clinical Sociology Review, 3, 25-38.
Snow, D. A. (1999). 1998 PSA Presidential Address: The value of sociology. Sociological Perspectives, 42, 1-22.
Straus, R. A. (1985). Using sociology: An introduction from the clinical perspective. Bayside, NY: General Hall.
Street, D. P., & Weinstein, E. A. (1975). Prologue: Problems and prospects of applied sociology. The American
Sociologist, 10, 65-72.
Turner, J. H. (1998). Must sociological theory and sociological practice be so far apart? A polemical answer.
Sociological Perspectives, 41, 243-258.
van de Vall, M. (1992) Sociological practice in modem policymaking: Supply and demand. Sociological Practice
Review, 3, 272-276.
Wang Yang-ming, 1472-1529, Chinese philosopher, Works ofWang-yang-ming. Translated by Henke. As cited in The
choice is always ours, edited by D. B. Phillips et al. Jove Publications, 1975.
Ward, L. F. (1883). Dynamic sociology. Boston: Ginn.
Wirth, L. (1931/1982). Sociology and clinical procedure. American Journal of Sociology, 37, 49-66. Reprinted in
Clinical Sociology Review, I, 7-22.
 CHAPTER 2

Intervention in Clinical Sociology

HOWARD M. REBACH

INTRODUCTION

Intervention-involvement in and interaction with members of a specific social system to

address specific social problems-is the defining characteristic of clinical sociology. Practi-
tioners blend the role of social scientist with the role of active social change agent. Intervention
along with the application of sociological perspectives, knowledge, and skills comprise the
unifying themes that span the diversity of clinical sociology. This chapter will briefly describe
the variety of clinical sociological intervention-the remainder of the book will provide
greater detail-and then go on to offer an overview of intervention that includes several
"guiding themes" followed by a general description of the intervention process.

THE DIVERSITY AND UNITY

OF INTERVENTION IN CLINICAL SOCIOLOGY

One way to characterize clinical sociology is by a three-dimensional matrix of clients,

settings, and activities (Sundberg et at., 1973). The term clients refers to those persons on
whose behalf intervention is conducted. They may be the actual persons who seek a clinical
sociologist, or other members of their social networks. (Deciding "who" your client is can
sometimes be a knotty problem.) The term client system is also useful to denote, more broadly,
the people affected by or involved in the development and implementation of a program to
address an identified problem. The term settings refers to the social and physical contexts in
which work takes place. These may include the consultant's office, a school, a business or
government agency, a community, and so on. Finally, the term activities refers to those things
that clinical sociologists do, alone or in concert with members of the client system and/or
members of an interdisciplinary team, in working toward solutions to identified social prob-
lems.
The multiparadigmatic nature of sociology is an element of diversity. Clinical sociolo-
gists may choose an interactionist, functionalist, social constructionist, critical, or conflict

HOWARD M. REBACH • Department of Social Science, University of Maryland Eastern Shore, Princess Anne,
Maryland 21853.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

15
16 HOWARD M. REBACH

perspective. Others may be more eclectic. choosing a perspective grounded in the circum-
stances of the case. Straus expressed the view that "whatever ... theoretical orientation [is]
brought to bear on the problem" (1987:72), eclecticism occurs in practice. Straus argued that
theory may help clarify the empirical circumstances, but intervention is about results. The
important criterion for intervention is that desired changes take place. Swann (1988) discussed
what he called "Grounded Encounter Therapy." Swann's approach to intervention emerged
from his interaction with clients. For both Swann and Straus, intervention programs are unique
to the specific clients as they see their social context. Thus, Swann noted, "The same problem
may have a different context for different clients and hence would be treated differently"
(1988:78).
Clinical sociological intervention takes place on the micro-, meso-, and macrolevels,
which adds to diversity. In an earlier attempt to impose some structure on the various forms of
intervention in clinical sociology, Straus defined levels of intervention as occurring with
persons, groups including families, organizations, and worlds. By organizations, he meant
such structures as "corporations and associations to communities and governments" (p.
54). "World" or "social world" he adopted from Lofland (1976) to describe more or less
organized fields of endeavor. These are referred to in phrases such as "the academic world,"
"the business world," and so on. They describe a type of subculture of "norms, values,
folkways, mores, language, and technology differentiating its participants from members of
other social worlds" (Straus, 1984:54).
This typology suggested, for Straus, targets of intervention. Where the client is an
individual, the target is the individual's behavior, both intra- and interpersonal. Where a group
is the social system of concern, the target was role relationships. For organizations, the target
was "the institutionalized patterns of relations between groups rather than the role relations
within the group" (Straus, 1984:58), and "routinized patterns of social relations" (54) that
constitute social organization oflarger-scale social systems. Finally, intervention in a "social
world targets the culture, mainly the non-material aspects of culture" (1984:54)
To Straus's typology, it is worth adding that intervention in clinical sociology may
address several social system levels. Thus, intervention agents may need to consider inter-
group relations, role relationships within groups, and individual conduct and role perfor-
mance, all in the same case.
The types of problems encountered, the techniques used, and the skills required are
related to the level of analysis. Straus (1982) described a "social behavioral" approach in
working with individuals and gave examples of work with obese persons. Also on the
individual level, Coyle (1996) used her skills as group facilitator and a technique she called
"deep learning groups." Clients were adult children of alcoholic parents. The purpose of the
intervention was resocialization and group members worked on issues of emotions and
identities associated with growing up in a dysfunctional and alcoholic family. Church (1985)
applied a social constructionist approach to describe the way couples jointly construct their
marriage and to work with couples experiencing marital distress. Voelkl and Colburn (1984)
described work with families that focused on strategic communication in the social organiza-
tion of relationships. Kallen (1984) described an intervention on behalf of a hospital develop-
ing a treatment component for sick and injured adolescents that included work with an
interdisciplinary team. Activities involved changes in the physical setting, an educational
component for staff, and restructuring of hospital routines and staff behavior. Jones (1984)
applied sociological skills and research working with designers, planners, architects, and
consumer groups in preparing built spaces for users. Activities included analysis of the social
consequences of specific design decisions. Anderson and Rouse (1988) and Sengstock (1987)
INTERVENTION IN CLINICAL SOCIOLOGY 17

reported clinical sociological interventions addressing the problem of spousal abuse. Seng-
stock described a community development intervention to increase awareness of the problem
and develop resources and services for abused spouses. Jacques (1982) reported macrolevel
intervention with the British National Health Service and Bennello (1982) worked nationally
"nd regionally helping to organize and develop worker-managed businesses. These few
examples illustrate the range of clinical sociological activities across levels of intervention. In
each of these settings, activities were developed according to the level of intervention.

GUIDING THEMES

Despite the many forms it can take, clinical sociology is unified by the fact that sociology
is the fundamental corpus of knowledge that illuminates clinical sociologists' understanding
and approach to cases. This body of knowledge directs our attention to social interaction and
social arrangements as the basis of problems and targets for change. Our general understand-
ing of sociology informs us of the relationship between social structures and individual action
and that the individual cannot be understood apart from the social context. We understand that
a group or any social structure is more than merely the sum of the individual members. Even
when work is on a microlevel with individuals or families we are aware that individuals are
tied into social networks that form a system that influences action. Action, in turn, is an
expression of culture, the culture of the interacting individuals, their subcultures, and the larger
cultural context.
There are some unifying themes in clinical sociological intervention:
• Problems are defined as social problems.
• Intervention is guided by the scientific method.
• Sociology provides the knowledge and skills base.
• Humanistic values guide practice.

Problems Conceptualized as Social Problems

Intervention is framed by the definition of the problem to be addressed. Clinical sociolo-

gists recognize the social dimension in matters that people are involved in. Thus, problems are
conceptualized as social problems.

Problems Arise from and Are Maintained by Social Arrangements

The norms, values, and patterns of relationship that develop within a specific social
structure as well as the cultural patterns within a population may themselves be problematic or
prompt dysfunctional adaptation to them. The hierarchical structure of an organization may
lead to alienation of lower status members who adopt maladaptive strategies to cope with their
feelings. The structured inequality of access to the opportunity structure may prompt some
young girls to have babies in an attempt to find personal validation that they have no other way
of getting. Cultural beliefs related to the capitalist ethic establish medical services as available
for those who can afford to pay for them. These cultural beliefs structure the organization of
services and have an impact on individual and community health. Where prenatal care is
delayed, the life chances of an infant are affected. Where economic necessity drives most
18 HOWARD M. REBACH

adults into the work force for most of the day, children and adolescents grow up with little
adult supervision, which can have problematic consequences for the individuals, families, and
society at large. These few examples suggest that prevailing social structures and patterns can
generate problematic situations.

Problems Involve Social Networks

Though an identified individual or group may be said to "have" the problem, others may
be causally involved or receive consequences to which they must adapt. For example, the
physical or mental disability of a family member may tax the finances and/or relationships of
the rest of the family. Gang activities within a community affect the entire community, as well
as the safety and well being of individual community members. Recognition of problems as
social problems directs us to look beyond the individuals or groups defined as problematic.
The behavior of a 9-year-old boy was defined as a problem at home, at school, and in the
neighborhood. It was necessary to work with him, others in his role set, and other systems.
Intervention included trying to teach his mother, a single parent with two other children, to
bring his behavior under her control. It was also necessary to work with teachers, other school
staff, and the school bus driver to help the boy reduce the perceived threats and frustrations that
appeared to prompt his actions. The program also included a session with his math class where
the boy, his classmates, the teacher, and I talked about appropriate behaviors and responses to
situations. With the help of the teacher and the other students, we enacted role-play situations
that included both inappropriate and appropriate action. The repeated role plays allowed us to
shape the behavior of the boy, the other children, and even the teacher. Follow-up suggested
that the intervention was working. The case example illustrates the need to look beyond the
individual defined as problematic to include social networks and systems.

Problems are Socially Identified

Objective conditions, by themselves, do not create problems (Hilgartner & Bosk, 1988).
The very definition of some set of conditions as "a problem" is itself a social act. It pre-
supposes some normative or socially accepted state and that some social actors have evaluated
a pattern or conditions in terms of that normative state and have defined it as deviant, "a
problem." And these actors have the power to make their label stick and get others to accept
their definition.
For example, ethnic warfare is, likely, as old as time. Powerful ethnic and religious
groups have oppressed, suppressed, and have committed or have attempted to commit geno-
cide: in Northern Ireland; in Rwanda; in the Middle East; in Ethiopia; on the Indian subconti-
nent; in South Mrica; and other locations around the world. In the former Soviet Union there is
conflict between Russians and Chechnyans. China has subjugated Tibet. But government and
media attention has singled out conflict in Bosnia and Kosovo and has placed those conflicts
on our public agenda in the latter half of the 1990s as problems for the United States and NATO
to address.
Glassner (1999) described the escalation of public concern over the emergence of a new
breed of youthful "superpredators" as a significant social problem. This was stimulated by
extensive media coverage of school shootings in Mississippi and Kentucky in 1997, followed
by similar incidents in Arkansas, Oregon, and Colorado in 1998 and 1999. But, as horrendous
as these shootings were, as Glassner pointed out, public alarm ignored the fact that violent
death in schools hit record lows in 1996-97 and that "youth homicide rates had declined by 30
INTERVENTION IN CLINICAL SOCIOLOGY 19

percent in recent years and more than three times as many people were killed by lightning than
by violence at schools" (1999:xv). On the other hand, Glassner noted that the connection
between gun violence and the presence of more than a quarter-billion guns held by private
citizens and the fact that "American children are twelve times more likely to die from gun
injuries than are youngsters in other industrialized nations" (p. 1999:xix), has not been clearly
defined as a social problem. I might note, however, that attendant government and media
attention may finally get gun violence edged a bit closer to our public agenda.
Glassner's examples illustrate that what gets defined as a social problem is a social
process with political and economic influences. The objective events and conditions require
attention and definition as problematic within a social system.

Problems Involve the Interaction of Levels

As sociologists, we are aware of multiple levels-that events, conditions, and processes

at the societal level affect the daily lives of individuals and the social structures they are a part
of; that the course of individuals' biographies are channeled by the times in which they live
and the social, economic, and political forces at work in those times. The macrolevel refers to
large social structures that endure over time. For most people, the everyday experience of
social life takes place in groups where they meet face to face with others-on the job, in neigh-
borhoods, at school, in houses of worship, in voluntary organizations, and so on. These are the
mesolevel structures that relay macrolevel forces and realities to shape individuals and
families, the microlevel.
Intervention, the "work" in clinical sociology, may take place across levels. Though the
client is an individual, couple, or family, the schools, workplace, community, and others may
also be involved. Intervention in large organizations may involve attention to role relation-
ships within specific groups, the relationships between groups within an organization, and
individual role occupants. Freedman emphasized this concern for the interplay of levels when
he noted that, when working with individuals, we need to be aware of the broader issues of
social structures and "when working on broader issues of social change, you have to keep in
mind the effect on the individual" (1982:39). Gutknecht, in discussing organizational develop-
ment, also argued that an intervention takes place across levels within a social system. He
noted that "clinical sociology infuses organizational development with more flexible tech-
niques of integrating micro and macro approaches to social and organizational change"
(1984:96).
The complexity of the issue of guns and gun violence illustrates the interaction of levels.
It involves both the civil rights and safety of individuals and families; it involves communities
and schools, police and the medical professions. It involves pro- and anti-gun and gun-control
factions within society. It involves political leaders and business interests. And it ultimately
involves the society and our sense of who we are as a people. Like most social problems, the
problem of gun violence makes us aware that change at one level affects other levels. The
levels are interdependent.

Intervention Is Guided by the Scientific Method

The relationship between scientific work and clinical work is of interest to many fields.
Casual reflection on the relationship often leads to the conclusion that they are different fields
of activity. Clinicians cannot take the role of disinterested scientist; the goal is positive,
20 HOWARD M. REBACH

beneficial change. Scientific work is seen as the description of the regularity of events within a
domain of events, the development of empirical generalizations, and explanatory principles.
Science deals with classes of events, not with singular events. Replication and reproducibility
are important in science. Science deals with establishing empirical generalizations about the
relationship between antecedent conditions and consequences that are independent of time and
place. Thus, we try to explain the variance of some outcome variable in terms of the variance
of the antecedents.
Where science and social science deal with trends and patterns of events, clinical work is
more specific. The difference is between nomothetic and ideographic explanation. The
nomothetic model of explanation seeks "to discover those considerations that are most
important in explaining general classes of actions or events," rather than "considerations that
result in a particular action or event" (Babbie, 1986:54). The ideographic model, on the other
hand, "aims at the very many, perhaps unique, considerations that lie behind a given action."
The ideographic approach is used by historians studying some historical event such as the
Great Depression. It is also used by clinicians seeking to understand a case.
Thus, clinical work is seen as dealing with the unique, with the singular event, rather than
classes of events. The problematic situation in a given case is filled with uncertainties and
complex interconnections, some of which are unknown and perhaps unknowable. The reality
of a case is without structure. Single cases are characterized by uniqueness and uncertainty.
The goal of clinical work is solution or at least amelioration of the problem presented. The
uniqueness of a case and the differences in goals would seem to separate scientific and clinical
work.
Deeper reflection suggests recognition and adoption of the role of clinician-as-applied-
scientist. Imposing structure on reality is a human endeavor. Application of the scientific
method is one way to impose such structure. By the term scientific method, I refer to a way of
thinking and acting that is systematic, open, and empirical. It is a way of developing reliable
information and a careful process for decision making.
Application of the scientific method begins with careful observation. Before attempting
intervention and problem solving, clinicians and members of the client system must first
develop and share a clear understanding of the problem. This calls for the development and
organization of reliable and valid data. The accumulation of data should lead to a formulation
of a conceptual hypothesis defining the problem. This hypothesis can be tested by operational
definition of key variables or indicators. Confirmation or support for this hypothesis (problem
definition) can be thought of as an empirical generalization of the form: If A, then C under
conditions B. That is, it specifies a relationship between an antecedent condition and a
consequence.
The next step is theory construction. In clinical work, this means the development of a
logical explanation for the observed relationship: identification of the "mechanism." The
intervention plan then functions as a hypothesis to be tested. Here again, careful identification
of key variables and indicators is crucial. Implementation of the intervention plan should
significantly change the observable values of the variables identified. If an adequate test of
the plan does not yield the hypothesized outcome, systematic reexamination and conceptual-
ization must take place and the process repeated. Box 1 summarizes this process:
Throughout, the emphasis of the scientific method is on observable events. Even where
cognitive events, such as peoples' assignment of meaning to situations or to self, are involved,
these events eventually manifest themselves in observable behaviors. Other emphases include
careful observation, basing conclusions on evidence, testing hypotheses, and discarding those
that are unsuccessful. The scientific method also prompts continuing evaluation of an interven-
INTERVENTION IN CLINICAL SOCIOLOGY 21

BOX 1: Application of the Scientific Approach to a "Case"

1. Careful observation: The collection and organization of data.
2. Formulation: Development of a causal theory and identification of key variables.
3. Intervention plan: A hypothesis about what changed conditions will affect key vari-
ables in desired direction.
4. Intervention activities: A test of the hypothesis/intervention plan.
5. Evaluation: Observe results on key outcome variables.

tion program. Program design in a specific case is essentially the formulation of a hypothesis:
given the problem as defined, the social context of the problem, and available assessment data,
the worker hypothesizes that the proposed intervention program will lead to a desired out-
come. The implementation of the program is subjected to continuous testing to support or
disconfirm this hypothesis. Work with clients is data-driven.

Sociology Provides the Knowledge and Skills Base

Clinical sociology relies on sociological methods, knowledge, and theory. Application of

the scientific method to the clinical process uses the methods of sociology for investigation of
a case. The array of such methods include both quantitative and qualitative methods: inter-
viewing, focus groups, sociometric methods, surveys and questionnaires, content analysis,
participant and nonparticipant observation, and analysis of records and archival data. These
are structure promoting activities. The methods provide the data for conceptualization of the
problem, identification of key actors and their roles, analysis of the social systems involved,
and development of an operational definition of the problem and the changes needed.
Sociological findings channel creative thinking for the analysis of a problem and design
of an intervention program. For example, findings that children have major health problems
following their parents' divorce (Guidubaldi & Clerninshaw, 1985) and that mothers' reports
of children's health are associated with marital status and ethnicity, together with other
demographic factors (Angel & Woroby, 1988) could inform the development of a plan for
health services within a community, a basis for activism nationally, or the basis for work with
an individual child or mother and child.
Pifia (1998) worked with a human services organization to provide culturally sensitive
services to Spanish-speaking Latino immigrants. One possible approach is to train individual
staff members in cultural sensitivity. But as Pifia noted, as a sociologist, she was "skeptical
about how lasting a change could be that is targeted only at individual behaviors and attitudes"
(p. 69). Sociological theory, the systems and constructivist perspectives, "allowed for insight
beyond individual traits and behaviors of members of the agency" (p. 69). Pifia identified
structural barriers to cultural sensitivity within the agency and explored the need for structural
change. This led to work on "the organizational factors relevant in promoting culturally
competent services" (p. 69). Assessment studied how interactions and the relationships among
parts of the agency as well as the relationship of the agency to other systems affected delivery
of services to Latino immigrant clients. Pifia concluded:
22 HOWARD M. REBACH

With the systems and constructivist perspectives, my analysis identified how the lack of integration of
Latino providers in the agency, combined with their role conflict and clashes of expectations and goals
with other providers and management and the institutional silence about multicultural issues, impaired
service delivery to Latino immigrant clients. These findings led to structural solutions. [emphasis
added] (p. 69)

Humanistic Values Guide Practice

Though guided by the methods of science, intervention in clinical sociology is also

guided by humanistic values. Professional help is sought to redress an existing or potential
disequilibrium between the client and the environment, stemming from attempts to cope with
and adapt to the environment. Clients seek professional helpers because they are confronted by
problems they cannot solve with their own resources. Their inability to solve their own
problems causes distress for them, for others within their social system, or for the social
system itself. Help is sought because the client or client system is "stuck" and has no
strategies for becoming unstuck, for choosing new outcomes or new courses of action to
achieve existing or changing goals. Previously learned and acquired strategies for handling
and adapting to circumstances do not achieve desired outcomes, and this failure to achieve
such outcomes has become problematic.
The humanistic view recognizes the voluntary nature of action and that people are active
constructors of their lives, themselves, and their situations. People actively construct their
understanding of their experiences as they represent reality to themselves. But it is not a
solitary process. Social structures constrain and channel them. Reality is negotiated in inter-
action with others in specific contexts. Though the individual actor actively constructs reality,
that reality can only be fashioned from the materials at hand. At any given moment, actors in a
situation choose behaviors based on their construction of events and self and each actor's
present adaptation is the best he or she can make it. The actor is striving for autonomy, self-
determination, and desired outcomes. Maladaptive behaviors develop through the same types
of processes that produce more adaptive behaviors: interaction and learning within a socio-
cultural context.
All this implies a particular orientation to intervention. It implies a "working with" rather
than a "doing to" or a "doing for" approach to intervention. The clinician's role is to assist the
client(s) to add constructive choices to their repertoire of action. Ultimately, the clients or
members of client systems will choose their own courses of action. This clinical orientation
calls for respect for clients' autonomy, ability to learn, their unique-often idiosyncratic-
ways of learning, and ability and right to control their own destiny within the systems in which
they choose to operate. It requires recognition of the fact that clients are capable of solving
problems and reconstructing reality in appropriate ways as options open up for them. Finally, it
requires recognition that the clinician should not stigmatize the client for having a problem and
the clinician does not blame the client for the existence of the problem. Behaviors that are
regarded as "maladaptive" by observers may be strategic moves, the actor's attempt to
understand and cope with the world. A humanistic approach sees the genesis of "problems" in
clients' attempts to cope with their surroundings and the demands that those surroundings
place on them. Such an orientation acknowledges the role played by developmental processes
and by the social systems in which people exist.
For example, many contemporary observers decry the fact that illiteracy is on the rise in
the United States. The literacy level, even of undergraduate college students, has been found
wanting. One analysis blames the youth for lack of motivation and failure to learn. An
INTERVENTION IN CLINICAL SOCIOLOGY 23

alternative analysis suggests that social systems have failed these youth; the schools, their
families, the mass media, and their communities have failed to find effective methods for
teaching literacy and/or have failed to promote the skills and values that promote literacy.
These social systems, in turn, respond to social, political, and economic realities and priorities.
The recognition that systems shape maladaptive actions of individuals and social units, just as
they also shape adaptive behaviors, will enable the clinical sociologist to adopt the most
helpful orientation to clients-the recognition that clients are competent, capable, autonomy-
seeking partners in the clinical enterprise.
Intervention in clinical sociology is what Gutknecht called a "client centered" collabora-
tive effort which includes "sensitivity to cultural traditions of client groups and awareness of
the ways in which the structural embeddedness of interlocking problems affects ... behavior
and structures" (1984:95). Gutknecht emphasized that collaboration should lead to "develop-
ment of an ongoing learning system," and the "need for clients to participate in the formula-
tion of their own questions and devise their own answers" (p. 96).
While Gutknecht's remarks referred to the organizational setting, they apply, as well, to
all levels of intervention. The clinical sociologist does not assume an authoritative role to
adjust persons to systems, but rather works with people so that their systems meet their needs
and they develop their own problem-solving capacities. This partnership mode objectifies the
problem. It is not something that the client has and that the clinical helper will cure. Rather,
the problem becomes something to which the client and the clinical helper will combine
resources and talents to find constructive alternatives.
The humanistic emphasis on respect for clients includes following canons of ethical prac-
tice. The first rule of ethical practice is "do no harm." This rule calls for a deep and abiding
concern for the safety and well-being of persons with whom clinicians become involved. The
requirement goes beyond remediation of issues that arise in the course of intervention. It calls
for a proactive stance. All courses of action are examined for potential risks and unintended
negative consequences. Steps are taken to remove risks where possible.
The requirement to do no harm requires clinicians to maintain professional competence
and not to go beyond their areas of competence. It also requires clinical sociologists to avoid
exploitative or inappropriate relationships with clients and members of the client system. This
extends to avoiding even the appearance of such relationships. Examples of inappropriate or
exploitative relations include sexual exploitation, instances of which surface from time to
time. Outside business arrangements, those outside the client-clinician agreement, are another
example of potentially exploitative relationships.
Respect for clients' right of self-determination also means that all information is shared,
that there are no hidden agendas, nothing held back, no secret strategies or coalitions. All
persons involved are to be kept fully informed of the potential risks and benefits of interven-
tion activities so they can participate fully in decision making at all stages of intervention and
are able to give informed consent to activities in which they choose to participate.
Confidentiality is another important aspect of ethical practice. It directly bears on the
issue of trust between client and clinical worker. It involves the negative prescription not to
reveal private matters as well as the positive prescription to act to protect clients' rights to
privacy. This means that clinical workers must refrain from gossiping or chatting about clients.
It means maintaining security on notes, records, and meetings. It also means training secre-
taries, receptionists, and others involved that they are not to reveal information that may come
to their attention. It means informing clients of the limits of confidentiality so they can exercise
judgment. Finally, it means that when information must be shared, clients must give informed
written consent.
24 HOWARD M. REBACH

As Bruhn and Rebach (1996) have pointed out, intervention raises values issues. The very
act of recognizing that a problematic condition exists is a value judgment. The goals and
objectives for change add values-relevant judgments. So do the strategies that might be used to
achieve goals. Ethical practice requires clinicians to be keenly aware of their own values and
exercise great care not to impose their values on clients.

THE PROCESS OF INTERVENTION

In addition to the guiding themes, certain general considerations are relevant across the
various levels of sociologically based intervention for social change. They will be dealt with
here by calling attention to:
• Intervention is a process.
• Intervention involves behavior change.
• Intervention must address barriers to change.

Intervention Is a Process

Intervention is a process, not an event. Just as the problematic situation is not an event-
it developed over time-its amelioration is also a process that occurs over time. Moreover, it
is a social process. The intervention agent interacts with members of a client system to achieve
objectives set through negotiation with clients and members of a client system.

Intervention is a Social Process

A clinical sociologist enters an ongoing client social system and, in effect, creates a new
social system, one that includes the clinical worker. In the process, client and worker come
together to explore, to deliberate, to learn. Together they define a problem for work, generate
possible courses of action, evaluate each and decide on problem-solving activities, and
evaluate results. Together they take stock of resources and negotiate who will do what and
when. In the course of work, interaction with and the cooperation of a variety of actors may be
necessary. And judgments will have to be made about the consequences of the change process
for all members of the client social system and for others as well.
The relationship between a clinical sociologist and members of the client system is a
critical social aspect of the intervention process. A lot has been written about the nature of
effective relationships with clients, much of it stemming from the early work of psychologist
Carl Rogers (1951). The establishment of a good working relationship must be a goal from the
outset. Interaction between client and clinician must lead to feelings of mutual trust. Only in a
climate of trust can clients feel safe and be open in discussing the problem, fully revealing
relevant information and sharing their feelings. Clients' feelings of trust also directly relate to
their willingness to make commitments to the intervention program, to their participation in
program planning, and their motivation to carry out planned activities and follow through.
Only with feelings of trust will clients be willing to experiment with and try to learn new
behaviors and new ways of relating to others. Common sense tells us not to invest in a process
or person we have little confidence in.
The key to an effective helping relationship is the formation of a "therapeutic alliance," a
INTERVENTION IN CLINICAL SOCIOLOGY 25

partnership among status equals. This is often difficult to establish. People usually seek
professional help with a problem when their own strategies are not working. They expect the
professional to have certain skills, knowledge, experiences, and judgments that can provide a
remedy for the problem.
A partnership among status equals is noncoercive. It is not the professionals' role to
impose their judgments or be directive. Clients expect professionals to share their expertise by
providing information and offer guidance based on their knowledge and experience. People
expect to benefit from professional judgment. But they do not want their power of choice taken
away. Clients' autonomy must be respected; they have the right to choose and to direct the
process. And from a practical point of view, clinical workers cannot make people do things
they do not want to do.
Along with status equality and respect for clients' self-determination, the professional
should offer a personal rather than an impersonal relationship. One component is to show a
positive, lively interest in clients. This means being able to listen to people and to move at their
pace. It means paying attention to them, focusing on them, and trying to understand. People are
more likely to attend and to act if they feel supported, encouraged, cared about, and under-
stood.
Another component is acceptance, taking people where they are, recognizing that the way
they are is a product of their socialization experiences. It does not mean blanket approval of
their present activity. Sometimes we have to deal with truly negative or destructive behaviors,
such as violence, abuse, exploitation, and vandalism. Acceptance means not stigmatizing,
labeling, or censuring, accepting the person while not accepting the acts and recognizing the
potential that people have for change. From a practical standpoint, the change process has to
start from where they are now. Placing people on the defensive will be counterproductive.
A third component is empathic understanding. While another person cannot really "walk
a day in my moccasins," empathic understanding means paying close attention for a period of
time. While clinicians need to understand about the other, empathic understanding means to
understand with the other. We "understand with" actors when we have an interpretive sense of
their subjective states.
Two more components are caring concern and "genuineness." Caring concern means a
real concern for others' well-being. Genuineness means being real, sound, dependable, no
sham or pretense or false fronts. It means that others can trust your honesty, that what you say
is what you mean, and that there is no manipulative intent. It also means being able to admit,
"I don't know."
All of these components-status equality, respect for persons' autonomy, empathy,
caring concern, and genuineness-underscore the need for sensitivity to diversity among
clients. Class status, gender, racial and ethnic group membership, religion, sexual orientation,
and physical disability have all been bases for discrimination, harassment, and unequal
treatment. Judging members of less powerful groups from the perspective of the majority is
not consistent with caring concern or with humanistic values.
As we shall explore later in this chapter, problem solution ultimately requires behavior
change. Change is risky. And it has the potential for failure. But anything worth doing is worth
doing poorly the first few times. Persons are more likely to take the risk involved with change
and learning new ways when they know they are supported and valued and will not be
criticized; when their attempts are encouraged. Clinicians are agents of socialization (or
perhaps resocialization). Persons are more likely to learn new ways when they have confi-
dence in the socialization agent. And they are more likely to experiment with and learn new
ways in the context of a safe, supportive relationship where the cost of failure is not too dear.
26 HOWARD M. REBACH

In sum then, intervention is a social process that operates through a relationship. The
substantive parts of the intervention process-the actual intervention activities-require the
cooperation and coordination of all concerned. This depends on their willingness to participate
and to carry out agreed-on activities. Their motivation depends, in turn, on their confidence
and trust which arise from a positive working relationship.

Steps in the Process

The process of intervention proceeds through specific steps: assessment, program plan-
ning, program implementation, and program evaluation. The assessment phase includes those
activities designed to gather data leading to a definition of the problem and an understanding of
it. In addition, assessment should identify the relevant actors, which systems are involved,
what needs to be changed, and what can be changed. Program design is the development of an
action plan to achieve the goals of intervention. It includes a statement of who will do what,
when, and where. Program implementation turns the plan into action. Finally, evaluation
determines the efficacy of the plan.
These phases are presented here as discrete steps. In reality, they are not discrete.
Assessment continues throughout the course of intervention. As work on a case proceeds,
workers become increasingly familiar with the circumstances and the client system. Experi-
enced clinical workers find that they often get new insights. In addition, as the clinical situation
or the relationship with the client changes, the client may present information previously
withheld-for a variety of clinical reasons-that alters the clinical picture. For example, after
several weeks of work with a depressed adolescent who had made at least two known suicidal
gestures, the client revealed that, on several occasions, she had been sexually abused by an
uncle. She reported she had privately wished the man dead-and he had died shortly there-
after. The girl subsequently harbored a sense of guilt at having "caused" the man's death,
which affected her interaction with significant others and seemed partially to explain inter-
action with agemates that resulted in among other things, problematic self-conception. The
presentation of these facts significantly altered the clinical picture and subsequent work.
There is an important feedback loop in the above intervention schema-the loop between
program design, implementation, and evaluation. Appropriate evaluation is as essential to
intervention as all other steps, but it is the most frequently neglected. It cannot be stressed too
strongly that the evaluation step must be built into all intervention plans and must be an
ongoing activity that occurs in conjunction with program implementation. The program is
designed to alter the value of certain critical variables or indicators. The program should be
carefully monitored to see if the critical indicators show improvement, no change, or worsen-
ing over time. Improvement indicates the program may be working. If continuing evaluation
shows no change, exacerbation of the problem, or shows undesirable side effects, reassess-
ment and redesign should be undertaken and necessary program changes implemented and
evaluation should continue. To reiterate a point made earlier, ongoing evaluation is the appli-
cation of the scientific method to intervention. It is beyond the scope of this chapter to give a
detailed description of the phases, but the following general considerations are offered.

Assessment. In the assessment phase, clinical sociologists begin a case study. The tools
for assessment include the array of research methods. The goal is to have enough of an
understanding of the client social system, the problem situation, the environment, and possi-
bilities and readiness for change to plan problem-solving strategies. Often, a place to start is
the presenting problem, the clients' statement of conditions they want changed, conditions that
led them to seek outside professional help.
INTERVENTION IN CLINICAL SOCIOLOGY 27

Clinical sociological intervention, as Freedman pointed out, may have to "move beyond
the clients' formulation of the problem to consider other factors that affect functioning,
especially broad social trends" (1982:37). Whyte (1982) also suggested questioning the
clients' formulations, the "standard model," the way they have always done things. Referring
to organizations, Whyte cautioned that the client may conceptualize the problem as "the
standard model is not working well." Those who accept the standard model, however, tend to
normative thinking. They "assume that it would work well if only they could recruit better
people for leadership positions, provide better training for supervisors and develop better
means for monitoring activities and punishing people who are not doing what they are
supposed to do" (p. 11).
For example, an administrator may report that one of the departments in an organization
is not functioning well; technicians, clerical staff, and workers are demoralized and complain-
ing about the way they are treated by professional staff; there is significant conflict among a
few of the key professionals; service users, the clients of the organization, are complaining
about the services they receive. Management wants the situation corrected.
The concerns, as briefly expressed above, constitute the presenting problem. Though
administration is the "client," the "client system" also includes the members of the depart-
ment, management, and possibly other relevant actors such as customers or patients or service
users. The clients' statement identifies some general goals that seem clearly interrelated: im-
prove employee morale, end the internal conflict (or develop more effective conflict manage-
ment), improve service users' satisfaction, and generally improve the overall productivity of
this department.
The clients' statement does not reveal what specific changes need to take place to achieve
these goals. There is something about the way this group has evolved within its context that
gives rise to the problems identified by management. One goal of the assessment is the
development of a restatement of the problem, first in conceptual and then in operational terms.
For example, study of the department might reveal that clear lines of authority are lacking or
the level of staff training may be deficient; the problem may be in the way the task is structured
and how new technologies have or have not been introduced; the problem may stem from
assignment of tasks, the reward structure, and the way supervision is conducted; the problem
may result from changes in the nature or number of service users without concomitant
adjustment by the department; the problem may arise from this department's maladaptive
adjustment to changes in the larger system of the organization; and so on. The point here is that
assessment must lead to identification of key variables and a formulation or explanatory theory
of the problem which, in tum, can point the way to things that can be changed and how to
change them.
Assessment might include extensive interviews and/or focus group interviews with mem-
bers. Questionnaires that tap employee morale and user satisfaction with services might be
used to establish baseline indicators of these variables. Archival data might be used for
indicators of productivity. Observation techniques may also play a part. If coordination of
work among the various components is identified as an important contributor to the problem, a
study of the task and task performance and present coordination techniques may be necessary
to identify specifics. Assessment should try to determine factors causing the problem as well as
outcomes or consequences that maintain the problem. While the existence of the problem may
be dysfunctional for some, perhaps it serves a function for others who may resist change. Other
barriers to change must be identified as well.
The assessment process should be carried out with the general collaborative approach
discussed above. The client and/or other members of the client system have "expert" knowl-
edge of their social system. They may need guidance on how to develop useful data to develop
28 HOWARD M. REBACH

problem-solving strategies. The professional's role is to provide this guidance and to partici-
pate with members as part of the research team exploring the problem. The assembled research
data should lead to a formulation which, in turn, should lead to a clinical hypothesis that states
what measurable, observable changes should affect the key variables such as employee morale
and productivity. With such a hypothesis in hand, the next step is program planning.

Program Planning. The formulation, the explanatory theory of the problem, should
give rise to statements of steps to be taken. These should be expressed in concrete, observable,
measurable behaviors. To continue the above example, perhaps deficiencies in staff training
were identified as significantly contributing to the problem. Thus, a program plan might
include the statement, ..All staff members will participate in 15 hours of training over the next
30 days," and might go on to specify the location and content of the training. Statements such
as these-called process objectives-can be monitored; it can be determined if this step
occurred as planned.
The program planning should include an evaluation plan. Evaluation should be con-
cerned with two types of objectives, process objectives and outcome objectives. Process
objectives are statements about steps that should occur to bring about desired changes.
Outcome objectives are statements about observable, measurable consequences associated
with problem solutions, such as increased morale, decreased conflict, and increased user
satisfaction. Evaluation activities should be included as an integral part of the intervention
plan. This has often been neglected, which results in poor evaluation, makeshift data collec-
tion, and questionable usefulness in determining whether or not the program is working. For
best evaluation, it should be a regular part of the intervention plan.
The plan itself is developed as a collaborative effort between the clinical sociologist and
members of the client system. First, there is the matter of respect for others' autonomy and
self-determination. The client and/or relevant members of the client system should direct the
change process. Certainly, the professional should provide input, but those most affected by
the problem should control the process and make decisions on action. Members' skills and
knowledge of their own social system are important resources in planning for change. In
addition, when members have participated in planning, the plan is more likely to address their
needs. Members may also develop a sense of "ownership" of the problem and solutions and
may thus be motivated to make the plan work.
Some elements that may be helpful in an intervention plan are:

• Preparation for change. Assessment should reveal both the willingness and the capac-
ity for change within the client system. Preparation for change may involve a variety of
activities such as dissemination of information, dealing with potential resistors, coor-
dinating with others, and maybe even a pilot project. Change is never easy for some
people; careful preparation for change may increase the likelihood of success.
• Plan of action. Program planning should include a detailed statement of who will do
what. The plan should identify specific actors and their responsibilities.
• Timetable. In addition, the intervention plan should specify how and when various
activities will be introduced.
• Monitoring progress and adapting. If change is a process, it is not likely to occur sim-
ply by introducing a specific set of activities. The process should be constantly moni-
tored and activities adapted accordingly. The intervention plan should have explicit
monitoring activities, responsibilities assigned to specific persons, and provision made
for ongoing reconsideration of activities in light of the ongoing process of change.
INTERVENTION IN CLINICAL SOCIOLOGY 29

• Accountability. Closely related to monitoring, accountability refers to making sure that

evaluation activities are built into the intervention plan. This step is neglected all too
often. Program evaluation should begin with and be an integral part of programming.
Accountability also means making sure that parties take responsibility for program
activities and that they meet their responsibilities. Finally, accountability means ade-
quate follow-up to see that desired changes continue and that the knowledge gained
from the intervention is disseminated to others who may benefit from it.

Program design is an exercise in the practical and the workable, not the ideal. Limitations
of resources, such as time, energy, money, and personnel, must be taken into account. Existing
social, political, economic, and physical constraints must also be taken into account. The
clinical sociologist must be aware of what can be changed and not waste time and resources
and create frustration attacking things that cannot be changed, given the resources available
for the work.
Careful analysis is necessary to determine the locus of intervention. Some set of circum-
stances may be found to bring about maladaptive responses on the part of a client system. For
example, the actions of one system-individual, group, or institution-may be found to
reliably elicit a specific patterned action on the part of another system. This interaction may
produce an outcome that is functional for one or both systems involved, but the train of events
may prove maladaptive in some way. Change efforts may attempt to alter any or all of these
situations. Assessment needs to point the way to the partes) of the sequence of events where
change can take place.
For example, David Britt (personal communication, 1989) worked with a company that
made cooling systems. The company found that overhead costs were rising. The company's
practice was to ship the systems to the customer, but on arrival, it was found that the systems
did not work on site. Customer complaints were handled by a customer relations unit of the
company, which would schedule engineers and technicians to go to the site and make the
necessary adjustments. It was this latter response that created unacceptable excessive cost to
the company. Customer complaints never got back to the Production Department or the Ship-
ping Department. The change was to have customer complaints go directly to Production.
Production and Shipping later coordinated to modify procedures and equipment, which
significantly reduced the rate of failure of systems to work when they arrived at the customer's
location.
Initially, the company's response to the situation was the first target of change, that is,
changing the routing of customer complaints. This led, later, to changes in the antecedent
conditions, the production and shipping of systems to customers. In turn, these changes led to
more positive outcomes-the company saved a substantial sum of money and probably
prevented damage to its reputation.
A change in the antecedent conditions may produce a new response leading to new
outcomes. Where preconditions cannot be changed, perhaps responses can be altered, or inter-
vention can alter the situation so changes can occur in response that are more positive than the
outcomes of the habitual response pattern.

Program Implementation. Clinical-sociologist-as-change-agent enacts a role as teacher

and guide after the assessment is complete and the goals of the work have been contracted. In
work with individuals, with individual conduct the target, the task is resocialization, what Fein
described as "role problems," helping individuals "change dysfunctional social roles into
more satisfying ones" (1988:88).
30 HOWARD M. REBACH

For example, adult children of alcoholics were often "parentalized" in their families of
origin. They often had to take on role responsibilities that were beyond their years and
experience and had to cope with situations with little guidance and few effective strategies. In
addition, their experience provided little security and they learned not to trust since the
alcoholic parent often made promises subsequently not kept. Adult children of alcoholics can
remain stuck in earlier role performances. They often display continued inability to trust
others, have difficulty with relationships, especially close relationships such as marriage, and
continue the parentalized role by generally taking responsibility for and trying to direct the
actions of others. These can be sources of disappointment and distress. Another source of
distress is that adult children of alcoholics are often perfectionistic, stemming from their
earlier belief that if only they had tried harder and been better, things would have turned out
differently. These patterns interfere with their performance of a variety of social roles-
spouse, worker, parent, and so on.
As Fein (1988) noted, these roles and ways of enacting them are at the core of identity.
Fein cited Stryker who described roles not tied to specific social settings as "trans-situational
roles." Performance of these roles becomes part of a person's definition of self-roles such as
family hero and scapegoat-and, therefore, part of his or her behavioral repertoire across
social settings.
Consider the case of Will, a 32-year-old white married man and father of a 4-year-old
girl. Will had been an alcoholic for about 5 years. Four years earlier, he stopped drinking on his
own, without treatment. At the time of intake, he was in a partnership with two others in a
building contracting business that was quite successful after three years of operation. Will
came alone to the first session and listed several problems: he could not trust anyone, he and
his wife were in constant conflict with each other, especially over child-rearing, he was
embroiled in trying to straighten out the lives of his four younger siblings, all adults now, and
he was concerned that he "couldn't feel anything," including remorse over his father's recent
death. Will's earlier conflicts with his wife had included physical abuse, but not for the last
several years.
Assessment revealed, among other things, Will's father's history of alcoholism, the
father's consistent denigration of Will as worthless and stupid, the father's abuse of the mother,
Will's attempts to win his father's approval (though failing no matter how hard he tried), and
Will's taking on a quasi-parental role in helping to raise his younger siblings and supporting!
protecting the mother.
Resocialization as an intervention strategy includes work with the individual and with
significant others, such as parents and spouse or present partner. Selection of others depends on
the case. For example, with a child or adolescent, parents, siblings, teachers, friends, and
classmates may be included. With Will, work included individual sessions and sessions with
him and his wife. In the individual sessions, we carefully went over his earlier socialization
experiences with instruction on how these early role performances manifested themselves in
present conduct. His present predicament was demystified as Will learned how his prior social-
ization and role models shaped his present definition of self and his adult role performances.
Since roles are negotiated in interaction, work in sessions with his wife included instruction in
spousal communication, such as how to conduct conflict, instruction on joint parenting, and
instruction and homework designed to facilitate a more egalitarian role relationship with his
spouse and changes in role relationships with his now-adult siblings. Methods included role-
playing, role reversal, and modeling by the clinical sociologist. Resocialization also included
referral to the self-help group Adult Children of Alcoholics. The purpose of the referral to the
group was to help Will and his wife develop a supportive network of others who understood
INTERVENTION IN CLINICAL SOCIOLOGY 31

the problem and could help them develop coping strategies. Though presented here in brief,
the case illustrates work on at least two levels-individual and group-and the instructional
role of a clinical sociologist in resocialization as well as in helping the clients find supportive
networks.
Intervention with groups and families often involves role relationships. Attention should
be paid to power structures, communication structures, and the nature and organization of
family systems and subsystems. An example was the case of Sheila. The local school asked for
help with this 12-year-old girl whose actions disrupted the entire elementary school. On arrival
at school, Sheila began screaming and refusing to attend class. School personnel-teachers,
principals, guidance counselors, and school nurse-all attempted to mollify the girl and get
her to attend class. Eventually, in despair, the girl's mother was usually called. She was asked
to take Sheila home and keep her there for a few days.
At intake, the problem was identified as Sheila's concern that "something terrible"
would happen to her mother and she wanted to be with her mother and be assured of Mom's
safety. At intake, the girl admitted to weighing 210 pounds (which was an underestimate by
20 pounds). She admitted that she was teased unmercifully by her classmates, a situation she
said she could no longer take and wished to avoid.
The antecedent conditions included the interactions between the girl and her classmates,
the school's requirements for attendance, and specific requirements for performance of the stu-
dent role-going to class, doing work, and so on. The child's response was to engage in ac-
tions designed to escape/avoid the punishing situation, and, by and large, her actions got the
outcome she wanted: the school suspended her, her family allowed her to stay home for as long
as they could, and they permitted her to stay home from school whenever she wished. This
sequence, however, was seen as maladaptive by both school personnel and the mother. The
girl may suffer educational and developmental deficits that affect her life chances, and county
laws governing school attendance could lead to serious consequences for the parents.
Assessment revealed that Sheila's father had little positive to say about school in general,
about Sheila's school, or about the staff at the school. The father, who weighed 350 pounds,
doted on Sheila, though he was autocratic toward his wife and Sheila's older sister. He issued
commands to his wife and older daughter, but made no demands on Sheila and supported her
every move, especially with regards to school. As a result, Sheila became the dominant figure
around which the family structure revolved-she achieved this status with the father's collu-
sion. At the time the case was referred, however, the father was disturbed by Sheila's actions,
although he mistrusted the school and doubted their ability (as well as mine) to deal with his
daughter or with the problem.
Intervention in this case called for instructing Sheila's parents about the present structure
of their family and about methods of regaining control-of restoring what some family
therapists call "the executive subsystem" empowering the parents to gain control of Sheila
and her behavior and to end the disruption her behavior was causing.
Multiple interventions are indicated here. Obviously, one issue is the girl's weight, which
may later prove unhealthy for her. However, the conditions of school are set as an antecedent.
Though the system offered some home teaching in cases such as severe illness, they saw it as
a temporary measure and their resources for this are limited. In any event, that is not indicated
here since home teaching would not solve the problem-it would be the ultimate reward to
Sheila for her actions. However, it may be possible to alter the reactions of her peers, and to
change the response of school staff and parents. By these interventions, it may also be pos-
sible to change the girl's reaction to school.
This case required work with Sheila, her school, and her family. Resocialization of Sheila
32 HOWARD M. REBACH

was part of the work with this family as well as helping the family restructure role relation-
ships. In addition, work included intergroup relationships in negotiating between the family
and school personnel who were also implicated in the problem. Altering role relationships
within the family and altering the relationship of the family to the school also had the effect
of resocializing Sheila and contributed to a solution of this problem.
These cases have illustrated some themes for sociological intervention. One is that socio-
logical work often must cross levels. Lippitt called this "the challenge of multi-system
thinking, i.e., to integrate data about the client at the level of individual, group, and organiza-
tional dynamics, and interactions with the environment" (1985:39).
A second theme is the role of sociologist as teacher in helping clients resolve problems.
The humanistic approach of clinical sociology asserts that people will and can solve their own
problems and that work with clients should leave them with enhanced problem-solving skills.
Thus, the instructional role of sociologist-as-helper pays attention to this humanistic view.
Rather than taking responsibility from clients, doing for them, this role helps them learn to
do for themselves as they learn alternative strategies.
At the level of larger social systems, such as organizations, Lippitt's analysis of work
with organizations also showed a preponderance of teaching roles for sociological consultants
as well as the role of group facilitator in brainstorming and other group problem-solving
sessions. The sociologist's role is not only providing the instruction for change; as Lippitt
noted, providing organizational clients with insight about and guidance through the change
process also facilitates constructive change. Readers are directed to Lippitt's excellent article
for more detailed consideration.

The Goal of Intervention Is Behavior Change

The goal of intervention is behavior change. Problem solution requires change. For
change to occur, significant actors and role occupants must alter their actions and/or inter-
actions within relevant contexts. This is the major way that intervention in clinical sociology
differs from other forms of intervention: the emphasis is on observable, measurable changes in
overt action. The focus is not on unobservable intrapsychic events or hidden causes, nor is the
goal some vague specification of enhanced functioning or the restoration of equilibrium. The
work must proceed with clear operational definition of desired outcomes, with careful mon-
itoring of indicators specified a priori. If these do not show movement, reassessment and
redesign takes place. Observable behavior change is the goal. Though a clinical sociologist
may privately use terms like empowerment, role strain, and marginality, these are shorthand or
summary phrases. They may be helpful in understanding a case, but, as Voelkl and Colburn
(1984) pointed out, these terms must be translated to specific interactional behaviors within
the client system. They are not solvable problems.
The clinical sociologist is aware that application of a label does not lead to application of
a generic set of techniques. There are no sets of techniques mechanistically applied. The inter-
vention agent must have reflective and adaptive capacities. The clinical sociologist constantly
monitors events and creatively adapts intervention steps to interact with changing conditions,
unstable conditions, and changing goals. The sociocultural contexts are sources of environ-
mental disturbances that require program adaptation. Intervention steps consider the socio-
cultural contexts and the specific patterns of action within context.
Though behavior change is the goal, cognitive events are not totally ignored. In his many
writings on clinical sociological intervention, Straus (1984) directed our attention to the need
INTERVENTION IN CLINICAL SOCIOLOGY 33

to change clients' operational definitions of the situation "since they form the basis upon
which conduct will be constructed by human actors." Straus noted, however, that sociological
interventions "are more concerned with the manifestations ... in patterns of conduct and joint
conduct being enacted by the individuals, groups, and/or systems under scrutiny" (p. 52).
While cognitive events may underlie action, behavior change can result in cognitive change
and vice versa. Thus, for Straus, the operational definition of the situation is found in pat-
terns of action of an individual or groups of persons in small and large social systems.
Ultimately, even internal socially constructed realities manifest themselves in behavior and,
ultimately, it is behavior that must change if problem solving is to take place.

Barriers to Change

Since change is the goal, the clinical sociologist needs to analyze why client systems do
not change. Issues are knowledge, skill, and motivation in order of increasing difficulty where
the success of intervention is concerned. Clients may be stuck because they lack knowledge of
constructive alternatives. They may not be aware of changing conditions requiring new
adaptive strategies. The value of useful information as a component of intervention cannot be
overlooked. Clients may lack the skill to make options into real alternatives to their present
course of action. Program activities may include education, training, role rehearsal, incorpora-
tion of new kinds of roles, and so on, increasing the pool of skills that allow for adaptive
change. Sparrow used all of these techniques and more in teaching parenting skills to black
parents in a nonurban setting. The program, which "emphasizes the role of Black culture in
parenting," involved "role analysis and group dynamics as teaching tools" (1995:121). The
IS-session parent training offered instruction and discussion of a wide range of topics.
With knowledge and skills, however, the clients or members of a client system may not be
motivated to make necessary changes. Change carries an element of risk and unpredictability.
The nice thing about the way you have always done things is its familiarity and you can predict
the outcome, even if that outcome does not maximize your rewards. Change-oriented interven-
tion may produce serious disequilibrium within the client system and spark efforts to restore
that equilibrium. For example, when an individual starts to change his or her actions, members
of the person's role set may exert pressures against change. They typically have related to
the person in a specific way and may not be prepared to change their familiar and habitual
interaction pattern.
Assessment should also try to uncover any actors who benefit from the problematic
situation and their relative power to sabotage change efforts. Even by inaction, certain actors
in key roles may disrupt attempts to bring about change. In some cases these actors are opinion
leaders or legitimizers. In other cases legitimizers and decision makers, such as managers, may
be all for change whereas resistance comes from workers who may be threatened by change or
whose superior knowledge of actual conditions creates a very rational resistance to proposed
changes. To be effective as a change agent, the clinical sociologist must consider all elements
of a system.
Other aspects that detract from clients' motivation to change need to be considered in
program planning. The program steps and the changes must be consistent with clients'
conception of self (individual or corporate), their moral and ethical standards, their socio-
cultural norms and practices, and so on. The situation gets more complex when these elements
are themselves at the root of the problem. For example, in work with an individual, the
conception of self is extremely negative. In family work, a spouse's conception of his or her
34 HOWARD M. REBACH

role may be problematic. Brisbane and Stuart (1985) reported how subcultural norms of
keeping things that go on in the home, in the home, conflicted with several black women's
participation in a group for black women with alcoholic parents. This conflict caused them to
withdraw from the self-help group, which was designed to deal with the many problems faced
by adults reared by alcoholic parents.

CONCLUSION

Clinical sociology is not a chair-bound activity. The clinical sociologist must "go where
the action is." In assessment, the clinical sociologist must go to relevant social environments
and observe functioning of client systems. As a change agent, the clinical sociologist must
again be on hand to instruct and guide actors in making the changes they desire. The work
helps client systems change networks, add roles, strengthen relationships, deal with inter-
actional difficulty and with socially constructed reality.
Intervention in clinical sociology is guided by humanistic values, by sociological knowl-
edge and theory, and by the application of the scientific method that involves continuing
evaluation of the progress of intervention and creative adaptation of the client situation. Each
case presents a unique challenge to be approached with creativity and care. And the work calls
for imposing structure on the materials of a single case, to understand the case; setting the
problem for work; and creatively devising strategies that will interact with the problematic
situation to bring about desired changes.
However, the clinical sociologist's task is not completed when the client's specific
problem is solved. The task of the change agent is to leave the client system not only with the
specific problem solution but with enhanced problem-solving abilities to ensure that the
positive changes will last beyond the term of the clinical work. Not only must the clinical
sociologist bring about a specific change, it is also necessary that intervention plans include
establishing structures that prevent regression and facilitate continued adaptation and change
as needed by the social system.

REFERENCES

Anderson, c., & Rouse, L. (1988). Intervention in cases of woman battering: An application of symbolic interaction
and critical theory. Clinical Sociology Review, 6, 134-144.
Angel, R., & Woroby, J. L. (1988). Single motherhood and children's health. Journal ofHealth and Social Behavior,
29,38-52.
Babbie, E. (1986). The practice of social research (4th ed.). Belmont, CA: Wadsworth.
Benello, C. G. (1982). Clinical sociology in the service of social change: The experience of developing worker
management. Clinical Sociology Review, 1, 93-114.
Brisbane, F. L., & Stuart, B. L. (1985). A self help model for working with black women of alcoholic parents.
Alcoholism Treatment Quarterly, 2, 199-219.
Bruhn, 1. G., & Rebach, H. M. (1996). Clinical sociology: An agenda for action. New York: Plenum Press.
Church, N. (1985). Sociotherapy with marital couples: Incorporating dramaturgical and social constructionist ele-
ments of marital interaction. Clinical Sociology Review, 3, 116-128.
Coyle, S. (1996). Using deep learning groups among adult children of alcoholics. Clinical Sociology Review, 14,
103-118
Fein, M. L. (1988). Resocialization: A neglected paradign. Clinical Sociology Review, 6, 88-100.
Freedman, J. (1982). Clinical sociology: What it is and what it isn't-A perspective. Clinical Sociology Review, 1,
34-49.
Glassner, B. (1999). The culture offear. New York: Basic Books.
INTERVENTION IN CLINICAL SOCIOLOGY 35

Guidubaldi, J., & Cleminshaw, H. (1985), Divorce, family health, and child adjustment. Family Relations, 34, 35-41.
Gutknecht, D. B. (1984). Organizational development: An assessment with implications for clinical sociology.
Clinical Sociology Review, 2, 94-108.
Hilgartner, S., & Bosk, C. L. (1988). The rise and fall of social problems: A public arenas model. American Journal of
Sociology, 94, 53-78.
Jacques, E. (1982). The method of social analysis in social change and social research. Clinical Sociology Review, 1,
SO-58.
Jones, B. (1984). Doing sociology with the design professions. Clinical Sociology Review, 2, 109-119.
Kallen, D. (1984). Clinical sociology and adolescent medicine: The design of a program. Clinical Sociology Review, 2,
78-93.
Lippitt, R. (1985). Six problem-solving contexts for intervention decision making. Clinical Sociology Review, 3,
39-49.
Lofland, J. (1976). Doing social life. New York: Wiley-Interscience.
Pifia, D. L. (1998). Providing culturally sensitive services to Latino clients: A case study of a nonprofit organization.
Clinical Sociology Review, 16, 67-92.
Rogers, C. (1951). Client centered therapy. Boston: Houghton Mifflin.
Sengstock, M. (1987). Sociological strategies for developing community resources: Services for abused wives as an
example. Clinical Sociology Review, 5, 132-144.
Sparrow, K. H. (1995). Adapting a parenting skill program for blacks in southern Louisiana: A sociological
perspective. Clinical Sociology Review, 13, 120-128.
Straus, R. (1982). Clinical sociology on the one-to-one level: A social-behavioral approach to counseling. Clinical
Sociology Review, 1, 59-74.
Straus, R. (1984). Changing the definition of the situation: Toward a theory of sociological intervention. 2. Clinical
Sociology Review, 2, 51-63.
Straus, R. (1987). The theoretical base of clinical sociology: Root metaphors and key principles. Clinical Sociology
Review, 5, 65-82.
Sundberg, N. D., Tyler, L. E., & Taplin, J. R. (1973). Clinical psychology: Expanding horizons. Englewood Cliffs, NJ:
Prentice-Hall.
Swann, L. A. (1988). Grounded encounter therapy: Its characteristics and process. Clinical Sociology Review, 6,
76-87.
Voelkl, G. M., & Colburn, K. (1984). The clinical sociologist as family therapist: Utilizing the strategic communica-
tion approach. Clinical Sociology Review, 2, 64-77.
Whyte, W. F. (1982). Social inventions for solving human problems. 1981 Presidential Address. American Sociologi-
cal Review, 47, 1-13. Reprinted in Clinical Sociology Review, 5, 45-64.
 CHAPTER 3

Communication and
Relationships with Clients
HOWARD M. REBACH

INTRODUCTION

Clinical sociologists practice at many levels across the social spectrum. They use a variety of
theoretical perspectives and apply techniques germane to the setting of practice, the assessed
problem, and the client system. The structuring formula common to all clinical sociologists-
and to all the helping professions-is that a client comes seeking help. People expect pro-
fessionals to have special knowledge, procedures, and techniques. The success of specific
techniques, however, is related to the quality of one's relationship with clients. The purpose of
this chapter is to discuss the nontechnical issues of clinical work (Parloff, 1986), the client-
professional relationship.
Forming positive relationships with clients is as much art as science. It involves coming
to the encounter with certain mind-sets, a few techniques, the ability to "read" people, and the
flexibility to adapt interaction in response to others' behavior. As Schon (1983) observed, "the
unique case calls for an art of practice which 'might be taught if it were constant and known,
but it is not constant.' " For Schon, the art of practice calls for "reflection in action," the adroit
selection of behaviors based on the dynamics of the relationship and on what the client
presents from moment to moment. No amount of instruction in how to draw, how to use light
and shadow, how to use color will produce a Degas or Monet. But these and other mundane
skills may be necessary when artists apply their creativity. So it is with the art of practice.
Relationships emerge from interaction. Your communication skills and how you "use
yourself" often determine the course of interaction and the developing relationship. This
chapter will consider communication and the development of relationships between clients/
members of a client system and clinical workers. Because my own practice is primarily with
individuals, families, and small groups, this chapter is biased toward sociological practice on
the microlevel, but at any level, you must eventually meet face to face with identifiable role
occupants, gain trust and cooperation, and form a productive working relationship.

HOWARD M. REBACH • Department of Social Science, University of Maryland Eastern Shore, Princess Anne,
Maryland 21853.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

37
38 HOWARD M. REBACH

A note on terminology is relevant here. I use the term client to refer to the person or group
that hires you. The term client system refers more broadly to the client and others within the
client's social network. This could mean family members, co-workers, adversaries, em-
ployees, services providers, or anyone else that you might interact with as part of your work
with a case. For simplicity, the term client will be used to imply both.
The importance of the relationship with clients cannot be overstated. Your ability to
conduct a valid and useful assessment and design and implement an intervention program
depends on how willing clients and members of a client system are to trust you and work
cooperatively with you. People may have to reveal embarrassing or threatening facts and
feelings or expose their vulnerability in the face of powerful norms that stress adequacy or
even perfection. You may need to ask them to expose their deeply held-and often hidden-
feelings, or question their definition of self. The course of the work will depend on your ability
to develop an effective working relationship with clients.

ON RELATIONSHIPS GENERALLY

Relationships between people are emergent and come to be rule governed. Factors that
influence interaction and the development of relationships can be identified, but emergent
phenomena cannot be completely predicted from knowledge of the context, sociocultural
background, or characteristics of interactants. The possibilities for the emergent structure are
infinite. Communication is both an expression of culture and a creator of it. Although social
roles, statuses, context and purpose of interaction as well as normative social behavior act as
constraints, a relationship emerges as participants communicate, process information from
transactions, and adapt in context. The emergent relationship and its rules are the result of a
specific kind of negotiation among interactants.
When strangers meet, Person (defined here as the one who initiates interaction) presents
self to Other (Goffman, 1959). This presentation is influenced by Person's history, self-
conception, and definition of the situation-Person's role definition, status vis-a-vis Other,
purpose for the interaction, context in which interaction takes place, and so forth.
In the normal course of everyday life, Other, conforming to a normative social contract,
generally accepts Person's presentation of self and also offers a presentation of self. Both try to
manage the impression the other forms. Usually, they collude in each other's impression
management. As interaction continues, the different selves try to adjust to each other. They
continue to "train" each other on how they are to be seen and treated.
Training is conducted outside the awareness of the participants; most of the time, the
interactants are not aware they are training and being trained. Training is carried in the
messages each gives in response to messages received from others. As Bateson (1972) argued,
relationships are the exchange of ... messages. Interactants set and try to maintain personal
boundaries as they respond to others (Vuchinich, 1984).
As mutual training continues, the relationship is a source of information that is fed back.
Each person adapts, reads the feedback, adjusts some more, and so forth. Interactants adopt
specific rules in interaction, define other(s), self, situation, as they interpret messages. The
process is dynamic, not static. An actor's definition of the situation is not fixed but the actor
continually adapts to the flow of feedback. Over time, the relationship develops patterns and
norms and becomes governed by implicit rules. The training is a form of negotiation. As each
trains the other, they are negotiating their relationship. Actions that Person directs to Other are
accepted, modified, or rejected. Actions that are accepted are likely to be repeated and become
RELATIONSHIPS WITH CLIENTS 39

a feature of the relationship. Repetition of unacceptable behaviors may undermine the relation-
ship, perhaps to the point where one of the interactants withdraws from the relationship.
Continued interaction is a product ofjoint willingness to continue, which is contingent on
rewards stemming from continuing. A person cannot determine if the interaction has potential
rewards unless a definition can be placed on the situation. The person processes information in
attempting to determine what the outcomes-rewards or costs-are for self.

THE CLINICAL RELATIONSHIP

What is generally true is true of clinical relationships. They emerge from interaction,
develop patterns and rules, and are constrained by context and purpose. Clients enter the
encounter searching for structure and assume the existence of an objective reality that can be
shared (Gurevitch, 1988). They will attempt to train you to perceive them and treat them in
ways that are familiar to them or the ways they prefer to be seen and treated. And they will
assess the likelihood of rewards from interaction.
Beyond these similarities, the relationship between a clinical sociologist and a member or
members of a client system is not an ordinary social relationship. You are there to develop a
special kind of relationship-a helping relationship. Unfortunately, it is not possible to pro-
vide a precise, invariant operational definition of that relationship, nor is it possible to specify
an invariant set ofbehaviors. Clients and settings are unique. The key is how you adapt your
communication in context; the difficult task is to create a close yet professional relationship.
The relationship you get is the one you ask for, both overtly and unconsciously, as the client
perceives your communication behaviors and assigns meaning to them.
The time spent with the client must be used to construct a working relationship, and
understanding of the problematic situation, define objectives, and attempt to move toward
them. Understanding the situation requires understanding with and understanding about. The
former refers to understanding the client's models of reality from their perspective. Like a
good ethnographer, you must attempt to understand their cognitive world, discover their
modes of cognition and perception (Lindesmith et at., 1988), and learn "those features of
objects and events which they regard as significant for defining concepts, formulating proposi-
tions, and making decisions" (Frake,1962). People will have their own ways of understanding
their reality and their own ways of constructing and accounting for the problematic situation.
You must understand and accept their reality without defining it as objective reality. You
must also retain an analytic perspective, to interact with Other in terms of your world, the
world of analytic concepts.
You must also bring to the situation the awareness that your behaviors contribute to the
structure and quality of the relationship. You must present conditions that communicate the
uniqueness of clients' relationship with you. You must communicate your interest in them, that
you are trustworthy, and that you can be helpful.

Presenting Conditions

Evidence from a variety of sources suggests that the client-clinician relationship be

defined as status equals mutually engaged in problem solving. Humanistic values remind us to
respect clients' rights to self-determination. Yourrole is notto tell clients whatto do butto help
them expand their range of choices so they can cope more effectively with their environment.
40 HOWARD M. REBACH

Although your background and training may make an appropriate course of action seem
obvious, clients may be unable to use it because it is not yet included in their model of reality.
Their social reality (e.g., class, gender, organization membership, ethnicity, culture) may make
your "solution" unacceptable or inaccessible.
From this perspective, then, the client-clinician relationship is seen as a working partner-
ship among role occupants who are status equals. Carl Rogers (1951) characterized the ap-
proach as "client centered," an orientation that respects others' significance, worth, and
dignity as human beings. Rogers wrote:
Do we tend to treat individuals as persons of worth, or do we subtly devaluate them by our attitudes and
behavior? Is our philosophy one in which respect for the individual is upper most? Do we respect his
capacity and his right to self-direction, or do we basically believe that his life would be best guided by
us? To what extent do we have a need and desire to dominate others? Are we willing for the individual
to select and choose his own values, or are our actions guided by the conviction (usually unspoken) that
he would be happiest if he permitted us to select for him, his values and standards, and goals? (p. 20)

Rogers's approach, often stereotyped as "nondirective," does not imply laissez-faire.

Passivity could communicate lack of interest, indifference, or rejection and does not indicate
to the person that you care or that you believe the person to be worthwhile. But Rogers's
approach suggests that practitioners, in whatever setting, show concern, respect, genuineness,
accurate empathy, and nonjudgmental regard. These do not produce change, as such, but they
set the conditions for progress (Wexler & Butler, 1976).
Studies of professional-client interaction in medical settings found that the" ... affective
component of the physician's communication ... [was] a major feature in patients' evalua-
tions" (Buller & Buller, 1987:375). The affective component included directing behavior
toward the person rather than the "case," allowing adequate time, and showing interest. Buller
and Buller compared what they called an affiliative style with a controlling one. An affiliative
style included behaviors that communicated friendliness, empathy, warmth, genuineness,
candor, honesty, a desire to help, and a nonjudgmental attitude. A controlling style was one
that communicated control over the interaction with obvious power differences. Buller and
Buller found a high correlation between patients' evaluations of physicians' communication
and their satisfaction with healthcare services. Greater satisfaction was associated with the
affiliative style.
Studies of psychotherapy find that the relationship climate between the therapist and the
client is associated with progress and satisfaction (Lorr, 1964). A facilitative climate is one in
which the therapist genuinely tries to understand what the client has to say, is accepting,
interested, nurturing and egalitarian, and shows respect.
Saltzman et al. (1976) studied the relationship aspects in the initial stages of psycho-
therapy. Compared with those who showed their dissatisfaction by dropping out, remainers
expressed feelings of (1) being respected as human beings, (2) being understood and under-
standing what the clinician tried to convey, (3) being able openly to express feelings and
receive an open reaction, (4) confidence in the clinician's competence and commitment to help
as long as needed, (5) uniqueness of the relationship and the response they received, (6) being
involved in a relationship that they thought about between meetings, and (7) corning to grips
with problems and making progress. Therapists' reactions also made a difference. Data
showed that for clients who remained, therapists felt able to (1) accept and respect the client as
the client is, (2) understand what the client tries to convey and is understood by the client,
(3) express self and communicate openly, (4) have a sense of concern for and participation
with the client, (5) be involved in an ongoing relationship that was anticipated between meet-
ings, and (6) acknowledge emotional reactions generally and toward the client in particular.
RELATIONSHIPS WITH CLIENTS 41

Data also showed that these relationship aspects were positively correlated with clients'
and therapists' assessments of client improvement and problem resolution. These results indi-
cate the importance of the interpretations clients/members of client systems place on the
messages they receive.

Communication

The most basic, axiomatic statement stresses the impossibility of not communicating.
Given the presence of another person, "you cannot NOT communicate" (Watzlawick et aI.,
1968:49). The presence of an observer creates the possibility that the observer will assign
meaning to your behavior. You may not intend to send a message, but you have no control over
whether or not someone interprets your behavior. You also have no direct control over what
meaning the observer assigns. Each observer applies a personal model of reality to interpret
messages. Your intentions are not a necessary component of the meanings that an observer
assigned to your actions.
As people and as clients and clinicians, we make behaviors available for interpretation on
many levels. The most obvious are the language symbols that we use, but language is just one
band that carries potential meaning. Paralinguistic cues-stress, intonation, speech rate and
pitch, vocabulary, and so on-and nonverbal cues also influence interpretations. Eye contact,
hand and facial gestures, gross body movements, and postures are examples. A person's use of
time, space, and context also have potential message value to an observer.
Messages are not always consonant across modalities. For instance, consider the total
message of a parent who tries to discipline and elicit obedience from a child but conducts the
entire transaction while smiling, barely looking at the child, and never moving from a slouched
position in an easy chair. The words may admonish, but the other behaviors seem to give the
child tacit permission to ignore what has been said.
Though communication occurs whether we intend to send messages or not, we also
operate on our environment by intentionally encoding messages, most often verbal messages.
The purpose of such messages is to elicit a more or less predetermined response from the
audience member(s). Perhaps a second axiom of communication is to note that each message
carries at least two kinds of information: content and relationship information (Watzlawick et
aI., 1968). The content aspect is defined as the semantic meaning and the response you, as
message source, want from the receiver. The relationship aspect of messages contains infor-
mation about who you think you are and how you see your relationship to the other person.
Most often, the content aspect is carried in the words.
Relationship information is usually carried through paralinguistic and nonverbal behav-
iors. Epstein (1986) reported that higher status interactants initiate more touching than lower
status people. Women show more facial display of feelings and smile and look at interacting
partners more often than men do. Men and higher status people take more personal space and
are more likely to interrupt and "over top" (talk while other is talking). Men are especially
prone to over top when talking to a woman or a child. Social characteristics such as class, race,
ethnicity, age, occupation, and gender as well as context cues-the topic, roles of interactants,
purpose of interaction-influence communication behaviors.
For clinical workers, tuning in to nonverbals is an important part of establishing effective
relationships. Nonverbal messages may be a clue to inner states (Epstein, 1986). Early investi-
gators indicated that nonverbal messages may reflect actors' adaptation to the situation and
communicate information about their reactions to their interacting partner (Argyle, 1969;
42 HOWARD M. REBACH

Mehrabian, 1972). Those who seek approval use more eye contact as they search for cues to
structure behavior. People also avert gaze during nonfluency and when they are dealing with
complex or more intimate material. There is also less looking at a disliked person (Exline,
1969; Exline & Winters, 1965; Kendon, 1967).
The point of this discussion is to alert beginners and even experienced clinical workers to
the range of elements that have potential message value for clinicians and clients. Effective
communication, getting the response you want, requires carefully observing your receivers
and adapting your communication behaviors on the bases of the feedback you receive.

Preparing for Communication

One way to achieve effective communication is to prepare for it. The most basic step in
preparing for communication is to take stock of yourself. Have a good look at your own
attitudes, biases, prejudices, and blind spots that may act as barriers. Are there certain kinds of
people, situations, topics, or problems that you do not care to deal with or that make you feel
uncomfortable? For example, how do you feel about authority and hierarchical structures? Do
you automatically identify with one side or the other? Do you see all lower status members as
downtrodden and oppressed and all authority as exploitative? Or do you see higher status
members as invariably right and lower status members as recalcitrant? Are there certain
political, social, or economic stances that arouse your impatience or hostility? Do you grow
impatient or get frustrated when certain religious or moral positions are introduced? Are you
prone to moralize? Do you grow impatient with people who question you or who do not
immediately understand you? Do you shy away from or get irritated when people are hostile,
dependent, or passive? Do you need to talk constantly or at least when there is a brief lapse in
the conversation? Do you have mannerisms that call attention to themselves or are distracting?
Absentmindedly shaking a foot, picking at nails, or fiddling with a pen are physical examples.
Verbal examples include excessive use of jargon or verbalizations such as "yeah, hunh"
uttered repeatedly after every phrase or sentence of the other person. Learning about yourself
can be very useful, but it is not easy. Monitoring yourself can be helpful. Working with a
trusted colleague can also be helpful if you take the time to debrief each other's actions and
can be open and candid with each other. Role-playing and videotaping can also help you learn
a great deal about your own interactive behaviors.
Another way of preparing for communication is to pay attention to the physical surround-
ings, which should provide privacy and be free of distractions including telephone calls,
interruptions, and people milling about. The environment should help communicate that the
person is important, has your undivided attention, and that this is a safe place to speak without
fear of being overheard. Each individual clinical sociologist may have to decide on role props,
trappings of status and expertise, and questions of furnishings and their placement. Various
combinations communicate different things. For example, meeting with people while you sit
behind a big imposing desk in an equally imposing chair while they sit in smaller, ordinary
chairs in front of the desk places a barrier between you and may imply status differences. No
desk between you and similar chairs for all may create a more open and egalitarian, partnership
feeling. Gathering around a conference table, communication can be influenced by the shape
of the table and where the various actors sit. The choices you make will depend on the tone
you wish to set.
If your client is an organization, you should learn something about the organization and
its culture, its purpose and goals, and status structure. Organizations often develop a spe-
RELATIONSHIPS WITH CLIENTS 43

cialized language that differentiates insiders and outsiders. Businesses,police departments,

schools, healthcare providers all develop shorthand terms. Learning the jargon facilitates
communication. On the other hand, it is probably not a good idea to adopt street language or
adolescent slang in hopes of gaining acceptance if it will appear phony.
Anticipating the needs of clients is another way of preparing for communication. If
you are aware of special needs-an interpreter for non-English speakers or for hearing-
handicapped persons-you can make provision for such needs. One general need of most
clients beginning a relationship with helping professionals is the need for structure and role
clarity. You must be prepared to provide structuring information.
In some settings, particularly in microlevel practice, the professional may have the higher
status role. In other settings, status relationships may be less clear. In organizations, for
example, the professional may have to work with people who define their own status as higher
due to their position in the organization's hierarchy. It may also be the case that the profes-
sional is seen as an unwelcome intrusion or even a threat. You must be prepared to deal with
authority issues, hostility, and resistance.

Initial Meetings

Initially it may be best to be less task oriented and more person oriented (Shulman, 1984).
Introductions are obviously a part of openings. A warmup period may be appropriate. Some
sensitivity to client and setting is also a good rule. Too easy familiarity and automatic (or
nonreciprocal) use of first names may be inappropriate or offensive, indicating lack of respect.
Warm-up periods of informal conversation can be useful in establishing rapport, especially
in certain cultural groups such as Hispanics, Asians, and Native Americans (Hepworth &
Larson, 1986) or with adolescents or nonvoluntary clients. A warmup period provides clients
with an opportunity to "size you up" and begin to get an idea of what kind of person you are.
Sometimes it may be appropriate to provide information about yourself such as background,
expertise, auspices, and objectives. At other times, warm-up may be unnecessary. Clients
may be anxious to begin telling you their stories and will be annoyed by what they might
interpret as triviality. Again, sensitivity to clients and setting is the rule.
It is often useful, in initial meetings, to anticipate uncertainty and purposefully negotiate
structure. Reassurances of confidentiality and clarification of the need for a partnership
relationship may be a start. From there, you work toward structure as you and the client
negotiate a line of action (Blumer, 1962). For example, with a new client it may be useful to
describe that, together, you will need to conduct an assessment of the problem situation and
negotiate a concrete definition of it. This opens the way for negotiating the responsibilities of
each party.
When problems have been defined and agreed on, discussion of intervention options
brings clients and clinicians to a choice point. Given a clearer understanding of the problem,
statement of objectives, potential steps to achieve the goal, and the array of consequences, the
client may decide to terminate. The program may have effects the client is not willing to
accept; the client may not be willing to expend the resources necessary; or the client may not
be prepared to take the steps needed for change. If no acceptable alternatives are available, the
client may decide to accept the present level ofthe problem as preferable to change. You have
choices also. There may be agreement on the nature of the problem, its history, causes,
manifestations, and functions but disagreement on what steps to take. If the steps chosen by the
client are not compatible with your skills or values, admission of this and further negotiation
44 HOWARD M. REBACH

may be necessary. Tennination or referral may also be the only appropriate step. Having
decided to go on, program planning and contracting follows.
As assessment and establishing a relationship with clients begins, you need to answer
two important questions: Should you take the case? If you do, can you form an effective
working alliance with this client? You must detennine if the problem meshes with your skills
and legal limitations. Not all problems are within our purview. Often we can be most con-
structive by referring the case to a more appropriate source of help.
Second, ask yourself, do you want to take the case? You need not take every case that is
within your expertise. Certain types of cases may bore you. Others may take too much of your
time and emotional energy or conflict with your values. The decision to take a case is a
commitment. Half-hearted commitment is worse than not taking the case. It deprives the client
of the chance to work with someone who will make the necessary commitment to the work. A
poorly motivated helper is not a help.
If you choose not to take the case, it is your obligation to make an appropriate referral.
Your assessment centers on the goal of detennining what is the best referral for this client.
Making the referral should be an active task. It is not enough, in my view, to say, "You should
see a ," and tenninate the relationship. In discussion with the client, you can
identify a specific resource. This can include making telephone calls with the client present
and even scheduling an appointment between the client and the referral source. You can help
the client learn how to get access to the referral source and develop strategies for accessing and
overcoming barriers to effective use of the referral. In some cases, your most important
intervention will be to connect a client with resources.
One final note on referrals. Your obligation extends to a follow-up to see if the client was
able to use the referral, did use it, and how effective the referral was. This communicates to
both the client and the services network your continuing concern. It also provides you with
information to guide future referrals.
The second question was whether you can form an effective working alliance with this
client. Can you relate to this client system in a way that will allow you to understand and value
the people involved? Do your biases and personal preferences provide significant barriers?
Is there something about this particular client that you dislike? Is there something about this
client, organization, or this problem that engages your own history in ways that will make you
ineffective? Things like the background, language, gender, racial, ethnic, sexual orientation,
or subcultural membership may make it difficult for you to understand and form an alliance
with the client. The issue turns on whether or not you and your client can understand each other
and whether you can take an involved, yet objective approach.

Approaching Clients

Clinical sociologists must learn about a problem to help alleviate it. Members of the
client system have an understanding of the problem and models of reality to aid understanding.
These models are rich and rational and support inferences that meet needs and facilitate action.
This conceptual structure includes the causes and consequences of the problem. Your task is to
learn about the conceptual structure by getting into the clients' models. It is a problem of
communication between Expert and Other who will not necessarily share meaning for con-
cepts nor have the same way of organizing information. Clients have different sets of informa-
tion, which differ in structure because of different understanding of links between facts. The
Expert has more and different linkages. Evans et al. (1986) saw the problem as the absence of
RELATIONSHIPS WITH CLIENTS 45

shared vocabularies and shared meaning. Even when similar terms are used, their semantic
content may differ.
The challenge is to determine the meaning of terms the client uses and the phenomena
that the words label. Another common problem is the professional's use of terms that have
come to summarize (for the professional) a complex set of concepts and actions (e.g.,
"socialization"). Clients are unlikely to probe for clarification ofterms. You need to learn their
language and maybe teach them yours.
Special attention should be given to clients' labels for the problem that signify observa-
tions, subjective experiences, and other relevant information. Labels also affect ongoing
adaptation to and understandings of the problem. You need to pay close attention to language
and help clients unpack the cognitive content of the labels.

Open Listening

As clients begin to tell their story, active listening and empathic communication further
rapport. Be open to whatever they present. They will talk about whatever you will listen to, so
be careful and selective about what you choose to reinforce. You will get the story best if you
let clients tell it in their own way. Start where the client is. The work is a process, not an event;
do not jump to solutions. Attend to clients' concerns and emotions. Their agenda-they have
one-comes first. Listen to their questions without trivializing them. Questions contain
concerns. Answer them openly. By so doing you model openness and indicate your concern
and your respect, that you have no secrets and no hidden agendas. Be alert to cues, especially
nonverbal and paralinguistic cues already discussed, that express their feelings. There may be
authority issues, ambivalence about help seeking and change, or negative or hostile feelings.
Respond to these cues. It does no good to ignore them. Reach behind negative feelings by
openly acknowledging them and try to see what prompts them. Be alert to cues about client
motivation and expectations. These help you understand what they want and allow you to say
what you can do and how you can help (Hepworth & Larson, 1986).
Reach for strengths also. The temptation is to focus on dysfunctions, but noting strength
can help you and the client mobilize resources. Finally, be aware that people often speak in
global terms and metaphors. Your task is to help them reach a concrete problem definition that
can be operationalized and made the target of work.

Active Listening

An important communication skill for establishing effective working relationships is

active listening. This includes such skills as "minimal prompts," paraphrasing, empathic
responses, questioning, and summarizing.

Minimal Prompts. Minimal prompts are a set of verbal and nonverbal acts that indicate
that you are following what is said but do not disturb the flow. Verbally, minimal prompts can
be an occasional "uh huh," "yes," or "I see." Nonverbal indicators that you are following are
also important. Forward lean is a nonverbal indication of attention. Appropriate eye contact
and head nods also indicate that you are interested and are following. They also provide the
speaker with reinforcement.

Paraphrasing. Paraphrasing, restating in your own words your understanding of what

has just been said, also indicates following and interest. You must be careful not to put words
46 HOWARD M. REBACH

in the clients' mouths and to avoid interpretations, especially those derived from your precon-
ceptions. By paraphrasing, you provide an opportunity for the client to give you feedback,
correcting and extending your understanding. It also furthers the relationship by indicating
your active involvement.

Questioning. Asking questions is a part of any interview but be careful that you are not
cross-examining or interrogating. Open-ended questions are most useful. Generic open-ended
questions such as "Can you clarify that for me?" or "Can you tell me more about that?" invite
the client to elaborate a topic. Closed-ended questions are best used sparingly and only when
you need a specific bit of information. Generally, they limit talk production. You might ask the
closed-ended question, "Do you like working here?" Such a question usually elicits a one- or
two-word response. The open-ended question, "How do you feel about working here?" is
more likely to elicit more material and exploration of the employee's attitude toward the job.
Questions that begin with How or What or Could are usually more useful than Why
questions (Ivey & Gluckstern, 1974). For example, the employee might indicate low satisfac-
tion with his job. The question, "Why don't you like your job?" puts him on the defensive and
implies a judgment. He may not know why. Or it may not be as simple as like-dislike. The
question, "What is it about working here that you find unsatisfactory?" invites him to continue
and may elicit elaboration of his attitude.

Empathic Responding. Perhaps the most important skill and often the most difficult,
especially for beginners, is reaching for feelings. Be alert and sensitive to underlying or overtly
expressed feelings. Nonverbal behaviors often express feelings. Do not be afraid to ask about
them. Use your own experiences with people and yourself. If you observe anger or tension or
some other nonverbal display, you can reach for it by saying something like, "You seem very
tense right now. Can you tell me what you're tense about?" This lets the client know that you
are tuned in. It also focuses the interview on the here and now and may aid you and the client
deal with feelings surrounding the interview or your relationship.
Verbal productions also have a feeling component. An employee may say, "I've been
working here for 20 years. I work hard and try hard and what's it get me? Nothing!" The best
reflections of feelings are focused. A generic statement such as "I see you are upset" is too
diffuse. It recognizes a feeling but not its object. A more directed response might be, "You feel
you're not appreciated, that you never get recognition for the things you have contributed." A
useful form is to label the feeling and use a well-formed sentence with an object such as "You
_ _ _ _ _ _ _ about ." A response to the employee might be, "You're
angry about never getting any recognition for what you have done for the company." As with
paraphrasing, the client can revise and correct your interpretation.

Some Cautions. Generally, people will talk about what they think others will listen to or
want to hear. Be careful about what you reinforce. You may direct the person away from
material that is central. It is possible, especially for beginners, to become enthralled with the
soap-opera-like qualities of accounts that you might forget your role and lead the person into
ever more involved telling of stories that may not be germane.
Do not parrot. The person says, "I am really angry." To reflect feeling by saying, "You're
angry," is likely to elicit, "that's what I just said [ stupid]." Avoid overuse of contrived lines
like "I hear you saying.... " Also avoid making interpretations and judgments of the person's
private logic and ways of constructing reality. Finally, do not mind read. If you can make an
RELATIONSHIPS WITH CLIENTS 47

interpretation, paraphrase, or empathic response, check it out with the person to get feedback
on your accuracy.

Listenfor Sensory Language. Neurolinguistic programming (NLP) advocates listening

for people's sensory language as an aid to getting into clients' models (Bandler & Grinder,
1975; Grinder & Bandler, 1976). The theory asserts that people organize experience with
information received through the senses. Sensory experience is mapped into language. Though
we are capable of representing reality with all our senses, we differ as to which is the most
highly valued-either visual, auditory, or kinesthetic (feeling and physical sensations). We
reveal this with the sensory words we use, called predicates, which are verbs, adverbs, and
adjectives. You can determine a person's most valued representational system by listening to
these predicates. For example, the person who says things like "I see myself as unappreciated
around here" or "My view is ... " or, to take one of Crinder and Bandler's examples (1976:10),
"The dazzling woman watched the silver car streak past the glittering display" is using terms
that denote visual senses as the preferred mode. An alternate utterance such as "I feel I am not
appreciated around here" denotes kinesthetic senses as the speaker's principal mode.
Grinder and Bandler advocate matching predicates or sensory words when interacting
with clients or members of a client system. They offer the following example (p. 15):
Meaning: Describe more of your present experience to me.
Kinesthetic: Put me in touch with what you are feeling at this point in time.
Visual: Show me a clear picture of what you see at this point in time.
Auditory: Tell me in more detail what you are saying at this point in time.

Note the use of specific sensory terms in each example. By discovering the person's
preferred mode, you can understand more about how the person organizes his or her model of
reality. By matching predicates you can facilitate clearer, more direct communication and
facilitate trust building. Grinder and Bandler described this as follows:
Suppose we have a client who has a kinesthetic representational system. First we listen to his
experience, then we check out our understanding of what he says (his model of the world) and phrase
our questions-in fact structure all of our communication with him-with kinesthetic predicates ....
[I)f we communicate with predicates that are kinesthetic, it will be easier for him both to understand
our communication and to know [in this case to feel) that we understand him.... [T)o allow our clients
to understand our communication with greater ease is the basis and beginning of trust. (p. 14)

Bandler and Grinder (1975) have provided strategies for helping people chunk down
problems. Like the Symbolic Interaction perspective, they also note that we construct internal
representations of reality. People get into trouble, "not because the world is not rich enough to
allow them to satisfy their needs, but because their representation of the world is impov-
erished" (p. 45). Models are impoverished because the person deletes, distorts, or generalizes
in ways that impoverish his or her understanding of his or her world. The task is to understand
the people's representation and help reframe and/or elaborate their model of reality to add
constructive choices to their behavior. People display their models of reality through their
verbal productions.
Internal representations give rise to utterances, but they may be incomplete. Statements
like "We cannot communicate" or "I am anxious all the time" are incomplete. They are not
well formed. Something has been deleted. By asking the questions, "What is it that you cannot
communicate about?" or "What are you anxious about?" you invite the person to supply the
missing piece. Or you and the person may discover his or her model of reality is incomplete in
the same way that the utterance is incomplete.
48 HOWARD M. REBACH

An exchange like the following may also illustrate the idea of well formedness:
PERSON: We can't communicate.
You: [recognizing that this is not well formed] What is it that you cannot communicate
about?
The person may be able to identify some specific topic that leads to further exploration, or
he or she may respond (more typical):
PERSON: Everything.
You do not get frustrated but continue:
You: Can you tell me just one specific thing you have difficulty communicating about?
The idea here is to help the person go from vague, global utterances to specific areas that
are problematic. You cannot simply repair communication, but you might help people commu-
nicate about something specific to identifiable others.
You can also challenge deletions that impoverish with leading questions that invite the
person to explore an expanded model of reality. Perhaps having discovered what/who the
person cannot communicate about/with, you ask: "What stops you from speaking to X about
Y?" or "What would happen if you spoke to X about Y?"
Other utterances display distortions of reality. Listen for generalizations, presuppositions,
and semantic ill-formedness that impoverish the person's model of reality and limit choices.
An example of semantic ill-formedness might be an expression like "They never made me feel
valued or part of the team." This is a distortion that attributes control of one's reality to others
and gives them responsibility for one's feelings and well-being. These formulations should be
rejected.
The basic strategy for working with people involves listening carefully to the forms of
utterances as well as to the content. Utterances that are not well formed provide clues to the
problem and to ways of helping. More detailed elaboration of Bandler and Grinder's commu-
nication strategies for helping people is beyond the scope of this chapter. Interested readers are
encouraged to study The Structure of Magic and subsequent publications that describe the
approach of NLP.
In sum then, effective communication with clients involves careful listening and respond-
ing. This section has tried to sketch briefly some skills that have proven useful. We tum now to
further cautions.

BARRIERS, BREAKDOWNS, AND PROBLEMS

Many things can interfere with communication. You must avoid the "like-me" assump-
tion often characteristic of everyday interaction. In a medical setting, McElroy and Jezewski
(1986) found that miscommunication occurred when staff assumed that patients' lifestyles
were similar to their own. This included class differences, household composition, daily
routines, marital status, and so forth. Ignoring economic differences, making poor assumptions
about patients' knowledge and abilities, and failure to follow through by providing adequate
information and clarification also contributed to communication breakdown and, thus, poor
outcomes.
Hepworth and Larson (1986) offered a laundry list of things that inhibit effective commu-
nication and relationship building:
RELATIONSHIPS WITH CLIENTS 49

Content
1. Moralizing
2. Advising and giving suggestions
3. Judging, criticizing, blaming
4. Persuading, giving logical arguments, lecturing, arguing
5. Analyzing, diagnosing, making glib dogmatic interpretations
6. Sympathizing, consoling, excusing
7. Sarcasm and inappropriate humor
8. Threatening, warning
Process
9. Using questions inappropriately; too many closed-ended questions, stacking ques-
tions, questions that have hidden agendas
10. Interrupting inappropriately or excessively
11. Dominating interaction
12. Fostering social interaction
13. Infrequent responding
14. Parroting or overusing phrases and cliches (e.g., "ya know")
15. Dwelling on remote past
16. Inappropriate self-disclosure.
Creating a defensive climate also inhibits communication (Cline & Johnson, 1976). A
defensive climate may be created by evaluation, control, superiority, certainty, by ordering,
warning, preaching, advising, lecturing, judging, ridiculing, diagnosing, praising. These
things cause persons to focus on how they appear to you, how to appear favorable in their own
and others' eyes, and how to dominate, win, impress, and escape, avoid, or reduce real or
anticipated punishment.

Client Training Clinician

In ordinary social interaction, actors train each other. When you interact with clients, be
aware that their communication behaviors will represent their habitual ways of interacting.
This can be a trap for the unwary who automatically react to clients' presentations. Research
by Heller et al. (1963) demonstrated that clients' actions can evoke personal reactions from
therapists. In their study, trained actors posing as clients confronted counselors with one of
four conditions: friendliness or hostility, dominance or dependence. Results from the clinical
interviews showed that client dominance evoked interviewer dependence, whereas client
dependence evoked interviewer dominance; client hostility evoked interviewer hostility,
whereas client friendliness evoked interviewer friendliness. These counselors appeared to
react as though this was ordinary social contact, not a clinical encounter. These results suggest
that clinicians be alert to a tendency to be drawn into the clients' patterns rather than adapting
to clients' presentations. You are not offering a clinical relationship when you allow your
judgments of clients to structure your reactions.
Being drawn into the existing patterns goes beyond the interview setting discussed by
Heller et al. Although it is important for the clinician to learn clients' vision of reality and how
clients define themselves, the clinician must avoid being trained to accept clients' version of
reality with their problematic features.
As Snow and Anderson (1987) asserted, the drive for a sense of self-worth is basic,
50 HOWARD M. REBACH

though achievement depends on roles that are differentially distributed in social systems. To
avoid stigma, people engage in identity work, "the range of activities to create, present, and
sustain personal identities congruent with and supportive of self concept." Thus, clients and
members of a client system present "accounts" consistent with their identity work. Although
you must accept the persons, you must understand that the accounts they present are geared to
have you accept their versions of reality. Accepting persons, however, is not the same as
accepting their versions of reality.
An individual is part of ongoing social networks, which include the person's significant
others and those with the power to influence the person's conduct. You enter and become part
of an ongoing social system to learn about and help the system change. Your entry creates new
relationships and alters existing ones, and the social structure changes.
An ongoing group develops a culture, sets of norms, rules for interaction, and characteris-
tic ways that members communicate and relate with each other. Members share meaning about
the objects and events in their world and, in particular, about the nature of the problematic
situation and its causes. Overall, the system, though perhaps characterized by dysfunctional
elements, has a stable equilibrium of which the dysfunction may be a necessary part. The
organization of families with an alcoholic member that continues to support the alcoholic
behavior is but one of many well-known examples.
The entry of the clinical sociologist, even if invited, is a threat to the system's equilib-
rium. The clinician, as a new entrant into the system, needs to be wary of being drawn into the
culture of the group. There will be powerful attempts to influence you to share the socially
constructed reality. Various members of the client system may present accounts of conduct in
hopes that you will accept and validate their definitions of the situation. Families, groups, and
organizations will similarly attempt to socialize you into seeing things the way they do. In
addition, social systems ordinarily have set communication and relationship patterns that will
be upset as change occurs. These patterns will work against change, and you should be alert to
these.
Finally, how members of a client system communicate with you are important assessment
data. People's characteristic behaviors are thoroughly internalized, and they usually occur
outside the actor's awareness. Even when they are on their "best behavior," possibly because
of your presence, people will have difficulty keeping their habitual communication behaviors
masked for long. Observation of their communication patterns may provide useful clues to the
problem situation. Use your own reactions as a source of hypotheses. If, in interaction with a
person or group, you feel angry, or helpless, or calm, or defiant, or happy, others who are part
of the group or who interact with the individual may also have the same response. Do not
automatically assume this but treat it as a hypothesis to be checked by assessing how others
react to the group's or person's communicative behaviors.

CONCLUSION

Communicating and forming effective working relationships with clients requires self-
awareness and attention to communication skills, as well as the flexibility to adapt communi-
cation in context to others. It is the art and craft of professional practice. There are few rules
or guidelines, but successful practice cannot be achieved without being able to form effective
relationships.
RELATIONSHIPS WITH CLIENTS 51

REFERENCES
Argyle, M. (1969). Social interaction. New York: Atherton Press.
Bandler, R, & Grinder, J. (1975). The structure of magic, I. Palo Alto, CA: Science and Behavior Books.
Bateson, G. (1972). Steps to an ecology of mind. New York: Ballantine Books.
Blumer, H. (1962). Society as symbolic interaction. In A. Rose (Ed.), Human behavior and social processes (pp. 179-
192). Boston: Houghton Mifflin.
Buller, M. K., & Buller, D. P. (1987). Physician's communication style and patient satisfaction. Journal ofHealth and
Social Behavior, 28, 375-388.
Cline, R, & Johnson, B. M. (1976). The verbal stare: Focus on attention in conversation. Communication Mono-
graphs, 43, 1-10.
Epstein, C. F. (1986). Symbolic segregation: Similarities and differences in the language and nonverbal communica-
tion of women and men. Sociological Forum, 1, 27-49.
Evans, D. A., Block, M. R, Steinberg, E. R, & Penrose, A. M. (1986). Frames and heuristics in doctor-patient
discourse. Social Science and Medicine, 22, 1027-1036.
Exline, R. V. (1969). The effects of cognitive difficulty and cognitive style upon eye to eye contact in interviews.
Unpublished paper reported in Argyle, M. (1969). Social interaction. New York: Atherton Press
Exline, R v., & Winters, L. C. (1965). Affective relations and mutual gaze in dyads. In S. Tomkins & C. Izzard (Eds.),
Affect, cognition, and personality (pp. 319-350). Berlin: Springer.
Frake, C. (1962). Cultural ecology and ethnology. American Anthropologist, 64, 53-59.
Goffman, E. (1959). The presentation of self in everyday life. Garden City, NY: Doubleday.
Grinder, J., & Bandler, R (1976), The structure of magic, II. Palo Alto, CA: Science and Behavior Books.
Gurevitch, Z. D. (1988). The other side of dialogue: On making the other strange and the experience of otherness. The
American Journal of Sociology, 93, 1179-1199.
Heller, K., Myers, R A., & Kline, L. V. (1963). Interviewer behavior as a function of standardized client roles. Journal
of Consulting Psychology, 27, 117-122.
Hepworth, D. H., & Larsen, J. A. (1986). Direct social work practice: Theory and skills. Chicago: Dorsey Press.
Ivey, A. E., & Gluckstern, N. B. (1974). Basic attending skills: Participant manual. North Amherst, MA: Microtrain-
ing Associates.
Kendon, S. (1967). Some functions of gaze direction in social interaction. Acta Psychologica, 26, 22-63.
Lindesmith, A. R, Strauss, A. L., & Denzin, N. K. (1988). Social psychology (6th ed.). Englewood Cliffs, NJ:
Prentice-Hall
Lorr, M. (1964). Client perceptions of therapists: A study of the therapeutic relation. Journal of Consulting Psychol-
ogy, 28, 146-149.
McElroy, A., & Jezewski, M. A. (1986) Boundaries and Breakdowns: Applying Agar's concept of ethnography to
observations in a pediatric clinic. Human Organizations, 45, 202-211.
Mehrabian, A. (1972). Nonverbal communication. Chicago: Aldine-Atherton.
Parloff, M. B. (1986). Frank's 'common elements' in psychotherapy: Nonspecific factors and placebos. American
Journal of Orthopsychiatry, 56, 521-530.
Rogers, C. (1951). Client centered therapy. Boston: Houghton Mifflin.
Saltzman C., Luertgert, M. J., Roth, C. H., Creaser, J., & Howard, L. (1976). Formation of a therapeutic relationship:
Experiences during the initial phase of psychotherapy as predictors of treatment duration and outcome. Journal
of Consulting and Clinical Psychology, 44, 546-555.
Schon, D. E. (1983). The reflective practitioner. New York: Basic Books.
Shulman, L. (1984). The skills of helping individuals and groups. Itaska, IL: Peacock.
Snow, D. A., & Anderson, L. (1987). Identity work among the homeless: The verbal construction and avowal of
personal identities. American Journal of Sociology, 92, 1336-1371.
Vuchinich, S. (1984). Sequencing and social structure in family conflict. Social Psychology Quarterly, 47, 217-234.
Watzlawick, P., Beavin, 1. H., & Jackson, D. D. (1968). Pragmatics of human communication. New York: Norton.
Wexler, D. A., & Butler, 1. M. (1976). Therapist modification of client expressiveness in client-centered therapy.
Journal of Consulting and Clinical Psychology, 44, 261-265.
 CHAPTER 4

Ethics and Sociological Practice

JOYCE MILLER IUTCOVICH AND SUE HOPPE

Sociological associations, like other scientific and professional organizations, exist to repre-
sent individuals bound together by cornmon goals, values, and training. Members of profes-
sional associations generally share beliefs about appropriate ways to achieve goals and about
the kinds of relationships that should exist among members of the profession as a group,
individual professionals, and society (Merton, 1982). At some point in the evolution of
professional associations, such ethical standards of conduct are codified. In contrast to other
professional associations such as the American Medical Association, which adopted its first
Code of Ethics in 1847 (Beauchamp & Childress, 1983), few social and behavioral science
associations began to promulgate codes of ethics before the mid-twentieth century.
In our discussion of ethics and sociological practice, we examine factors that have
influenced the development of ethical codes; identify crosscutting ethical principles and
specific codes of conduct within the context of different sociological practice endeavors; and
discuss some of the ethical challenges that sociological practitioners face. It is important to
keep in mind throughout this chapter that there is no one code of ethics that governs socio-
logical practitioners. Practitioners can have an affiliation with more than one sociological
association. The Code of Ethics of the American Sociological Association (ASA) provides the
most comprehensive code of conduct for sociologists-in particular, the most recent version
of the Code in which practice activities are explicitly considered. Two national sociological
practice organizations, the Society for Applied Sociology (SAS) and the Sociological Practice
Association (SPA), have codes. (See their respective web sites for copies of the ASA, SAS,
and SPA codes.) In addition, because of the nature of practice activities, many sociological
practitioners are affiliated with other professional associations that represent their particular
line of work, each association with its own set of ethical standards or codes. These include, for
example, the American Evaluation Association, the American Association for Public Opinion
Research, the Marketing Research Association, the American Association of Public Adminis-
trators, and the American Association of Marriage and Family Therapy.

JOYCE MILLER IUTCOVICH • Keystone University Research Corporation, Erie, Pennsylvania 16502 SUE
HOPPE' Department of Psychiatry, University of Texas Health Sciences Center, San Antonio, Texas 78284.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

53
54 JOYCE MILLER IUTCOVICH AND SUE HOPPE

PROFESSIONALIZATION AND CODES OF ETHICS

We begin our discussion by examining the functions of codes of ethics. Frankel (1989)
has identified eight possible functions of codes of ethics of professional associations. Here, we
focus on five of the functions. First, a code can be an "instrument of professional socializa-
tion" that creates a sense of group solidarity, identity, and allegiance. Second, a code can be a
"moral anchor" or an "enabling document" that provides guidance in evaluating alternative
courses of action and making informed choices when ethical dilemmas arise. Third, a code can
be a "source of public evaluation" and a way to "enhance a profession's reputation and public
trust." Fourth, a code can be a "support system" for professionals "against unwarranted
erosion of their power or improper demands on their skills by outsiders." Finally, a code can
be a "deterrent to unethical behavior" by linking ethical standards to adjudication procedures
and possible sanctions for unethical behavior.
Any particular code may fulfill all or only some of these functions since codes tend to
vary in their level of complexity, with some being relatively general while others are detailed,
almost encyclopedic in coverage (Rossi, 1995). The one function that codes most often fulfill is
that of a moral anchor. "It is clearly within the purview of [a] profession, indeed is part of its
social contract with society, to provide standards of practice, to ensure that practitioners
understand them, and to see to their enforcement" (Pescosolido, 1991:353). It is through
adherence to an ethical code that professions have been accorded privileged social status,
gained the public trust, and have been able to maintain a tradition of self-regulation and
monopoly over provision of their services. Since professional groups have more autonomy
than other occupational groups, they must "make good" their claim to regulate their members'
practice and behavior (Abbott, 1983).
Over the past several decades, we have witnessed Watergate, Wall Street insider trading,
physicians and hospitals exposed for Medicare and Medicaid fraud, experiments on radiation
conducted without informed consent, as well as fabrication, falsification, and plagiarism in
science (Bayles, 1981; Pimple, 1997). These dramatic examples of unethical conduct, among
others, represent a potential threat to the values of our society (Bayles, 1981). In fact, the recent
rise in popularity of professional ethics as an important topic of discussion has been fed by
reports of misconduct. Whereas in the past violations of professional ethical codes may have
been frequent, they escaped detection or punishment for the most part. However, over the past
several decades public outcry related to ethical violations has been widespread, reflecting the
development of a "new emphasis on consumer rights" that demands greater accountability on
the part of professionals (Bayles, 1981:4).
In the United States, exposure of unethical professional behaviors followed closely on
Nazi experiments, conducted in the name of "science," during World War II. In 1946, the
United States conducted the Second War Crimes trial of some of the Nazi physicians involved
in the atrocities. The trial, which came to be called the Nuremberg Trial, marked a "watershed
as far as reaction to experimenting on human subjects is concerned" (Bower & deGusparis,
1978:3). While the trial focused on the criminal nature of the Nazi experiments, the judges also
grappled with much broader ethical concerns regarding medical research. They established the
Nuremberg Code, a set of ten principles of human experimentation, the most important of
which was voluntary consent to research.
The importance of the Nuremberg Code cannot be overemphasized. Its impact has
extended beyond biomedical to social and behavioral science research, and it influenced the
subsequent development of research regulations in the United States. In 1974, Congress passed
ETHICS AND SOCIOLOGICAL PRACTICE 55

the National Research Act, which mandated institutional review boards (IRBs) and called for
the creation of the National Commission for the Protection of Human Subjects of Biomedical
and Behavioral Research. The Code of Federal Regulations Governing Research on Human
Subjects (45 CPR 46) and the Belmont Report grew from the work of the Commission. The
Belmont Report is a succinct summary of three basic principles to be used to evaluate the
ethicality of research (respect for persons, beneficence, and justice) that illustrates how the
principles should be applied (Wigodsky & Hoppe, 1996). The Belmont Report should be
required reading for sociologists.
The first Code of Ethics ofthe ASA was drafted in the mid-1960s and became effective in
1971. The ASA Code of Ethics serves all of the five functions that were described earlier, as
reflected in its organizational scheme that embodies aspirational principles, specific standards
of conduct, methods of preventing and solving ethical problems, and regulatory elements. Like
many other codes, it adopts federal research regulations by reference. The original code has
been revised three times, the most recent and most substantial revision having been initiated in
1993 and adopted in 1997. Several factors precipitated the extensive code revision, including
erosion of public confidence in research, the passage of federal research and misconduct regu-
lations, and directives to give greater attention to professional ethics from associations such as
the American Association of University Professors and the National Academy of Sciences.
Prior to the adoption of the first ASA Code of Ethics, prominent sociologists argued
against its inception. One sociologist asserted that debate in a court of law is the only way to
determine whether behavior is unethical and that sociologists are usually scientists or scholars,
there being "no real need to protect anyone, unless it be the sociologist from others"
(Freidson, 1964:410). Another sociologist urged colleagues to "vote against the adoption of a
code that obscures more than it illuminates, and to press instead for an officially sponsored
conference on the ethical problems of sociology" where the moral issues facing sociologists
could be "debated freely and fully rather than be obscured behind over-general principles"
(Becker, 1964:410).
Some might be tempted to dismiss these opinions as negative reactions to a perceived
attempt to curtail the autonomy of sociologists. However, the opinions raise several issues
about the scope, utility, and implementation of codes of ethics of professional associations.
One issue relates to the relationship between social organization and social control, concepts
that are not foreign to sociologists. Members of associations such as ASA, SAS, and SPA gain
much from their involvement in the organization, at the price of accepting limitations on the
freedom to do as they please in their professional activities. The ability of a professional
association to satisfy the needs of its members largely depends on shared understandings and
agreed-on rules rather than on enforcement of rules and sanctions of unethical behavior. A
professional association is a "community" of interdependent individuals, to use Merton's
words. The more individuals in an association are mutually dependent, the more they exercise
self-restraint to avoid offending others and risking the loss of their cooperation, support, and
affirmation. In this way, shared ideals become effective instruments of control that guide
professionals, far more than enforcement of rules and sanction of unethical behavior.
A second related issue raised by the seemingly negative opinions is that codes of ethics
are unlikely to be internalized by members of a profession unless they are accompanied by
educational activities. Ten years after the first ASA Code of Ethics was adopted, Long and
Dorn (1982) surveyed ASA members to assess their knowledge and perceptions of the code.
Sixty-one percent of 240 respondents were aware that the code existed, but only 26% were
familiar with it. For many years, sociology students gradually learned about ethics in the
56 JOYCE MILLER IUTCOVICH AND SUE HOPPE

natural course of their work. However, research on methods of teaching and learning ethics
principles and ways of using them indicates that explicit discussion of ethics is required and
that ethics education is a lifelong process (Pescosolido, 1991).
When the ASA Code of Ethics was being promulgated, neither SPA (formerly the
Clinical Sociology Association) or SAS existed. It was not until 1978 that both of these organi-
zations were formed (Iutcovich, 1997b). SPA moved rather quickly to adopt a code of ethics in
1982, modeled after the then-current version of the Code of Ethics of the American Psycho-
logical Association (APA). Members of SPA usually are involved in micro-level interventions
(e.g., counseling, conflict mediation and resolution, and family therapy), so use of the APA
Code as a model was an obvious choice. However, the 1999 version of the SPA Code reflects
an attempt to remove psychological "residue" -instead of focusing on individual events and
interventions, sociological perspectives and interventions are highlighted (Koppel, personal
communication, July 15, 1999). We note that the ASA also used the current APA Code of
Ethics as a model in its most recent revision of the Code, but for different reasons. The APA
Code had a well-organized, user-friendly organizational structure and it fully incorporated
role-related standards (i.e., rules for research, teaching, practice, and service).
SAS did not establish an ethics committee until 1987 and approve its first code of ethics
until 1995. Although considerably later in their development of a code of ethics, SAS's estab-
lishment of a code approximately 15 years after their formation is typical of most professional
associations. It takes a number of years to establish an organization and develop a consensus
about substance and method-something that will be required in getting members of a
professional group to adopt a code of ethics. Not having a code of ethics does not necessarily
reflect a group of professionals without ethics. Sometimes the members of an organization are
so divided on the issue of what is proper professional conduct that it is impossible to achieve
endorsement of a given set of standards (Rossi, 1995). In the case of SAS, it is more likely that
the membership did not feel there were significant ways in which the profession could do harm
that needed prevented. Further, standards of professional conduct already existed within ASA,
reducing the extent to which SAS felt compelled to establish a separate set of standards.
Amazingly, there are no sections of the ASA, SPA, SAS, and APA codes that conflict,
although the codes emphasize different ethical principles. This speaks to the considerable
cross-fertilization that occurred among the associations in the process of drafting their most
recent codes, and to the apparent consolidation of the identities and ethical expectations of
sociologists. It reflects increased awareness and appreciation of the variety of roles that
sociologists occupy, especially the contributions of practitioners who in the past have been
seen as second-class citizens.
Today, sociologists are less skeptical about the value of codes of ethics and they increas-
ingly engage in discussion of ways in which codes give guidance in anticipating and avoiding
ethical problems, and provide support in dealing with unethical behavior. However, many
codes only layout a general framework to guide decision making, without educating the user
or indicating where the user might tum for information. Sieber (1994) has likened this to road
signs that guide one to a destination. Motorists who are new to an area can be totally confused
by the road signs they encounter, not knowing which signs pertain to them and which can be
safely ignored, or even what some signs mean. Motorists notice some signs when it is too late
to do anything about them; planning ahead is not always possible. Some signs make sense only
to motorists who are already familiar with the area and scarcely need signs. In others words,
codes are useful to those who are already immersed in the analysis and resolution of ethical
issues-who already have an ethical roadmap. Professional associations must take the respon-
sibility for being friendly traffic cops to assist inexperienced drivers.
ETHICS AND SOCIOLOGICAL PRACTICE 57

CROSSCUTTING ETHICAL PRINCIPLES

There are a number of common ethical themes that characterize the codes of different
professional associations. While the associations label the themes in slightly different ways,
we use the term principles to indicate the broad-based, general concepts that serve as
foundations for more specific ethical standards of conduct, or rules of behavior that opera-
tionally define the principles within the context of various professional roles. These specific
standards of conduct often reflect the extent to which a profession considers itself as "consult-
ing" or "scholarly." Bayles (1981:9) defines the two types of professional groups in the
following way:
Consulting professions. such as law. medicine, architecture, psychological counseling [and applied and
clinical sociology] have traditionally practiced on a fee-for-service basis with a personal. individual
relationship between client and professional.
Scholarly professions such as college teachers or scientific researchers usually have many clients at the
same time (students) or no personal client (jobs assigned by superiors in a corporation). A scholarly
professional usually works for a salary rather than as an entrepreneur who depends on attracting
individual clients.

There are sociologists who maintain an identity as a consulting professional or "practi-

tioner" with a focus on applying scientific knowledge in a variety of contexts. They may be
independent entrepreneurs with a client base, or they may be salaried by a corporation and
have jobs assigned by a supervisor. On the other hand, there are sociologists with a scholarly
identity who work within the academy and define their professional work in terms of teaching
and the development of scientific knowledge. Some sociologists straddle the academic and
nonacademic worlds, having a dual identity.
Although consulting and scholarly professionals face somewhat different ethical issues
by virtue of their work activities, there are several crosscutting ethical principles that are
embedded within the codes of ethics of the associations to which they belong. The principles
represent ethical ideals to which professionals are to strive. The key principles include:
1. Competence. Professionals are expected to be competent or capable to perform their
work. Society trusts that professionals have acquired the education, training, and
experience to provide particular services. Professionals recognize the boundaries of
their particular competencies and the limitations of their expertise, and decline work
they are not competent to perform. In emerging areas of knowledge and expertise,
professionals take precautions to protect the welfare of those with whom they work
and they take the steps necessary (e.g., ongoing education or other appropriate
resources) to acquire the level of expertise to perform.
2. Integrity. Professionals are expected to be honest and fair in their work and representa-
tion of self. Professionals act in ways that inspire trust and confidence and they do not
knowingly make statements that are false, misleading, or deceptive. In addition,
professionals are aware of their own personal beliefs, values, needs, and limitations
and how these may impact their work. If situations arise where there is a conflict of
interest or potential for bias, professionals inform other parties of this and take steps to
avoid potentially improper or harmful activities.
3. Professional and scientific responsibility. Professionals within the scientific commu-
nity are expected to uphold the standards of science and maintain their objectivity.
They also accept responsibility for their actions. They recognize the public trust and
do not engage in behaviors that might compromise this trust. Further, they are
58 JOYCE MILLER IUTCOVICH AND SUE HOPPE

concerned about the misconduct of colleagues. While recognizing the importance of

collegiality, professionals do not let a desire for collegiality outweigh their shared
responsibility for ethical conduct. When necessary, professionals consult with appro-
priate others to avoid or prevent unethical conduct.
4. Respect for others. Professionals respect the rights, dignity, and worth of all people.
They respect the right of individuals to privacy, confidentiality, self-determination,
and autonomy. Where legal and other obligations may conflict with these individual
rights, professionals are clear about their conflicting obligations. Professionals strive
to eliminate bias in their work based on differences in sociocultural characteristics.
5. Social responsibility. Professionals, particularly those within scientific disciplines,
have a responsibility to the communities within which they live and work. They
should consider the impact of their work on society and address questions that are
raised by their work. Professionals recognize that their work is ultimately to serve the
public good.

ETIDCAL STANDARDS FOR SOCIOLOGICAL PRACTITIONERS

As previously indicated, the crosscutting principles can be operationalized in terms of

specific rules of conduct. Here, we discuss the issues that most affect sociological practi-
tioners: conflict of interest, informed consent, confidentiality, public statements, publication
issues, and workplace fairness, equity, and collegial relationships.
Translating these broad-based ethical principles into more specific rules of conduct
requires us to examine first the broad range of sociological practice endeavors. Although there
is debate on the definition of applied and/or clinical sociology (Iutcovich, 1997a), we suggest
the following ways to conceptualize the varied work of sociological practitioners:
• Practitioners exist within different work settings (e.g., public versus private sectors;
business, industry, or government; for-profit or not-for-profit organizations; academic
versus nonacademic institutions; employee versus self-employed).
• They vary in terms of specialization, which may impact their choice of employment
situation (e.g., evaluation and social policy, health and illness behavior, demography,
complex organizations and organizational change, deviance and criminal behavior,
family, minority relations).
• The practice of sociology can vary along three dimensions: the first is the level of social
organization (e.g., micro, meso, macro) where sociology is practiced, the second is
whether the practitioner is an active or passive agent of change, and the third is the
method of gathering or processing information that the practitioner uses (e.g.,
gathering/organizing existing information or conducting empirical research through
quantitative or qualitative techniques or a combination of both).
A sociological practitioner who is a sociotherapist, counselor, or family therapist works at
the microlevel of social organization, as an active agent of change, and as a gatherer/organizer
of available information to counsel a client. The practitioner may be a self-employed specialist
in family relations. In this capacity, the practitioner may also serve as an expert witness.
A sociological practitioner who conducts evaluation research may be self-employed as an
independent consultant, work for a private consulting organization, or work within an agency
as an internal evaluator. Some evaluators specialize in a particular area (e.g., criminal justice,
social welfare, education) or conduct evaluations within various contexts, considering their
ETHICS AND SOCIOLOGICAL PRACTICE 59

methodological skills in evaluation as a specialty. The latter generally work at the mesolevel of
social organization, act as passive agents of change (i.e., can make recommendations, but do
not hold positions of authority to affect the change), and utilize empirical research techniques
as the method of gathering/processing information.
The professional activity of any individual sociological practitioner may not be easily
categorized in accordance with this scheme but it helps us to recognize the depth and breadth
of single sociological applications and allegiances that affect the ethical issues they face.
Moreover, sociological practitioners are likely to have affiliations with associations outside
sociology that represent their practice endeavors. Adherence to multiple codes of ethics may
create situations where there are conflicting sets of expectations, some of which are not easily
resolved.
With this range of sociological practice endeavors in mind, we now turn our discussion
to a number of specific rules of conduct and how they relate to sociological practice.

Conflict of Interest

A conflict of interest arises when personal interest prevents an individual from perform-
ing his or her professional or public obligations in an unbiased manner. The consequences of
these conflicts can be the loss of objectivity, the potential for decreased effectiveness as a
professional, and the possibility of harm and/or exploitation of another party. The underlying
principles of integrity, professional and scientific responsibility, and respect for others all
come into play when we examine specific rules of conduct related to conflicts of interest.
Objectivity is one of the essential tenets of professional and scientific responsibility; thus,
there is a special need to be alert to and guard against any situation where objectivity may be
impaired.
Financial interests have often been equated with conflict of interest because they are
tangible and therefore fairly easily detected. This can be an issue for internal (agency)
evaluators of social programs. Internal evaluators have financial interests (i.e., their jobs) in
making sure that the programs with which they are affiliated are effective. "The community
for internal evaluators is their workplace; regardless of the kind of organization, they are
committed to making that community work well, both in particular instances and in the long
term" (Mathison, 1999:31). The results of an evaluation may determine the viability of a
program and its potential for future funding. An internal evaluator may be in a weak position to
confront matters related to ineffectual practice, specific weaknesses of a program's operation,
or issues of complicity and unethical practice. Such serious issues related to unethical practice
can place the internal evaluator in the position of being a "whistle-blower," subject to
ostracism orreprisal. "Fear ofloss of one's job, friendships, or dissolution of one's community
or organization are serious risks for the internal evaluator" (Mathison, 1999:32). There are
considerable personal and organizational risks that internal evaluators face, requiring a deli-
cate balance between loyalty to an organization and commitment to professional standards.
It can be argued that financial interests always loom in the background when sociologists
in practice have paying clients. The nature of these relationships is based on expectations that
are engendered by the client's direct hiring and reimbursement of sociological practitioners,
irrespective of whether they are applied researchers, organizational consultants, or expert
witnesses. With such norms of reciprocity, it is incumbent on a professional to guard against
overindentification with a client's views or needs. Sociological practitioners whose ongoing
livelihood depends on attracting and retaining clients may find it difficult (at least in the short
60 JOYCE MILLER IUTCOVICH AND SUE HOPPE

tenn) to adhere to ethical standards that are not consonant with a client's perceived interests.
As an example, an expert witness may feel pressured to report research results that shed a
favorable light on a client's case, knowing that future work with the client depends on
satisfaction with the outcome of the current case. These are pressures felt by a consulting
sociologist that may not be felt by those within an academic environment. As a guide to
handling such situations, Fitzpatrick (1999:9) indicates that because the "relationship of the
consulting professional is closer to the client than to other stakeholders, the professional must
guard against bias toward, or overidentification with, the client's views or needs."
Conflicts of interest can also stem from a professional's personal interests. If a sociologist
is a marriage and family therapist, being asked to provide services to a friend or relative can
result in a potentially troublesome dual relationship. The ability of the practitioner to remain
objective in providing the service can be compromised because of its potential for damaging
the friendship or relationship. The prohibition against providing therapy for a friend or relative
may seem obvious; however, potentially harmful dual relationships can sometimes creep up
on professionals or go unrecognized in the daily exercise of one's responsibilities.
Boundaires with regard to professional versus personal relationships are sometimes
obscure. In the context of one's work (e.g., as an organizational consultant, applied researcher,
expert witness), friendships are fonned that in and of themselves are not unethical, but they
require special attention and a differentiation of role relationships within certain contexts. As
an example, when a consultant works with a government agency and the same project officers
over many years, going to dinner and engaging in conversations of a personal nature are not
uncommon. However, in the context of the work, a superordinate-subordinate relationship
exists (i.e., a project officer has authority over a consultant and may have considerable
influence over awarding future grants and contracts). Given this, the prohibition against the
subordinate giving gifts or buying dinner and drinks for the superordinate is of particular
importance. While there are strict restrictions on this within government (to avoid the appear-
ance of bribery), the same restrictions may not exist in other types of consulting relationships.
Indeed, as an entrepreneur, strategies for gaining new business (or keeping what one currently
has) involve treating clients well and forming close relationships
Multiple relationships within the context of one's professional and personal life cannot
always be avoided and they are not inherently wrong. The difficulty is in deciding where the
boundaries lie given the basic proscription against participating in dual relationships when
there is the likelihood of harm or chance of crossing the threshold of exploiting another.
According to Korenman and Shipp (1994), a conflict of interest can also arise in relation
to one's intellectual leanings (e.g., pet theories and ideas). This is a potential source of bias
when one is asked to evaluate another's work that is contradictory or a step ahead of one's
own. While it is unavoidable to have particular intellectual leanings and there are circum-
stances where the promotion of these is appropriate (e.g., as an expert witness), there are
situations where it is necessary to withdraw from deliberations. If one's ability to remain
unbiased and refrain from doing harm to a competitor is compromised, then it is important for
a professional to make such conflict of interest known and to take the necessary steps to avoid
the appearance of bias.
All of these sources of bias-financial interests, personal interests, and intellectual
leanings-represent potential conflicts of interest. They can pose problematic situations for
sociological practitioners who are committed to carrying out their responsibilities in an
unbiased and objective manner. However, these potential conflicts may not be easily recog-
nized, the conflicting values are not always obvious, and the choices of conduct may not be
clear-cut. Dealing with handling conflicts of interest involves recognizing situations in which
ETHICS AND SOCIOLOGICAL PRACTICE 61

there is a conflict of interest or the appearance of a conflict of interest, avoiding relationships

that might precipitate such conflicts, and disclosing conflicts to affected parties. In general, all
professionals are to refrain from undertaking an activity when they know that a conflict of
interest might impair their ability to discharge duties impartially or effectively. Sociologists,
whether in practice or not, are to disclose all relevant financial, personal, or professional
relationships that might lead to a conflict of interest, including the disclosure of the sponsor of
their professional work. These are to be disclosed to their institutions and in public speeches
and writings, allowing others to make a determination as to the level of bias that mayor
may not exist.

Informed Consent

Informed consent is one of the ethical cornerstones of research, emanating from the
principle of respect for others. The most comprehensive guidelines for informed consent are
the federal research regulations. The regulations make it clear that informed consent is an
ongoing process, not a piece of paper or one conversation in time. The consent process aims to
ensure that research participants understand that their decision to participate is voluntary, the
nature of the research and what they are being asked to do, reasonably foreseeable risks and
benefits, the extent to which information obtained about them will be confidential, and who
they may call if they have questions at the time of consent or later. In addition to detailed
elements of consent, the federal regulations require that researchers use language that is
understandable to research participants in obtaining their informed consent, that they consider
special circumstances that increase the potential for coercion (e.g., students who take part in a
professor's research, employees in an organization undergoing an internal evaluation, clients
in a research project conducted by their family therapist), and that they document in writing the
process of obtaining consent.
Sociologists have not always believed, and a few are still skeptical, that informed consent
for research on the order of what is mandated by federal regulations is necessary because, in
many instances, there is little risk to participants. It has been argued that the consent process to
which sociologists must conform is based on a medical model and that many potential
participants would be "scared away" by detailed descriptions of possible but highly unlikely
risks. However, it is not well understood that federal regulations allow for instances in which
consent can be waived altogether (e.g., record reviews, observation of public behavior) or
when brief verbal consent can be used in lieu of a written consent document, and that
institutional review boards (IRBs) are usually willing to accommodate variations in consent
strategies if researchers provide adequate justification for such. Many IRBs that review survey
research have developed specific institutional consent policies for personal interviews and
self-administered questionnaires. For example, most of these IRBs consider the return of a
mailed questionnaire to constitute consent.
Consideration of the method of consent and the level of detail needed to make an in-
formed decision to take part in research are not always simple. "Vulnerable" populations (e.g.,
children, persons with mental illness) may not be able to understand the required information
and others (e.g., prisoners, persons dependent on welfare) are so positioned that the voluntari-
ness of their consent may be in question. Covert research and research that involves deception
or incomplete disclosure pose complicated consent issues. In cases where such methods are
the only alternative to obtaining important information, common sense and sensitivity to the
lack of full consent are essential. In particular, sociologists using these methods must ask
62 JOYCE MILLER IUTCOVICH AND SUE HOPPE

themselves whether the information that is withheld would influence the decision of potential
participants to take part in the research or put them at considerable risk.
A particularly troublesome issue for sociologists who evaluate government programs is
the waiver of informed consent by state and/or federal authorities. Attempts being made by
many states to reform their welfare programs illustrate situations in which evaluations are
conducted without informed consent of program participants (Lovell, 1995). In Michigan, for
example, at least 36,000 families have been or will be involved in such a study by the time it
is completed. The state was able to undertake the evaluation without informed consent for
several reasons. First, the Department of Health and Human Services ruled that consent was
not legally required, probably because the evaluation was not federally funded. The Supreme
Court upheld this decision, setting a legal precedent that has wide-ranging implications.
Second, existing administrative data are the primary source of information and the data are
already accessible to internal evaluators. Third, valid results of evaluations of social experi-
ments such as welfare reform to which program participants are randomly assigned cannot be
obtained if participants fully understand the purpose and policy consequences of the evalua-
tion (e.g., reduced benefits). They may agree or refuse to take part if they can figure out which
course of action would most benefit them.

Confidentiality

The importance of maintaining the confidentiality of private information about individ-

uals obtained in the course of research, teaching, and practice has been long recognized. Like
informed consent, the specific standards related to the maintenance of confidentiality and
limits surrounding any promises of confidentiality are based on the principle of respect for
others. Privacy refers to the right of individuals to have control over the extent, timing, and
circumstances of revealing personal aspects of their lives to others. Confidentiality generally
means that private information about an individual will not be shared without his or her
consent. There may be situations in which private information about an individual becomes
known without consent. For example, an organizational consultant may have access to
employee records in order to study salary equity and its influence on company growth. There
may also be situations in which private information such as child abuse becomes known in the
course of research or practice and must be reported to appropriate authorities.
The maintenance of confidentiality has become increasingly complex with new methods
of creating and handling records, technologies for the transfer of information, the trend toward
data sharing, and statutory and institutional limitations on confidentiality. Knowledge of basic
institutional, state, and federal requirements and constraints on confidentiality in research,
teaching, and practice; thoughtful analysis of how research and practice data may be used in
the future (e.g., sharing of research data with other investigators, subpoena of treatment notes
for a divorce hearing); and training research staff, teaching assistants, and office staff in
responsibilities to maintain confidentiality are important.
Threats to maintaining confidentiality in research are probably more common than one
would think. One of the most sensational cases involved a sociology graduate student with
interests in radical social movements. The student wanted to focus on animal rights activism as
part of his graduate work and submitted a proposal to this effect to the department. He planned
a vacation and asked a former research participant to housesit. While the student was on
vacation, animal research facilities on campus were vandalized and animals were stolen or
"liberated." After the sitter appeared on television to support animal rights activists, he was
suspected by authorities of being involved in the break-in. The student saw a newspaper article
ETIDCS AND SOCIOLOGICAL PRACTICE 63

about the break-in when he returned home and discussed it with the sitter and some of the
sitter's friends. Authorities suspected the "friends" as well and wanted the student to reveal
the nature of their conversations. After months of refusing to testify in court, the student"gave
in" and revealed what he considered to be nonconfidential information. He did not answer
questions that pertained to his ongoing ethnographic research on animal activism. The student
was jailed for four months.
This case is based on a real situation that occurred in 1991 (Scarce, 1995). It illustrates
difficulties in giving promises of confidentiality to research participants and the possible con-
flicts that may arise between ethics and law. There is fear among some sociologists that people
will not be willing to participate in research if investigators are unable to pledge absolute
confidentiality. There is also fear that sociologists will avoid doing high-risk research that
could yield information valuable in solving social problems.
In a case not involving criminal actions, two sociologists studied three Alaskan coastal
villages over four years to assess the impact of the Exxon Valdez oil spill on levels of stress
among residents of the communities. Over 3000 individual damage suits had been filed against
Exxon. The plaintiffs cited the sociologists' published work as evidence of damage; the
defendants argued that the only way to validate the research findings was for them to reanalyze
the raw data and other related research documents. The sociologists resisted because it would
jeopardize the confidentiality of their subjects-the communities they had studied were small
and information about subjects might be identifiable. They offered to provide data without
names and in collapsed categories. To compromise, the court requested only the first two years
of data, from which all identifiers had been destroyed previously by the researchers, and re-
quired that it be analyzed by a technical expert not affiliated with Exxon. There is no certainty
that data collected after the first two years of the project will not be subject to the same
jeopardy (Marshall, 1993; Rent, 1993).
It is possible to obtain a Certificate of Confidentiality from the Department of Health
and Human Services if one conducts research on sensitive topics such as sexual attitudes,
preferences, or practices; use of alcohol, drugs, and other addictive substances; illegal con-
duct; information damaging to financial standing, employability, or reputation; and mental
health. Identifying factors such as an address, when there is fear of immigration enforcement,
or in-depth information about a study population that is easily identifiable and a research
project that is well known might also qualify for a Certificate of Confidentiality (Fanning,
1996). The research project for which protection of confidentiality is sought does not have to
be federally funded. Certificates of Confidentiality "permit honest, deliverable promise of
confidentiality to subjects" but they carry complicated caveats and are not a panacea for the
issues researchers face in making guarantees of confidentiality.

Public Statements

Public statements or communication related to one's professional services, products, or

publications can include, but are not limited to, paid or unpaid advertising, brochures, printed
matter, directory listings, personal resumes or curricula vitae, interviews or comments for use
in the media, statements in legal proceedings, lectures and public oral presentations, and
published materials. In examining these various forms of public statements or communication
it is important to differentiate between those that may be considered advertising and promo-
tional in nature, versus those that are made in the context of one's work (e.g., interviews about
an applied research project, as an expert witness, as a keynote speaker).
Historically, the notion of advertising or promoting one's professional services was
64 JOYCE MILLER IUTCOVICH AND SUE HOPPE

taboo. It has only been in the last several decades that many of the consulting professions have
liberalized their stance on this activity, resulting in specific standards that delineate the
limitations of such statements. This change in position evolved gradually, but the precipitating
factor occurred in the early 1980s when the Federal Trade Commission (FTC) began investiga-
tions into ethics codes of the American Medical Association (AMA), the American Dental
Association, and other groups. There were sections of these codes that the FTC believed posed
"impermissible restrictions on methods of competition" (Canter et at., 1994:15). Once the
U.S. Supreme Court upheld the action of the FTC against the AMA in 1982, the door was open
for other investigations and significant changes in the ethics codes of many consulting
professions. According to Canter et at. (1994:14) "advertising and promotional issues have
been some of the most 'volatile' in terms of changes in the [APA] code."
On the other hand, other types of public statements have been recognized as a legitimate
professional activity-if one has a recognized specialty, the public will often seek opinions
since there is a level of trust that these opinions are unbiased and based on solid professional
expertise. This trust is grounded in the principles of integrity and scientific responsibility, i.e.,
professionals are honest and fair in their work and representation of self. And as scientists
upholding the basic standards related to the development of their body of knowledge, their
professional opinions are considered objective and based on systematic investigations that
have been subjected to verification by other scientists.
Practicing sociologists who promote client-based services are to take steps to ensure that
their communications are accurate and that they do not include false, misleading, or deceptive
statements. This applies to statements from themselves as well as others. Further, if practi-
tioners provide sociological information or professional opinions, they are to consider the
limits and uncertainties of present sociological knowledge and techniques. In other words,
sociological practitioners are not to make claims that they cannot substantiate.
The challenge for sociological practitioners who are client-based is to know where to
draw the line with regard to advertising and promotion. While false, misleading, or deceptive
statements are generally prohibited, "sound bites" intended for promotional purposes may
leave out a lot. It would be fool hardy in one's advertising and promotional materials to make
qualifying statements and disclaimers about one's ability to provide focus group facilitation,
organizational development consulting services, or marketing research. To be competitive,
sociologists in private practice need to convince potential clients that their services are of
higher quality, more cost effective, or both, in comparison to others.
Knowing that the FTC has ruled that professional groups cannot have their ability to
compete curtailed, there is still the unspoken rule that "professionals" should not engage in
the type of advertising and promotion that is considered acceptable practice in other areas of
business and industry. When we see ads for personal injury attorneys that say "Call our office
and we'll make money for you," we envision "ambulance chasers" and associate a "sleaze
factor" with such ads. With a sense of nostalgia, professionals eschew any type of self-
promotion or playing political games to gain recognition. We feel that having expertise and
doing good work is sufficient-a reputation as a qualified professional automatically follows.

Publication Issues

"Publication" refers to the communication of research results and other information

through articles in peer-reviewed journals, book chapters, reports, and grant applications. We
focus on written dissemination of research results and other information, but many of the
ETHICS AND SOCIOLOGICAL PRACTICE 65

ethical issues that we address are also pertinent to oral communications such as lectures and
presentations at professional meetings. We also focus on the ethical publication responsi-
bilities of individual sociologists, although journal editors and reviewers have ethical respon-
sibilities in this area as well (Simpson, 1990; Stryker, 1990).
Three major violations of ethical standards of publication are considered here: plagiar-
ism, falsification of data, and inappropriate authorship credit. There is broad consensus about
the seriousness of these violations: we are not aware of any codes of ethics of social and behav-
ioral science associations that do not contain strong, proscriptive statements about plagiarism,
falsification of data, and inappropriate authorship credit. These offenses are potentially
damaging to the profession of sociology, to the advancement of knowledge, and to the reputa-
tions and career advancement of the individuals involved.
Plagiarism is commonly defined as the "theft" of another's words and/or ideas and the
presentation of those words and/or ideas as one's own. In some instances, there may be ambi-
guity about what constitutes plagiarism. For example, one might question whether the source
of ideas or terms such as meritocracy and marginal man, which are more or less in the public
domain, needs to be cited. Additionally, the theft of words and/or ideas occurs with varying
degrees of intentionality. At one end of the plagiarism continuum, it may be difficult to
remember the original source of an idea that emerges in conference or seminar discussions or
in conversations that take place between colleagues in a hallway. Clarification about the need
and way to acknowledge the work or contributions of others can be discussed with professors
if one is a student, with colleagues, or with persons knowledgeable about ethics from a
sociological perspective.
At the other end ofthe continuum, using long passages oftext from another's published
work without proper credit is blatant, deliberate, and clearly inappropriate. There have been
instances in which a researcher has submitted a nearly identical copy of an article, already
published by someone else in a refereed journal, to another journal in a related field (there are
also instances in which a researcher has submitted a nearly identical copy of his or her own
already published work to a journal in a related field). Choosing a journal in a related field
reduces the chance of readership overlap and of being caught, and it maximizes the likelihood
that the article will be accepted for publication because it has already passed the test of peer
review. The publish-or-perish imperative and pressures to obtain research funding, which
continue to characterize many universities and research centers, are thought to tempt sociolo-
gists and other professionals to plagiarize to this extent.
What prevents someone from plagiarizing the work of another? Sociologists whose work
has been plagiarized and with whom we have spoken would say "Not much." It is easier for
someone like Alex Haley to spend just a few months rather than years of effort to produce a
volume like Roots. How do persons who plagiarize get away with it? We suspect that most
instances of plagiarism, even egregious ones, go undiscovered, or are not discovered until well
after the offense has taken place. And, holding offenders accountable for their acts is more
difficult than it may seem. However, the personal and professional costs of plagiarism, if one
is caught, can be high.
Falsification or misrepresentation of data is another way to deal with pressure to publish
in order to advance up the career ladder, or simply to keep a job. All misrepresentations of
data in published works impede the progress of science, whether or not they are intentional,
because they form the basis of inferences made to guide theory development and other
research. This is one reason why most codes of ethics call for data sharing to facilitate the
reexamination of research findings and the replication of results.
The worst-case scenario involves faking research data in whole or in part, especially
66 JOYCE MILLER IUTCOVICH AND SUE HOPPE

when they cannot be challenged because promises of confidentiality prevent disclosure of

sources. More subtle forms of intentional misrepresentation of data involve such acts as
breaking randomization in a social experiment and assigning subjects to different conditions
when it is thought that their responses would be likely to support the hypothesis being tested.
Even inadvertent errors in recording of responses or in statistical computations can constitute
ethical violations. One might not ordinarily think of such errors as an ethical issue, except that
the errors decrease the utility of the research (Rosenthal, 1994). Trained and closely supervised
research staff are essential to avoiding inadvertent misrepresentation of data.
In addition to the accuracy of data that are reported, there is the issue of data that are not
reported and why they are not reported. When research has been poorly designed and
implemented, "self-censoring is admirable" but it seems "wasteful of information" that could
be used by other researchers. However, failure to report findings that contradict one's own pet
hypothesis, or that of a contractor or funding agency, is clearly "poor science and poor ethics"
(Rosenthal, 1994).
Falsification or misrepresentation of data addresses the question of "What was really
found?" The issue of authorship credit addresses the question of "Who really found it?"
(Rosenthal, 1994). With the trend toward collaborative research, disputes about authorship
credit have increased. The ASA Code of Ethics states that sociologists take authorship credit
"only for work they have actually performed" and that "publication credits are based on the
relative scientific or professional contributions of the individuals involved, regardless of
their status." To redress the lack of credit or recognition that students in many instances
have received in the past, the Code further states that a student is "usually listed as principal
author on any multiple authored publication that substantially derives from the student's
dissertation or thesis." Fine and Kurdek (1993) have outlined "process" and "outcome"
recommendations to guide decision making about authorship credit and order. While their
recommendations primarily address faculty-student collaboration, they are useful for ap-
proaching decisions about authorship credit in general. Most importantly, early in the process
of collaboration, there should be frank and open discussion by those involved about the
division of labor in preparing a publication, authorship credit and order, and responsibility for
the work after it is published. For sociological practitioners who engage in proprietary
research, it is essential to obtain publication and authorship agreements in writing in a contract
before research is undertaken.
It is almost impossible to know the extent to which sociologists engage in unethical
behavior, but results of a survey of faculty and doctoral students in large graduate departments
of sociology and three other disciplines (civil engineering, chemistry, and microbiology) shed
light on the publication issues that have been discussed here (Swazey et al., 1993). About 10%
of sociology faculty and doctoral students had "observed" or had "direct evidence" of
plagiarism on the part of faculty in their department. Falsification or "cooking" of data was
estimated by faculty and students at about 5 and 10%, respectively. Thus, plagiarism and data
falsification among academic sociologists may not be "rampant" but they are not extremely
rare, at least by these accounts. More disturbing is the finding that about 30% of faculty had
inappropriately assigned authorship credit according to both faculty and students.

Workplace Fairness, Equity, and Collegial Relationships

Within the context of a work situation where sociologists may interact with employers/
employees, supervisees, clients, research subjects, and colleagues, a set of standards of be-
ETHICS AND SOCIOLOGICAL PRACTICE 67

havior that are derived from the principles of respect for others, personal integrity, and
professional responsibility are relevant. As professionals who are acutely aware of how group
differences affect values, attitudes, and behavior, sociologists place a high level of importance
on the notions of fairness and equitable treatment of others. Given this, there are often rules of
behavior within sociological codes of ethics that prohibit discrimination, exploitation, and
harassment. Further, there are expectations about how one interacts with colleagues and others
within a work environment-being responsible as an employee or employer, being clear about
expectations and role performance, and being responsible in upholding the standards of the
profession.
Federal law guarantees fair and equitable treatment of a number of legally protected
categories of individuals in the workplace and federally funded services. Laws specifically
prohibit discriminatory behavior that treats persons differently because of their race, religion,
ethnic or cultural background, sex, age, or disability status. The Civil Rights Act of 1964, the
Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and the Americans with
Disabilities Act of 1990 detail the prohibitions. However, professional codes of conduct that
govern the behavior of sociological practitioners often cover other situations and include other
categories of individuals who are often treated unfairly or are subject to discrimination. For
example, the Guiding Principles for Evaluators (American Evaluation Association, 1994)
states that evaluators have the "responsibility to identify and respect differences among
participants, such as differences in their culture, religion, gender, disability, age, sexual
orientation, and ethnicity and to be mindful of potential implications of these differences when
planning, conducting, analyzing, and reporting their evaluations." The ASA Code of Ethics
(1997) includes all of these factors, as well as health conditions and marital, domestic, or
parental status.
Prohibitions against sexual harassment, harassment in general, and exploitation of others
are also found within the ASA Code of Ethics. As with discrimination, sexual harassment is
prohibited by law. Harassment (in general) and exploitation are not. However, they have
reached a level of importance and there is general agreement among sociologists that the
behaviors are sufficiently offensive to be prohibited in the ASA Code of Ethics. Sexual
harassment, as legally defined, consists of sexual solicitation, physical advances, or verbal or
nonverbal conduct that is sexual in nature, and that is (1) unwelcome, offensive, or creates a
hostile workplace environment, and the person knows or is told this; or (2) sufficiently severe
or intense to be abusive to a reasonable person in the context. Sexual harassment can consist of
a single intense or severe act or multiple persistent or pervasive acts. Harassment, in general, is
similarly defined, absent the sexual connotation. A similarly clear definition of exploitation is
missing. The ASA Code of Ethics only states that "if sociologists have supervisory, evaluative
or other authority over students, supervisees, employees, or research participants, they are not
to exploit them for personal, economic, or professional advantage." However, for anyone who
has been embroiled in such a controversy, it is not easy to delineate what constitutes exploita-
tion. Is asking a student or employee to baby-sit for you on the weekend (for pay) exploitation?
Do consensual sexual relations between faculty and students (or employers and employees)
constitute sexual harassment or exploitation? What may be considered exploitation to one can
be within acceptable bounds to another.
Being a responsible employer means engaging in fair employment practices and avoiding
discrimination in hiring and promotion, as well as clearly communicating job-related require-
ments for hiring, promotion, termination, and conditions of employment. Being a responsible
employee means giving adequate notice when leaving a position. Being a responsible prospec-
tive employee means being honest about one's qualifications and experiences.
68 JOYCE MILLER IUTCOVICH AND SUE HOPPE

Extending these standards to the consulting sociologist, we note that the ASA and SAS
Codes of Ethics explicitly require practitioners to clarify the details of a project, including such
aspects as deadlines for key phases of a project and final deliverables; the proprietary nature of
study results; and the publication rights of the client and sociological practitioner. The
American Evaluation Association has similar guidelines; its code states that "evaluators
should negotiate honestly with clients and relevant stakeholders concerning the costs, tasks to
be undertaken, limitations of methodology, scope of results likely to be obtained, and uses of
data resulting from a specific evaluation. It is primarily the evaluator's responsibility to initiate
discussion and clarification of these matters, not the client's."
The responsibility of professionals to uphold their standards is generally found across
most codes of ethics. It reminds the professional group about the public trust they are afforded,
which should not be jeopardized by the inability of a professional group to self-regulate. Given
this, sociologists, whether in practice or not, are expected to recognize ethical violations and
take steps to correct this behavior, either informally or through established systems of
enforcement. However, for sociological practitioners who are not networked with other
sociologists or affiliated with any professional organizations that have enforcement proce-
dures, what are they to do? Furthermore, for sociological practitioners who become affiliated
with other professional groups having different (and conflicting) standards, there are no easy
solutions to the dilemmas they face.

ETHICAL CHALLENGES FOR SOCIOLOGICAL PRACTITIONERS

Throughout this chapter the ethical standards that guide the behavior of sociological
practitioners along with their attendant ethical challenges have been emphasized. Now, we
expand on these points by raising questions that sociological practitioners have faced or are
likely to encounter in the future.
What kind of behavior reaches the threshold of an ethical violation versus what is just
"bad practice" and/or behavior that is "not up to standard"?
Review of numerous documents variously entitled codes of ethics, ethical principles and
standards, and guiding principles, has revealed statements that range from the very general to
the very specific. General statements, such as the following, leave little room for disagree-
ment:
All members of Qualitative Research Consultants Association [QRCA] conduct qualitative research in
a professional manner, and strive at all times to ensure that respondent recruiting, analysis and report
preparation meet high standards of excellence.

The public trusts professionals to be competent in the conduct of their work. If asked,
what professional would say that she or he is not competent? However, defining or measuring
competence in any field is not easy. For sociological practitioners, does competence mean that
one must be trained and experienced in a certain methodological technique or have studied and
used a particular theoretical framework to be able to use it in one's own work or work for
others? If this were true, sociologists with newly granted doctorates would have difficulty
finding employment and those who had been in the field for a considerable amount of time
might not be able to use new data analytic techniques without having proven expertise in
their use.
ETHICS AND SOCIOLOGICAL PRACTICE 69

The question being raised about thresholds of unethical behavior and differentiating
unethical behavior from bad practice is an important one. To answer it, the level of specificity
of ethical principles and standards needs to be considered, as the response may be an artifact of
the wording of statements in codes. Undoubtedly there is an advantage to general guiding
principles in that most, if not all, professionals can endorse them. Affirming the principles
produces a sense of self-satisfaction and creates a condition under which members of a
profession are able to claim conformity, no matter what they do. Further, statements of ethical
principles, when framed and displayed in an office, reassure clients that the professional in
whom they have confidence, abides by ethical standards (Rossi, 1995).
But do very generally stated ethical principles provide much in the way of guidance for
professionals? Given that there is considerable variation in behavior, the question as to what
really constitutes an ethical violation goes begging. In a professional organization where there
are no enforcement mechanisms in place to interpret the standards and produce a body of case
"law," ethical codes are little more than window dressing. As Rossi (1995:59) argues: "If a
professional organization is to go beyond piety, it should have the courage to discipline its
members and forcefully to state what are its guiding principles in practice."
Having standards that are very general presents challenges in applying them to concrete
behaviors. At the other end of the continuum, when there is too much specificity, there can be
problems in differentiating between what might be considered "best practices" versus ethical
mandates. Professionals enjoy autonomy and this results in different approaches to work. The
autonomy and diversity are highly valued. Translating ethical standards into specific practices
can result in gray areas. When a particular practice reaches a certain threshold of importance
to members of a profession, it is generally translated into an ethical standard. However, there
are many practices and procedures that have nothing to do with ethics.
For example, the QRCA has explicitly differentiated between their Code of Ethics and
their Guide to Practices. Their recommended consultant practices include 17 pages of very
specific statements reflecting what qualitative researchers should do (e.g., "Consultants
should satisfy themselves that they understand and can fulfill the research needs of the client
before accepting an assignment. Any questions or ambiguities should be clarified in ad-
vance"). The QRCA carefully differentiates between ethical mandates and recommended
practices, but other codes are not as clear about this. Even the ASA Code of Ethics has
statements that can easily lead to frivolous claims of an ethical violation. Consider this state-
ment: "When financial support for a project has been accepted under a grant, contract, or
consultation, sociologists make reasonable efforts to complete the proposed work on sched-
ule." While it is important to fulfill one's obligations in a timely manner, perhaps this "ethical
mandate" is best left as "recommended practice."
Any ethical code that emphasizes extreme positions on the continuum of generality to
specificity may not serve a profession well. A balance needs to be reached. When guiding
principles are operationalized into specific standards, members of a professional group need to
seriously think about behaviors that obviously reach the threshold of an ethical violation.
When faced with conflicting sets of ethical standards or when standard operating
procedures in their line of work differ from those in a professional code of ethics, how do
sociological practitioners resolve the differences? What is acceptable behavior for them?
As indicated previously, sociological practitioners may be engaged in a variety of
endeavors and become networked with other professional groups, each having its own set of
ethical standards. Given this, sociological practitioners may face situations where the stan-
70 JOYCE MILLER IUTCOVICH AND SUE HOPPE

dards of one organization conflict with the standards of another. For example, in the Guiding
Principles for Evaluators there is an obligation for evaluators to prevent or correct misuse of
their results "within reasonable limits." If a politically appointed official misuses the results
and the evaluator is a public employee, what is he or she to do? Lovell (1995) argues that
evaluators need to take steps, at least within their own management structure, to confront this
misrepresentation. And if a report has been publicly released or is available under the Freedom
of Information Act, then the press and/or political opponents have the responsibility of con-
fronting the official. But if a report has been lawfully suppressed and it becomes "privileged
information," then a conflict exists, at least for an internal evaluator who is a public employee.
Under the code of ethics of the American Society for Public Administration, the internal
evaluator is to "respect and protect the privileged information to which we have access in the
course of official duties" (Lovell, 1995:64). Resolving dilemmas such as this is not easy;
making a decision about a course of action may require a great deal of personal reflection and
consultation with other professionals. Even identifying choices of action can be difficult.
In other situations, sociologists in applied research settings who are under contract with
clients who are not part of the academic/scholarly world can often face dilemmas regarding
their scientific responsibilities. There is an expectation within scientific communities that
researchers publish their research results and share their data to give others the opportunity to
replicate studies and validate the findings. However, when working in a proprietary environ-
ment, data are owned by the client, not the researcher. Therefore, notions of sharing data or
publishing findings are matters to be negotiated with the client and not automatically assumed.
Specific to the entrepreneurial activities of sociologists, the SAS Code of Ethics makes
these statements:
Members conducting research for clients should also clarify specific details of a project with their
clients, either verbally or (preferably) in writing, prior to the beginning of a study. These details include
the deadlines for key phases of the project, final deliverables (including reports, data and related
electronic media), proprietary nature of study results, and related publication rights of the client and
member.
No member will attempt to sell information for a personal profit that is confidential or proprietary
unless they are authorized to do so.

While this situation does not pose the same moral issue as the first example of how to
correct misuse of research results, it represents a problem for applied researchers who main-
tain a strong allegiance to a "scientific" identity. Generally, applied researchers are able to
negotiate publication rights, although they may be subject to final approval from the client. In
these situations another problem can arise. A client may exert pressure to present results in a
particular way, threatening the integrity of the research process and the reporting of the results.
Finally, client-based sociological practitioners need to make decisions about appropriate
methods of promoting and advertising their work, where lines are to be drawn between profes-
sional and personal relationships, and what constitutes a conflict of interest, since gaining
power and influence are the "name of the game" in the business world. For a practitioner who
has been socialized within a scholarly/academic environment, there is a lingering sense that
the business world is tainted. Having testimonials from former clients, running paid ads in the
media, and having glossy promotional material are considered "glitz and glitter" without
substance. However, these are highly acceptable competitive behaviors for profit-driven
businesses. As long as they meet the litmus test for "truth in advertising," people can evaluate
the ads for what they are--attempts to convince the buying public to purchase their
products and/or services. Further, establishing networks of individuals who can "open doors"
ETHICS AND SOCIOLOGICAL PRACTICE 71

for you, help you "land that contract" or "put in a good word for you" are all part of being in
business. While professionals may feel "above" all that, they do so at the cost of gaining new
business.

Can sociological practitioners take on advocacy roles without compromising their pro-
fessional responsibility to remain neutral and unbiased? To whom does a sociological
practitioner owe allegiance?

Many sociological practitioners enter applied and/or clinical work because of a sense that
it is something they can do to "make a difference." Abstract theorizing, narrowly focused
research endeavors, and the monotonous routine of teaching just "don't seem to do it" for
those captivated by the practitioner's world. Practitioners who work for (as a consultant) or
within (as an employee) community groups and organizations (e.g., assist them to organize,
conduct planning activities, evaluate their efforts) often get caught up in their activities and
purpose for being.
On the one hand, as a professional assisting a community organization, knowing where to
draw the line between what is supposed to be neutral/unbiased professional expertise versus
advocacy work can sometimes be difficult. If a sociological practitioner is a consulting
researcher, this line can be drawn more readily since there are specific guidelines that govern
data collection, analysis, and reporting. It is often helpful to have a system of checks and
balances in place. However, when a sociological practitioner serves a community organization
in a non-research-related role, or is an employee who has administrative as well as research
responsibilities (e.g., internal evaluators), then the dividing line can become blurred. For
example, internal evaluators might feel pressure (or feel compelled as an advocate) to down-
play negative findings and accentuate the positive for public relations purposes (Adams, 1985;
House, 1986). A way for internal evaluators to avoid this is to have the client for the internal
evaluation "sufficiently distant from both the evaluand and the evaluator within the organiza-
tion, that is, high enough in the hierarchy such that the 'truth' is what matters most" (Worthen
et al., 1997, as quoted in Mathison, 1999).
The difficulty for any sociological practitioner is that once the line has been crossed and
it is known that one is a supporter for a particular cause or effort, any subsequent effort to be a
neutral, unbiased professional (or researcher) becomes suspect.
On the other hand, some say that today's evaluation environment is much different than in
the past. Foundations that fund community-based interventions with evaluation components
represent a change in the way evaluation research is conducted. There is talk of partnerships
among evaluators, communities of interest, technical assistance providers, and the foundation
(Nee & Mojica, 1999). This represents a movement away from third-party, "at-a-distance"
evaluation work, to one that is more consultative, where there are negotiated processes occur-
ring with the people or organizations affected by the evaluation, and where there is a need for
timely feedback so that corrections in programming efforts can be made expeditiously (as
required by accountability movements that call for performance-based evaluations). This
paradigm shift poses fundamental questions. Can an evaluator and sponsor enter into this new
covenant with those being evaluated, without violating professional principles and ethics? Can
evaluators provide timely feedback without compromising objectivity? As Nee and Mojica
(1999:39) have stated: "The challenge is how to straddle the proverbial fence without splitting
our pants." The ethical tensions that exist in these situations are many and not always easily
resolved in a landscape where there are constantly shifting sands.
72 JOYCE MILLER IUTCOVICH AND SUE HOPPE

What are evaluators and/or applied researchers to do when their clients lack under-
standing of the ethical standards related to informed consent, confidentiality, unbiased
reporting, and scientific responsibility to publish results and share data?
Frequently, applied researchers and/or evaluators provide their services to clients who
have little understanding of the research process and the ethical standards to guide the
behavior of researchers. To further exacerbate this situation, there are generally other stake-
holders who have an interest in a particular research project and their level of understanding
may be even less than that of the client. Our previous discussions have highlighted some of the
dilemmas that applied researchers face when they are asked to forego procedures of informed
consent, to breach confidentiality, to present research results in a positive light, and to deny the
release of data that are proprietary.
Researchers who have been schooled in their own discipline recognize that these situa-
tions violate ethical standards, but because such codes do not extend to the clients of applied
research, it can be an uphill battle to resolve these issues. In a critique of the Guiding Principles
for Evaluators, Newman (1995:105) has argued that a more complete ethical model of
evaluation "should provide evaluators with principles guiding their process and practice;
inform clients of evaluators' obligations and duties; provide clients with principles guiding
their involvement in the process and practice of evaluation; inform evaluators of clients'
obligations and duties." A one-way model of evaluation ethics currently exists-it is the sole
responsibility of an evaluator to engage in ethical research. Newman (1995) insists that it is
important to educate a client (as well as other stakeholders) about how to ethically propose and
commission an evaluation, how to interact during an evaluation, and how to use evaluation
information. Ethical dialogues between clients, consumers, and evaluators could aid in the
educational process. Topics might include confidentiality, management of information, and
ownership of reports. Such efforts would go a long way in bringing these issues to the forefront
and reduce the ethical tensions that remain unspoken. In light of the changing nature of
evaluation where participatory evaluation, empowerment, and shared decision making are
becoming the norm, such dialogues can have an important impact on the ethics of evaluation
practice (Newman 1995).

CONCLUSIONS

Sociological practitioners, as consulting professionals, face situations that scholars do

not, but the core principles that guide most professionals still apply-competence, integrity,
professional and scientific responsibility, respect for others, and social responsibility. Specific
ethical standards of conduct may, however, vary as a function of practice activities.
Because sociological practitioners apply their knowledge and skills in a variety of ways
and tend to straddle multiple worlds, they may be faced with numerous ethical codes to guide
their behavior. Consequently, facing an ethical dilemma where there are conflicting standards
can be a reality for them. Regardless, ethical choices must be made and the decisions are not
always easy. As some might say, it is not difficult to do the right thing; rather, it is difficult to
know what the right thing is.
Most professional organizations consider their ethical codes to be "living documents."
This means that ongoing dialogue and discussion of ethical principles, how they apply in
specific contexts, the challenges professionals face, how the challenges are resolved, and how
ETHICS AND SOCIOLOGICAL PRACTICE 73

codes may change over time are all important. To that end, we hope this chapter provides some
food for thought for sociologists who are engaged in the practice world. Bon appetite!

REFERENCES
Abbott, A. (1983). Professional ethics. American Journal of Sociology, 88, 855-885.
Adams, K. A. (1985). Gamesmanship for internal evaluators: Knowing when to "hold 'em" and when to "fold 'em."
Evaluation and Program Planning, 8, 53-57.
American Evaluation Association. (1994). Guiding principals for evaluators. Charlottesville, VA: American Evalua-
tion Association.
American Sociological Association. (1997). Code of ethics. Washington, DC: American Sociological Association.
Bayles, M. D. (1981). Professional ethics. Belmont, CA: Wadsworth.
Beauchamp, T L., & Childress, J. F. (1983). Principles of biomedical ethics. London: Oxford University Press.
Becker, H. S. (1964). Against the code of ethics. American Sociological Review, 29, 409-410.
Bower, R. T, & deGusparis, P. (1978). Ethics in social research. New York: Praeger.
Canter, M. B., Bennett, B. E., Jones, S. E., & Nagy, T F. (1994). Ethics for psychologists: A commentary on the APA
ethics code. Washington, DC: American Psychological Association.
Fanning, J. (1996). Determining the need for and obtaining certificates of confidentiality. Paper presented at a
conference on Strategies for Addressing the IRB s Current Obstacles: Holding it Together and Measuring our
Success. Public Responsibility in Medicine and Research (Nov. 11-12), San Diego, CA.
Fine, M. A., & Kurdek, L. A. (1993). Reflections on determining authorship credit and authorship order on faculty-
student publications. American Psychologist, 48, 1141-1147.
Fitzpatrick, J. L. (1999). Ethics in disciplines and professions related to evaluation. New Directions for Program
Evaluation, 82(Summer), 5-14.
Frankel, M. S. (1989). Professional codes: Why, how, and with what impact? Journal ofBusiness Ethics, 8,109-115.
Freidson, E. (1964). Against the code of ethics. American Sociological Review, 29, 410.
House, E. R. (1986). In-house reflection: Internal evaluation. Evaluation Practice, 7(1), 63-64.
Iutcovich, J. (1997a). Defining sociological practice, applied sociology and clinical sociology. The Useful Sociologist,
18(Spring), 6-7.
lutcovich, J. (l997b). The professionalization of applied sociology: The role of sociological practice organizations. In
S. F. Steele & J. M. Iutcovich (Eds.), Directions in applied sociology: Presidential addresses ofthe Society for
Applied Sociology (pp. 7-40). Arnold, MD: Society for Applied Sociology.
Koppel, R. (personal communication, July 15, 1999).
Korenman, S. G., & Shipp, A. C. (1994). Teaching the responsible conduct ofresearch through a case study approach:
A handbook for instructors. Washington, DC: Association of Medical Colleges.
Long, G. L., & Dorn, D. S. (1982). An assessment of the ASA code of ethics and committee on ethics. The American
Sociologist, 17, 80-86.
Lovell, R. G. (1995). Ethics and internal evaluators. New Directions for Program Evaluation, 66(Summer), 61-67.
Marshall, E. (1993). Court orders 'sharing' of data. Science, 261, 284-286.
Mathison, S. (1999). Rights, responsibilities, and duties: A comparison of ethics for internal and external evaluators.
New Directions for Program Evaluation, 82(Summer), 25-34.
Merton, R. K. (1982). Functions of the professional association. In A. Rosenblatt & T F. Gieryn (Eds.), Social
research and practicing professions (pp. 199-209). Cambridge, MA: Abt Books.
Nee, D., & Mojica, M. I. (1999). Ethical challenges in evaluation with communities: A manager's perspective. New
Directions for Program Evaluation, 82(Summer), 35-45.
Newman, D. L. (1995). The future of ethics in evaluation: Developing a dialogue. New Directions for Program
Evaluation, 66(Summer), 99-110.
Pescosolido, B. (1991). The sociology of the professionals and the profession of sociology: Professional responsibility,
teaching, and graduate training. Teaching Sociology, 19, 351-361.
Pimple, K. (1997). Defining misconduct in science: Some reflections on the American experience. Trends, 1V(2), 1-27.
Rent, G. (1993). Confidentiality in social research threatened. The Southern Sociologist, 25, 1-2.
Rosenthal, R. (1994). Science and ethics in conducting, analyzing, and reporting psychological research. Science and
Ethics, 5, 127-134.
Rossi, P. (1995). Doing good and getting it right. New Directions for Program Evaluation, 66(Summer), 55-59.
74 JOYCE MILLER IUTCOVICH AND SUE HOPPE

Scarce, R. (1995). Scholarly ethics and courtroom antics: Where researchers stand in the eyes of the law. The American
Sociologist, 26, 87-112.
Sieber, J. E. (1994). Will the new code help researchers to be more ethical? Professional Psychology: Research and
Practice, 25, 369-375.
Simpson, R. L. (1990). The ethical responsibilities of referees. The American Sociologist, 21, 80-83.
Stryker, S. (1990). Ethical issues in editing scholarly journals. The American Sociologist, 21, 84-86.
Swazey, J. P., Anderson, M. S., & Lewis, K. S. (1993). Ethical problems in academic research. American Scientist, 81,
542-553.
Wigodsky, H. S., & Hoppe, S. K. (1996). Humans as research subjects. In D. C. Thomasma, & T. Kushner (Eds.), Birth
to death: Science and bioethics (pp. 259-269). London: Cambridge University Press.
Worthen, B., Sanders, J., & Fitzpatrick, J. (1997). Program evaluation: Alternative approaches and practical
guidelines. New York: Longman.
 CHAPTER 5

The Effects of Social Change

on Clinical Practice
NATHAN CHURCH

INTRODUCTION

The issue of social change and clinical practice is more complicated than the title of this
chapter would appear to indicate. The issues involved in conceptualizing social change reflect
the essential role of sociology in the process of establishing clinical interventions in human
behavior at the individual, organizational, and societal levels.
This chapter begins with some of the problems raised by considering any clinical ap-
proach within its broader social context. These considerations, it is hoped, will stimulate the
reader to think about the serious nature of clinical work and the particular advantages of
sociology as a basis for clinical work. In the second section, a procedure for incorporating an
awareness of social change into the formulation of an intervention is presented. The final
substantive part examines the effects of recent social changes on clinical practice at various
levels. The chapter concludes with some remarks about the implications of social change for
clinical practice and some suggestions about the future of clinical sociology.

CONCEPTUAL CONSIDERATIONS

Clinical sociology is naturally situated to deal with the role that social change plays in our
efforts to intervene successfully in human behavior. This does not mean that all sociological
clinicians attend to the issues of social change when they approach a problem. Sometimes they
do not. When they do choose to deal with these issues, they are empowered with a perspective
that is sensitized to the dimension of human behavior that is framed for us by the nature of
social change.
It should be noted that social change is one of the subfields of sociology, and has been
since the nineteenth century, when Auguste Comte made the distinction between social statics
and social dynamics. The limited objective of this chapter is to isolate the features of social
change as it impacts sociological interventions as well as how those interventions are them-

NATHAN CHURCH' St. Cloud State University, St. Cloud, Minnesota, 56301.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

75
76 NATHAN CHURCH

selves aspects of social change. The chapter is not intended to deal with social change itself.
This is a large subfield of sociology. It should also be noted that social change, of course, will
occur whether or not we or others design clinical interventions.
Other disciplines involved with clinical endeavors do not typically embrace the issue of
social change. This is a serious shortcoming of nonsociological clinical perspectives and
shows the critical need for the clinical sociology perspective. The sociological clinician finds
it not only interesting but essential to understand why, in the 1950s, you would be hard-pressed
to find a single case of anorexia nervosa, and yet, by the mid-1970s, you could not find a high
school or college campus in the country that was not struggling to deal with a range of eating
disorders that included not only anorexia but also bulimia, bulimarexia, and obesity. The
sociological understanding of this "symptom" of social change is essential to the development
of effective clinical interventions (more on this topic later). To simply accept the existence of
newly emerging clinical problems on the microlevel, as do most disciplines that pursue
interventions on this level, is to render even a basic understanding of the etiological process of
the problem on various levels impossible. It is even possible for clinicians to exacerbate
emerging problems by reifying them through labeling and developing techniques of interven-
tion without first coming to grips with the location or generation of the problem within
dynamic social structures.
One might ask, for example, if our society's current fascination with attention deficit
disorder is the rather sudden emergence of a new "clinical" problem, or if it reflects changing
social expectations. Try to find a reference to this problem 20 years ago, or 50 or 100 years ago.
One could speculate that 100 years ago we might find that the very kind of people currently
"afflicted" with this "disorder" were, in fact, the very kind of people settling the Western
frontier of this country. Now, in the highly structured environment that characterizes our
education system, those unable to maintain focus for 50-minute blocks of time, on a wide
variety of topics, not of their own choosing, are considered to have this "clinical disorder."
The broad implications of social change for clinical interventions highlight the necessity
to conduct the analysis of any problem on the three essential levels that typically characterize
the interrelated foci of sociology: micro-, meso-, and macrolevels of analysis. Other disci-
plines and perspectives are not naturally predisposed to conduct multilevel analyses. Soci-
ology is uniquely situated to do so (if we can successfully dislodge it from its ivory tower
isolationism). It is critically important that those of us who conduct clinical sociology primar-
ily at the microlevel maintain a high degree of awareness and commitment to the necessity of
multilevel analysis lest we simply become "another mental health profession." We must be
committed to what C. Wright Mills (1959) called the sociological imagination-a vivid
awareness of the relationship between personal behavior and the societal context within which
it is framed. The sociological clinician not only finds it interesting, but essential, to note that an
individual who committed suicide in Detroit was unemployed as a result of the closing, 5
months earlier, of an automobile manufacturing plant. While there are critical intrapsychic
factors at play, the clinical sociologist will attend to the fact that the plant closing is social
change at a mesolevel, an aspect of change at the macrolevel, both of which have an impact on
this human's behavior at the microlevel.
The "client" or object of analysis in sociologically oriented clinical work may, and
usually does, undergo significant systematic change in a relatively short time and lives within
larger social structures that are constantly undergoing change. Even choosing or being chosen
to be a client of a sociological clinician (i.e., hiring a clinical sociologist as an organizational
consultant in a manufacturing firm or being an inmate who is assigned to a clinical sociologist)
is social change. As that clinical relationship is pursued, there are likely to be further aspects of
THE EFFECTS OF SOCIAL CHANGE ON CLINICAL PRACTICE 77

social change. The formation of the clinical process itself is social change, as are later aspects
of the clinical undertaking. For example, the acquisition of a formal label in such a process
may hinder or help the intervention. The labeling ofjuvenile delinquents is one example of the
potential hindrance, and the Hawthorne effect is a good example of the helpful process
involved in labeling. Also, the object of intervention can experience change for reasons that we
may be unaware of or over which we may have little or no control. For example, an inmate
may become a parolee, not because of any successful intervention on the clinician's part but as
a result of prison overcrowding and a court mandate to release a specific percentage of inmates
to alleviate the problem. The same inmate may be the subject of derision by peers for having
"fraternized with the enemy" by forming a genuine rapport with the clinical sociologist.
Likewise, a manufacturing firm may be sold to, or taken over by, a larger corporation that does
not favor the use of social scientists as consultants.
We must accept the fact that intervention itself is social change to a degree that may vary
considerably depending on how extensive it is and the levels at which it occurs. Interventions
at the macro- and mesolevels will have a greater effect on more behavior than will changes at
the micro-level. The many historical examples of the effects of single individuals on meso-
and macrolevel social structures are, typically, the exception rather than the rule.
In addition to the fact that our clinical work will effect specific social change for the
particular object(s) we are analyzing, our clinical work will result in distinct social changes at
the meso- and macrolevels. The very acts of clinical intervention require various levels of
organization. Clinical sociologist is not a stand-alone term; it comes attached to the history and
organizational structure of the discipline of sociology and to the movements within it. As we
practice our profession as clinical sociologists, we create social change as we create new
terms, procedures, organizations, methodologies, journals, books, and everything else that
goes along with a professional enterprise within the context of an advanced technological
society.
As a culture, we grasp social process and social change quite well when our work
involves physical technology, but we have failed to appreciate the dynamics of social technol-
ogies that we have and continually produce. Sociologists and anthropologists have developed
the concept of culture lag to highlight the inevitable delay between the introduction of a new
technology and the adjustment of the culture to that new technology. We have not been as
sensitive to culture lag when it involves the introduction of new social technologies such as
psychotherapy or democratic decision making. Thomas Szasz (1970) and others have com-
mented on the use of the medical model to deal with some kinds of behavior and the impact
that this has had on the law and criminal proceedings with regard to competency to stand trial.
We are still struggling with this issue and will continue to do so in the foreseeable future.
Another illustrative case is presented by U.S. Christianity and other religions that have
yet to resolve the dilemma presented by their support or belief in static moral principles and
their apparent belief in, and commitment to, the democratic process. The dilemma is the
"obvious" contradiction between the two philosophical systems, especially because the
democratic process is so intricately involved in a dynamic relationship with social change,
particularly with respect to the development of law and various bureaucracies.
It is not my desire to demonstrate all of the features of culture lag as it relates to the
introduction of these relatively new social technologies but to illustrate the fact that we do not
fully appreciate their reality. We must be sensitive to social change as we consider cases. We
must also be aware of the fact that we are creating social change as we establish new
dimensions of our profession. We also create specific social changes through the interventions
we devise.
78 NATHAN CHURCH

As we create new dimensions of our profession, we must be careful to avoid letting

premature concepts find their way into the more static aspects of the social change we bring
about. Premature clinical concepts, for example Freud's "unconscious," may set a field back
for decades. The seductiveness of such a concept, which may help to account for an initial set
of difficult conceptual problems, may deter the search for more accurate and helpful concepts.
Even when more accurate and explanatory concepts are discovered, they must often wait a
long while to replace their popular predecessors. Thus, important and helpful concepts in
family therapy, for example, co-dependency and the dynamics of being an adult child of an
alcoholic, have been hindered at the developmental and the implementation levels. Some of
this process is inevitable; greater awareness and attention by clinical sociologists could result
in more progressive and useful intervention than is available in other perspectives and
disciplines.
We are inextricably engaged in social change. Important ethical questions are raised for
sociological practitioners as interventions are implemented. Clinical sociologists are uniquely
situated, conceptually, to deal with the reality of effecting change. Merton's concept of
unintended consequences has become a pennanent fixture of the sociological perspective. It
has alerted us to the fact that, regardless of what we intend to accomplish with a particular
intervention, it may result in a number of unanticipated outcomes. This suggests at least two
ethical requirements for the clinical sociologist: (1) commitment to careful observation of the
consequences following the implementation of an intervention and (2) commitment to the
anticipation of unintended consequences prior to the implementation of an intervention. The
use of simulation, when possible, and the development of other mechanisms such as peer
reviews should enhance our abilities to anticipate the consequences of our interventions,
which should then be monitored according to a set of guidelines established for that purpose.
The foregoing are a few of the conceptual considerations that the dynamics of social
change imply for clinical sociology. They are not an exhaustive list of those implications,
merely an illustration of some of the issues that are involved and a demonstration of the
superiority of sociology as a basis for clinical interventions when the process of social change
is particularly important. It is hoped that thoughtful clinicians with expertise at the various
levels of intervention will give attention to the issues raised here and contribute to a further
refinement of the clinical sociological perspective.

CONTEXTUAL DETERMINATION

The first order of business for the clinical sociologist should be the analysis of social
changes that have been instrumental in structuring the situation or phenomenon to be dealt
with. The clinical sociologist is uniquely trained and sensitized to the social context within
which events occur and phenomena exist and should be able to deal with a situation in a
fashion that is least likely to create self-fulfilling prophecies and cultural myths. It is critical
that the clinical sociologist incorporate analysis of social change and social context into the
development of an intervention. Otherwise, the clinical sociologist merely becomes another
mental health professional, consultant, or policy expert with nothing of particular merit to
offer over others in the same area of practice. In the pages that follow, we will look at an
example at each level of analysis-micro-, meso-, and macrolevels-to see how the sociolog-
ical practitioner might go about the process of contextual determination.
Let us suppose that you have been commissioned to work with an adolescent with a drug
abuse problem and want to determine the context of your work with this adolescent. You could
THE EFFECTS OF SOCIAL CHANGE ON CLINICAL PRACTICE 79

begin with an assessment of the tenns used to define the situation. For example, what is an
adolescent? Because it does not take a long trek back into history to determine a time when the
tenn adolescent was nonexistent, you can begin to isolate the social changes that resulted in its
development and use. As Demos and Demos (1973) noted, until 1900, the word was nonexis-
tent in our literature. It is interesting to note that Aries (1962) made a similar contribution
regarding the concept of childhood as a status. The sociological clinician begins with the
understanding of age status as a fluid rather than a static phenomenon. Even the tenn
adolescent is insufficient to identification of this individual's age status. Is she or he an early
adolescent, middle adolescent, or late adolescent? As these age status indicators illustrate,
something as individual as one's identity is wrapped up in complex features of social change at
the macro- and mesolevels of analysis. Even more important to delineate are the critical
features of those social changes and how and why they resulted in labels that indicate
differences in age status.
In our example, Demos and Demos pointed to two important changes at the macrolevel:
(1) the shifting economic focus from an agrarian society to an industrial one and (2) the inter-
related process of urbanization. They also pointed to two significant changes at the mesolevel:
(1) the development of child labor laws and (2) the emergence of the juvenile justice system.
All of these changes, they argued, resulted in a displacement of the adolescent from the
economic role of an apprenticing agrarian producer. The result, for adolescents, is a loss of
meaning for existence, not merely in an emotional sense but also in an economic sense.
This point is easily overlooked by the traditional clinical professions that might respond
to this adolescent's drug abuse problem. They try, therapeutically, to induce a sense of mean-
ing, often through the technology of group process and positive peer pressure. Such programs,
on the whole, are miserable failures, unable to transmit a genuine sense of meaning or alter the
adolescent's position within the macro- and mesolevel structures of society. Adolescents are
very perceptive with regard to this reality, even though traditional therapists often label their
complaints as "acting out" or "resistance" to therapy. The obvious challenge to the clinical
sociologist is to discover concrete ways in which adolescents can locate themselves within the
macro- and mesolevel structures in which they exist, ways that adolescents can genuinely
identify as meaningful to themselves.
The clinical sociologist would also want to discover what meso-level structures this and
other adolescents have to contend with; what definitions adolescents use to characterize
school, police, youth culture phenomena, religion and so on. It is not enough, and it is less than
infonnative or helpful to observe, that one feature of being an adolescent is the experience of
"adolescent rebellion." To use W. I. Thomas's (1923) concept, the sociologist would want to
discover adolescents' "definition of the situation," "the situation" being their perception of
the meso-level structures that they contend with on a regular and concrete basis.
There are other questions to address in analyzing this problem: the socialization experi-
ence of this adolescent and how it differs from, or is similar to, that of adolescents who can be
identified as living within different or similar cultural, subcultural, religious, racial, or regional
groupings; the patterns of socialization that this adolescent's parents have carried forward
from their own families of origin; the nonnative standards, values, and definitions of the
situation that this family has established and how they have changed over time; the family's
definition of the situation with regard to the adolescent's drug abuse problem; how the family
would change if this adolescent's drug problem was resolved. As family therapists like Jay
Haley (1976) and Salvador Minuchin (1974) have noted, the behavior of an individual within
a family structure may serve some purpose for that family. A change may result in resistance
by family members, regardless of their verbal indications of support for change.
80 NATHAN CHURCH

The clinical sociologist then must ask some questions regarding the social changes that
have resulted in the definition of the adolescent's use of marijuana as a drug abuse problem.
One might ask how the adolescent's use of this substance has come to be labeled as a serious
problem while the mother's long-term use of Valium and the father's history of dependence on
alcohol have not been labeled as such. Is the adolescent's use of marijuana more damaging
emotionally, socially, or physically than the parents' use of Valium and alcohol? Adolescents
tend to be very keen in their ability to decipher the contradictions that are present in such
situations. The clinician must be prepared to grasp and appreciate the reality of those contra-
dictions and to deal with them honestly with the adolescent and the parents.
The clinical sociologist must realistically resolve these complex contextual issues or
stand indistinguishable from other mental health professionals. It is hard to envision the merit
of yet another "brand" in the mental health marketplace. If these sociological issues are
addressed adequately, however, we should expect interventions that are clearly effective, well-
grounded conceptually, and quite readily accepted by other clinicians. We should also use our
insights to pursue interdisciplinary collaborations to address significant "psychological"
problems in our culture.
At the mesolevel, let us suppose that, as clinical sociologists, we have been asked to
consult with an institution of higher education interested in establishing an effective program
for the recruitment of minority students. Before we design an intervention, we must determine
the context for the problem. As with our adolescent drug problem, a good place to begin is with
an analysis of the social changes that have taken place and how they define the terms we use to
describe the problem. We do not have to go very far back into history to find an absence of
terms such as minorities or recruitment of students. As Joyce Ladner (1973) and others have
pointed out, sociology itself has been staffed and directed by the dominant group in our
society. It has, in fact, contributed to the problem of racial and ethnic discrimination. Soci-
ology must be cognizant of itself: a difficult and suspect enterprise under virtually any
circumstance. In addition, the task of determining the social changes on the macrolevel that
have resulted in the terms that we use to frame the problem is one that must be undertaken.
On the mesolevel, we must also look to the social changes within the institution that has
established the framework within which the intervention is to be designed and implemented. It
is important to consider not just the immediate social changes that have resulted in the desire to
accomplish this end at this time, but also, if the intervention is successful, the changes that will
be created within the institution and the academic support and student service capabilities
available to meet the demands that an increased minority enrollment would require.
On the microlevel, one must ask how personality-dependent the desire for increased
minority enrollment is. Does the push for this outcome reflect a change that has been
experienced by the president or the board of the institution, or does it reflect a genuine change
in the institution itself? What changes will occur in the personal lives of the minority students
who enroll? Will they lose their affiliations with their families, friends, and former neighbor-
hoods? Will they experience so much stress, anomie, and alienation in the process that their
personal quality of life will suffer significantly?
I have raised these issues to point out how important an assessment of the social changes
at all levels is to determining the context of the problem for which clinical sociologists design
an intervention.
On the macrolevel, let us suppose that you have been asked by the U.S. State Department
to be involved in the formulation of a strategy to reestablish diplomatic relations with Iran.
You need to assess the social changes in both countries that have been instrumental in
formulating the terms by which we make reference to the problem.
THE EFFECTS OF SOCIAL CHANGE ON CLINICAL PRACTICE 81

Analysis must be conducted from both the U.S. world-view and the Iranian world-view.
Realistically, you would have to broaden this to include a number of key players in world
events, such as the United Nations, the nations of the former Soviet Union, the other OPEC
nations, Israel, and Islamic cultures that are Sunni rather than Shiite. It is critically important to
understand the social changes in the United States that motivated our initial relationship with
Iran in the modem era, especially with the Shah, and the changes that occurred within Iran that
allowed for this initial relationship. To appreciate, fully, the complexity of the problem, the
broader historical framework of social change within Iran must be understood. Then you
would have to understand former U.S. policy with regard to Iran and the kind of social change
that it induced within the latter. You would also have to be aware of the social change that has
occurred since the breaking of diplomatic ties between the two countries.
At the mesolevel, you would have to observe the critical changes that occurred in the
international relations organizations or bureaus within both countries and at the various
business and economic organizations and the changes that have been important in framing the
context of the problem. At the microlevel, you would have to assess the changing roles and
viewpoints of the various actors and the changing actors in the drama of relations between the
two countries.
In addition, you would have to anticipate the kind of changes that would be effected
within either country, should the strategy be successful. How would this alter perceptions of
the arrangement of power within the Middle East? To do otherwise would relegate the clinical
sociologist to the anonymous, and less effective, role of policy formulator.
There are many other aspects of change to be analyzed and many steps involved in
determining an adequate model and effective techniques for the resolution of our conflict with
Iran. The point of this exercise is to highlight the significance of considering the dynamics of
social change as they affect the development, implementation, and evaluation of an interven-
tion to solve problems at the macrolevel of analysis.
In considering examples of problems at the micro-, meso-, and macrolevels of analysis,
we have raised more problems than we have solved. This has been the very point of this
exercise. Clinical sociology has something unique and valuable to offer at all levels of
analysis, partly because it recognizes the complexities that are involved in these problems.
What we have only touched on here illustrates the complexities involved in the dynamics of
social change. There are many issues of similar importance that sociologists are uniquely
situated to analyze. One could argue that it is the very same ability of sociologists to appreciate
the complexity of the intervention process that accounts for their reticence in getting directly
involved with the formulation and implementation of interventions. Individuals who are
directly involved in interventions become immersed in sociological issues with which they
must, and do, grapple. For some, this grappling comes without the benefits of a sociological
perspective and sociological knowledge. This places a heavy burden on the individual with a
sociological perspective to become more fully involved in interventions at all levels of
practice.

DETERMINING THE CONTEXT

OF ADVANCED TECHNOLOGICAL SOCIETY

In the foregoing examples of specific problems at different levels of analysis, we have

focused our attention on the need to determine the particular sociological context for a
problem in order to develop an effective intervention for its resolution. We have noted that this
82 NATHAN CHURCH

contextual determination requires an analysis of the way in which particular social changes
have situated the problem, and we have seen how the intervention itself must be seen as social
change. A set of primary elements of social change sets the ground for any clinical sociology
situated within U.S. or any other advanced technological society. What informs a sociologi-
cally based intervention approach is not simply the "big picture," which is presented by an
awareness of macrolevel phenomena. It is also a keen sense of social change and its effect on
the interplay between phenomena at the macro-, meso-, and microlevels of analysis. This is
where the potential of clinical sociology exists. In order to appreciate this interplay, clinical
sociology must sense the way in which social change has situated advanced technological
society and the dynamic nature of society as it continues to undergo change on these levels.
What follows is a sample of those elements of social change that have had, are having,
and will continue to have a profound influence on clinical practice. Changes at any level of
analysis effect changes, or have implications for, other levels of analysis. However, it is easiest
to specify important social changes by the level at which they primarily occur.

Macrolevel Changes

Beginning with the publication of Daniel Bell's book, The Coming of Post-Industrial
Society, in 1973, sociologists and social thinkers have recognized sufficient change on the
macrolevel to call the label of industrial society into serious question. What will serve as an
adequate label for contemporary society is a question that has remained a topic of discussion
and debate since Bell's volume emerged. It may simply indicate that we have to be well within
the parameters of an emerging set of social structures for some time before we can identify its
central features sufficiently well to corne up with a new label. The changes are typically
incremental and a significant mixture of old and new features clouds our ability to make clear
distinctions. Until a new label can be applied, we probably are saddled with a number of post
identifications such as postindustrial, postmodern, posttraditional, and so forth. In this
chapter, the term advanced technological society has been used. Although I am no more
committed to this term than to any number of alternatives, the term does highlight a feature of
contemporary society that has been suggested throughout the chapter-the predominance of
the development of new technologies, physical as well as social, over the past two or three
decades. In fact, we have a general expectation of built-in obsolescence in any new technology
that is developed. There has also been an attempt in this chapter to highlight the significance of
changes in social technologies.
In addition to the emergence of a technology-based orientation on the societal level, there
have been some key demographic changes. One of these is a pattern generally referred to as the
"graying of America," which draws attention to the fact that, as a result of declining death
rates and declining birth rates, our population has become proportionately older. Clinical
sociology must be sensitive to this fact because it affects so many aspects of the quality of
human life. It represents a fundamental change in the ratio of wage-earning to non-wage-
earning individuals within the society. It is also well past the time for adequate planning. We
are already experiencing this change. The pressure on the Social Security system is adequate
testimony to this unfortunate fact. It is of little wonder that so many clinical sociologists
already work in this area; the need for adequate models and interventions is great.
Family size has shrunk considerably during the last two to three decades. This is related to
the changing age composition of the society and to serious complications within an immigrant
society. The growth of the existing population is almost at replacement level, yet the popula-
THE EFFECTS OF SOCIAL CHANGE ON CLINICAL PRACTICE 83

tion continues to grow significantly due to large-scale immigration. Incoming populations

soon outstrip the growth of the existing population due to extensive immigration and the fact
that immigrating populations tend to have an initially high birth rate. The social, economic,
and racial problems that result are complex, especially in a society in which democratic ideals
and freedom are strong inhibitors of rigid and restrictive immigration policies.
In a relatively short time, we have experienced escalating rates of divorce and a growing
number of single-parent and stepparent families. This has resulted in the emergence and
growth of mediation as a method that is preferable to adversarial models of achieving the
dissolution of families. It is, however, far from becoming the norm. We must acknowledge the
reality of a growing proportion of women and children whose socioeconomic position has
suffered because of an inadequate system of child support. We also must acknowledge the fact
that stepfamilies are more likely than intact families to be prone to problems of conflict,
instability, and physical and sexual abuse of children.
We have witnessed a phenomenal growth in dual-career marriages. This has resulted in
massive economic changes that have, at least in part, fueled a situation in which the presence
of two working spouses is no longer a matter of choice but of financial necessity. This has
created greater disparity between the purchasing power of families at different income levels,
particularly between that of two-parent families and that of single-parent families. It has also
created a childcare dilemma for our society.
We have seen an amazingly rapid surge in megalopolitan growth, growth in the Sunbelt
population, and business migration patterns. This has created problems of sizable proportions
for our urban areas, particularly in the Sunbelt locations where growth has been much more
rapid than that of other urban locations. Complex problems involving planning and zoning, air
and water pollution, availability of adequate water and transportation have emerged. We have
seen the flight of some corporations from historically established urban areas and the host of
urban problems that those same corporations helped to create. What we have been left with are
decaying urban areas without their former tax base to fund rebuilding and renewal programs.
In addition to demographic changes, the role of women has changed dramatically in
recent years. Women have made significant advances in educational attainment and advance-
ment in the work force, but they are far from reaching parity with men on almost any indicator.
They have gained little in high-paying executive and governmental positions and earn about
three-fourths of what their male counterparts earn when performing the same job. Sexual
harassment and violence against women show little sign of abating.
Our social world can be described as highly depersonalized and anonymous. This has
resulted in a growing rift between our private experience and the society within which we live.
Levels of political apathy and chemical abuse are high, indicating the severity of the problem.
Sweeping changes in telecommunications technology have taken place in recent years.
There appears to be no end in sight for the refinement and development of entirely new
technologies in computers, the Internet, satellite-based communications, cellular telephones,
and available interactive digital systems, even in the form of touch-tone telephones, software,
and related technologies. This has led to an information explosion that is unprecedented in
history. It has changed virtually every facet of the workplace and created a new generation of
computer illiterates. It has given us the ability to access enormous amounts of data. It has made
our money and a lot of other things more an electronic reality than a physical reality. It has
introduced some thorny security and privacy issues as well.
The techniques by which we surveyor poll people have become extremely sophisticated.
This is one area that is highly illustrative of culture lag with regard to the introduction of a
social technology. The impact this has had and will have on the forecasting of elections is
84 NATHAN CHURCH

profound. Even before the polls in parts of the country have closed, election outcomes can be
projected with a high degree of accuracy. The fact that every political campaign with even a
modest budget has an in-house pollster on the payroll raises some serious questions about the
current and future state of the selection of our leaders and the resolution of substantive
initiatives through a potential form of "high-tech follower-ship." This new technology also
poses some difficult ethical and privacy issues for those involved in mass marketing and the
measurement of consumer preferences.
Recent decades have seen the phenomenal growth and influence of multinational corpo-
rations. It is common knowledge that a host of countries are dwarfed by the output and power
of many large multinationals. The implications for international politics have been a topic of
considerable discussion by radical social thinkers since the late 1960s, but we still do not have
a clear picture of the consequences for national and international politics or economics.
We have been observers of major changes in religion since the late 1960s, when a seem-
ingly inexorable process of secularization suddenly reversed itself. The growth in religious
ranks occurred where it was least expected-within fundamentalist religious groups, while
many liberal denominations continued to lose strength. Charismatic elements emerged within
the most formal and ritualistic religions, such as the Catholic and Episcopal churches, and
religious pluralism reached totally unexpected proportions, running the gamut from Eastern
religious gurus and swamis of every sort to New Age religious mysticism touting the salutary
and spiritual qualities of crystals and pyramids. We are a long distance from an understanding
of the basis for these changes in religion or exactly what their impact might be. We did learn, in
1980, that the growth of fundamentalism could fuel a thunderous return of the Republicans
to the executive branch of government. We also saw the fundamentalists discover the use of
television and, along with it, scandal and "sin." We have also witnessed the emergence of a
form of "urban religious terrorism" as some right-to-life advocates have proclaimed them-
selves as the "appointed" executioners of those, ironically, accused of executing the unborn.
This, and antigay campaigns of the religious right are clear clashes between the ideals of
fundamentalism and the basic tenets of democracy.
Although this is admittedly a thumbnail sketch of macrolevel social change, it does give
us an idea of the general macrolevel context for clinical sociology without making it the sole
topic for a book-length treatise. Even full-length books on macrolevel issues are uniformly
thematic, rather than comprehensive, an indication of the enormity of the task.

Mesolevel Changes

The mesolevel is the area within the contemporary world where most change is currently
under way. In the United States, especially, Western society has demonstrated a tenacious
grasp on inefficient bureaucratic structures for organizations, agencies, and corporations. As
Naisbitt and Aburdene (1985) indicated, however, the challenge both for production and for
the quality of the human work experience is to create new mesolevel structures that demon-
strate high levels of efficiency while maintaining human dignity and worth. The Japanese have
led the way, at least with regard to efficiency. There is still much to be learned and applied in
this area, and clinical sociology is well situated to forge new social technologies here. It may
be our greatest hope of making an impact while expanding the perspective and familiarizing
society with the advantages of using sociology clinically. It is less than certain, however, that
clinical sociologists fully realize the potentiai here. If we are to be successful in this area, it is
critical that we know the context for our practice at the mesolevel as well as the macrolevel.
What follows are only some of the most obvious aspects of change at the mesolevel of analysis.
THE EFFECTS OF SOCIAL CHANGE ON CLINICAL PRACTICE 85

We have seen a change in the mentality of those who are in charge of organizations and
agencies. Perhaps due to intense international competition, leaders have increasingly focused
on the issue of accountability. Instead of simply assuming that a particular organizational
structure or technique is working, they have insisted on knowing if it is working. There has
been a phenomenal growth of what social scientists call evaluation research or outcomes
assessment. It is likely that needs assessments, simulations studies, and the like also will
increase.
We have observed the emergence of an era of scientific management. We have seen
experimentation with quality circles and worker ownership, respectively, as scientifically
generated technologies to devise more effective means of management and increased em-
ployee motivation. The success or failure of different companies or organizations is closely
watched as studies and assessments are printed in lay publications as well as in more academic
business journals or newspapers.
Decided efforts have attempted to reorganize the structure of the business enterprise
through what has been referred to as corporate restructuring. These have often been large-
scale efforts involving huge corporate entities rather than small-scale experimental changes.
These efforts have been less than scientific in nature and have usually been motivated by panic
or fear of losing further ground to foreign competitors.
It has become accepted practice for organizations or corporations to provide in-house
training programs for their employees. Some firms, like Arthur Anderson (one of the Big
Eight accounting firms), have set up veritable in-house colleges. In this process, new group
technologies like brainstorming, focus groups, cross-functional teams, production or problem-
solving groups are presented to employees as methods to improve production or resolve
specific company problems.
The introduction of computerization and robotics occurred in the United States after it
had been in place in Japan for some time. The effects of this change on U.S. business and
workers are poorly understood, but they are being pursued with considerable vigor, motivated,
many would say, by panic or fear that without them we will lose even more ground to the
Japanese and other international competitors.
The use of the Internet as a vehicle for commerce is developing rapidly. As consumers
gain more confidence with e-commerce security, this will surely grow rapidly. There is a
frenetic pace, however, involving very rapidly shifting technologies, especially of hardware
and software interfaces and a wide range of data transmission and networking options. It is
hard to know if telephone, cable, or wireless communication links will serve as the primary
platform, or if it will be a combination of these or an emerging technology. High-tech indus-
try leaders are in too much flux to be described effectively. The world of communications
and digital technology is a particularly fertile ground for clinical sociology, both now and as
general patterns begin to emerge.
Although little more than a thumbnail sketch of mesolevel changes has been offered, it is
hoped that it will stimulate thinking about clinical practice in this area. Hopefully, it will also
help to communicate the importance and potential of clinical sociology on the mesolevel.

Microlevel Changes

One could have started with the microlevel and worked up to the macrolevel in the
foregoing analysis of social change. But it would have given the appearance that most of the
identified changes emanated from changes that occurred at the microlevel. My position here
is one that is distinctly sociological. It identifies changes at the macro- and mesolevels and the
86 NATHAN CHURCH

impact that changes at these levels have on life at the microlevel, rather than the reverse.
Particular individuals sometimes have dramatic effect on the course of social change but only
in terms of how much impact they have on the macro- and mesolevel social structures that
affect the microlevel. One could take an individualistic approach and chronicle the ways that
specific individuals' lives have been affected by the course of social change. That is the grist of
novels and biographies. To their credit, they give a special flavor to our genuine understanding
of social change. Our task here, however, is to look at a few of the crucial changes that have
occurred to phenomena that exist primarily at the micro-level. To the careful analyst, these
changes will clearly illustrate the interplay of microlevel phenomena with phenomena on the
macro- and mesolevels. They are presented here to emphasize the societal context of clinical
practice on the microlevel. They demonstrate what nonsociological practitioners typically take
for granted as they deal with microlevel phenomena nonreflectively. It is the task of an
effective clinical sociology to situate microlevel events within the dynamic interplay of social
structures at other levels, thereby removing them from their reified positions within contempo-
rary society.
When looked at from the perspective of the small minority of the population actually
afflicted with a mental disorder, the use of psychopharmacology would appear to be an
important, if somewhat limited shift from the widespread use of electroconvulsive shock
therapy and of physical restraints to a much more humane form of treatment for the mentally
ill. The widespread societal use of tranquilizers, mood elevators, antianxiety, hyperactivity,
and sleep-inducing medications, however, indicates a very real change in the way in which we
view and deal with emotional and behavioral problems. Often, treatment involves little more
than the prescription and monitoring of the proper psychoactive medication, which may
consist of little more than a general awareness that the original behavioral or emotional
problem has not recurred.
Similar to psychopharmacology is the use of behavior modification techniques, partic-
ularly with the mentally retarded and with children and adolescents in rehabilitative and
correctional settings. This is also true, to a lesser extent, of learning environments and early
child-rearing strategies employed by educated parents.
There has been a decided reinterpretation of the freedom of individuals to make choices
about their personal identity, especially their sexual orientation. This is not true of all segments
of the larger society, but it has largely characterized the academic, legal, and political arenas
for the individual who chooses to make his or her same-sex orientation known. Even with
the outbreak of AIDS, this change has been an enduring feature of our age. It may be doubtful
that this has changed the number of people with a homosexual preference, but it certainly has
changed the self-identity of people with such a sexual preference, even since the time that the
psychotherapeutic community considered it a diagnosable psychopathology.
By the late 1970s and early 1980s, the words anorexia and bulimia were regular parts
of the language of the larger culture and had, for a few years, been part of the exclusive
discourse of the psychotherapeutic community. These problems were quickly identified with
the pressures of the culture on a young woman's appearance and with the problematic nature of
certain family structures and dynamics.
Although we have long been aware of the problems of alcohol abuse, we "suddenly"
became aware of the consequences of growing up in a family characterized by alcoholism and
the family dysfunction that it causes. In short order, groups and techniques that offered help to
the "adult child of an alcoholic" (ACOA) sprang up allover the country. By the mid-1980s,
these concepts and techniques were part of our cultural and individual discourse.
In the late 1970s, we began to see some alarming changes in the behavior of our
THE EFFECTS OF SOCIAL CHANGE ON CLINICAL PRACTICE 87

preadolescent and older children. Previously untouched by the changes in our society, individ-
uals in these age groups began to commit suicide in numbers that did not exist earlier. Drug
addiction and alcoholism also began to take on a younger face. In urban areas this has been
especially pronounced, as have increasing levels of gang-related violence and the well-
publicized incidents involving the use of firearms by disenfranchised students against their
peers and teachers.
By the early to mid-1970s, the evidence became clear that there was a direct link between
stress and a variety of mental health and physical problems, notably, chronic heart disease.
People began to find myriad ways to insulate themselves from the specter of stress. They began
jogging and engaging in other forms of aerobic exercise; they tried meditation, progressive
relaxation, yoga, guided imagery, biofeedback, and many other stress-reducing strategies.
More recently, this has been supplemented by a wide range of nutritional approaches. In addi-
tion, herbalogy, Oriental medicine, acupuncture, acupressure, chiropractic, aroma therapy,
massage therapy, and a variety of other alternative healthcare approaches have emerged.
These examples of change give little more than a glimpse of the context for clinical
sociologists working at the microlevel of analysis. The important thing for the sociological
practitioner at the microlevel to remember is that uniquely sociological insights about individ-
ual behavior and emotions relate to an understanding of the macro- and mesolevel structures
within which they ultimately occur. It is too easy to get wrapped up in the nature of individual
problems and to forget their sociological context. If one looks back on the few examples that
have been listed, one will see that behavioral problems are generally treated as if they had
existed forever and were unrelated to larger social issues and processes. Unless clinical
sociologists make a point of those sociological dynamics, they will be indistinguishable from
their psychological practitioner colleagues and equally ineffective in resolving problems and
improving the quality of life.
The formal discipline of sociology suffers from the one-sidedness of an intellectual
enterprise without a genuine testing ground of practice. For far too long, sociologists have
deluded themselves into believing that empirical research is the testing ground of the disci-
pline. The genuine testing ground of empirical findings that are grounded in theory is the
application of those findings to real problems in the real world. Every other discipline holds
itself to this difficult but ultimately reasonable standard. It is a sleight-of-hand maneuver or
simply intellectual cowardice to propose that the mere interplay of theory and research is an
adequate test of the mettle of an intellectual enterprise. I submit that the rest of the academic
world and a good bit of the nonacademic world has figured this illusion for what it is. It is high
time for sociology itselfto come to grips with its accountability to its ultimate clientele. Surely
the time has come for sociology to thoroughly rethink its raison d'etre.
We have learned that the dimensions of social change involve new physical technologies
and their impact on social structures. We do not yet fully appreciate or adequately understand
many of the new social technologies.
We have seen other practitioners take as ultimately real, clinical problems that are reflec-
tions oflarger social changes. Responding to a problem without a global, dynamic perspective
that is uniquely available in sociology not only obfuscates our understanding of it but results in
a process of reification of the problem.
We have noted the way in which our interventions are themselves dimensions of social
change. We must isolate interventions to minimize the possibility of unintended consequences.
We have an ethical obligation to measure outcomes. We must determine what kinds of
simulations we can develop to anticipate the effects of our interventions and to determine the
degree to which we are bound to perform them and the situations in which it is acceptable to
88 NATHAN CHURCH

study interventions in vivo. We need to create standards that we can use as "templates" for
detennining the level of intervention that we should design. And we need to uncover the
principles of the effects of microlevel changes on meso- and macrolevel structures (as well as
all of the possible pennutations of each level affecting the other levels).
All of these complex and challenging ethical and professional issues will face a clinical
sociology that is serious about its role in the arena of interventions. In some cases, we have the
advantage of following interventionist colleagues who have trod similar paths, and we can
save ourselves a few unnecessary steps. In other cases, the nature of sociologically based
interventions is so unique that we will have to go alone into the uncharted territory that lies
ahead.

REFERENCES
Aries, P. (1962). Centuries of childhood: A social history of family life. New York: Knopf.
Bell, D. (1973). The coming of post-industrial society. New York: Basic Books.
Demos, J., & Demos, V. (1973). Adolescence in historical context. In M. Gordon (Ed.), The Americanfamily in social-
historical perspective (pp. 209-221). New York: St. Martin's Press.
Haley, J. (1976). Problem-solving therapy. San Francisco: Jossey-Bass.
Ladner, J. (Ed.) (1973). The death of white sociology. New York: Random House.
Mills, C. W. (1959). The sociological imagination. London: Oxford University Press.
Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.
Naisbitt, J., & Aburdene, P. (1985). Re-inventing the corporation: Transforming your job and your company for the
new information society. New York: Warner Books.
Szasz, T. (1970). Ideology and insanity. New York: Anchor Books.
Thomas, W. I. (1923). The unadjusted girl. Boston: Little, Brown.
 PART II

LEVELS OF INTERVENTION

Clinical sociologists apply the sociological perspective in practice with social units across the
spectrum. At the most microlevel is practice with individuals but we recognize that the
individual is a social unit. Through the socialization process, each person comes to reconstruct
his or her social environment, internally. In addition, each person is a part of many larger social
units: families, groups, communities, and organizations. Problems that arise may stem from
one's prior socialization or from difficulties adapting to or coping with social roles or
relationships with others in social situations in which one finds oneself. Problems may also
arise with the social systems themselves. Collectively, the members of social systems must
manage sources of tension that arise within the group and those that arise in interaction with
other groups and hierarchical levels. The chapters in Part II discuss clinical sociological
practice at the individual, family, group, community, and organizational levels.
The authors of the chapters in this section-experienced practitioners-were each asked
to describe the type of problems appropriate for their type of intervention, to describe the
intervention techniques in detail with detailed examples-the how-to-do-it-and to relate
the application to sociological theory. For example, Chapter 6, on work with individuals,
draws on the theory and research tradition of the sociology of emotions and describes helping
clients reframe their internal dialogue from troublesome to less troublesome. Work with
families, detailed in Chapter 7, describes a focus on the interaction among family members and
the relationships that result from the interaction patterns that have developed. By recon-
structing the interaction itself, family work can assist individual members in their adaptation
and restructure the intrafamily relationships toward improved functioning of the family unit.
It is also recognized in Chapter 7 that families are embedded in their communities and in the
larger society-illustrating the interaction of levels-and should remind practitioners that
the problems that families face often have to do with their negotiation with the outside
world.
Group process itself can be a powerful force for change. The abundance of therapy
groups, support groups, growth groups, and even focus groups attests to the utility of group
process. Chapter 8 is on "groupwork," the use of groups to help bring about change both for
individual members and for communities and organizations.
Community organization has also long been recognized as an effective basis for positive
social change. When community members unite and take responsibility to act collectively to
improve conditions in their communities, people are empowered and can direct the course of
social change to meet their needs. Chapter 9 discusses the concept of community and the work
of community organization.

89
90 PARTll

Certainly, at least since Weber, formal organizations have been a continuing subject for
sociological investigation. As noted in Chapter 10, less attention has been paid to the inter-
actions between formal organizations. Yet, this interaction has important implications for
clinical sociology within such organizations. Chapter 10 discusses intervention in formal
organizations and calls attention not only to the internal aspect but also to the interorganiza-
tional aspects.
 CHAPTER 6

Work with Individuals

BEVERLEY CUTHBERTSON JOHNSON

INTRODUCTION

When individuals have difficult intersections with themselves, significant others, or their
social contexts, they can benefit from therapeutic assistance. There are many therapists from
many disciplines who work with individuals and their emotional problems and disorders.
These include psychiatrists, psychologists, and clinical social workers, among others. They all
have special roles. This chapter will focus on a sociological approach that has as a theoretical
base, symbolic interaction and the sociology of emotions. The intervention involves cognitive
restructuring and reframing symbolic representations and definitions of self and situations.
This chapter will describe how clinical sociologists can help provide socioemotional
understanding to individuals who experience difficult and, at times, anguished intersections
with life, or to individuals who experience what is currently defined as mental illness. Clinical
sociologists can also offer preventative counseling and education for individuals who have
family histories of emotional disorder or who have experienced events that have left them with
exquisite emotional sensitivities. In addition, the chapter will outline the process clinical
sociologists can use to assist individuals, their significant others, families, and community
members in socioemotional re-creation. The work involves transforming patterns of thinking,
feeling, and behaving as well as environmental circumstances that have dysfunctional conse-
quences.
Some fundamental ideas underlie a sociological approach. First, patterns of thinking,
feeling, and behaving are strongly influenced by prevailing sociocultural themes, values,
ideals, objects, rituals, and institutions. Second, social identities, roles, relationships, and
group memberships (family, peer groups, ethnic groups, and so on) are important factors in the
way individuals develop their specific emotional repertoires. Individuals are influenced by
their life experiences in a social context, and they make sense of and adapt to those experiences
in ways that may lead some to define their lives as meaningless or devoid of positive meanings.
They may also create meanings at odds with normatively defined and accepted meanings.
This chapter will include an example of socioemotional understanding and re-creation
by presenting a case study of a young man diagnosed with Attention DeficitlHyperactivity
Disorder.

BEVERLEY CUTHBERTSON JOHNSON • Southern Desert Medical Center, Tempe, Arizona 85282.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 200l.

91
92 BEVERLEY CUTHBERTSON JOHNSON

RELEVANT LITERATURE

Sociologists have done extensive work on understanding the individual within a social
context. Glass (1992), for example, discussed clinical sociological work with persons whose
problems stemmed from growing up in alcoholic families. He examined the formation of the
subjective view of self in the children of alcoholics, emphasizing the role of primary socializa-
tion in the internalization and formation of maladaptive behaviors and self-concepts. Glass
described how primary socialization resulted in the internalization of troublesome cognitions,
emotions, and behaviors in the adaptations of the children of alcoholics to their environments.
Symbolic Interaction formed the theoretical base for Glass. W. I. Thomas's (1931) con-
cept of the "definition of the situation" was a key component in understanding individuals'
social reality. Glass also referred to Shibutani's (1961:87) concept of adaptation as a "combi-
nation of techniques for coping with difficulties" and "well-organized ways of coping with
typical problems which become crystallized through a succession of adjustments." Those
techniques "can then become part of the personality, as established behavioral responses to
certain situations" (Shibutani, 1961:110). Intervention in these cases involved helping clients
understand how their selves were formed, assisting them in taking responsibility for change,
and facilitating the process of resocialization.
Fein (1997:41) asserted that most treatment paradigms missed the importance of the
sociological dimension. He identified four primary types of individual troubles: the physiolog-
ical, the moral, problems in living, and role problems. He emphasized problems with social
roles and addressed three major steps in working with those problems: (1) reexperiencing
painful roles, (2) relinquishing the role scripts that hold them in place, and (3) renegotiating
superior replacements. Fein (1990:168) outlined how role play enables people to act out and
rehearse their interactions and role negotiations in a situation that is non-threatening. Fein
wrote: "In general, a clinician who functions as a mediator helps his client and the client's role
partners by making them aware of their respective wants and by enhancing their understanding
of the options they have in responding to one another" (Fein, 1990:170).
Gordon (1990:150) pointed out the influence of social structure on emotions: "Most
emotions originate in cultural definitions of human relationships, not in human biological
nature." Gordon also explained that the effects of social structure on emotions are mediated
through differentiation, socialization, and management. In regard to differentiation, he pointed
out that societies and subgroups commonly distinguish among types of emotion through four
components-bodily sensations, expressive gestures and actions, a social situation or relation-
ship, and the emotional culture where for each emotion there are associated vocabularies,
norms, and beliefs (1990:150-152). In regard to socialization, he stated that the goals and
processes through which a child developed into a functioning member of society involved the
child acquiring the cognitive and behavioral skills to act within the emotional culture, for
example, becoming aware that an emotional display can serve as an interactional technique
and resource (1990:158-160). In addition, Gordon delved deeply into emotion management
and provided an in-depth account of how individuals work to create, intensify, suppress, and
transform emotions in relationship to sociocultural norms for appropriate emotional displays
in specific situations or relationships (1990:163).
See and Straus (1985) brought insight into understanding the important role that the
social plays in the individual's essence. "Our very sense of who and what we really are, the
ways in which we think, even the thoughts we think and the things we feel it is 'only natural'
for us to do-all these things have their origins and their foundations in social life" (1985:62).
They quote other "working with individuals in society" pioneers, such as Mead and Cooley,
who argued that "mind, self, and society are different aspects of one and the same stream of
WORK WITH INDIVIDUALS 93

meaning-filled human behavior." See and Straus (1985:66) and W. I. Thomas (1931) stated that
"preliminary to any self-determined act of behavior there is always a stage of examination and
deliberation which we may call the definition of the situation. And actually not only concrete
acts are dependent on the definition of the situation, but gradually a whole life-policy and the
personality of the individual himself follow from a series of such definitions."
More pioneering ideas in patterns of sociological intervention with individuals are
brought out by Roger A. Straus (1984:51-63). He states that sociologically "the intervention
itself will, in one way or another, involve a strategy of redefining the situation. At the personal
level, for example, sociological counseling might involve reconstruction of the client's as-
sumptive realities and/or social-behavioral tactics specifically designed to change his or her
conduct in everyday life" (p. 54).

SOCIOEMOTIONAL UNDERSTANDING

This section will describe a clinical sociological approach to work with individuals. As
Lewis Wirth (1931) has noted, clinical sociology is not synonymous with social pathology.
Instead, its aim is to identify and understand patterns of behavior within social contexts. The
goal is not to define specific patterns as inherently disordered or pathological but to examine
the nature, origin, and consequences of particular patterns and processes. The goal is to
understand and be emotionally honest about patterns and processes that have disruptive or
destructive personal and social consequences.

Assessment

In socioemotional assessment, clinical sociologists consider emotion as complex yet

critical to understanding how individuals establish, alter, transform, or destroy meaning. Through
in-depth interviews, participant observation, social histories, and requesting the completion of
a Socioemotional Journal (see the Appendix) by individual clients, the clinical sociologist
facilitates exploration and reflection. The socioemotional assessment gathers information on:
• Patterns of thinking, feeling, and behaving that contribute to satisfying and unsatisfy-
ing personal meanings
• Patterns ofthinking, feeling, and acting that contribute to constructive and destructive
social meanings
• The social and cultural contexts in which the patterns develop, are maintained, and
have consequences
By recording in their socioemotional journals in an emotionally honest fashion, individ-
uals can discover their specific emotional repertoires and the strategies they use to manage or
not manage their emotions. They can identify which emotions they routinely experience. They
can also come to understand how social themes, values, institutions, objects, and rituals play
a role in the emergence and management or nonmanagement of their emotional patterns and
processes.
Major areas of understanding for individuals to explore are (1) understanding the socio-
emotional self, (2) understanding through language and its relationship to emotion, behavior,
and sociocultural contexts, and (3) understanding through emotion and its relationship to
language, behavior, and sociocultural contexts. Emotional honesty and understanding is the
first major step. Only then can individuals reflect on and choose to enact different patterns.
94 BEVERLEY CUTHBERTSON JOHNSON

Understanding the Socioemotional Self

A trustful, supportive clinical sociological approach assists individuals in reflecting on

the socioemotional selves they have created. They are especially encouraged to take into
account social factors and contexts that have influenced those selves. They can then under-
stand how, as See and Straus (1985:62) have noted, the "life of the individual is intimately
connected to the life of society."
The following questions are often used in my sociotherapy sessions to encourage and
help individuals reflect on their social being:
• What does your identity and individuality consist of, and how was it obtained?
• What definitions of the situation do you usually make?
• What are the socioemotional consequences of those definitions? For you? For others?
• Were you socialized in regard to any of those patterns?
• What roles did you take? Make?
• How do you judge your personal worth? Do you have a private social identity? Public
identity? Both?
• How do you obtain validation or support for a specific social identity when others
refuse to accept your statements about yourself?
• Do you try to maintain your identity? Change it? Regain a lost identity? How important
are the responses of others to your identity?
• How do you create and maintain personal relationships? Do you choose not to create or
maintain them? Do your relationships often become disrupted? How?
• How do you explain your behaviors to others? To yourself?
• What responses do others usually make toward you? Do you attempt to get other people
to make responses toward you that you desire?
• When are your acts defined as appropriate? Inappropriate? Helpful? Destructive? By
whom? By what standards?

Understanding through Language and Its Relationship to Emotion, Behavior, and

Sociocultural Contexts

Langage plays a major role in individuals' establishment of meaning. The specific

linguistic generalizations of individuals become linked to particular neurophysiological pro-
cesses that, established in long-term memory, enable the individual to react to particular
circumstances and experiences. These patterns can develop over time or in relation to a
specific, deeply moving incident. For example, anxiety can become a reactive pattern in an
individual who has come to the generalization that the relationship between self and a
particular situation poses a "possible threat, vulnerability, and lack of control." With that
definition of the situation, the individual may respond with neurophysiological processes that
are linked to sweating, tension, and increased pulse rate.
To understand the role of language in the establishment of individual meaning, it is
important to identify what terms, concepts, and symbols are used and how they are employed
in referring to particular individuals, objects, relationships, beliefs, or circumstances. It is also
pertinent to assess the types of statements used and their consequences.
• Are clients' statements filled with conclusions like "I am perfect" or with either/or
formats like "I am perfect or worthless?" What consequences do such statements have
for themselves and others?
WORK WITH INDIVIDUALS 9S

• Are clients' statements always specific and concrete, focused on minute details?
• Do clients' statements reflect creative, imaginative styles of thinking, filled with ideas
or propositions outside the boundaries of established beliefs and values?
• Are clients' statements normatively rigid in their form and content?
It is important to explore how statements relate to one another. Some statements may
intersect in a conflicting or neutralizing manner, canceling out particular meanings. For
example, an individual may state, at the completion of an assignment in school, "It's not that
great." Other statements may support a dominant theme, such as "I'm right." The authenticity
of statements can also be noted. Pretenses or ritual performances can have troubling implica-
tions, for instance, always stating after anguishing experiences, "No problem."
It is pertinent to discern who individuals focus on and in what manner. For instance, do
they concentrate on themselves or on specific or generalized others? An example is an
individual who may constantly focus on what someone else has not done, could have done, or
did not do rather than on what he or she wants to do.
Part of socioemotional understanding is identifying the general statements individuals
make about themselves, others, and their environments. Do they define their circumstances as
intolerable, their roles in life as despicable, or their relationships with others as unfulfilling?
The answers to these questions will assist clinical sociologists in determining the typical
content, patterns, and processes through which individuals reach important conclusions about
themselves, others, and their environments. Only then can they assist the individuals in clearly
identifying the standpoints from which their adaptive strategies are attempted or abandoned.
Incorporated in the meaning individuals establish are important neurophysiological,
psychological, natural, and social contexts. Neurophysiological contexts include bodily pro-
cesses, forms, states, or changes that are taken into account when individuals make sense of
themselves and their environment. Psychological processes, mediated through bodily pro-
cesses, include auditory, tactile, olfactory, and visual sensory perceptions as well as ongoing
mental processes and established patterns of meaning retained in long-term memory. Natural
environments include factors such as weather conditions, pollution, disasters, and particular
physical surroundings. Social environments include other people, relationships, and cultural
beliefs, norms, values, and attitudes as mediated through individuals and groups of people or
established institutions, rituals, structures, and objects. They also include the arenas in which
meanings are expressed, shared, interpreted, evaluated, and validated or rejected.
Neurophysiological, psychological, natural, and social contexts intersect with linguistic
processes in the establishment and transformation of meaning. Accordingly, it is imperative
that the clinical sociologist identify the words, phrases, concepts, and intersecting statements
through which individuals relate to and define their experiences. It is only through such
comprehension that important meanings, including those labeled divergent meanings, can be
understood.

Understanding through Emotion and Its Relationship to Language, Behavior, and

Sociocultural Contexts

It is important that the clinical sociologist develop a compassionate understanding of

each individual's particular emotional repertoire or recurring generalizations and linked
feelings. A prevalent emotion, for example, is fear, which is linked to individuals' conclusions
that they are vulnerable to threat. Anxiety, another significant emotion, emerges when individ-
uals conclude "possible threat, vulnerability, and lack of control." Other common emotions
96 BEVERLEY CUTHBERTSON JOHNSON

are aggravation, irritation, and annoyance that emerge from conclusions that certain behaviors
or circumstances are offensive, irresponsible, or unjust. These feelings often intensify to anger,
even rage, as the perceived severity of a perceived offense or injustice increases.
Widely experienced states of depression and stress are higher-order metageneralizations.
Usually, conclusions related to depression and stress are based on the intensity and extent of a
number of intersecting emotional experiences, the extent of troubling circumstances, or the
futility of adaptive efforts. In depression many aspects of a situation and the overall life course
are finally defined as overwhelmingly hopeless and unresolvable. Stress is related to feelings
of incredible pressure with little perceived opportunity for relief.
In identifying emotional repertoires, it is important that clinical sociologists note not only
the particular generalization and its linked "feeling" but the intensity and persistence of the
experienced feeling. For example, is the individual constantly irritable? Is the individual
always anxious? Is he or she continually extremely angry?
Exquisite emotional sensitivities (Cuthbertson Johnson & Johnson, 1992) or propensities
to be intensely reactive to particular events, individuals, or circumstances are highly signifi-
cant and must be identified. They represent tendencies to automatically respond from a
particular emotional standpoint, such as rage or panic. They also indicate emotional memo-
ries entrenched through long periods of use or implanted through a particularly traumatic
experience.
To understand the individual as fully as possible, his or her range of emotions must be
identified. Does the individual experience one basic outlook on life, such as continual anxiety?
Or does he or she experience a multitude of feelings, focused on a never-ending series of
generalizations? Divergent emotional experiences such as continual lust for sensual pleasure
should be considered as well as conflicting emotions, ambivalence, and the absence ofparticu-
lar emotions or emotions in general.
Clinical sociologists can also explore the ways individuals experience and define emo-
tions. Some individuals, for example, may feel that a continual, positive "high" feeling is a
normal necessity for accomplishing the goals that they have set for themselves. Only in
understanding the conclusion they have made can they have the opportunity to reflect on and
alter patterns that encourage that "high" through constant activity or the use of an outside
substance like cocaine.
Clinical sociologists can study how individuals take into account and make sense of-
objectify-their own emotions and the emotions of others. Interpreting and evaluating their
own emotions and related behaviors and the emotions and behaviors of others in an unreflec-
tive, repetitive fashion may lead individuals through an emotional career to further repetitive
definitions, generalizations, and linked feelings. An individual, repeatedly anxious regarding
her worthwhileness and lovability, for instance, may interpret others' nonresponse to her
requests for attention and time as a basis for continued feelings of total worthlessness and
related depression.
Furthermore, clinical sociologists can examine patterns of emotion management, a
process called self-upon-selfand self-upon-other emotion work by Hochschild (1979). Explor-
ing emotion-management strategies can provide important insights into the special social
identities that individuals may wish to establish, discard, or prevent. They may also reveal
destructive patterns of emotion management through the use of drugs or alcohol or other
patterns of emotion management behavior designed to distance, neutralize, or replace threat-
ening, unacceptable, or undesirable emotional experiences. In addition, they can uncover
harmful and manipulative strategies for creating desired emotional meanings as well as
damaging procedures of controlling emotional expression or other emotion-linked behaviors.
WORK WITH INDIVIDUALS 97

Identification of a person's typical emotional standpoints is useful and valuable. Emo-

tional standpoints are the usual generalizations and linked-feeling bases from which an
individual adopts particular behaviors. The clinical sociologist may uncover especially diver-
gent behavioral responses. For example, a person may use extreme withdrawal or rageful
attacks in relation to specific generalizations and the feelings linked to those generalizations.
Finally, the clinical sociologist can examine the personal and interactional emotional
careers through which particular emotions emerge, intersect, and are maintained, altered, or
diminished. From this process, particularly explosive emotional intersections, emotional
stalemates, or emotional terminations can be uncovered. For example, one person may
automatically eliminate anxiety through anger. Another individual may look at desire for
affection as threatening and become locked in feelings of fear when desire emerges. Other
individuals may have experienced such traumatizing, painful experiences with women in life
that they terminate any positive outlook on female relationships and develop ongoing feelings
of misogyny.
Each emotion represents a personally relevant, general conclusion about the relationship
between the individual and the environment. Retained in long-term memory, an emotion
prompts an immediate response-psychological, neurophysiological, behavioral-to indica-
tion of a specific, critically important personal or social meaning. Examining particular
emotions and how they are formed, interpreted, evaluated, and managed in relationship to
specific contexts can provide significant insight into the development, maintenance, and
consequences of mild to severe socioemotional disorders.

SOCIOEMOTIONAL DISORDERS

Individual problems are conceptualized as socioemotional disorders. The term is used to

reflect the view, first, that problem behaviors stem from feelings, cognitions, and symbolic
representations held by an individual. Second, these feelings, emotions, cognitions, and
symbolic representations arise from social interaction and also have social consequences for
the individual. The pathways to socioemotional disorders are diverse. Disorders may emerge
from ritual patterns of self-talk that develop over time and can prevent the formation of
positive emotional meanings, create negative emotional meanings, or result in a state of apathy
or indifference. Development of positive emotional meaning may be blocked because the
individual never refers to self in a positive manner or uses neutralizing or disqualifying
statements to devalue positive states. For example, the person, on completing a difficult task
that required a lot of extra effort, says, "It really wasn't that good," or "[someone else's] work
is better than mine." This speaker is devaluing and may also be training others to withhold
further praise. (This speaker may also be hoping for external validation by having the listener
disagree and praise the speaker's work).
Constant, negative social comparison, such as "He's better than I am" or "I can never
write like that," may prevent positive emotions from occurring and generate negative self-
images, depicting an inadequate or deprived self. The generalizations "never" or "always"
time after time add to an overall negative stance. Statements referring to what an individual is
not-"I'm not beautiful" or "I'm not desirable"-also have negative consequences as will
statements always referring to situations as negative- "Isn't it awful?" -or possibly
threatening-"What if he gets angry?"
Habitual statements like "I don't care" or "It doesn't matter" neutralize the significance
of events or circumstances, making them appear emotionally meaningless and behaviorally
98 BEVERLEY CUTHBERTSON JOHNSON

irrelevant and even experienced as meaningless or irrelevant. Never using either positive or
negative evaluations may also generate continual neutrality. Statements that constantly neu-
tralize may have other influential implications. Feeling emotionally neutral, an individual may
neglect the personally and socially harmful nature of certain behaviors.
Overgeneralization is a pathway to patterns of problem behavior. Overgeneralizations
often can result in bizarre, obsessional, paranoid, or delusional behavior, by continual refer-
ence to experiences as threatening or unjust and therefore experiencing fear and anger, an
individual may come to adopt a general standpoint that the world is threatening and unjust.
From this standpoint he or she may emotionally overreact to each perception of injustice or
threat. He or she may also engage in obsessive behaviors to control perceived threats or
injustices. Having developed continual patterns of overgeneralizations, the individual can
become entrapped by the emotions and behaviors (or lack of emotions and behaviors). His or
her specific ways of making sense of life and his or her relationship to life can therefore lead to
taken-for-granted conclusions that, if not reflected on, can have negative consequences on
themselves and others.
Overgeneralization in the form of a particular self-definition, such as the grandiose self,
may occur in relation to continuing self-statements that the individual is powerful or perfect.
The statements themselves may have emerged from a number of different circumstances. For
example, significant others may have constantly referred to the individual as ideal. Alter-
natively, the individual may diminish feelings of loneliness or isolation by continually defin-
ing him- or herself as "one with God." Furthermore, continual public use of these statements
may have paradoxical social consequences for the individual, like loneliness or degradation.
Undergeneralization may also create harmful consequences. Never abstracting, concen-
trating only on specific objects, individuals, or occurrences can facilitate an individual
responding impulsively or in a meaningless, chaotic manner. An individual may have diffi-
culty, for instance, because of a fear of abandonment by a beloved spouse, taking into account
and responding in a consistent, limit-setting fashion, to actual abusive experiences. Instead,
she may set aside the conclusion that abuse is constantly occurring and having harmful
consequences for herself and others.
Delusions of grandeur may also emerge as a means of resolving seemingly irresolvable
problems. For example, an individual living with his parents at the age of 30 has a situation that
is secure and comfortable but personally and socially viewed as dependent and weak. Threat-
ened by both personal and social definitions yet experiencing intense feelings of anxiety over
achieving independence, the individual may adopt and act on unrealistic beliefs like "I am
God" or "I am all powerful." The personal and social consequences of such a grandiose
delusion can be disastrous.
The long-term use of particular ways of defining situations may result in emotional
expressions like uncontrollable rage. For example, a son who was particularly sensitive to
criticism lived with a father who was highly evaluative, critical, and condescending. Continu-
ally defining the father's remarks as unjustly critical led to the son's experiencing persistent
anger. It also led to the son's adopting a standpoint that the father was totally and unjustly
critical. This standpoint of injustices and anger directed at the father provoked, in a continuing
spiral, additional critical comments from the father. Eventually, the son came to refer to his
father as "evil." Finally, as angry interactions continued, he came to see his father as the
"devil" and attacked him in a vengeful, psychotic rage.
Often among individuals with chronic emotional anguish, reality in its entirety is defined
as threatening, unsatisfying, unfulfilling, intolerable, or uncontrollable. Feelings, such as rage,
attached to these metageneralizations may be overpowering for both the individual and
WORK WITH INDIVIDUALS 99

society. It is therefore crucial to uncover how individuals come to those metageneralizations

as well as develop positive ways to deal with them. One individual, living in a personal and
social environment in which his definitions of the situation were never validated no matter
how much effort he made, came to the conclusion that he was "not enough" and doubled his
efforts toward perfectionism and achievement. Ironically, his perfectionist strategies rein-
forced his initial definitions of not being enough. He finally concluded that no matter what he
said or did, his efforts would be futile. Continuing the same standpoint with similar conse-
quences, he withdrew into despondency and despair. Eventually, defining the world as
uncaring and disregarding and himself as totally useless, he committed suicide.
Another individual was in a similar, stressful situation in which her viewpoints were,
over a considerable period of time, never accepted or validated. In fact, she was constantly
criticized. Eventually, she lost confidence in her ability to make any definitions at all. She
withdrew from thinking and social reality, becoming mute and catatonic.
Other individuals replace what they perceive as negative realities with personal idio-
syncratic versions of reality that are comforting, secure, or even empowering. One individual,
a daydreamer and meditator all her life, referred to happiness as an illusion and defined reality
as burdensome and unfulfilling. She also based many of her feelings not on what others did but
on the thoughts she attributed to them. In times of extreme personal stress, when her personal
and social reality seemed meaningless or negative, she withdrew into a fantasized, manic
reality. From that standpoint she engaged in many self-perceived, joyful, although irrespon-
sible, experiences.
Exquisite emotional sensitivities and linked behaviors may be the focal point of other
divergent behaviors. One individual, extremely sensitive to social evaluation, felt intensely
uncomfortable when looked at directly. To relieve his discomfort, he had, over time, developed
the habit of obsessively focusing on an object other than the individual who was observing
him. Excessive concern with a particular identity, such as not wanting to appear like a parent
who was continually depressed, prompted another individual to laugh when sad, making it
difficult for others to know her authentic feelings and act concerned toward her. Ironically, her
behavior created the very things she feared most-depression and disregard. Phobias may also
develop in the context of exquisite emotional sensitivities and the behaviors developed to
deal with them. Having experienced a number of severe and embarrassing anxiety attacks in
public and feeling anxious over possible future attacks, an individual may develop specific
strategies to avoid anxiety-provoking situations. Agoraphobia or the fear of being in open or
public spaces is one such strategy.
Since emotional meanings arise and are maintained in the course of social interaction,
social contexts can play an important role in the development of disorders, from mild to
severe. Social themes may be reflected in particular self-denigrating statements and related
feelings. For example, current social values based on career achievement or excellence in
school performance can generate an abundance of self-statements relating to mediocrity and
linked feelings of shame, self-disgust, or embarrassment. If continued over time and in
contexts with an ever-increasing focus on achievement, these self-feelings may evolve into
depression. Socially valued standpoints on physical form or emphases on career advancement,
time management, and assertiveness provide other examples. Respectively, they become a
factor in the development of anorexia and obsessive-compulsive disorder. Becoming obses-
sive about constantly working out and following an extremely meager diet may become a
strategic adaptation to feelings of deep fear regarding not being the "right," sociallyaccept-
able physical form and weight.
Interpersonal contexts can become arenas of stalemated as well as explosive emotional
100 BEVERLEY CUTHBERTSON JOHNSON

interactions. For example, a wife can become so fearful of her husband's angry reaction to
something she says or does that she becomes trapped into being continually careful about
every word she utters or behavior she enacts. She becomes locked in a personal adaptation
strategy that does not facilitate the means for both herself and her partner to make positive
changes in their troubling intersection. Individuals also can become locked into emotional
spirals, such as the shame-rage spiral discussed by Thomas J. Scheff (1987). He pointed out
that feeling traps can occur when one has emotional reactions to one's own emotional
reactions, instituting a closed feedback loop. Couples can also become locked in feeling traps.
For example, one partner may come to see the home setting as a safe arena for expression of
anger generated in work contexts. His or her partner may then continually lash out in response
to the outbursts.
Emotional spirals and their relationship to social contexts can become very complex.
Family contexts, for example, may change after a family member has experienced what is
socially labeled as "mental illness." New patterns of behavior may emerge as parents
experience the fear of a son's relapse. They become careful not to irritate or upset their son in
order to prevent a recurrence, and they may begin to view him as untrustworthy or irrespon-
sible. Controversy may also develop over the meaning of the son's emotions: Are they signs of
an upcoming episode or normal expressions of feeling? Parents and the son may experience
mixed feelings over particular medications the son has been prescribed. They may have hope
that the medications will prevent future episodes; at the same time, they may be fearful of
possible side effects. The son may also perceive himself differently. He may no longer trust
himself or his ability to control his feelings, and he may be fearful of returning to work because
of a possible embarrassing episode. Situations like these often terminate in emotional stale-
mates with distressful consequences for the individuals involved.
Finally, it is important to investigate the standpoints of professionals who assess and treat
what is labeled as "mental illness." How they make sense of an individual's behavior and
define its cause has critical implications for the individual, significant others, and society. The
predominant medical model and its focus on psychopathology and brain disease has an
important relationship to the self-definitions and behaviors of individuals with serious emo-
tional problems. It also affects the viewpoints of the disorder adopted by family members,
significant others, and society. An individual adopting the belief that he or she has a disease
and is therefore not responsible for any aspect of its emergence or control besides complying
with medication, may eventually lapse into alienated and stigmatized states, identifying him-
or herself as the victim of an illness. As Scheff has noted, "Residual deviance may be
stabilized if it is defined to be evidence of mental illness, and/or the deviant is placed in a
deviant status, and begins to play the role of the mentally ill" (1968:13). This is not to imply
that there are not important neurophysiological aspects over which individuals have little
control. It is only to suggest that the emphasis on illness in the current medical model has gone
too far in one direction, with serious implications.

SOCIOEMOTIONAL RE-CREATION

Following the assessment working toward socioemotional understanding the therapeutic

challenge for the clinical sociologist is to facilitate and support the client in choosing socio-
emotional re-creation, that is, assisting the client to initiate new patterns of thinking, feeling,
and behaving that respect his or her personal values, desires, and integrity as well as those of
others. Since the pathways to emotional problems and disorders are diverse, and, for each indi-
WORK WITH INDIVIDUALS 101

vidual, unique, the clinical sociologist must first enter the world of the individual and achieve
deep socioemotional understanding. This process does not occur without the establishment of
trust between the individual and the clinical sociologist as well as empathetic understanding by
the clinical sociologist of the individual's emotional standpoints and situations.
A major challenge for the clinical sociologist is to facilitate emotional honesty on the
part of the individual with regard to his or her taken-for-granted patterns of thinking, feeling,
and behaving; the contexts through which particular patterns have emerged or are maintained;
and the consequences of those patterns. An equally important challenge is to assist the in-
dividual in choosing to create and enact new, positive intersections with life. This is the point
where socioemotional artistry occurs.
It is important to note that the first encounter with an individual may be when he or she
is in crisis, a situation that at times may best be handled by emergency medical staff. Response
to a crisis situation is primarily based on the individual's current state and doing what is
important to prevent negative consequences for the individual, significant others, and the
community.
Crisis can provide an opportunity, moreover, to ascertain circumstances, events, or
relationships that have been defined by the individual as particularly threatening or intolerable.
They also enable the clinical sociologist to assess how an individual behaves in a crisis
situation. It is very important to ascertain whether crisis states are related to drugs or alcohol,
physical damage, or neurophysiological disorders. It is therefore always important to have
medical personnel assess the neurophysiological factors and assist in eliminating or control-
ling them through medication when necessary.
On the other hand, it is equally important to note that neurophysiological states are
intricately related to the individual's typical definitions of the situation and his or her intersec-
tions with the sociocultural environment. Each individual's routine neurophysiological states
have been mainly brought about by the taken-for-granted ways the individual has developed
in making sense of and relating to specific sociocultural contexts. Accordingly, it is highly
important that medical personnel realize that focusing only on medication for individuals
experiencing mental health crises prevents individuals from developing deeper understanding
of their entrenched emotional patterns as well as developing ways other than outside sub-
stances to alter those patterns.
Clinical sociologists can make important contributions to individual treatment through
positive use of an interdisciplinary community including physicians and psychiatrists who
have expertise in the neurophysiological aspects of disorders. They can also focus on their own
special abilities to understand the subjective and objective world of the individual and how
particular patterns of thinking, feeling, and behaving were created and habituated in specific
sociocultural contexts. Their expertise in the sociology ofemotions (see Cuthbertson Johnson,
et ai., 1994; Valentine & Derne, 1994) is especially important for they have a deep understand-
ing of emotion work (Hochschild, 1979); emotional generalization (Cuthbertson Johnson &
Johnson, 1994); exquisite emotional sensitivity (Cuthbertson Johnson & Johnson, 1992);
feeling rules (Hochschild, 1979); emotional resocialization (Fein, 1990, 1998); and socioemo-
tional understanding and re-creation (Cuthbertson Johnson, 1996). They can utilize those
understandings in working with art and dance therapists, for instance, and assist individuals in
unlocking dysfunctional patterns and creating new, self- and other-respectful patterns.
Clinical sociologists can also add important neurophysiological information to their
socioemotional understanding and re-creation practices. For example, neurosystems consult-
ing and brain mapping by a clinical sociologist colleague, Dr. Richard Soutar, is often used in
my practice as an important adjunct. Clients can view their body tension, temperatures, arousal
102 BEVERLEY CUTHBERTSON JOHNSON

levels, and brain wave patterns on a special computer screen. This enables them to "look
inside" and clearly see their particular autonomic responses as they respond to particular
statements and behaviors. As they work with changing special emotional habits, they can see,
on the computer screen, the positive changes within their inner being. This is an excellent
biofeedback strategy.
Furthermore, clinical sociologists can assist individuals and their significant others in the
identification of sociocultural values that influence personal beliefs, feelings, and behaviors
especially in relation to specific social identities and roles. An important example of this is
clinical sociologists' knowledge of cultural diversity. Also, with knowledge of interpersonal
and group processes, they often direct not only individual, but also couple, family, or group
sessions. Sociological understanding of resocialization and role change, as discussed by Fein
(1990, 1998), facilitates the development of positive role change.
Clinical sociologists can assist individuals in "navigating the system" through the
application of their knowledge of social themes, beliefs, values, norms, objects, rituals, and
institutions. They can also consult and work with other professionals, such as occupational
therapists, on possible job opportunities for particular individuals. In addition, they can assist
social workers in choosing or developing important community facilities.

EXAMPLE OF SOCIOEMOTIONAL
UNDERSTANDING AND RE-CREATION
Attention Deficit Hyperactivity Disorder is a current commonly diagnosed disorder in
children. Core "symptoms" are (1) distractibility (easily distracted); (2) inattentiveness to task
or short attention span; (3) impulsiveness, seeming to act without thinking and does not seem
to learn from or reflect on past experiences; (4) constant or intermittent restlessness, for
example, foot tapping, wiggling, or inability to sit still. Biological aspects include lower levels
of the neurotransmitter dopamine and significantly lower metabolic activity in regions of the
brain that control attention, social judgment, and movement.
A major prevalent medical solution has been the use of medications such as Ritalin
(methylphenidate), dextroamphetamine, and imipramine. Medications can assist in the alter-
ation of particular neurophysiological states related to emotions. Clinical sociological inter-
vention can add deeper understanding and positive alteration.
To facilitate socioemotional understanding of Attention Deficit Hyperactivity Disorder,
the following areas were explored.
• What were some of the typical conclusions young individuals labeled with Attention
Deficit Hyperactivity Disorder came to regarding themselves, others, their lives? What
primary feelings were linked to those conclusions?
• How did the individuals manage their feelings and with what consequences for them-
selves and others?
• What sociocultural themes, values, and identities were related to those conclusions?

Typical Conclusions and Feelings Linked to the Conclusions

It emerged that anxiety was a major emotion especially in regard to being evaluated with
the possibility of personal inadequacy, rejection, abandonment, or negative judgments by
teachers, peers, or family members. The generalizations identified as anxiety were possible
WORK WITH INDIVIDUALS 103

threat, vulnerability, and lack of control. Also identified were language patterns routinely
linked to the conclusions/generalizations of possible threat, vulnerability, and lack of control.
Language patterns identified showed that the young individuals' statements often led to
their anxiety conclusions. For example, they were found to overgeneralize through statements
such as ''I'm perfect" or ''I'm worthless." Statements like this led to their continually feeling
threatened by possible inadequacy.
Overgeneralized language patterns were also found to relate to routine emotion manage-
ment patterns. For example, statements like "I could never do that" kept the individual feeling
safe and from trying certain assignments or activities that related to his or her fear of failure.
Individuals also often undergeneralized by focusing on a specific object. Therefore, they
did not have to concentrate on a possible threatening sociocultural setting or evaluation. This
was a diversion emotion management technique and refocused attention on something the
individual felt he or she could control.
Individuals were often found to maintain ambiguity. They did not make specific, direct
statements. Instead, when queried, they routinely responded with statements like "I guess,
sometimes." A specific answer might be a threat. They therefore maintained ambiguity,
preventing a possibly threatening conclusion or definite commitment.
Individuals also devalued, making aspects of their surroundings of no value or conse-
quences. Examples are: "I don't care." "I'm bored." "I don't want to be bothered by friends."
"School is not primary."
Related to devaluation was trivializing. This happened in many creative ways; for
example, they labeled a finished project a "glump of meat" or a good grade as unimportant or
undesirable. This eased their anxiety over the importance in the societal framework of grades
and rewards but prevented their appreciating and enjoying the process of learning.

Management Strategies

To reduce anxiety, they also made certain important things bad; for example, one
individual who had finished a special art project on which she had diligently worked, devalued
it, saying, "It's crude, dude stuff. I hate it." Specific behaviors were found linked to patterns of
making definitions of situations. For example, some students often blackened out finished
projects with ink or ripped them up in front of the teachers. This gave them a feeling of control
over preventing possible negative evaluations.
At times, individuals desired achievement yet feared possible inadequacy. They used
language patterns such as "I hate writing" or "Even if I try my best I can't draw that good."
They often flung objects like pencils across the room as they made such statements. This was a
metaphoric strategy they had developed for programming in themselves that their desire for
achievement was worthless. It was their way of resolving inner emotional conflicts, like their
desire for achievement battling their fear of possible inadequacy.
Other emotion management practices identified were distraction techniques. They self-
distracted by purposefully not thinking of school. "I don't want to think of school garbage.
I think ofthings at home." They also learned not to hear orforget requests. "I did not hear." "I
forgot."
An additional emotion management strategy identified was selfor a self-objectfocus. For
example, they would continually play with their hair or zippers. This behavioral habit
distanced them from anxious feelings that emerged when they concentrated on a setting or task
that they felt they might not be able to do adequately.
104 BEVERLEY CUTHBERTSON JOHNSON

Also, they other1ocused. They zapped others with a pen or concentrated on others'
negative behaviors or weaknesses by being critical, intrusive, or judgmental. In this way, they
were able to focus on others' deficiencies and remove themselves from concentrating on
themselves and their responsibilities. As a result, they often distanced positive peer relation-
ships.
Another strategy identified was other-distraction. They distracted others with statements
like "I want to tell you some bad stuff." This gave them interaction with peers in a self-
controlling fashion. At the same time, it diverted their attention from the regular school setting,
which they had come to define as one they might not be able to adjust to in a positive, self-
validating fashion.
Many individuals also perfonned. They would focus on performance to such an extent
that they did not remember their own previous responses or hear others' requests. For example,
one 8-year-old focused on performing the "Clever Young Man" identity and concentrated on
little else. Another boy, aged 11, had an intense fear of not being noticed or included. He acted
out the "Perfect Problem" identity. His aberrant behaviors were focused on but prevented his
having a respected, comfortable inclusion in the school setting. It also distracted other students
from their teacher and school assignments.
Some individuals withdrew or rebelled. "No, I'm not playing any more." "I don't want
it." This kept them safe but separated them from social reality.
A final strategy identified was masking, for example, continually saying "Things are just
great, perfect" or ''I'm not scared of anything, not one little bit." This assisted them in
managing their fear or anxiety, but it separated them from "real life." Patterns like these, when
used repeatedly, can eventually evolve into what is labeled delusional experiences.

Sociocultural Themes, Values, and Identities Related to Conclusions

Social contexts were found to play an important part in individuals developing particular
patterns of thinking, feeling, and behaving, especially emotion management strategies. For
example, some of the individuals' family settings were found to include family members who
were critically evaluative or reactively angry in response to the individual and his or her
thoughts, feelings, or behaviors. The individuals therefore had developed some of the adaptive
strategies noted to protect themselves from not being what they "should be." It was also
discovered that at times, when in home settings, they often responded to others' hurtful
remarks with laughter or with understanding accommodation. Many times they also negated
others' emotional expressions. "They aren't really angry at me." Enacting patterns like these
in a continual fashion can create what is termed illusions.
In several cases, home environments were made up of parents who believed and stated
that their son or daughter was "perfect" from birth. These children developed feelings of
inadequacy or possible threat if they were not "perfect."
Also, social themes were found to playa predominant role in the patterns of thinking,
feeling, and behaving in the young individuals. For instance, their adaptive strategies were
often closely related to social emphases on achievement, tests, grades, evaluation, labels (good
student; bad student), comparisons, specific attention to tasks at hand, completion of tasks, and
specific "time" frameworks.
After socioemotional understanding, a major challenge for clinical sociologists is facili-
tating the young individuals to create positive alternatives to their entrenched patterns and
processes. A specific example of socioemotional understanding and re-creation follows.
WORK WITH INDIVIDUALS 105

Individual Case Study

Socioemotional Understanding

Jay was a 7-year-old member of a special center for education group. This group was
established for young people who had not been able to adapt positively to regular elementary
school settings. He had been socioemotionally understood in a manner that a number of
specific patterns of thinking, feeling, and behaving were identified. He had been found to enjoy
group interactions and often responded with interest to other members of his education group
and group projects. He was a bright, sociable individual who made several positive contribu-
tions to group sessions. However, at the same time, he demonstrated specific patterns of
interpretation and behavior that had troubling consequences for him and for group members.
Jay continually interjected, through verbal statements, different ways of organizing or
carrying out the activities prescribed by leaders or implemented by his peers. This behavior
had the consequences of distracting himself as well as others from the established context and
activities in progress.
Jay often used exaggerated, fabricated, and especially unusual or outrageous accounts in
group discussions. This behavior demonstrated his astute sense of humor and verbal clever-
ness, but it took attention away from the flow of conversation and task at hand.
When given an assignment for which he felt any measure of possible inadequacy
(primarily writing or drawing assignments), Jay would scribble the words or figures and then
blot them out with a black marker.
In his written or drawn work, including blotted-out projects, Jay would focus briefly on
messing up by saying "I messed up." He would then engage in strategies to negate the
possible or actual response of others to his "messing up" as well as any personal anxiety he
was experiencing. For instance, when his peers made statements about his blotting out his
part of the project or, at times, about his not desiring to participate, he would turn to group
leaders and say, "They aren't really angry at me." He would also turn to his peers and say, "I
don't care if you guys laugh at me." Continual use of these statements effectively negated the
response or the importance of the response of others.
Over time, Jay attempted to control his performance to demonstrate his ability, bright-
ness, and cleverness. By focusing on displaying his identity as a bright, clever young boy, he
often lost focus on specific directions, even his own previous answers to a leader's or peer's
questions. As a result of this pattern of behavior, he often seemed to lack short-term memory
for instructions as well as for his own specific statements or behaviors. He placed primary em-
phasis on presenting, maintaining, or legitimating his essence as an especially intelligent boy.
At times, Jay would engage in behavior that would direct attention (his own and others)
away from personal anxiety in initiating or carrying out a written project. He would do this by
concentrating on his dislike for the threatening task-"I hate writing." The defined unimpor-
tance of the task or the futility of even initiating an attempt at the task would follow: "If I try
my best, I can't draw that good." When Jay would begin a writing or drawing project, he
would also attempt to get it over with as quickly as possible as well as continually check out
his performance with group leaders- "I am being really good, aren't I?"

Socioemotional Re-creation

Specific moves were made for Jay to alter some of his patterns. He was involved in
activities, for example, the school band, that demonstrated the importance of his being a part of
106 BEVERLEY CUTHBERTSON JOHNSON

established settings or procedures. Such situations are a primary part of everyday life, and it
was crucial that Jay learn how to comfortably relate to some things "the way they were."
At the same time Jay was encouraged, in a balanced fashion, to retain his creative ability
in the area of rearranging or altering set aspects of situations. There may be times when
alteration or change is desirable and important. The parents, band leader, as well as Jay were
focused on encouraging and enacting appropriate ways to make suggestions regarding positive
changes in the band setting.
Jay's verbal ability was a wonderful asset, and he could be guided eventually toward a
profession that utilized verbalizations, such as a public relations coordinator, sales manager, or
entertainer. It was suggested, therefore, that he be rewarded for his verbal cleverness when it
was used appropriately and was not damaging to social contexts. He was also encouraged to
experiment with and develop skills in those areas that were not his primary strengths. It was
suggested to school educators that they at first emphasize oral testing techniques with Jay or
give him an above-average amount of credit for oral rather than written or drawn assignments.
They were also given suggestions for how to assist Jay in improving his writing and drawing
skills in a relaxed, comfortable manner.
Jay was encouraged to pay attention to the variety of factors involved in particular
settings or outcomes and the processes through which those factors contributed to specific
conclusions. He was discouraged from focusing on only generalized conclusions and either/or
formats, such as acceptable or not acceptable, bright or not bright, perfect or not perfect, and
messing up or not messing up.
Jay was also encouraged to develop an awareness of the complex array of characteristics
that an individual has. In combined clinical sociology/art therapy sessions, he was focused on
metaphorical demonstrations that presented the importance of characteristics or areas some
people may regard as "weakness" or "undesirable." For example, Jay completed drawing
projects using many shades of color, showing him that, at times, colors he thought were too
light or ugly could play an important part in the finished product.
Jay was led to understand how valuable it was at times to "mess up" or have "limits." He
was encouraged to mess up a project purposely, then create something unique and worthwhile
from the "mess-up." He was also encouraged to mat and frame some of his drawings,
demonstrating how the structuring and enclosing of a picture could add to its visibility and
beauty.
Jay was especially assisted in acknowledging and working with the negative responses of
others. "If your peers are angry, how might you, Jay, contribute to their definition of the
situation? How can you appropriately deal with it?"
His family was also given socioemotional understanding and suggestions for recreation.
They were asked not to concentrate on things being "messed up," or "not finished," or
"imperfect." They were shown how to value the opportunity to deal with a difficult situation
and treasure the challenge of working together in understanding the specific factors involved
in the situation. They were assisted in not concentrating on perceived imperfections or
inadequacies that influenced Jay's definitions of situations. Furthermore, they were shown that
if something Jay initiated did not work or resulted in irritating consequences, he did not have to
be left, abandoned, thrown out, ignored, or focused on for his deficiency. They could, together,
use the situation to contribute to the joining together and well-being of family members.
Jay and his family were also asked to engage in more family (mother, father, brother, and
Jay) activities whether those activities were games, attending community events, or planned
family social activities like birthday parties.
WORK WITH INDIVIDUALS 107

Finally, the family and the school were requested not to focus on expectations or
performance. Rather, they were shown how to value a many-faceted individual with a number
of talents and personal areas to develop. They were shown how to assist Jay in concentrating
on the interesting nature of a project, the joy of discovering different ways to carry it out, and
the sense of well-being that could be involved in the process of carrying out or completing a
project.

SUMMARY AND CONCLUSION

Socioemotional understanding and re-creation can occur only through entering the
lifeworlds of individuals and identifying the patterns, processes, and contexts through which
they create, maintain, adapt to, and sometimes alter critical emotional meanings.
The most important areas to identify include discernment of the linguistic chains of
interpretation and evaluation through which individuals' emotional meanings emerge. Partic-
ularly important is discerning the statements that refer to individuals' self-definitions, defini-
tions of others, and definitions of social settings. A second area of major significance is
determining the interplay between the individuals' statements and habitual generalizations
regarding themselves and their intersections with life. Understanding those generalizations is
the pathway for discovering the individuals' emotional repertoires, including the range,
intensity, and valence of their specific emotions.
A third area to explore deeply is the interplay among the individuals' emotions; for
example, are their feelings of anxiety continually replaced by feelings of anger? Also, highly
relevant is noting if there is an absence of emotions, for example, a lack of positive feelings,
but a preponderance of negative feelings or the absence of any feelings.
Another highly relevant area of exploration with the individuals is how they take into
account, interpret, evaluate, manage or not manage, and express or not express their emotions,
which can lead to the individuals continually creating additional generalizations and linked
feelings. This exploration assists them in understanding emotional spirals that can emerge
continually from the individuals' repetitive patterns and processes of thinking, feeling, and
behaving as well as in relation to constant types of social interactions and contexts.
Metageneralizations, like depression or stress, are also of special significance because
they often become the beginning or endpoint of the individuals' emotional spirals.
Once patterns are explored and identified, individuals can come to understand the
multifaceted aspects of emotionality. They can, with the help of professionals, come to know
the neurophysiological patterns linked to the crucial emotional meanings they create.
They can also develop a deep understanding of the social contexts through which emotional
meanings emerge including social beliefs, values, norms, institutions, rituals, social objects,
social resources, life events, interpersonal contexts, and significant other's established emo-
tional patterns and linked behaviors.
In regard to very severe emotional problems and disorders, it is important to pay special
attention to individuals' exquisite emotional sensitivities or their tendencies to emotionally
react with no apparent cognitive mediation. Especially important to identify are the generaliza-
tions on which specific reactions are based and the objects of reactions as well as the impor-
tant differences between emotions present in the world of fantasized meanings but not in the
world of shared meanings. Individuals with exquisite emotional sensitivities often have
tendencies to go toward extremes such as undergeneraiization and overgeneralization as well
108 BEVERLEY CUTHBERTSON JOHNSON

as engage in overly ritualized behaviors or focused concerns. These individuals can be

facilitated in exploring particular life events or circumstances through which specific inter-
pretations or behaviors have become extremely ritualized.
A special area to examine is the presence of patterns of adaptation that include the
creation, through cognitive processes, of multiple selves or multiple realities. It is also ex-
tremely relevant to honestly acknowledge and understand adaptations to perceived intolerable
situations through reality replacement, withdrawal, or destruction. Individuals can discover
that they may have constructed creative adaptations that use resources not generally employed
in normative practice, for instance, the use of auditory and visual resources to resolve intoler-
able situations.
Clinical sociologists can be valuable resources in facilitating individuals with extreme
adaptive patterns to understand the sociocultural contexts through which particularly diver-
gent patterns have emerged, especially the particular sociocultural themes through which
certain patterns of divergence may be more likely than others. Furthermore, they can assist the
individuals in clearly acknowledging the consequences of particularly divergent patterns and
processes on the individual as well as their significant others and the community.
Only in understanding their patterns and processes can individuals choose to alter certain
ways of thinking, feeling, and behaving, manage special sensitivities, or alter particular social
circumstances that contribute to their socioemotional profiles. They can especially come to
understand their values and increase their ability to resolve specific crisis situations and
ongoing problems. They can also reduce specific social role limitations and develop alterna-
tives that do not include self-destruction, loneliness, and alienation. They can, with the
assistance of the clinical sociologist, create feelings of increased control and reduce feelings of
powerlessness, hopelessness, and social isolation.
A major step for clinical sociologists is to encourage each individual to take emotional
responsibility/responsible emotionality for the personal and social consequences of his or her
patterns and processes. Mter assisting individuals in honestly exploring, understanding, and
reflecting, clinical sociologists can facilitate individuals choosing to affirm and enact more
positive strategies for their own well-being as well as others.
Clinical sociologists can also, through the use of educational workshops and support
groups, encourage the emotional responsibility/responsible emotionality of partners, family
members, and significant others. The individuals involved in the workshops and groups can
develop a deep understanding of emotional disorders as well as reflect on how they may
choose to alter some of their patterns or processes of thinking, feeling, and behaving in order to
expedite individuals with exquisite emotional sensitivities being able to have respectful
support in working with entrenched patterns.
Furthermore, the community is a vital aspect of socioemotional understanding and re-
creation. Community members can be facilitated in developing new understandings of socio-
emotional disorders and providing the contexts and resources that value and respect as well
as support and assist individuals with special emotional challenges.

REFERENCES
Cuthbertson Johnson, B. (1996). Socioemotional understanding and re-creation. Clinical Sociology Review, 14, 44-61.
Cuthbertson Johnson, B., & Johnson. J. M. (1992). Exquisite emotional sensitivity and capture. In N. K. Denzin (Ed.),
Studies in symbolic interaction (pp. 155-166). Greenwich CT: JAI Press.
Cuthbertson Johnson, B., & Johnson, J. M. (1994). Emotional generalization: An integrative proposition. In N. K.
Denzin (Ed.), Studies in symbolic interaction (pp. 163-184). Greenwich CT: JAI Press.
WORK WITH INDIVIDUALS 109

Cuthbertson Johnson, B., Franks, D., & Doman, M. (1994). The sociology ofemotions: An annotated bibliography.
New York: Garland Publishing.
Fein, M. L. (1990). Role change: A resocialization perspective. New York: Praeger.
Fein, M. L. (1997). Clinical sociology and the individual client. Clinical Sociology Review, 15, 40-50.
Fein, M. L. (1998). Resocialization: A neglected paradigm. Clinical Sociology Review, 6, 88-100.
Glass, J. E. (1992). An alternative understanding of the cognitive, emotional and behavioral characteristics of
individuals raised in alcoholic homes: A clinical theory of the individual. Clinical Sociology Review, 10, 107-117.
Gordon, S. L. (1990). Social structural effects on emotion. In T. Kemper (Ed.), Research agendas in the sociology of
emotions (pp. 145-179). Albany, NY: SUNY Press.
Hochschild, A. (1979). Emotion work, feeling rules, and social structure. American Journal of Sociology, 85,
551-575.
Scheff, T. J. (1968). The role of the mentally ill and the dynamics of mental disorder: A research framework. In S. P.
Spitzer & N. K. Denzin (Eds.), The mental patient: Studies in the sociology of deviance (pp. 8-22). New York:
McGraw-Hill.
Scheff, T. J. (1987). The role of shame in symptom formation. In H. B. Lewis (Ed.), The shame-rage spiral: A case
study of an interminable quarrel (pp. 109-149). Hillsdale, NJ: Erlbaum.
See, P., & Straus, R. A. (1985). The sociology of the individual. In R. A. Straus (Ed.), Using sociology (pp. 61-80).
Bayside, NY: General Hall.
Shibutani, T. (1961). The society and personality. Englewood Cliffs, NJ: Prentice-Hall.
Straus, R. A. (1984). Changing the definition of the situation: Toward a theory of sociological intervention. Clinical
Sociology Review, 2, 51-63.
Thomas, W. I. (1931). The unadjusted girl. Boston: Little, Brown.
Valentine, C. G., & Derne, S. (1994). Syllabi and instructional materials. Washington, DC: American Sociological
Association.
Wirth, L. (1931). Clinical sociology. American Journal of Sociology, 37, 49-66.

APPENDIX: SOCIOEMOTIONAL JOURNAL

Name: _ Date: _
Emotion Experienced: _

Intensity of Emotion: 1 234 5 6 7 8 9 10

Very Mild Intense
Situation(s), thought(s), and/or behavior(s) associated with emotion:

At the time or afterards did you REFLECT upon your emotional experience? Did you try ot
make sense of it? How?

At the time or afterwards did you MANAGE your emotional experience?

_ _ _ Yes No
If yes, to what degree? 1 2 3 4 5 6 7 8 9 10
Strongly Managed Not Strongly Managed
110 BEVERLEY CUTHBERTSON JOHNSON

If yes, how did you manage it?

If no, where there personal or social consequences?
If yes, were there personal or social consequences related to your management strategies

Where any particular verbal or nonverbal displays or expressions involved with your emo-
tional experience? If YES, describe them.

***Reflect upon and note any SOCIAL beliefs, values, themes, objects, rituals, or
institutions related to your emotional experience. For example:
General sociocultural themes, values, institutions, resources, objects, or rituals:

Specific sociocultural groups, settings, themes, values, rituals, or experiences and

their relationship to your particular patterns of emotional experience, expression
and management:

Family patterns and processes that may have been involved:

WORK WITH INDIVIDUALS 111

Social Identities and Roles (Gender, Age, Ethnicity, Occupation, for example, or
Treasured/Abhorred Personal Self-Identities) that may have been involved:

Socialization factors that may have been involved. Were you taught to (or not taught
to) know, experience, manage, or express particular "feeling rules," for example, or
specific habits of "emotional control?"

Personal Values that may have been involved. And, how might those personal values
relate to broader social themes?

ADDITIONAL COMMENTS:

Developed by Beverley Cuthbertson Johnson, Ph.D., C.C.S.

 CHAPTER 7

Work with Families

ANTOINETTE COLEMAN

INTRODUCTION

Increasingly, clinicians have become aware of the sociocultural factors that intertwine and
affect the healthy growth and development of family life. For many years, family work in
clinical practice has been dominated by individually oriented models grounded in traditional
psychological and psychiatric knowledge and skills (Swan, 1994). Primarily psychological
and psychiatric treatment approaches have focused on the intrapsychic issues of individuals.
These approaches rarely consider that the problems of individuals are best understood as
rooted in the relationships among family members and how these relationships are also
influenced by social interactions external to the family.
For the most part, psychological and psychiatric approaches treat the identified individ-
ual(s) in the family who exhibit(s) the most disruptive behavior. To illustrate, the child in the
family who acts out repeatedly and has poor relationships with family members becomes the
identified client for treatment; a mother and daughter of a family of six members are treated for
problems of their dyadic relationship. According to individually oriented models, once the
intrapsychic issues of the identified disruptive family member(s) have been treated, the family
should be able to regain a healthy level of growth and development. Without minimizing the
significance of the psychological and psychiatric orientations for working with troubled
families and given today's diverse cultural and environmental climates, it is imperative to view
human problems within the family context.
The discipline of sociology, through the practice applications of clinical sociology, finds
it most important to understand that a family is a unique human group that must be looked at
and diagnosed from the dynamics of its social systems, social situations, and social environ-
ment. Grounded in the knowledge and principles of sociology, clinical sociology does not
perceive the treatment of families from the perspective that families are mere aggregates of
interacting personalities. Clinical sociologists view families as sociocultural systems attempt-
ing to sustain themselves within their social environment. As sociocultural systems, families
enmesh the customs, values, family patterns, and religious beliefs of family life that are shaped
over time by larger social and political forces in the environment (Green, 1999).
Families function on the premise of group living which is collective sharing among

ANTOINETIE COLEMAN· School of Social Work, Norfolk State University, Norfolk, Virginia 23504.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

113
114 ANTOmETTECOLEMAN

individuals living together as a system, functioning to achieve the common objective of

survival through adaptation within a larger social system. Adaptation refers to members'
ability to cope with environmental changes, both within and outside of the family, while
sustaining a healthy level of functioning. It is important to note that family members do not
passively react to social situations. They are active participants in creating and reshaping their
understanding and thinking about what is real in order for them to survive within the group
(family). In group life, through the process of social-cognitive interactions, family members
develop their own world-view. A world-view, as defined by Leashore (1995), is one's percep-
tion of self in relation to other people, objects, and institutions such that individuals establish
cognitive and behavioral views of the world and their role and place in it. The world-views of
family members become infused into family interpersonal relationships such that either a state
of homeostasis or disequilibrium occurs within the family system.
When a family is confronted with umesolvable difficulties, clinical sociologists find it
crucial to assess the interplay among all social systems (micro, meso, and macro) that directly
or indirectly affect the family structure. Clinicians study the interaction among microsocial,
mesosocial, and macrosociallevels to learn how family members define their roles within the
family structure and in the larger social environment. To gain information to assess the
family's level of coping, the clinician must join the family as a nonpermanent member during
the therapeutic sessions to understand the problem that has overloaded the family's adaptive
and coping mechanisms and brought them into therapy.
To join or joining a family is a therapeutic practice, used in systems-oriented family
approaches. The clinician enters the family system during the therapeutic session to engage its
separate members and subsystems in communicating for the purpose of gaining access to
explore issues and to help modify the dysfunctional aspects of the family system (Goldenberg
& Goldenberg, 1996). By joining the family during the therapeutic session, the clinician can
assess the sequences of interactions that influence the interpersonal relationships of the family
members and gain insight into their social realities.
In addition to joining, the clinician becomes respectfully accommodating to the family's
style during the therapeutic session. The therapeutic practice of accommodating, used primar-
ily by structural family therapists, is the clinician's attempt to make an adjustment to adapt to
the family style in order to build a therapeutic alliance with the family (Goldenberg &
Goldenberg, 1996). Both joining and accommodating help to create a safe and secure environ-
ment for a family to explore their problem(s), as well as the family's experiences with
community systems. The clinician understands and works with them to establish alternative
ways of confronting the issue(s) that brought them to a dysfunctional impasse.
The clinical sociologist and family members' work together becomes identifying the
problem behaviors and/or situations that stem from interpersonal relationships within the
family structure, and how the structure is affected by the larger environment. This type of
clinical work attempts to redefine roles and/or situations to achieve healthy family functioning
to adapt and cope as a social system to changes within their environment. In work with
families, the central focus in clinical sociology is to intervene as a change agent jointly with
the family for problem solving.
Clinical sociology is the practical application of sociology that expands it beyond the
theoretical realm, to the treatment of relevant family problems that affect human functioning in
our social environment. Problems can also include child abuse, juvenile delinquency, single
parenting, alcohol and drug abuse, aging, death and dying (Cox, 1994). The process of (1) as-
sessment, (2) intervention, and (3) evaluation, provides a framework for working with a
variety of social problems that challenge families in society. This chapter will present a family
WORK WITH FAMILIES 115

systems framework for assessing family functioning, and the utility of family-focused inter-
vention for work with families. The theoretical and practical purviews of the literature will be
presented as well as a case assessment. Finally, an analysis of the strengths and weaknesses
of the family systems framework will be presented, with specific attention given to the family-
focused intervention approach.

REVIEW OF THE LITERATURE

Families are social systems in which all members influence and are influenced by the
actions of every other member and the larger social environment. Families must be viewed
within a systemic context. Family problems do not develop in a vacuum, nor does the owner-
ship of the family's problem(s) belong to just one family member. The problem(s) that
confront families can be most effectively dealt with by understanding and treating the
"whole" system, not just its parts. Essentially, the work to be done with families should follow
the fundamental premise of systems theory- "the whole and the parts of a system (i.e., the
family system) and other social systems can only be explained in terms of the relationships
that exist between the parts" (Lane, 1970). As stated earlier, because families are unique
human groups, it is important to analyze and understand the behaviors of the individual family
members in relation to the ongoing operations of the family as a group and individual
memberships in other social systems. The components of a family can be analyzed in terms of
homeostasis, structure, subsystems, alignments, power, and coalitions that, when functioning
properly, are fundamental elements that enable the family to engage in adequate problem
solving both within the family system and with other environmental systems.
Most evident to viewing families from this perspective is the articulation of family
organization theory based on the substantiating research and family work of Salvador Minu-
chin (1974) and his associates-i.e., work with poor inner-city youth and their families in the
New York Wiltwick School-that integrates structural family therapy as a part of systems-
oriented family therapy. Minuchin emphasized that it is critical to process the how, when, and
to whom family members currently relate within and outside the family as a way of under-
standing the problems (Hanna & Brown, 1999). The work of Minuchin (1974, 1984) indicates
that before they can regain a healthy state of stability, the family and clinician must first work
to analyze and understand the sequences of family transactional patterns that may be func-
tional or dysfunctional and the influences of other environmental systems. Family trans-
actional patterns are the established routines of interactions that involve a minimal level of
mutual accommodation for regulating family members' behaviors within and external to the
family unit.
The construct of wholeness of the family system is further understood by analysis of the
hierarchical influence of the family organization, and the importance of individual determi-
nants that impact the interdependent functioning of family subsystems. It is also important to
analyze how these subsystems influence and are influenced by other environmental social
systems such as schools, churches, social services organizations, courts, and legislative groups
(Goldenberg & Goldenberg, 1996). The ability of a family's structure (its longstanding and
common transactional patterns) to adapt to changing conditions as it moves through life cycle
stages will ultirnatly determine whether functionality is sustained or dysfunctional patterns
arise. Within families, life cycle stages are the biopsychosocial changes that occur over the
life span of the family. For example, the birth of a couple's first child places them into the life
cycle stage of parenthood. As children grow older and leave the home, the family system
116 ANTOINETTE COLEMAN

enters into the life cycle stage referred to as the empty nest syndrome-the period in the
family's structure when parents and children no longer reside together.
Minuchin (1984) and others found that families attempt to maintain a delicate balance
between a steady state (stability) and change when moving from one life cycle stage to the
next. Therefore, the greater the degree of functionality as it pertains to family homeostasis,
structure, subsystems, alignments, power, and coalitions, the greater chance the family has to
remain in a steady state of functioning. To the extent that these structures within the family are
not functioning properly, there is a greater likelihood of the occurrence of a state of instability
leading to a breakdown in problem-solving abilities and to adapt and cope in a functional
manner.
Human behavior is influenced by the family's interpersonal relationships (microsystem)
and the subsystems that evolve from such familiar relationships. It is also influenced by other
social systems (meso- and macrosystems) that contribute to the structure of human behavior
within a family. The ongoing family operational components of homeostasis, structure,
subsystems, alignments, power, and coalitions will be analyzed in this chapter to assess the
behaviors and situations of families using the family-focused intervention method. This
method recognizes the influences of meso- and macrosystems when working with families
(microsystems). Family-focused intervention is based on the theoretical premise of an ecologi-
cal family approach (Kaplan & Girard, 1994; Bronfenbrenner, 1979).
An ecological family systems approach, such as family-focused intervention, moves the
focus of intervention from the individual to the family, to subsystems within the family, and to
the family's interaction with the community. The identified client's problems are considered a
symptom or reflection of difficulties within the family. Grounded in the ecological family
systems approach, family-focused intervention is focused on the family as a whole, with the
treatment process directed at the underlying patterns in the family and at issues in the
community that reflect the crisis (Kaplan & Girard, 1994). The family is viewed within a social
context and its members' level of functioning is seen as inextricably linked to the environment.
Thus, family-focus intervention treats family members as interdependent, needing support
from people outside the immediate family, and sees individual development as strongly
influenced by environmental factors. Family-focused intervention first addresses the immedi-
ate family concerns and then addresses issues from a community perspective. This interven-
tion approach is most effective when it takes place in the environment in which the family
lives. This allows the clinician to actively aid the family in exploring not only the resources
within the family system but also the community and its resources. Significant empirical data
support the view that not only the immediate family but also extended family, community, and
social networks affect the emotional, mental, and physical well-being of an individual family
member (Wasik et at., 1990).
In the application of family-focused intervention in work with families the problem-
solving process of (I) problem assessment, (2) implementation of intervention, and (3) evalua-
tion of intervention is key to analyzing family systems, and the larger environmental systems
that affect the family. Rebach and Bruhn (1991) posed four questions that guide the use of the
aforementioned problem-solving process.
• What is the presenting problem?
• What is the selected intervention?
• What will be the most optimal conditions for the intervention to be effective?
• How effective was the intervention?
These questions assume that, within a therapeutic milieu in which family-focused intervention
is employed, rapport will be established between the clinician and family members.
WORK WITH FAMILIES 117

Family Homeostasis

Families work toward maintaining a sense of balance or homeostasis through the organi-
zational structure they establish and the operations that support it. In order to maintain balance
within the family, a range of restricted interactional patterns and acquired mechanisms for
sustaining and restoring balance emerge (Hana & Brown, 1999). Whenever the homeostasis of
the family is threatened, the family seeks to restore equilibrium through those acquired
mechanisms for problem solving. Minuchin (1974) stated that families, in an attempt to
conserve a state of equilibrium, have the tendency to maintain preferred transactional patterns
and resist change as long as possible, often to the point of dysfunction.
The functionalist perspective views family homeostasis in accordance with the ecological
systems that affect the human behavior of the family. According to functionalism, the mainte-
nance of the functionality of the family system in the environment is attributed to it organiza-
tional patterns. It suggests that the family system has a structure denoting a set of functionally
interrelated components such that the actions of anyone component of the family influence the
functional abilities of all other components within the family (Rebach & Bruhn, 1991).
Furthermore, functionalism considers family homeostasis from the perspective that the func-
tions of each system level within and external to the family (Le., suprasystem, system, sub-
system, and sub-subsystem) have an influence on the constancy of the family structure to adapt
and its ability to change or enter into a state of disequilibrium. This also affects their
interactions with other meso- and macrosystems such as schools, churches, community
agencies, and government.
In addition, the ecological factors of culture, ethnicity, and race affect the homeostasis of
the family structure from within (microsystem) as well as at the meso- and macrosystem levels
(McGoldrick, 1998). The culture of the family defines the customs, values, and beliefs handed
down over time that enable its members to structure their behavior, establish their world-view
and their perspectives on the rhythms and patterns of life in order to help them maintain a state
of equilibrium within the family. Ethnicity influences family homeostasis in that it provides a
sense of belonging to a larger group with whom they share a common ancestry and cultural
heritage, i.e., race, religion, or national origin. Ethnic identity offers them a frame of reference
and stability (Kumabe et aI., 1985).
Race defines peoplehood by distinguishing genetically transmitted physical characteris-
tics. However, within our society, race affects family homeostasis more as an issue of political
oppression than culture or genetics. Nevertheless, within our society many cultural, ethnic,
and racial differences exist that are both real and meaningful to its members. These cultural,
ethnic, and racial differences reflect the diversity that exists in society. These differences are
not always embraced within the meso- and macrosystems in our environment. When these
differences are not addressed in the larger environment to value the culture, ethnicity, and
racial identity of families, families in these groups often experience conflict with larger
environmental systems to the point that the equilibrium of these families is often threatened
(McAdoo, 1999; McGoldrick et aI., 1999). For example, the state of equilibrium for African-
American families is often threatened as they struggle to protect their identity and personal
dignity from the discriminatory and oppressive actions that are manifested in the larger
societal systems (meso- and macrosystems). Clinicians should first engage with families to
understand their values, customs, beliefs, and patterns. Then, examination must be undertaken
to determine the extent to which meso- and macrosystems in the environment directly or
indirectly impact the homeostasis of families that are members of ethnic and racial minority
groups. These factors (culture, ethnicity, and race) are key to helping families achieve or
sustain a state of homeostasis.
118 ANTOINETTE COLEMAN

Families seeking clinical intervention are frequently in a state of disequilibrium. Mem-

bers are unable to manage the stress of a situation(s) using the coping and adaptation
mechanisms that had worked for them in the past. And the longstanding environmental
systems that families depend on as resources during crisis become ineffective in helping the
family regain a sense of homeostasis. It is important for the clinician to analyze the trans-
actional pattern of family members.
There are two types of families for clinical intervention. The first are families that have
retained their equilibrium by identifying a specific family member as "the problem." These
families experience a state of disequilibrium when systems such as schools, social services,
and courts identify "the problem" family member as disruptive to the larger community. This
creates a state of disequilibrium in that the family strives to protect its level of functioning
using the dysfunctional behaviors of "the problem" family member. The second type are
families that only see the problem behavior of the identified family member as disruptive, and
do not identify the functioning of the total family system or the influence of systems within the
larger environment as problematic. Families represented in the former group are those in
which intervention is often involuntary, and the latter group represents families who fre-
quently seek intervention on a voluntary basis.
The interventions rendered to help families regain a state of positive functioning are
provided by meso- and macrosystems within the communities in which families live. For
example, human services agencies within communities provide in-home services, case man-
agement, outpatient mental health care, respite care, foster care, shelters, transitional housing,
and so on, mandated by federal, state, and local laws and regulations to address problems such
as underemployment, unemployment, homelessness, substance abuse and alcoholism, mental
illness, mY/AIDS, elder care, juvenile delinquency, parental incarceration, child maltreat-
ment, and spousal abuse that confront families. At the microlevel, the clinician must join the
family to begin to collect data in order to assess the breakdown in family functioning. The
clinician works simultaneously with various members and their subsystems to assess what is
the behavior (sequence of transactional patterns) within the family structure and in the external
environment that contributed to the family's state of disequilibrium.
In a study conducted by Harrison et al. (1999) on the use of family-focused intervention in
work with families with troubled children, significant improvements in family homeostasis
were found in the areas offamily cohesion and family conflict for 176 parents and 160 children
participating in weekly family sessions. In addition, Harrison et al. (1999) found that other
studies conducted on family stability reported similar findings that family-focused interven-
tion is superior to individual therapy in helping families with troubled children reestablish a
sense of equilibrium in the family. Based on earlier controlled studies, Fraser et al. (1988)
found that a number of prevention researchers strongly supported family-focused intervention
to regain family homeostasis in the treatment of delinquency, substance abuse, and associated
mental health problems affecting youth within the family system and the community.

Family Structure

Family structure provides the basis from which the clinician can assess the functions and
operations in the family and its external environment. Functions refer to the action modes by
which family members fulfill their purpose within the system, while operations are those
functions that get actualized through defined activities. The clinician must determine how the
family structure is organized to dictate how, when, and to whom members relate and the
WORK WITH FAMILIES 119

sequence of transactional patterns involved (Minuchin, 1984). Assessment of family structure

allows the clinician to assess the operational rules created by the family to carry out its
important functions. It provides a framework for understanding the routine and enduring
patterns that reveal how the family decides to organize itself to maintain stability (homeo-
stasis) when it experiences change that requires problem solving skills.
The functionalist perspective suggests that stability is gained through interdependence,
the interconnectedness of the family structure, and the social life of the family. The social life
of families includes the culture, ethnicity, and racial composition. These factors influence the
family's ability to function and achieve stability through interdependence within the family
system, and through other social systems (McAdoo, 1999; McGoldrick, 1998). For example,
Latino families, as an ethnic minority, place strong cultural emphasis on family unity, welfare,
and honor in order to maintain a sense of identity and functioning within the larger society.
Such cultural values and beliefs among Latino families help them to achieve stability and
interdependence within the family system and the communities in which they live.
Furthermore, proponents of structuralism believe that in order for families to function
well within their environments, they should be hierarchically organized (Colapinto, 1991).
This hierarchy should be organized so that parents retain more power, responsibility, and privi-
leges than children; that older children should have more role- and age-appropriate power,
responsibility, and privileges than their younger siblings. Furthermore, functions within the
family structure must be complementary. Complementary family structures are those func-
tions and operations within the family that work together. For example, the mother and father
act as a team in determining disciplinary measures for their children. Complementary family
structures are sustained through family members' actions to engage in collaborative and
reciprocal roles within the family and the environment. Reciprocal roles are defined statuses
within the family and the environment that are mutually beneficial to the family structure. For
example, the roles of mother and PTA chairperson are reciprocal roles that a woman maintains
to help her children and the school system in the community in which the family lives. It
becomes important in the assessment of a family to determine whether these roles (comple-
mentary or reciprocal) have changed, what brought about the change, and to what degree these
structures were healthy within the family and functioned harmoniously in the community. The
assessment process takes on a multisystems focus. It must explore the internal interactional
patterns of the family, the community systems the family directly interacts with, and the
impact of public policies on the family. Therefore, clinicians must determine to what extent the
structures in the family can support a steady state of functioning for the family within the
environment in which they live.
When working with families using microlevel intervention approaches, Kaplan and
Girard (1994) found, in reviewing more than 50 family programs nationwide, that family
therapy, in-home family crisis intervention, and family case management have emerged as the
key modalities for enhancing family functioning. In using such intervention approaches,
clinicians join with the family to explore the extent to which the members are vested in
maintaining their preferred patterns of interactions, even when such patterns are not working
for the family. As the clinician engages the family in the intervention process, he or she is often
met with resistance by family members to needed changes in the family structure when the
changes deviate too fast or too far from the established rules or transactional patterns of the
family. This resistance from family members is their attempt to regain their own sense of
equilibrium regardless of the degree of unhealthy functioning that may exist. Through micro-
level family intervention approaches, the clinician must be able to help the family members
adapt to needed changes within the family structure; for example, the adolescent wants more
120 ANTOINETTE COLEMAN

independence from hislher parents, the father is unable to work due to illness, or the mother
returns to college.
Bribitzer and Verdieck (1988) studied family services agencies employing family sys-
tems interventions. They found that focusing on the use of informal systems significantly
increased family functioning. Overall, the study indicated a strong positive correlation be-
tween families' need for supportive relationships and stability to complement the family
structures. Specifically, interventions that used informal systems (mesosystems) within family
services programs showed that the functions and operations in the family structure are more
conducive to engaging in successful problem solving when supportive informal systems-
kinship and friendship networks, church affiliations, clubs, and organizations-are a part of
the intervention.

Family Subsystems

Subsystems are operational components within the family to target for change. Basic
family functions are carried out in part by organized subsystems that coexist within the family.
Family subsystems are often organized according to gender, generation, common interest, or
function. Gender-organized subsystems include members in the family grouped together
according to gender. For example, a gender-organized subsystem includes the mother and
daughter(s) acting together on matters concerning the family. Subsystems organized by
generation comprise family members who act together within family structures that are a part
of the same generation (Colapinto, 1991; Pinkston & Linsk, 1984). An example is grandparents
within the family structure who act in concert only with each other on family issues. Cornmon-
interest subsystems are family members who share similar views on how matters should be
undertaken within the family. For example, children become a common-interest subsystem to
get their parent to grant them a later curfew. Finally, subsystems organized by function are
family members within the family structure who come together for the purpose of maintaining
order and conducting the operations needed to sustain stability. For example, a functional
subsystem can be a mother and father who work together to manage the family finances.
The objective of the clinician is to analyze the various subsystems to determine what
roles they play in contributing to the overall functioning of the family system. Frequently,
family members hold concurrent memberships in several subsystems and clinical assessments
must include the multiple roles family members may engage in. Family members may have
different levels of power through their participation in different subsystems, different roles,
exercise different skills, and engage in different interactions with members of other sub-
systems in the family (Colapinto, 1991). For example, a mother may see herself as her
children's friend and enter into a subsystem with them of fun and games. On the other hand,
she is a member of a subsystem where she shares a complementary role with her husband and
is responsible for being a co-disciplinarian.
In role theory, family subsystems denote the behaviors and characteristics as reflected
through the roles members maintain in the subsystem. Furthermore, role theory states that
family members within a subsystem share a common identity-social position-within the
family system (e.g., hierarchical, power) regardless of how many subsystem memberships
they maintain (Biddle, 1979). For example, a son who is a part of a sibling subsystem enacts
the role of helping his younger sisters in the absence of their parents. He is also a member of a
gender-oriented subsystem in the family that includes his father and grandfather, in which he
plays the role of the youngest male. In part, family subsystem roles persist because of the
functions they serve within the family system and they are embedded within the larger social
WORK WITH FAMILIES 121

environment. Also, these subsystem roles are influenced by the culture, ethnicity, and race of
the family system and the way these characteristics are perceived by the meso- and macro-
systems within the larger environment (McAdoo, 1999; McGoldrick 1998).
The clinician will need to work with the family to understand that the key to family
functioning is the absence of unresolvable role conflicts created by subsystem memberships
regardless of the level at which the role conflict exists. Whether role conflicts exist at the
microsystem level (within the family) or mesosystem level (e.g., schools, neighborhoods) they
will affect family functioning. To illustrate, a mother and son dyad may exist in a family that
excludes other family members. However, the mother, in her role as a parent delegate to the
city council for the school board, may have to work on activities that her son opposes, which
may create an unresolvable conflict between the mother and son. The clinician must under-
stand how unhealthy subsystems sustain themselves within the family structure. Such sub-
systems disrupt the homeostasis in the family, particularly as the family progresses through its
life cycle stages. Therefore, as family members seek to use their preferred coping and adapting
mechanisms, often different problem-solving skills are needed that the family is not equipped
to supply during a period of instability.
Therefore, the clinician works with the family to help them reveal and clarify the
boundaries and rules that define subsystem membership. Subsystem boundaries and rules
determine who will participate and the roles members will have in interaction with one another
and those outside the subsystem. Such boundaries and rules may be based on temporary
alliances (e.g., father and son attend a rock concert together), or they may be more longlasting
with clearly defined boundaries and rules, such as roles and interests that differ between
grandparents and parents. Clinically these boundaries must be assessed to determine if they are
functional for the family's stage of development.
The most common subsystems that clinicians must assess and determine whether inter-
vention is needed include spousal subsystems, parental subsystems, and sibling subsystems.
Spousal subsystems provide the clinician with critical data for assessing family stability. The
way in which husbands and wives learn to negotiate differences and eventually adjust to one
another's needs and develop complementary roles, tells the clinician a great deal about the
probability of family stability and flexibility to change as future circumstances dictate. The
clinician's assessment of the parental subsystems must focus on whether the parents deal with
new responsibilities within the family, complement essential roles, and negotiate differences
in parent attitudes and styles. The clinician attempts to analyze how well parents accommodate
each other's individual perspectives and regularly renegotiate their relationship as children
grow and require different attention from each parent.
Sibling subsystems offer children their first experience with peer group interactions.
Through assessment of the sibling subsystem, the clinician is able to determine the degree to
which the family supports children as they learn to interact with their parental subsystem to
work out relationship changes that occur between parent and child. Also, the children in the
sibling subsystem learn how to communicate with each other as they embark on changes in
their lives (i.e., biological, social, and emotional). If the family has only one child, the clini-
cian analyzes how well the child interacts with other children of the same age to develop these
life skills.

Alignments, Power, and Coalitions

Family alignments are analyzed as a part of the clinical assessment to determine how
family members choose to join or oppose one another to conduct family tasks. Clinical work
122 ANTOThffiTTECOLEMAN

with the family dictates that the clinician assess which alignments within a family are dysfunc-
tional. Minuchin referred to dysfunctional alignments as triangulation (Minuchin, 1974).
Triangulation occurs when a parent demands that a child support him or her against the other
parent. When the child aligns with one parent, the other parent views the child's actions as
betrayal, thus a dysfunctional structure is established in the family. Triangulations are often red
flags denoting family dysfunctions. Once triangulations in the family have been assessed, the
clinician must help the family move to the intervention planning and implementation phase of
their work.
Power in families refers to authority (who becomes the decision maker) and responsibil-
ity (who acts on making decisions). Clinicians must assess the bases on which power
alignments may form-are they emotionally or psychologically based? Essentially, the clini-
cian is working to determine to what degree any family member influences another, and the
outcome of their influence on family activities and functioning. In an assessment of power, the
clinician must understand that power within a family is determined by the active or passive
relationships that develop among members that enable the interests of one or more members to
prevail in deciding the outcome of the activity. For example, the father's authority depends on
the mother's cooperation and the children's compliance. Also, in the assessment the clinician
must examine how power within a family is associated with the activity, and how well the
family members relinquish positions of power when they are not engaged in that activity. This
is particularly relevant to teens as they progress through the period of adolescence. For
example, an older teenager may have the power to be responsible for younger siblings during
the absence of the parents. However, the older sibling must relinquish his or her position of
power with the younger siblings when the parents or parent is present.
The assessment of power also enables the clinician to understand how family members
handle social interactions external to the family group. For example, the clinician in a family
services agency may be working with a single mother, head of household. The mother
maintains a dominant role with her children and extended family members. It is important to
examine to what extent the mother demonstrates the same dominant behavior when she
interacts with individuals on her job or in other social systems in the community in which she
lives. This enables the clinician to understand the impact power has on the internal functions
within the family system, as well as how power positions in the family influence members in
their interactions with other systems in their community and the larger environment.
Power positions operating within the family do not always originate within the family.
Positions of power within the family can be a result of meso- and macrosystems in the society
that have legal responsibilities, represent religious orientations, provide educational services,
administer healthcare, and so on. These may shape the way power positions are established in
families. For example, a family that comes to the attention of the juvenile court and educa-
tional systems because the daughter is selling drugs is sanctioned by the court into family-
focused intervention. The clinician learns that the daughter feels alienated from her family.
Their religious practice, as dictated by the church leadership, creates power relations within
her family and other families in the church that support females being treated as "nobodies"
and males as privileged. In this case the power in the family is influenced by a mesosystem-a
religious institution. Intervention in this case might involve working with the family on the
power relationships within the family and on the prevailing influence of the religious institu-
tion on the family, regardless of whether the relationship between the family and the religious
institution is one-way or mutual.
Coalitions constitute structural alliances between specific family members against a third
member. Coalitions are considered stable or detouring (Goldenberg & Goldenberg 1996;
WORK WITH FAMILIES 123

Minuchin et aI., 1978). A stable coalition within a family system represents a fixed and
inflexible union (e.g., father and daughter) that takes primary responsibility for the day-to-day
functions of the family. When families interact with community systems, it is often a stable
coalition in the family that carries out the functions with the community system on behalf of
the family system. However, stable coalitions can become crippling to other family members.
For example, a family comprising the father, mother, and adult children are in need of
assistance from a local social services agency to locate nursing care for the mother's elderly
father. As the family engages the services of the agency, only the members of the stable
coalition-the father and oldest son-interact with and have the responsibility for handling
the functions designated by the agency. This leaves the remaining family members in a limited
position in their interaction with the external system because the stable coalition within the
family handles such functions to the extent that the remaining family members are excluded.
On the other hand, a detouring coalition occurs when two family members hold a third
member responsible for the interpersonal difficulties or conflicts within their family and with
systems in the community (Goldenberg & Goldenberg, 1996; Minuchin et aI., 1978). For
example, parents may hold their substance-abusing son responsible for their marital and job
difficulties, as well as the acting-out behavior of the younger children in the family. A
detouring coalition limits the family's ability to engage in successful problem solving. This
coalition places the blame for the family's problems on one person (Le., the substance-abusing
son) so that the other members of the family do not have to deal with the possibility that their
actions may be contributing to the problems within the family (DeMarsh & Kumpfer, 1986).
A detouring coalition within the family affects its members' interactions with community
systems because those systems may be defined as disruptive to their sense of stability and their
ability to maintain their status quo. It blocks the family's ability to engage in successful
problem solving. Clinicians must assess (1) whether coalitions exist within the family; (2) the
type of coalition(s), if any, that exist within the family; and (3) how healthy or unhealthy the
coalitions are to family functioning (microsystem) and their interaction with systems in the
community (meso- and macrosystems). Family-focused intervention concentrates on reducing
the stress that coalitions in the family can create. The objective of intervention is to increase
positive functioning among family members and with community systems that do not rely on
family coalitions that are unhealthy for its members (Bacari, 1999).
Alignments, power, and coalitions are interrelated phenomena within a family system
that influence the problem solving needed to sustain a sense of equilibrium. Clinicians believe
that in order for the family to engage in successful problem solving, the system must clearly
define (1) generational hierarchies, (2) alignments between members on family issues that
determine their interaction with each other and with other social systems, and (3) defined rules
on power and authority with members in the prevailing role within the family and systems in
the larger environment.
Alignment, power, and coalitions from the conflict perspective represent the inequality
and dominant positions that operate within the family system that can insulate families from
successful problem solving with various systems in the environment. These dominant posi-
tions use resources afforded to them through their positions of alignment, power, and coali-
tions to maintain status that ultimately creates conflict for other family members and members
of systems external to the family. Such conflicts among family members and in the larger
environment lead to instability (disequilibrium) within the family system that also leads to
needed changes in the family structure.
In addition, alignments, power, and coalitions are dictated by the family's ethnic group
status and race (McGoldrick, 1998). Ethnic group status influences family alignments, power,
124 ANTOmETTECOLEMAN

and coalitions through the unique shared cultural traditions and heritage that span across
generations and guide the structure and functioning of families. Often, ethnic group status and
social class are viewed within the same context. However, the subtle difference between social
class and ethnic group status is that social class places more attention on the economic and
political strata within society. Race as a major cultural definer and divider influences family
alignments, power, and coalitions mainly from the meso- and macrosystems in our society. For
example, an Asian-American family and white family who are neighbors and friends may
come into conflict along racial lines regarding issues about the school system their children
attend. Families adhere to certain values, beliefs, and societal pressures that help them create
various alliances among family members, power distributions, and coalitions within the family
system and systems in the community.

HOW TO DO IT

In working with families, the goals for clinical sociologists are based on the hypotheses
formulated from the assessment of the interactional sequences in the family (Bruhn & Rebach,
1996). Special attention is also given to the interplay among the micro-, meso-, and macro-
social contexts in which the dysfunctional behavior manifests itself. By using a family systems
approach such as family-focused intervention discussed earlier, clinicians regard symptoms as
consequences of organizational difficulties within the family and the influences of systems in
the larger society. Clinicians find that viewing symptoms in this fashion enhances the produc-
tivity of the therapeutic process. It allows the clinician a broader spectrum from which to
assess family functioning and greater flexibility to intervene to help members in the work they
must do to make changes in the family structure.
In work with troubled families, regardless of the extent of the family crisis, clinicians
using family-focused intervention begin with an assessment of the family unit, the microlevel
system. Clinicians who engage families in this intervention approach use the therapeutic
techniques of joining, accommodating, tracking, enactment, reframing and relabeling as they
work with the entire family unit. In group sessions the goal of the assessment is to understand
the dynamics of the family that inhibit their ability to find solutions to their problem(s). The
techniques mentioned not only provide insight into the interactional patterns that occur within
the family, but also allow the clinician to establish rapport with family members which
facilitates examination of members' perceptions of meso- and macrosystems that influence
their ability to function. The therapeutic technique of joining helps the clinician demonstrate to
the family that they have a safe and secure environment to change the dysfunctional inter-
action patterns, even when initial resistance is presented by members (Goldenberg & Golden-
berg, 1996). As discussed earlier, the therapeutic technique of joining the family allows the
clinician to be a nonpermanent member through accommodating to the family's style and to
problem-solve with the family to move them away from a state of disequilibrium to a healthy
state of homeostasis and functionality (Goldenberg & Goldenberg, 1996). In family-focused
intervention, the clinician's efforts are directed to the present, and adhere to the principle of
taking action first to understand the social circumstances of the system (family). Through this
"here and now orientation" less of a message of individualized pathology is sent to the family.
Thus, the ability to build nonthreatening rapport can be established initially with the family
system.
From the communication among family members, the clinician learns the life symbols,
styles, language, and values of the family using the technique of tracking (Goldenberg &
WORK WITH FAMILIES 125

Goldenberg, 1996). Because the family is a microsystem within the larger environment, this
technique permits the clinician to deliberately attend to and adopt the family's life symbols,
style, language, and values in order to understand how the family functions within its
boundaries and in society. As the family's life symbols, style, language, and values are
examined, the skill of tracking allows the clinician to (1) learn the meanings each member has
and (2) use the meanings to influence family interactional patterns. The outcome of using this
technique is to move the family's interactional patterns toward healthier functioning by
developing problem-solving skills that can adapt to changes in the family system. This
therapeutic effort helps confirm that the clinician values the content of what family members
say without directly soliciting information (Goldenberg & Goldenberg, 1996). Furthermore,
tracking engages the clinician, later, to influence more fluently the transactional patterns of the
family. Minuchin (1974) views this therapeutic tactic as "leading by following." Tracking is a
viable restructuring strategy when working with the members in the family as a system.
Another therapeutic technique used in family work at the microsystem level of interven-
tion using the family-focused approach is enactment (Goldenberg & Goldenberg, 1996). The
clinician uses enactment to stage an event that allows members to bring an outside family
conflict into the session so that the members can spontaneously demonstrate how they handle
the conflict. The clinician learns through observation the sequence of family interactions in
order to develop a plan or new set of rules for facilitating the family to restructure transactions.
This technique enables the clinician to help the family redefine transactional patterns through
strengthening generational boundaries and the hierarchical order in the family, and learn how
family members use their interactional skills to engage with other systems within the larger
environment.
Finally, the therapeutic technique of reframing is quite useful to the clinician to reduce
tension among family members, and with meso- and macrosystems within the larger environ-
ment (Goldenberg & Goldenberg, 1996). Reframing allows the clinician to get members to put
behaviors in a new, more positive perspective through relabeling. Relabeling as a part of the
reframing technique teaches family members to verbally redefine an event in order to make
dysfunctional behavior seem more reasonable and understandable, with the primary intent of
provoking in other members a more positive reaction to the behavior. For example, family
members may state "Mother likes to inform others" compared to "Mother is a big mouth."
This example of reframing and relabeling presents more functional communication behavior
within the family system. The clinician uses the reframing technique typically within the
context of the enactment technique. This enables the clinician to redefine, with the family, the
presenting problem(s) on the micro-, meso- and macrosystem levels to allow them to interact
more positively within the family system and with larger environmental systems. Not intended
to be deceptive, reframing is used by the clinician to change the family's perspective with the
goal being to ultimately change family behavior patterns on the basis of the new available
alternatives and options open to them (Goldenberg & Goldenberg, 1996). Clinicians employ-
ing family-focused intervention using these techniques have demonstrated positive outcomes
for families in crisis (Szapocznik et aI., 1991).
Furthermore, as a part of the family-focused approach, the clinician must examine what
interventions might be needed with meso- and macrolevel systems to help the family function
better. Many meso- and macrosystems in our society, such as schools, courts, service agencies,
and legislative bodies, represent varying degrees of complexity and are often not quick to
make needed changes to accommodate the needs of families. However, in working with
families, clinicians must assess (1) the family's connections to community support resources;
(2) the available services that address the needs of families and take positive recognition of
126 ANTOThffiTTECOLEMAN

their cultural orientation, ethnic background, and racial membership; (3) the coordination of
formal and informal family-center support systems; and (4) the extent to which the community
and higher system levels promote systemwide policy changes that affect the well-being of all
families (Rothman & Sager, 1998). The clinician must help the family become more connected
to community resources, if need be, by helping them learn what is available to them and how to
use the available services more effectively.
In addition, clinical sociologists should examine to what extent the meso- and macro-
systems in our environment designated to help troubled families do not address the needs of
families in crisis. There are significant gaps in the policies and services operating in these
systems. This advocacy function focuses on the enhancement of families' capacities to access
needed services and enhancing the capacity of the environment to provide for the needs of
diverse family systems. Also, as the clinician works with families to link them to services, the
clinician must become involved in facilitating the family in coordinating the services they
need to receive from formal systems such as social services organization, and courts and the
support gained from informal systems such as kinship networks, friends, social clubs, and
religious organizations in their environment. And finally, at the meso- and macrosystem
levels, as clinical sociologists work with troubled families they must promote within our
society the needed changes in services patterns that often require policy action at the service
delivery level (mesosystem) and/or within the broader community of policymakers (macro-
system) to enhance the capabilities of families to sustain a state of homeostasis using
community resources (Rothman & Sager, 1998).

Case Assessment: Family-Focused Intervention

The following case assessment delineates the application of a systems framework for
assessing family functioning in clinical sociology.

Case of the Larson Family

Family System. Bill Larson, father, age 38; his children: Nelson Larson, son, age 15, and
Cara Larson, daughter, age 13; and Erica Smiths, Bill's fiancee, age 35.

Presenting Problem. Disruptive behavior of Cara Larson in the family and school.

Assessment. Mr. Bill Larson, a divorced single parent, has within the last year been
awarded custody by the court of his teenage children, Nelson (son) and Cara (daughter). He
sought help with his daughter's disruptive behavior at school and in the family from a family
services agency. Mr. Larson was engaged in a 2-year custody battle against his ex-wife,
Cheryl, the children's mother. Cheryl's custody of her children was terminated during the
custody case. The court found her unfit to be the custodial parent because she left the children
unsupervised while traveling with her numerous male friends. Bill's divorce from Cheryl, 3
years ago, was a result of several affairs she had while they were married.
Currently, Bill is engaged to Erica whom he has been dating for a year and a half. Erica
does not reside in the home with Bill and his children. Both adults agreed that Bill needed to
work on his relationship with his children now that he had custody of Nelson and Cara. Cara is
angry with her father for turning against her mother (Cheryl) and is saddened because she
cannot see her mother without her father being present. Cara disrespects her father, Erica, and
WORK WITH FAMILIES 127

the teachers in her school, and she is always arguing with her brother, Nelson. Bill has not been
able to reason with Cara about her behavior, because of his inability to communicate with his
daughter about her mother.
Nelson's actions are those of a parentified child (a child who assumes parental roles and
responsibilities as afforded to him or her). Nelson exercises inappropriate power within the
family in regard to the decisions he makes and the responsibility he takes. He interacts with
his sister, not like a brother, but as her parent. Nelson aligns himself with his father, especially
when it comes to his mother. His interactions with Erica are cordial because of his father's
relationship with her.
Bill has attended numerous school conferences regarding Cara's disruptive behavior and
poor school performance. Nelson's teacher reports that he is doing extremely well in his
classes and is not a conduct problem in the classroom, but has noticed that his relationships
with his classmates are poor because he acts more like their parent than a peer. Bill identifies
the problem in the family to be Cara's behavior and sees his son as just growing into manhood.
Nelson views his classmates as immature and silly, and feels they need to grow up and take
responsibility. He feels that his sister does not understand the things their mother did to their
father and them. Erica attempts to interact with both children, but is verbally abused by Cara,
and understands that Nelson is only being pleasant because of her relationship with Bill.
Bill and Erica's relationship is strained, and as an engaged couple they are having difficulties
viewing their future due to the problems with Cara.
The Larson family is in a state of disequilibrium. The presenting problem in this family is
Cara's disruptive behavior at school and home. Cara's behavior is a symptom that denotes
organizational difficulties within the family system (microsystem) and that also involves the
school system (mesosystem). The functioning of the family structure, subsystems, alignments,
power, and coalitions represents an imbalance in the family homeostasis in terms of the
following: (I) dysfunctional subsystems-parental and sibling subsystems that have impacted
interactional patterns within the family and school systems, (2) an inappropriate alignment
within the family structure that created a triangulation, (3) misplaced authority and responsi-
bility that have created a power alignment, and (4) a detouring coalition among family
members.
Specifically, the family demonstrates inadequate problem-solving abilities to resolve the
issues in the family (microsystem) and school (mesosystem) that are rooted in the disruption of
the spousal and parental subsystems-Bill (custodial father) and Cheryl (ex-wife); impending
new spousal and parental subsystem-Bill and Erica (fiancee); triangulation-Bill and
Nelson (teenage son); detouring coalition-between Bill, Nelson, and Cara (teenage daugh-
ter) with Cara being seen as the problem; and the conflicting parentified role of Nelson in
exhibiting inappropriate power interactional patterns within the family, especially with his
sister, and also his peers. The intervention plan to be implemented for the Larson family using
a family-focused intervention approach will involve changing interactional patterns within the
family structure to regain a healthy state of homeostasis. Through family sessions, the
intervention will focus on the adoption of problem-solving abilities for the Larson family to
help them successfully manage and adapt to the current life cycle changes within their family
system, and how to approach changes in the future that impact both the family and other social
systems.

Hypotheses.
• HI-The establishment of new family interactional patterns will appropriately
strengthen family homeostasis, structure, subsystems, alignments, power, and coalitions.
128 ANTOINETTE COLEMAN

• H2-The establishment of new family interactional patterns will appropriately

strengthen family member interpersonal relationships with the school system.
These hypotheses formulated from the assessment of the interactional sequences in the Larson
family are used to develop and implement the intervention plan.

Intervention. The following interactional patterns must be addressed through clinical

intervention in the family and school systems as agreed on by the family members and
clinician:
1. The family members must work toward recovery, through changing interactional
patterns, from the loss of the old family structure that involved the biological mother.
2. New interactional patterns between parent Bill, Nelson, and Cara must be created.
3. Bill, Nelson, and Cara must work toward interactional patterns that include Erica as a
potentially new member of the new family structure.
4. Bill and Erica must work toward interactional patterns that denote their future.
5. Erica must work to establish interactional patterns for relating to Cara and Nelson
that are healthy for her as well as the children, and not just based on her relationship
with their father.
6. Functional interaction patterns must be worked on between Cara and Bill to resolve
Cara's anger regarding not being able to interact with her mother without feeling
intruded on by her father, and for Cara and her father to be able to interact to help her
not displace her anger about the loss of her mother in the family structure onto her
school performance.
7. Work toward helping Nelson reestablish a healthy interpersonal relationship with his
biological mother to enable him to regain a sense of being a son and not a parent.
8. Help Nelson to develop new interactional patterns within the family structure as a
son and brother not as parent, through eliminating the triangulation alignment, and
detouring coalition between him and his father toward his sister.
9. Help Nelson develop appropriate interactional patterns with his peers through elim-
inating his position of power within the family structure.
10. Involve Cara's teachers and school counselor in helping her establish interactional
patterns to return to her prior good level of academic performance and interactions
with teachers and classmates as she adjusts to the changes in her family.
These areas for intervention will be undertaken by the clinician using the therapeutic tech-
niques of joining and accommodating, enactment, and reframing and relabeling, as well as the
incorporation of intervention with system external to the family system. The intervention
would be most effective under the conditions of (1) family members are in agreement that the
areas identified in the family structures that require work will accomplish the changes they
wish to achieve, (2) cooperation by all family members to participate in family sessions is
necessary, and (3) all members will attend the scheduled family sessions as a family group to
work toward change as a family system.

Evaluation. Family members (Bill, Erica, Nelson, and Cara) will provide afamily self-
report during a month follow-up session after weekly sessions have been ended. The family
self-report will include a record of the interpersonal relationships that have occurred among
family members, peers, and the school within a I-month period, inclusive of the conflicts that
occurred and how they were solved.
WORK WITH FAMILIES 129

The clinician will observe the family interactional patterns during the follow-up sessions.
The focus for the clinician is to determine how well the family members are adapting to new
interactional patterns within the family structure, as they work toward maintaining a state of
homeostasis.
The clinician will also determine how well family members are managing interpersonal
relationships in the school system. The specific interpersonal relationships to assess in follow-
up are (1) Cara and her teachers and classmates, (2) Nelson and his classmates, and (3) Bill and
his rapport with the school to understand for himself, as well as for his children, their
interactional pattern with teachers, classmates, and other peer group members in the school
setting.
Evaluative outcomes would be measured for the Larson family, focusing on their prog-
ress to meet the established intervention goals, 1 month after their last therapeutic session. The
clinician continuation or termination with the Larson family would be based on how well the
members are adopting interactional patterns to maintain family homeostasis during the follow-
up evaluations.

STRENGTHS AND WEAKNESS OF THE SYSTEMS APPROACH

The family systems approach provides clinical sociologists working with families a solid
foundation for applying theoretical frameworks and sociological theories that primarily ad-
dress human interactions from the perspectives of the system of origin and other environmen-
tal systems. This approach involves the use of multisystem clinical intervention that brings
about new experiences, insights, and understanding among family members to restructure
their transactional patterns, to be able to function within the family system and with other
external systems. The unique qualities of the systems approach are that it involves all members
of the family system and can include other systems (e.g., school, job, social agencies) that
influence the problem/situation confronting the family.
The systems approach as used in a therapeutic modality challenges the family members to
look beyond the symptoms they associate with the identified patient (family member), and to
begin to view all members' behaviors, including their own, within the context of the family
structure and the larger environmental systems. This therapeutic approach forces the family to
examine its covert rules that govern the transactional patterns operating between family
members and what the influences are for such rules (e.g., culture, ethnicity, race). Family
members have the opportunity to determine how functional or dysfunctional their interaction
patterns are, given the family's life cycle changes that may be internally and/or externally
induced. Family members can also determine how well these rules support them within the
family system as well as in their interactions with other systems.
From a sociological perspective that stresses the interplay among all levels of systems,
the clinical sociologist has the ability to offer the family leadership, direction, and encourage-
ment to examine and discard rigid structures that are no longer functional, without anyone
member being the scapegoat for the problems/situations. For example, changes in the relative
positions within the family may need altering such that husband and wife become closer, and
more distance is placed between the mother and son dyad, with the son being directed to
engage in healthy sibling and peer relationships. While the son may have been identified as the
problem, because of his fighting and excessive absences from school, the systems approach
allows the clinician to treat the entire family system in regard to their transactional patterns
that denoted a state of imbalance in the family structure. Redefining the family system and its
130 ANTOINETTE COLEMAN

interpersonal relationships to examine issues within the family (e.g., subsystems, alignments,
parental authority, coalitions) as well as those world-view experiences is a strength of this
approach. Essentially, the work that is done with troubled families using the systems approach
has its merits, as our social environment becomes so systemically complex. Clinical outcome
research studies conducted by Szapocznik et al. (1991), Tolan and McKay (1996), and Braziel
(1996) on family structure, functioning, development, and conflict resolution within the family
system and the influences of external environmental systems found that family systems
intervention approaches grounded in the ecological perspective-i.e., family-focused, family-
based, in-home services-demonstrated higher success with families than individualized
intervention approaches. It is critical to acknowledge and explore systemically those conflicts
that arise from alignments and coalitions embedded in the family systems and other social
systems with whom family members interact. Through such therapeutic processes using the
systems approach family members are able to eliminate dysfunctional behaviors and begin to
maintain a state of homeostasis within the family and larger environment, even as they
confront life cycle changes.
Because the family systems approach focuses on the wholeness of systems and becomes
so multifaceted in scope, it becomes quite intense for the clinician to ensure all parts of the
family are addressed. Therefore, the clinician must remain focused on the sequence of
transactional patterns of the family and assess very thoroughly those transactions and not
become overwhelmed by the dynamics that the family systems approach offers for analysis.
Day and Bazemore (1995) stated that family-focused intervention with families involved with
the juvenile justice systems and social services organization necessitates that the clinicians
must remain grounded in assessing the transactional patterns of the family and interactions
with other systems in the larger environment relevant to the family, such as schools and
church.
McGoldrick (1998) stated that the systems approach is an extremely useful framework for
work with family; however, as families and society become more diverse, the systems
approach is quite scant in addressing the multidimensional aspects of culture, ethnicity, and
race. The family systems approach is limited in its acknowledgment of these factors within
systems. But the challenges that these factors possess for most systems, particularly family
systems, are more far-reaching than just the level of acknowledgment. For McGoldrick (1998),
the mere nature of the family's cultural, ethnic, or racial backgrounds is a critical determinant
of the healthy or unhealthy state of families and their interdependent relationship with other
social systems in their environment. Fundamentally, on all systems levels, culture, ethnicity,
and race become pivotal considerations for understanding the family system as a human group
and the influences that political, religious, educational, health, human services, and commu-
nity systems, just to name a few, have on family functioning. Essentially, while the systems
approach provides a strong operational framework for working with families, the solid
integration and exploration of culture, ethnicity, and race are necessary.

SUMMARY

Working with families from a family systems approach is pertinent to clinical sociology.
It affords a humanistic perspective to assess and intervene with troubled families. Critical
attention is given to the interplay between the family system (microsystem) and other environ-
mental systems (meso- and macrosystems). The systems approach facilitates redefining prob-
WORK WITH FAMILIES 131

lem behaviors within the family system and its influential external social systems. Finally it
enables clinical sociologists to be guided by the empirical methods of (1) thorough gathering
of data during the assessment phase, (2) identification of the problem(s), (3) hypothesis
construction and testing, (4) intervention planning and implementation, and (5) evaluation of
the outcomes of the intervention administered.

REFERENCES

Bacari, A. (1999). The reaction of the family system to rapid therapeutic change in one of its members. American
Journal of Psychotherapy, 105-1\5.
Biddle, B. J. (1979). Role theory: Expectations, identifies, and behavior. New York: Academic Press.
Braziel, D. (Ed.). (1996). Family focused practice in out of home care. Washington, DC: CWLA Press.
Bribitzer, M. P., & Verdieck, M. J. (1988). Home-based, family centered intervention: Evaluation of a foster care
prevention program. Child Welfare, 37, 255-266.
Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press.
Bruhn, J. G., & Rebach, H. M. (Eds.). (1996) Clinical sociology: An agenda for action. New York: Plenum Press.
Colapinto, J. (1991). Structure family therapy. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook offamily therapy
(Vo\. 2, pp. 417-443). New York: Guilford Press.
Cox, H. (1994). Presidential Address, Society for Applied Sociology: The sociologist as an activist. The Journal of
Applied Sociology, 10, 1-24.
Day, S., & Bazemore, G. (1995). The return to family intervention in youth services: A juvenile justice case study.
Journal of Sociology and Social Welfare, 22(3), 25-50.
DeMarsh, J. P., & Kumpfer, K. L. (1986). Family-oriented intervention for the prevention of chemical dependency
in children and adolescents. In S. Griswold-Ezekoye, K. L. Kumpfer, & W. Bukoski (Eds.), Childhood and
chemical abuse: Prevention and intervention (pp. 1\7-151). New York: Haworth.
Fraser, M. W., Hawkins, J. D., & Howard, M. O. (1988). Parenting training for delinquency prevention: Child and
youth services. New York: Haworth.
Goldenberg, I., & Goldenberg, H. (1996). Family therapy: An overview (4th ed.). Belmont, CA: Brooks/Cole.
Green, J. W. (1999). Cultural awareness in the human services: A multi-ethnic approach (3rd ed.). Boston: Allyn &
Bacon.
Hanna, S. M., & Brown, J. H. (1999). The practice offamily therapy: Key elements across models (2nd ed.). Bel-
mont, CA: Brooks/Cole-Wadsworth.
Harrison, R. S., Boyle, S. W., & Farley, O. W. (1999). Evaluating the outcomes of family-based intervention for
troubled children. A pretest-postlest study. Research on Social Work Practice, 9(6), 640-654.
Kaplan, L., & Girard, 1. L. (1994). Strengthening high-risk families. New York: Lexington Books.
Kumabe, K. T., Kishida, C., & Hepworth, D. H. (1985). Bridging ethnocultural diversity in social work and health.
Honolulu: University of Hawaii School of Social Work.
Lane, M. (1970). Introduction to structuralism. New York: Basic Books.
Leashore, B. R. (1995). African American overview. In Encyclopedia of social work (19th ed., Vol. 1, p. 1\2).
Washington, DC: NASW Press.
McAdoo, H. P. (1999) Family ethnicity: Strength in diversity (2nd ed.). Thousand Oaks, CA: Sage.
McGoldrick, M. (Ed.). (1998). Re-visioningfamily therapy: Race, culture, and gender in clinical practice. New York:
Guilford Press.
McGoldrick, M., Giordano, J., & Pearce, J. (Eds.). (1999). Ethnicity andfamily therapy (2nd ed.). New York: Guilford
Press.
Minuchin, S. (1974). Families andfamily therapy. Cambridge, MA: Harvard University Press.
Minuchin, S. (1984). Family kaleidoscope. Cambridge, MA: Harvard University Press
Minuchin, S., Rosman, B. L., & Baker, L. (1978). Psychosomatic families: Anorexia nervosa in context. Cambridge,
MA: Harvard University Press.
Pinkston, E. M., & Linsk, N. L. (1984). Behavioral family intervention with the impaired elderly. The Gerontologist,
24(6), 576-583.
Rebach, H. M., & Bruhn, J. G. (Eds.). (1991). Handbook of clinical sociology. New York: Plenum Press.
132 ANTOnffiTTECOLEMAN

Rothman, J., & Sager, J. S. (1998). Case l1umagement: Integrating individual and community practice (2nd ed.).
Boston: Allyn & Bacon.
Swan, L. A. (1994). The practice of clinical sociology and sociotherapy. Rochester, VT: Schenkman Books.
Szapocznik, J. (1991). Assessing change in family functioning as a result of treatment: The structural family systems
rating scale (SFSR). Journal of Marital and Family Therapy, 17(3), 295-310.
Tolan, P. H., & McKay, M. M. (1996). Preventing serious antisocial behavior in inner-city children. Family Relations,
45, 148-155.
Wasik, B. H., Bryant, D. M., & Lyons, C. M. (1990). Home visiting: Procedure for helpingfamities. Thousand Oaks,
CA: Sage.
 CHAPTER 8

Group Work
L. JAY BISHOP

INTRODUCTION

The purpose of this chapter is to provide information on the basic components of groups, how
they work, and how group workers may be able to make them work better. This chapter will
provide an overview of how to work with groups. It will assist the reader in starting and
developing group skills. It will also give information on how to lead and terminate a group.

GROUP WORK

Not every collection of people constitutes a group. A group is a small, face-to-face

collection of people who interact to accomplish a purpose (Brown, 1991). A small group is
defined as two or more individuals who pursue common goals, are interdependent, interact
with each other, share norms concerning matters of common interest and participate in a
system of interlocking roles, influence each other, find the group rewarding, and define
themselves and are defined by others as belonging to the group (Johnson & Johnson, 1997).
Primary groups are groups that are characterized by face-to-face interaction, interdepen-
dency, and strong group identification such as families and very close friends. Group structure
is a stable pattern of interaction among group members. It develops whenever two or more
persons join together to achieve a goal. Group norms develop in all groups and are a form of
social control over individual behaviors and expectations of work within the group. They
enable groups to act in an orderly manner (Toseland & Rivas, 1998). They are shared
expectations and beliefs about acceptable ways of acting in the group situation. Norms change
and develop as the group itself develops.
Another type of group is theformed group. This differs from the natural group, which is
one that forms spontaneously, is based on friendship, and is without sponsorship. Formed
groups are ones in which an outside influence has convened it for a purpose (e.g., counseling,
committee work, academic classes). Participants in a formed group mayor may not have the
option of attending, such as inmates in a prison or patients in an alcohol treatment center. The

L. JAY BISHOP· Department of Social Science, University of Maryland Eastern Shore, Princess Anne, Maryland
21853.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

133
134 L. JAY BISHOP

different types of formed groups are for education, growth, mutual sharing, remedial. and task
work (Reid. 1997).
Within the group itself, issues occur around role conflicts, status, and power (Johnson &
Johnson, 1997). Role conflicts occur when different people within the group have different and
conflictual expectations of the obligations of a person's role behavior. One's status is a
function of the degree to which an individual has power and authority within the group. High-
status individuals generally have more dominance in the group's process and more influence
on the outcomes of decision-making within the group.
Using groups in decision-making is beneficial because of the added resources and
motivations brought to the decision-making process by the members. The interaction among
the members also increases the likelihood that someone will come up with a higher quality
decision because of the dynamics of being able to build on others' ideas in an open forum. The
group process also gives members a chance of identifying the negative consequences of
various alternatives that an individual acting alone may miss (Zastrow, 1999).
Groups are not always the best way in which to make decisions. Problems that are more
appropriate for individuals to perform without using a group process are (1) when a decision
has to be made quickly and there is no time to bring a group together. (2) when decisions are
not extremely important and the decision-maker follows the precedents set by the group, and
(3) when the decisions are not vitally important and do not require a lot of commitment from
the group (Zastrow. 1999).
Group work is a series of actions carried out by the clinical worker during the life of a group.
It entails deliberate intervention strategies used during the developmental life of a group.
Groups provide the means by which an individual can learn acceptable norms, can learn to
sustain close interpersonal relationships, and can learn to participate in broader social systems.
Group work is used to help individuals. families, groups, and organizations work more
effectively in achieving their goals and to improve the functioning among group members.
Group work is goal-directed activity with small treatment and task groups aimed at meeting
socioemotional needs and accomplishing tasks. Worker activity is directed both at individuals
and at the group as a whole within a system's context (Toseland & Rivas, 1998). Group work is
goal-directed in that it is planned activity undertaken by the clinical worker to assist members
in a thoughtful and structured process.
Group work may be used to assist people who need social support in order to pursue
educational or employment opportunities. Group work is appropriate in helping members
acquire more appropriate social skills and to support their personal growth. It continues to be
the intervention of choice for many therapists to help individuals resolve personal problems,
relieve emotional pain, or achieve goals.

TYPES OF GROUPS

Groups encountered in practice settings are often classified according to their primary
purpose. The principal types of groups are used for treatment, education, growth, therapy, and
socialization. Treatment groups are established for support, education. growth, therapy, and
socialization (Toseland & Rivas. 1998). Support groups may be used in therapeutic settings.
Support groups help members deal with stressful situations they may be experiencing. For
example, the use of AIDS support groups has increased. These groups are comprised of mem-
bers who are HIV positive. that is, infected with the virus that causes AIDS. Members of these
groups usually meet on a weekly basis, share ideas about coping with the illnesses that they are
GROUP WORK 135

susceptible to, discuss the multiple problems associated with the dizzying array of medications
they must take, and share emotional support with the multiple losses they encounter. A
problem that many AIDS organizations have is dealing with the diversity of individuals who
have AIDS. The recent increase in the numbers of African-American males and females with
AIDS has caused considerable discomfort for the AIDS organizations that were only accus-
tomed to providing services to white gay males. Even though many traditional AIDS organiza-
tions have made efforts to address this problem, many African-American and other racial and
heterosexual groups do not feel they belong. Efforts must be made in any group setting where
there are issues relating to differences among the consumers to offer each group its own
support services. The stress caused by being HIV/AIDS positive does not seem to be enough to
cross the racial and cultural divides of some individuals. In one recent situation, a community-
based organization lost its state funding because it was principally serving the white gay
community that created it and not the African-American community, even though there were
more HIV/AIDS positive persons in the local African-American population. Shortly after
losing the state funding, the organization closed. Because it operated in a semirural area, there
are now no providers of support services to any of the HIV/AIDS-positive population.
In dealing with HIV/AIDS infected persons, another concern involves having people in
the group who are in various stages of the disease. Members who are newly diagnosed can
learn a plethora of information from others who have had the disease for some time. Also,
those who are in more advanced stages of the disease can offer their support and share their
experiences with the newly diagnosed (Barouh, 1992). Finally, the group leader needs to
reflect the group itself as much as is possible. Due to the sensitive and personal issues involved
with living with HIV/AIDS, it is highly recommended that the group leader reflect the group as
to gender, race, and sexual orientation.
Education groups assist members to learn new skills or gain knowledge. The goal of the
group is acquiring information and the process of obtaining the information is also important.
Group discussion is often used along with presentations and information sharing. An example
of education groups are the English as a Second Language (ESL) groups that have formed in
many cities and towns. Group members are often new to the country and English is a foreign
language to them. In order to learn English, they sponsor many social activities that allow them
to interact in a safe and comfortable environment and to learn and practice their English-
speaking skills.
Growth groups focus on helping members realize their potential. Self-improvement is
often obtained through members' self-disclosure and the feedback they receive. Since partici-
pants are seeking some type of cognitive or behavioral change, members will utilize the
interactions with other members to increase their interpersonal skills. Growth groups can have
as their goal consciousness raising, improvement of parent-child relationships, marriage
enhancement, and encounter group activities. The underlying leadership in this type of group
may consist of a group worker who starts the group but eventually the members will take the
role of leadership and share it.
A recent form of growth groups has been the advent of parent effectiveness groups in
some schools and agencies. Due to recent legislation and concerns about violence in the
schools, programs have been established to assist parents and their adolescent children to
communicate better and to lessen the stressful atmosphere in some homes. The leader in these
groups starts with a more directive approach in helping the parents and children to learn to deal
with the psychological, physical, and relationship issues faced by adolescents. As the group
matures, the parents and children are encouraged to take more responsibility in reading books
and articles and bringing personal issues to the group for discussion.
136 L. JAY BISHOP

Therapy groups are often the only types of groups that most people think of when con-
sidering the topic of groups. Therapeutic groups focus on improving the life course of
members and improving their daily functioning. Leadership here usually is in the traditional
model of the expert therapist running the group and the group members following along.
Socialization groups assist members in learning better interaction skills in the group in
order for them to be able to use these same skills in their daily lives. Often these groups will
use simulations, games, or role-plays to learn and practice the needed skills. Socialization
groups may run the gamut from assertiveness training groups to recreational groups. Using
peer educators or peer counselors with teenagers is a form of the socialization group. As
teenagers are highly influenced by their peers, using peer educators in group settings is ideal.
Youth can learn refusal skills in dealing with alcohol abuse, drug abuse, date rape, and HIV
prevention. The group leader can use role-plays and simulations to help engage the teenagers
directly in learning skills to avoid problems around these issues.
Groups are mostly conducted to deal with common issues or problems. The purpose of
the group may change from time to time. For example, initially, a group may provide informa-
tion and skills training to its members but later change to a support sgroup, which promotes
maintenance of the newly acquired behaviors. Using a group is a way to provide a system of
interventions to its members. Groups can introduce and reinforce appropriate behavior change
through modeling and support using various activities. Alcoholics Anonymous is famous for
its modeling program. By having new enrollees meet with a mentor who is a role model, the
new member can observe someone who has struggled with the problem of addiction and
successfully overcome the problem on a daily basis. The mentor also is a bedrock of support
for the new member when troubles occur and temptation ensues (van Wormer, 1999).
Some groups are open-ended groups where members can join and leave anytime. Other
groups are closed-ended where the same members meet together over a certain period of time
and would-be new members are not allowed entry. Generally, open-ended groups are useful
where there is the need or expectation of having new ideas and energy brought into the group
on a continuous basis. Allowing entrance of new members can also be useful to replace
members who no longer attend, for whatever reason. After a new member joins the group, that
person will learn the norms of the group or be ostracized by the more senior group members. A
problem with open-ended groups is that it is difficult for people to develop a strong sense of
trust for each other (Zastrow, 1997). Due to this ebb and flow of people at group meetings, one
would not try to bring about any major behavior or attitude change among the members of an
open-ended group.
All groups, whether closed or open ended, should have clearly defined goals and objec-
tives and clearly defined processes. Though closed groups are more structured, the structure of
a group should be based on the needs of the members. The closed-ended group will also
promote and facilitate trust among the group members because of constant interaction of the
same members with each other. It has the capacity to be a source of support for members. The
presence of each member provides security to all members. The closed group is useful in the
formation of specific outcome objectives. An example would be the decrease of certain
observable behaviors, such as negative criticisms of others or a lack of sensitivity to the needs
of others (Gitterman & Schulman, 1994).
Either open or closed groups can be used for problem solving where an issue or an event
is the focus of the group. Groups can also be used in enhancing self-esteem: In this type of
group, the leader pays more attention to the group member's strengths. The reason for the
emphasis on individual strength is to help them gain or regain self-confidence and to empha-
size the positive aspects of their lives rather than the negative. Sometimes there is the need for
GROUP WORK 137

a single-session, closed-ended group. A good example of this type of group is called a focus
group.

FOCUS GROUPS

Group interviewing is a method that can be used to conduct qualitative research. It is

typically a way to test new concepts, products, or messages in businesses, but can also be used
in other areas, such as human services (Edmunds, 1999). Focus groups can be used in human
services to conduct needs assessments and perform program evaluations. One needs assess-
ment for a state AIDS administration involved seven focus groups in five geographic regions.
Each focus group represented different interests and demographics of the state's population.
Based on the cumulative results of the focus group needs assessment, the state was able to
develop a better planning process for the consumers of AIDS prevention services (Bishop,
1997).
Generally, a focus group will consist of eight to ten individuals who were recruited to
represent the target population of consumers (Edmunds, 1999). Focus groups bring the
members of the group into face-to face interaction with the group worker who has previously
developed an interview guide. The informal nature of the group allows participants to interact
and discuss their perceptions and attitudes toward the product or message being investigated.
Focus groups are most useful when testing concepts that are new, to assist in the development
of more quantitative questionnaires, to generate ideas through brainstorming, or to assess the
appeal of a service or message to the potential consumers. Focus groups are least useful in
exploring sensitive or personal topics, to save money or time in lieu of more quantitative
research, or to assist an administration in making the final decision regarding a product or
message.
Since the atmosphere of a focus group session can be somewhat freewheeling and
tumultuous, it is imperative that the group worker plan for structure prior to the meeting. The
worker will also need to set the research objectives for the meeting. The research objectives are
developed around a common theme (Edmunds, 1999). Based on the objectives for the meeting,
the worker will need to develop a recruiting profile. The target population for the focus group
will be those who can best answer the questions derived from the objectives for the focus
group meeting. Therefore, planning for the first meeting involves carefully recruiting the
potential members for the meeting. The group worker will interview each potential participant
over the phone to assess the appropriateness of that person for the group. It is advisable to
overrecruit for the sessions to allow for no-shows. Participants are usually provided with some
type of compensation for participation. It is common to compensate participants to cover their
mileage, childcare costs, time, and the like (Edmunds, 1999). If allowable by the budget,
members are given between $25 and $100 to participate, depending on the length of the group
meeting and local standards. If the agency does not have funds, other items may be given, such
as coffee mugs, T-shirts, or coupons for services or products provided by local businesses or
agencies.
The number of sessions appropriate for the theme also has to be determined prior to the
first meeting. Generally, any research objective needs at least two meetings with two different
groups who represent the same target population. Interviewing multiple groups allows for
comparisons between the groups. The group sessions also need to be held in a timely manner
and as close together as possible. The passage of time can contaminate the findings and render
the information from the groups useless.
138 L. JAY BISHOP

After participants have been recruited, the worker must also obtain a place or places to
conduct the meetings. Accessibility for the participants is an important factor to be considered
in selection of a site. Other concerns involve privacy, comfort, and having a room where chairs
can be arranged in an open format, generally in a circle. The group worker usually has another
person on-site to arrange for the amenities that are needed for such a session. Food and
beverages must be easily available, so that participants can snack and talk in the same room.
The assistant may also be the recorder for the session.
The group worker will be following a carefully prepared discussion guide that includes
specific questions that need to be covered in the session. The interview guide should include
only open-ended questions to elicit the widest range of opinions and attitudes from the
participants. Where needed, the group worker can use closed-ended questions to elicit more
details and to narrow the discussion to several key points. A cautionary note is to plan carefully
to have enough questions to cover the topic for discussion, but to not be rigid about rushing to
get all of the questions discussed if time is limited. A good rule is to allow 10 minutes of
discussion per open-ended question. The objectives of the focus group can simply be rewritten
as open-ended questions and the group worker can use more targeted follow-up questions to
allow for in-depth discussions. It is important that the group worker keep the participants on
topic and have all the questions covered in the 90 to 120 minutes allowed for the session.
The interview guide should take into consideration the needs of participants to have time
for psychological breaks after an in-depth discussion. Often the in-depth discussion will elicit
strong emotions and the participants will need time to talk informally for up to 5 minutes
before continuing on to the next question and topic. The astute group worker will plan for these
short decompression sessions, as the participants will generally take them anyway. It is
important that the group worker note who is talking on each question and to obtain comments
from all present.
Even though most focus group sessions are audio and/or video recorded, the written notes
taken by another person can provide the needed context to bring the transcribed text to life. It is
also a good idea to have two electronic recording systems taping the sessions in the event one
malfunctions. It is crucial that the devices be tested prior to the session and that the operator
has experience with each device. This will avoid the frustration of having a revealing session
lost by 90 minutes of static on a blank tape. Finally, the group worker will need time after the
session to record insights, attitudes among members, and provide the setting for further
analysis of the transcribed text.
After the sessions have ended, the worker will analyze the notes that were made and
review the transcriptions for general themes. He or she will want to include in the analysis
direct quotes from participants to the meetings. The analysis should be detailed enough so that
the objectives are discussed in detail and the conclusion should be useful by summarizing the
results of the sessions.
The role of the leader in the focus group becomes very important, even though the
leader's skills are not apparent often to the group members. Groups can be useful in providing
this interpersonal skill training needed by group leaders.

REvmw OF THE LITERATURE

Empirical studies support the effectiveness of using groups for treatment. Toseland and
Siporin (1986) found in a review of well-designed studies that group treatment was more
effective than individual treatment in 25% of the studies that were reviewed. Individual
GROUP WORK 139

treatment was not found to be more effective than group treatment in any of the studies
reviewed. Group work has also been found to produce fewer dropouts from treatment than
individual therapy. Group work is most effective in situations where there is a need for enhanc-
ing social support but less effective in helping people with severe psychological problems
(Toseland et ai., 1990). Other literature reviews on group work have shown that group work in
general is as effective as individual treatment with persons who are not too severely limited
(Fuhriman & Burlingame, 1994).

GETTING STARTED

Planning and Preparation

Among the different models used in beginning the planning process of group work, one
that is generally used deals with the following: establishing the group's purpose, assessing the
potential sponsorship and membership of the group, recruiting members, composing the
group, orienting members to the group, contracting, preparing the group's environment, secur-
ing financial arrangements, and preparing a written group proposal. Establishing the group's
purpose refers to developing the overall goal of the group. The planners need to consider what
are the unmet needs of the target population from which members will be recruited. Potential
members may be asked for input in the planning process. Consideration must be given to who
thinks the problem exists and why they think that creating a group can solve it. The planners
must determine who generated the original question or concern to start the group-the clients,
the agency personnel, or community organizations.
Since many group work activities are agency sponsored, the planners must consider what
agency will be primarily responsible for developing the group and seeing it through to
termination. It is important here to be certain that the sponsoring agency will actually support
the needs of the group and that the group's goal fits easily into the mission of the agency. Also,
the group worker will need to determine what type of assessment of members will be used.
Here the planner is considering what type of persons may be included in the group. This aspect
will lead naturally into actually recruiting members.
Based on the type of group decided on, potential members may be recruited from agency
rolls, come from community organizations or businesses, or other related agencies. Direct
contact with potential members has been shown to be the best method for gaining the coopera-
tion of the members to attend the group sessions. Once an adequate number of potential
members have been obtained, the planner needs to compose the group. This is also considered
the assessment phase of the group. The group worker will have prepared an assessment tool,
which will be used to screen potential group members. Each candidate will be measured
against the standards established by the group worker for inclusion in the group.
After the members have been assessed, they need to be oriented to the group. This group
orientation usually consists of defining to the potential members exactly what the expectations
are, providing pregroup training in communication skills and acceptable group member
behavior, and completing the appropriate intake process for the agency.
During the beginning stage of the group, the group worker also develops a preliminary
contract for the group to consider. The final contract is negotiated with all group members
during the initial session. The contract may be written or oral. The contract includes rules that
are acceptable to all members. Generally, the contract should include the number of meetings,
the length of sessions, agreed-on rules of confidentiality, the attendance requirements, and the
140 L. JAY BISHOP

fees, as well as specific points relevant to the specific group context. Frequently a written
contract with each member will be agreed to and signed by the members and the group worker.
It will specify what the member will agree to and how the group work will assist the member in
achieving the established goals.
Preparing the environment deals both with ensuring that the room is physically accept-
able, and includes consideration of the time of day, noise, interference, and a barrier-free
setting for the physically challenged. Due to the needs and time constraints of group members
and the availability of inexpensive space, sometimes the arrangements are less than optimal.
Another consideration in the planning process is the overall financial support for the group. In
treatment groups, fees for service are standard, but in other situations there may be the need to
obtain funding or charge fees to the clients in order to secure adequate meeting space. Finally,
an agency-sanctioned group often requires a written proposal. Detailed answers to the points
established here would assist in preparation of the final proposal for the group to then move
onto the implementation stage.

GROUP DYNAMICS AND ACTIVITIES

Group dynamics give meaning to the group activities and the direction of the group work.
Group dynamics help leaders and group members to know what is happening in groups,
whether unconsciously or consciously. The conscious activities are the stated needs of the
various members, the stated goals and objectives of the group as a whole, and the plans made
by the group to achieve the goals. The unconscious activities deal with the unstated needs of
the members, the hidden goals and objectives of the members, and the interpersonal issues that
are not known to the members or the leader of the group. There are also forces exerted on the
group from the outside. The interaction of these forces and their aftermath determines why
groups behave as they do (Schulman, 1991).
When the group first meets, it is important for each member to get a sense of one's
territorial space. All members need time to create this territorial space and settle themselves
before they can work with the group. Each session or individual interview begins by sharing
names with all members. A name is our entrance to a person's life. Sharing names is a way of
bringing the awareness of all group members to the person mentioned. It is a simple way to
acknowledge each others' existence.
After the group first forms, there is a period when the group members will test the leader
to see how that person allows openness, honesty, and responsibility. Members will test each
other and the group leader in a variety of ways, including direct questions, listening and
observing responses to members' actions and feelings, and sometimes open challenges.

Getting Set

The leader needs to tell the members the purpose of the group and what to expect in the
group. Ground rules could include:
1. Members learning to listen and understanding what others are saying.
2. Members limit discussions to related issues.
3. Confidentiality.
4. Tell the members when the group will begin and end every week.
GROUP WORK 141

The Need for Structure and Authority

Let the group dictate the structure (someone will suggest a structure) but supervise the
direction. The leader will need to be aware of hidden agendas and attempts at power games.
When members are not included in the decision-making of the group structure, anger and open
hostility may ensue.

Periods of Silence

As the group develops there will be times when no one talks for several minutes. It is
common for the leader to want to jump in and break the silence, but it is best that the silence be
allowed to continue. This period means a lot in the life of a group and it could occur anytime.
Unseen activities that may be happening include suffering, struggling by group members
about concepts or feelings about self, or an embarrassing circumstance. Another reason could
be exhaustion leading to a melancholy type of silence and it may be a prelude to another stage
of an event in the group.

Beginning of Commitment

As the group process moves forward, members begin to share their ideas with each other.
One person's facial expression might show an eagerness to talk. The leader should invite that
member to share something with the group. The leader could start self disclosure to encourage
constructive work in the group. The speaker lays part of her- or himself on the table to see how
the group reacts.

Building Relationship

This is more formed on the responses to others' feelings and actions in a genuine and
caring way. Leaders and members should learn to respond to others with empathy and in a
nonjudgmental manner. Words like "I know how you feel, I've felt that way also" might be
used. Do not use a sympathy statement. This will not help the member, and will lead to denial;
it negates, smothers, hides, and promotes false sweetness in the fact.: of real loneliness. As the
group matures there will be periods of mask removing. This is a mark of growth in the group
and is characterized by realistic self-disclosure. Members feel safe in the group and with group
members. Members begin to tell others who they really are; this is a period of crisis and
growth. This awareness through the group experience can lead to mask removing.

LEADERSHIP

The next issue in the life of a group is the leadership issue. The focus here is on the role of
the leader as a group facilitator. Effective group leadership can improve the chances that a
group will succeed and poor leadership can limit the success of any group. Effective leadership
is vital to achievement of the purpose for which the group was formed. Brief consideration
of norms, the roles and functions of a leader, and the characteristics of a good leader can
142 L. JAY BISHOP

provide a better understanding of what participants are to be doing in a group in relationship

with the leader.
Group norms are the collective agreement on conduct or standards of behavior acceptable
to a group. Members' behaviors will be influenced by the group norms. Group uniformity is
possible if all members agree to the following conditions:
1. The members interact on an equal basis.
2. Personal interaction is maximized.
3. No member is exercising authority over the other members.
4. Competition by the members is minimized.
The leader can assist the group most if the style of leadership fits the group. The
successful leader should use power to avoid disorganization and to move the group forward
(Etzioni, 1961). By allowing the group to form its own goals, the leader may serve the group
best. Also, the leader must not dominate the group agenda and not use the group to carry out
personal ambitions. One goal of the group experience is to increase the abilities of members
eventually to operate independently of the group. The leader needs to provide ample oppor-
tunities for all members to exercise their own types of decision-making within the group itself.
Zastrow (1993) wrote that each of the leadership roles and styles differs with regard to the
formality of the functions and authority it carries. In more formal groups, the leader is
responsible for whatever happens in the group. An alternative to the above form of leadership
is to distribute the leadership role among group members. In this arrangement all members are
responsible for what happens in the group.

TYPES OF LEADERSHIP

Some of the earliest research on leadership was done for businesses and concerned how
to get the best managers. A popular theory about management was that there was a trait style of
leadership. This held that individuals were innately one type of leader, either authoritarian,
democratic, or laissez-faire. Democratic leadership was thought to increase the likelihood that
members would be allowed to reach their own goals. If the members were allowed to set their
own goals, the members' activities increased. The group that has its goals imposed on it is
most likely to be more passive. The leader becomes part of the activities that take place (the
means) through which the group is trying to achieve its objectives. This is also most effective
because of the ability of the leader to carry every member along. The members are part of any
decision made. The open interaction and the expression of attitudes, values, and feelings that
characterize the democratic group are worthy to uphold.
The group leader who is directive or authoritarian might find it difficult to achieve
cohesion in a group. However, the authoritarian leader can be seen as efficient and decisive.
Labeling any leadership style as good or bad is not useful. The reason is that a democratically
appointed leader may later become an authoritarian leader when the situation calls for the
leader to assume power. On the other hand, an authoritarian leader who is imposed on the
group might adopt a democratic system of leadership when consensus is needed. A disadvan-
tage of authoritarian leadership is that the leader's decisions might be perfunctory. This can
occur when the leader is under pressure to move the group along and does not trust the group to
make the right decision. Another shortcoming is that members might not be committed to the
decision of the leader. This might lead to factionalism, a decrease in the morale of the
members, and behind-the-scenes jockeying and maneuvering for positions among members.
GROUP WORK 143

An authoritarian leader who disciplines members when they object to decisions will not have
the support of the group. Members will focus on and complain about the leader's prejudices.
Disagreement in the group might pave the way for the need for a new leader.
Generally, democratic leadership is favored because it encourages members to openly
voice grievances that could lead to confrontation and conflicts in the group. The conflicts
include interpersonal antagonism between members, hostilities toward the leader, dissatisfac-
tions, and concern for personal advancement. The dynamics become necessary parts of
problem solving that democratic groups confront. The resolution of these issues generates
cohesion, a spirit of oneness, and commitment among the members. This problem-solving
orientation of the democratic style of leadership makes it more advantageous than the
authoritarian style. The sabotage of effort by the uncooperative member of the authoritarian
group is not present in the democratic style of leadership. In democratic leadership there is
strong commitment. This commitment encourages members to genuinely carry out the group
decisions and not to allow them to be compromised. Democratic leadership gives respect and
independence to group members. It creates a situation where the leader allows the members to
do their work without interfering. The contribution provided by democratic leadership is to
listen actively and utilize the comments and suggestions that the group members make. The
leader also assists the group to look for alternative answers to problems as necessary and
becomes loyal to the group norms and goals (Corey, 2000).

LEADERSHIP ROLE

The group function determines the role of a leader. If the group task is specific, the leader
needs to have adequate information and knowledge about the task of the group. The group
leader is also to possess adequate skills required to carry out the functions. Leaders should
proceed through a series of small successes. The leader should utilize activities that have high
rates of success to maintain the forward movement of the group. The leaders responsibilities
are to be trustworthy, to help facilitate each member's own growth and the growth of the
group, to maintain a safe environment for all members, to make sure all members are aware of
the need for confidentiality, to help silent members participate in the group by giving them
openings, and to keep the members on-task and present time focused (Corey & Corey, 1997;
zastrow, 1993).
Some authors believe that each of the leadership roles and styles mentioned above differs
in relation to the formality of the functions and authority that the roles carry. The group
leadership role varies in many ways from groups that have one person who is responsible for
whatever happens in the group. An alternative to the above form of leadership is to distribute
the leadership role among group members. In this arrangement all members are responsible for
what happens in the group (Zastrow, 1993).

FUNCTIONS OF A GROUP LEADER

A productive group is one where both individual and general goals of the group are
achieved. A successful group is also one where reasonable self-exploration takes place and
where honest and adequate feedback is given and received. Before a group can achieve
adequate feedback from members, there must be appropriate behaviors and attitude. Some
guidelines that can help to prepare group members for group membership are listed below.
144 L. JAY BISHOP

This can also enable you to develop a leadership style that is appropriate for your personality.
The guidelines are suggested leadership functions. These leadership functions involve teach-
ing members the general guidelines about active participation that will enhance constructive
group work.
1. Help members to establish trust and to know that expressing their lack of trust for the
group is acceptable.
2. Encourage members to express recurrent feelings. Discourage the use of vague words.
One way to do this is to encourage the use of "I statements." Stating clearly what "I
feel at this moment" will create this effect.
3. Self-disclosure: Members are to be informed and warned about what disclosures they
make. They have a right to know that they have control over what they disclose to the
group because there is no absolute confidentiality.
4. Members are to be active and not to play the role of an observer. Nontalkers should be
encouraged to express their feelings.
5. Members should be informed about the possible disruptions of their lives outside the
group. Participants in a therapeutic discussion group should be aware that the group
process may change their relationships with people outside the group.
6. Members should find their personal strength increase as they grow in the group.
Discovering an unidentified and unexpressed pain that had blocked them from living a
truly cheerful life might do this. Going through the painful experience in the group
may open a door for a joyful dimension to them. A creative side of oneself may be
discovered through group activities, such as crafts, songs, or poetry reading, by those
who have the opportunity to physically express themselves for the first time.
7. Members should be encouraged to listen attentively to others; they are to listen closely
to what others say and accept or disapprove of it with caution.
8. Members are to avoid labeling themselves. People who give themselves a particular
label might be fragile and use such names as a coverup (Corey & Corey, 1997).
Finally, a good leader has courage, a willingness to be a role model, cares about the members
of the group, has a belief in the group process, is open, wants others to become aware of their
own culture, is nondefensiveness in coping with attacks, is not obsessed with personal power,
has a great deal of stamina, has a willingness to seek new experiences, believes in self-
awareness, has a sense of humor, is inventive, and has a personal dedication and commitment
to the group (Corey & Corey, 1997).

GROUP LEADERSHIP TRAINING

Group leadership programs were first widely used in the 1970s. Results showed the most
successful of the programs were those that were well planned, well organized, and provided
adequate support. Research findings indicated that a more organized method of teaching
facilitators and the helping skills would result in better group interventions (Zastrow, 1999).
The results from other research showed that when some well-planned approaches of educating
leaders were used in academic areas, some improvements were recorded in the students' self-
esteem, classroom behavior, and academic achievement. More benefits were reaped because
the group leadership-training program had specific goals and objectives of training (Gitterman
& Shulman, 1986). One meaningful aspect of training group leaders is to use a program based
on practicing better listening skills. In order to teach better communications skills, it is impor-
tant for group leaders to have an understanding of group processes.
GROUP WORK 145

Group processes include:

Group Recognition of Closeness

This is a period of cohesion in the group and the spirit of oneness sets in. The feelings of
solidarity and a mutual bond of trust and caring prevail. This allows individuals to explore and
experiment with their own growth and development. The group then becomes a family unit.

Confrontation

Confrontation within the group is both good and bad. The feelings of anger are actually a
self-battle projected to the other party. This confrontation represents what we dislike and hate.
It is a personal struggle that we aim at others; a product of interaction of participants in the here
and now. Members confront each other when they are touched where it hurts. It is a way of
calling for help and for a solution to the suffering. It is a period of showing concern for
members and for oneself.

Healing the Emotional Wounds

This is a period of knitting together all the emotional pieces caused by shredded
emotions. It is the most constructive activity of the group process. At this stage, everything is
in the open. Healing is also eminent at this stage because an attempt at honesty previously
turned the group aside. A competent leader has the capacity to make the healing more
productive and efficient. Ineffective intervention at this stage may be harmful to the group.

Cohesion in the Group

There is a transcending experience because of the expression of feelings. Members are

at peace with each other; they have more awareness about self and others.

Changes in Relation to Self-Evaluation and Awareness

This will be reflected by the members' comments. A member may reveal that she or he
understands her or himself better. The group is a forum for members to evaluate oneself, and
search for the aspects of their behavior that make each of them unique.

Termination and the Effect of the Group Work

Due to the spirit of oneness and the good interpersonal relationships developed in the
group, members might wish the group work to continue. The sense of departure will create a
feeling of grief among the group members. After the group sessions, members are challenged
to practice what they learned in the group. They will be encouraged to be themselves and
reflect their new skills in their day-to-day activities (Corey, 2000).
146 L. JAY BISHOP

COUNSELING SKILLS AND THE GROUP

The group leader must also be aware of certain counseling skills that can be applied to
a group. The leader must be able to establish and maintain interpersonal relationships between
group members, assist members in examining the purpose of members' actions and behaviors,
reminding the individuals of the goals being pursued, and redirecting the flow of communi-
cations.
As the members interrelate, the leader will need to remain aware of the leader to members
communications while being aware concomitantly of the member to member relationships and
communications. The leader will be responsible for ongoing assessment of each member and
learning motives of each person's behavior (sociopsychological understanding) while skill-
fully allowing the members to share their motives with others. The typical assessment
techniques used by leaders are (1) family eco-maps, (2) relationship assessment, (3) early
recollections, and (4) use of art works or personal artistic creations. These give meaning to
one's life and are rich topics for personal insight.
The leader also points out the many layers of social connectedness within the group. By
revealing how people are communicating with each other and who communicates with whom,
the leader can allow members to see themselves as the group sees them. Such revelations assist
members in giving up wrong concepts of self, life, and dealings with others (Gitterman and
Schulman, 1986).
People have a need for acceptance and belonging, for feelings of membership with others
and for mutual aid (Glassman & Kates, 1990). The skills leaders use in the group process are
communications, relationship, and problem solving (Schulman, 1984). Schwartz (1976) devel-
oped the commonly used four phases of work: preliminary, beginning, work, and ending or
transition phases. The preliminary phase deals with the activities that a worker completes prior
to the first meeting of the group. In the beginning phase the worker deals with issues of
contracting with the members and arriving at understanding of the purpose of the group and
the norms associated with the group process. The work phase is also considered the middle
phase where the actual work of the group is done. The ending/transition phase is when the
group deals with the ending process of the group. Each phase has its own dynamics and
demands for the members and leader. Also, each group session has its own internal phases of
beginning, work, and ending/transition.

STAGES OF GROUP DEVELOPMENT

Three important things that occur in a group are the dynamics, process, and the activities
of the participants. Leaders need to have an adequate understanding of this process before
they can provide meaningful assistance in the group. These three factors apply from the initial
stage to the termination and the follow-up of the group sessions.

Preliminary Phase of Group Work

Before the first meeting of the group, the leader needs to prepare for the different
members who will be attending the meeting, their individual needs and issues, the physical
environment, concerns related to the purpose of the group, and possible taboo subjects that
the group may face. Schwartz (1977) termed this skill "tuning in." Issues the leader needs to
GROUP WORK 147

consider are how the role of leader will be carried out in this specific group, how to deal with
scapegoating among members when it occurs, and how to deal with strong emotions and
hidden agendas.
The importance of preparing for the group needs prior to the first meeting also relates to
the manner in which the leader will assist the group in developing open communications and
forming trust. Since groups have difficulty in dealing directly with strong emotions and with
taboos, they will often approach such issues in an indirect manner.
A skill used by the leader in such situations is referred to as responding directly to indirect
communications. The leader shows this skill by putting into words what the group seems to be
experiencing or feeling. The leader may notice that the members seem distant and are not
discussing the topic. The leader would point this out by a simple sentence, "Everyone seems to
be in their own thoughts; could it be that we don't feel comfortable talking about this subject at
this time?" By bringing the topic out into the open, hidden thoughts and feelings are no longer
threatening and the leader has shown how the group can accept these feelings or topics. This
creates honesty and openness in the group. Another aspect of the training process relates to the
dynamic nature of group work itself. As the group forms and develops over time, it begins to
move as a system of interacting group members. The group takes on a life of its own that the
sensitive leader will be able to utilize for the benefit of all. In systems theory this is often
termed the whole being greater than the sum of its parts.

The Beginning Phase

During the first meeting, the leader will contract with the group to set the stage for group
work to begin. The contracting process involves making members aware of the goals of the
group, the types of behaviors that are acceptable, the role the leader will play, and confiden-
tiality issues. This phase of group work is when the leader assists the group to become
responsible for the work and the concerns of the group members. The leader needs to assist the
group members to see the group as their own. The leader's role is to help the members to take
responsibility for the work of the group. Keeping the group on task is often difficult to do.
Some group members have their own personal agendas and may sidetrack the work of the
group in order to have their personal needs met. The leader can assist the group in either
assisting the member in solving the problem or in confronting the member to prevent further
distractions.
Also, some members may not be accustomed to performing in a democratic process and
will stop the work of the group. It is the leader's duty to be aware of when the group's
movement on an issue has stopped the work and to intervene. The leader will be able to point
out to the group that work has stopped and request help from the members to get things moving
again. If the leader has assisted the group in developing mutual trust and responsibility, the
group will confront the problem and cope with it.

The Work Phase

The skilled leader will be able to deal with individual needs and the needs of the group
as a whole. The necessity to serve the often conflicting demands of these "two clients" must
constantly be on the mind of the leader. It is the responsibility of the leader to assist the
members to confide personal secrets to the group and to protect the member if the group has
148 L. JAY BISHOP

difficulty in dealing with the issues. There may also be times when a member expresses strong
emotions and the rest of the group turns away from dealing with the member. It is again the
leader who needs to assist the group to take responsibility in dealing with the issues the
member has brought out into the open. The role the leader takes on in such circumstances is
that of a mediator between the two clients. Another role the leader will often assume is that of
an educator. It is common for the members to call on the leader at times to ask how they are
doing regarding their goal attainment and the group process itself. The leader can use these
opportunities to teach the group information on how group dynamics work and where they are
in the phases of group work.
The leader also takes on the role of a counselor often during the group work process.
When a member expresses very strong emotions, the leader may respond to the feelings by
saying, "You seem very angry at the group for not discussing your problem today. Can you tell
us more about that?" As the members learn to discuss sensitive issues, the leader will use
silence to allow the group members to assist each other. In this manner the group members
dominate the discussion with the leader speaking only to keep the group on target or to
encourage member-to-member communications. The leader needs to be constantly aware of
the dynamics the group is taking and to guide its direction with questions or statements. By
subtly directing the group in this manner, the group can be more efficient. The leader will also
be responsible in confronting taboos when they need to be brought to the group's attention. A
common taboo in most groups is simply not dealing with the silence of a member when a topic
is broached. By pointing out to the group that the topic appears to be causing difficulty with
various members, the taboo can now be discussed openly. A second type of taboo occurs when
the discussion circles a topic by no one is openly talking about it.
The leader will be using counseling skills to deal with the emotions expressed in the
group. Dealing with the feelings or emotions of the group is an important responsibility of the
leader. The leader will express unconditional positive regard and acceptance to all members of
the group. By modeling this positive acceptance other members will try to emulate it also. The
members perceive this sharing of feelings with the group positively and the leader is seen to be
a caring member of the group.

Ending/Transition Phase

From the first meeting of the group the leader will have contracted with the members as to
when the work of the group is to be completed. During the sessions the leader will often
remind the members that the group will end at the agreed-on time. During the final sessions the
leader becomes more assertive about the ending of the group. Members may appear to ignore
these statements because of their investment in the group and of denial that it will end.
Members may also become angry with the leader or with other members in the group as the
end approaches. In order to avoid any counterproductive situations, the leader may choose to
educate the group about the feelings and problems often encountered as a group nears its
completion. As members become aware of the impending termination of the group they often
become reenergized. This is sometimes due to the realization of some members that they have
not invested enough in the group and not benefited as they could have. They may also become
aware that the chance of gaining something significant is quickly eroding. It is fairly common
for members to express their anger and frustration during this phase by being absent, by
sabotaging the agenda, and by bringing up information or revelations that should have been
disclosed much earlier in the group process. As the end approaches the members may begin
GROUP WORK 149

talking only about their successes as a group and ignore any problems they had. They may also
hide any feelings and not want to discuss future plans. At the final session the leader reviews in
an informal manner the original contracts and facilitates a discussion of the individual and
group accomplishments. A final transition issue for the leader is to assist any members with
unresolved issues by making referrals to appropriate agencies or other sources of assistance.
Leading a group can seem at first to be a daunting endeavor. But with careful planning
prior to the first meeting, astute observations during the sessions, and honest feedback from the
members, the experience can also be extremely enriching. The group leader not only can help
to change the lives of the members of the group but can also be forever changed by the group
experience itself.

BENEFITS AND CONCERNS

The advantages of group work over individual treatment are that members realize they
are not alone with their particular problem. This allows them to be supportive of others and in
turn receive support; it permits them to see others working actively on their problems and
achieving success; it provides vicarious learning and peer feedback which cannot be obtained
in individual treatment; it allows them to participate in reality testing by engaging in role-
playing, trying out new skills, and rehearsing new behaviors in a safe social setting.
Group work also has its disadvantages. One concern with the group process itself is that it
can create member conformity and member dependency. By sharing their personal concerns
and desires, members can create an environment that will enforce a type of groupthink. In this
atmosphere group members reinforce the standards that have developed through their interac-
tions. As the group develops increased levels of trust and closeness, it is natural that members
would try to secure the feeling of closeness through mutual expectations of appropriate and
acceptable behavior. This conformity can act as a brake on further member experimentation
and risk taking. When members disclose private information to other members, they jeopard-
ize their own sense of security in that others may not accept their disclosure and also may
compromise the group confidentiality to outside persons. Another concern is that members
may become scapegoat targets of the others in the group. Nothing can be more shattering to a
member than to finally take the risk of disclosing a very private matter and then have the group
reject the member or even make the member a target of derision. A final concern has to do with
the fact that some members are more talkative or assertive than others and can often dominate
the group. It is crucial that the group leader ensure that those who are somewhat reserved do
not become lost in the group or suffer because of such dominance.

REFERENCES
Barouh, G. (1992). Support groups: The humanface ofthe HIVIAIDS epidemic. New York: Long Island Association
for AIDS Care.
Bishop, 1. (1997). Results of a state wide HIVIAIDS community-based organization needs assessment. Baltimore:
State of Maryland AIDS Administration.
Brown, L. (1991). Groups for growth and change. New York: Longman.
Corey, G. (2000). Theory and practice of group counseling (5th 00.). Belmont, CA: Brooks/Cole.
Corey, M., & Corey. G. (1997). Groups: Process and practice (5th ed.). Belmont, CA: Brooks/Cole.
Edmunds, H. (1999). The focus group research handbook. Chicago: NTC Business Books.
Etzioni, A. (1961). A comparative analysis ofcomplex organizations on power, involvement and their correlates. New
York: Free Press.
150 L. JAY BISHOP

Fuhriman, A., & Burlingame, G. (1994). Group psychotherapy: Research and practice. In A. Fuhriman & G. M.
Burlingame (Eds.), Handbook of group psychotherapy (pp. 3-40). New York: Wiley.
Gitterman, A., & Schulman, L. (Eds.).(1986). Mutual aid groups and the life cycle. Itasca, IL: F. E. Peacock.
Gitterman, A., & Schulman, L. (1994). Mutual aid groups, vulnerable populations, and the life cycle (2nd ed.). New
York: Columbia University Press.
Glassman, U., & Kates, L. (1990). Groupwork: A humanistic approach. Thousand Oaks, CA: Sage.
Johnson, D., & Johnson, F. (1997). Joining together: Group theory and group skills (6th ed.). Boston: Allyn & Bacon.
Reid, K. (1997). Social work practice with groups: A clinical perspective (2nd ed.). Belmont, CA: Brooks/Cole.
Schulman, L. (1984). The skills of helping: Individuals and groups (2nd ed.). Itasca, IL: F. E. Peacock.
Schulman, L. (199\). Interactional social work practice: Toward an empirical theory. Itasca, IL: F. E. Peacock.
Schwartz, W. (1976). Between client and system: The mediating function. In R. Roberts & H. Northen (Eds.), Theories
of social work with groups (pp. 171-197). New York: Columbia University Press.
Schwartz, W. (1977). Social group work: The interactional approach. In 1. B. Thmer (Ed.), Encyclopedia of social
work (Vol. II). New York: National Association of Social Workers.
Toseland, R., & Rivas, R. (1998). An introduction to group work practice (3rd ed.). Boston: Allyn & Bacon.
Toseland, R., & Siporin, M. (1986). When to recommend group treatment: A research of the clinical and research
literature. International Journal of Group Psychotherapy, 36, 171-201.
Toseland, R., Rossiter, c., Peak, T., & Smith, G. (1990). Comparative effectiveness of individual and group
interventions to support family caregivers. Social Work, 35, 209-219.
Van Wormer, K. (1999). Alcoholism treatment: A social work perspective. Chicago: Nelson-Hall.
Zastrow, C. (1997). Social work with groups (4th ed.). Chicago: Nelson-Hall.
Zastrow, C. (1999). The practice of social work (6th ed.). Belmont, CA: Brooks/Cole.
 CHAPTER 9

Sociological Work in Communities

MARY C. SENGSTOCK

INTRODUCTION

The gap between academic and applied/clinical sociology is well exemplified by an analysis of
the sociological treatment of the concept of "community." This concept usually rates at least a
mention in introductory sociology and social problems textbooks (Broom et al., 1984; Henslin,
1999; Sullivan & Thompson, 1988). But many sociological theory textbooks make no mention
of "community," as indicated by the index and table of contents (Coser & Rosenberg, 1982;
Perdue, 1986; Waters, 1994). Community discussions are largely limited to applied and clinical
sociology books and journal articles (Alinsky, 1984a,b; Anderson, 1986; Bridger, 1997;
Glassner & Freedman, 1979; Schultz, 1996; Straus, 1984).
Unfortunately, this results in little theoretical guidance for the work of applied or clinical
sociologists. In many instances, community studies tend to be "ad hoc": community re-
searchers often begin their work with few theoretical principles to guide them, and their
generalizations are rarely used to inform further research by others. In the present chapter,
I will attempt to draw together some of the principles about communities and community
ventures that have appeared in the applied and clinical sociology literature, with the hope that
some generalizations about community theory can be developed and may serve to inform
future studies in the area. I will begin with a review of the manner in which the concept of
community is used in the literature, and then proceed to discuss a variety of approaches to
community work used in applied and clinical sociology.

REVIEW OF THE LITERATURE:

VARYING DEFINITIONS OF COMMUNITY

Few community studies begin with a definition of community. Most simply go about their
analysis of the topic on the presumption that the meaning of community is well understood and
accepted. There are numerous ways in which "community" is understood, however, and
approaches that may be effective with one type of community may not be appropriate with
others.

MARY C. SENGSTOCK • Department of Sociology, Wayne State University, Detroit, Michigan 48202.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

151
152 MARY C. SENGSTOCK

Communities are typically defined as "groups ofpeople who share a common territory
and a sense of identity or belonging and who interact with one another"[italics added]
(Sullivan & Thompson, 1988: 376; see also Fritz, 1985; Glassner & Freedman, 1979; Park,
1952; Taylor & Randolph, 1975). Some analysts distinguish between "natural" communities,
which form automatically in social settings, and "intentional communities," in which mem-
bers of a group come together for the precise purpose of forming a community (Broom et aI.,
1984:92-93; Fritz, 1985; Radekop, 1975). Religious communities or communes are classic
examples. Since most sociological work with communities focuses on natural communities,
intentional communities will not be considered in the present chapter.
A closer look at the definition given above reveals that there are three components in the
concept of community: geographic ("share a common territory"), psychological (with a
"sense of identity or belonging"), and social ("groups of people... who interact with one
another"). In its purest form, therefore, a community is a group of people who share geogra-
phy, psychological identity, and a social interaction pattern. As Fritz (1985:138) notes, "The
clearest examples of communities in this sense of the term are villages, neighborhoods, and
small towns." It has also been noted that communities are defined by their "stories" -the nar-
ratives that members of the community relate to others because they exemplify the characteris-
tics that the community wishes to emphasize about itself (Bridger, 1997; Johnstone, 1990).
In preindustrial societies this definition was perhaps sufficient. Most "communities"
probably did share all of these factors. Residential areas tended to be small; everyone knew
everyone else and shared a common culture, value system, and style of living. As a result of
these shared attributes, members also identified with one another, felt a sense of cohesion, and
distinguished themselves, as a group, from other groups they encountered. In short, the
concept of "community" is really a hypothesis, which proposes that geography, identity, and
social interaction tend to vary together.
It is obvious that in modem, industrial, urban settings this is often not the case. Instead,
the several dimensions of community frequently diverge from each other, resulting in several
different types of community, depending on which dimension of the original concept the
members share. Many residential areas are nothing more than a place to live, and residents
may not even know those who live nearby, much less share a sense of identity with them. In
contrast, they may feel quite close to members of an ethnic, religious, or professional
grouping, even though these people may live at some distance from them (Broom et aI., 1984;
Henslin, 1999). It has even been noted that the Internet, with its highly nonterritorial character,
may serve as a community for some people (Henslin, 1999). Conversely, neither is the
geographic dimension totally irrelevant. Whether or not they wish to recognize it, persons who
live near each other share common concerns in many respects. Public health and safety issues
are obvious examples. Clearly, the three dimensions of "community" are variables, not
constants. And sociological work in communities, if it is to be effective, must take into account
these various dimensions.

Types of Communities

Since there are three major dimensions on which communities may vary, it follows that
there may be three major types of communities, depending on the dimension that the members
share: territoriality, sense of identity, or. degree of social interaction. A description of each
type is provided below. (See also Sengstock et aI., 1999, for another discussion of these
dimensions.)
SOCIOLOGICAL WORK IN COMMUNITIES 153

Identificational Community

When people speak of communities, they are usually thinking of one in which the
members share the "sense of identity or belonging" mentioned above. While some neighbor-
hoods still share a sense of identity, it was more common in the past. These communities
emphasize the types of relationships that Toennies called "Gemeinschaft," to distinguish them
from the formal relationships found in industrial society (Fritz, 1985). There are other groups
in which members may find this sense of identity in spite of considerable geographic distances.
These have a strong sense of "solidarity" and have been termed spiritual communities. Ethnic,
religious, and the intellectual community are examples (Fritz, 1985; Radekop, 1975). In
another work I have referred to such communities as "emotionally close communities"
(Sengstock et aI., 1999).

Geographic Community

This type of community is "an aggregate of people situated in a rather definite ecological
area" (Fritz, 1985:137). This view is central to the notion of community for most sociologists,
and postulates a "strong tie between the social system that develops and the territorial unit"
(Fritz, 1985:137). However, as previously noted, this correlation is an empirical question, and
sociologists should examine the geographic areas in which they are working to determine the
degree a social system has, in fact, developed. Some minimal interaction is probably inevitable
in geographic communities, but residents may deliberately avoid their neighbors and resist
developing a "sense of identity or belonging."

Purposive Community

The third dimension on which communities are based is social interaction. Again, it is
possible for a group of people to share this single dimension of community, while lacking both
a common geographic area and a sense of identity. They are called purposive communities
because their members are drawn together by "common objectives or purposes" (Fritz,
1985:137). Yet their members are often "emotionally detached"; professions or occupations
are examples (Sengstock et aI., 1999). These communities may include both members of a
profession or occupation and the clients or patients with whom they interact. Of course,
members of professions or occupations often develop a sense of common identity, but this
remains an empirical question. And some participants in these communities, such as the
clients, would be unlikely to do so.

HOW TO WORK WITH COMMUNITIES

ASSESSMENT: APPROACHING DIFFERENT
TYPES OF COMMUNITIES

If communities differ in the kinds of ties that bind them, then it follows that the
approaches that sociologists use in dealing with communities must differ as well. Hence, the
first step in community development work is determining the type of community with which
one is working. In the next section examples are provided of each of the three major types of
communities and the manner in which sociologists have worked with them.
154 MARY C. SENGSTOCK

Sociological Work with Identificational Communities

The identificational community is one that I have defined as having the clear sense of
identity and strong social bond associated with the original "ideal type" of community. In the
current chapter, however, these communities may have these close social and identity ties with
or without the geographic closeness included in the original community definition. Sociolo-
gists have been working with identificational communities for decades; in some instances,
particularly in an earlier generation, these were also geographically based. Indeed, most
people who work with such communities do not see them as a special type of community, but
only as "the community" per se.
Today, the identificational communities most frequently cited in the literature are ethnic
communities. Most studies of ethnic groups as communities focus on the importance of
considering community values and culture in the provision of community services (McCall et
ai., 1997). Such communities are often highly organized and provide significant services to
their members (Hongdagneu-Sotelo, 1994). In contrast, programs designed by outsiders with
the dominant population in mind may not be applicable to Hispanics, Native Americans, or
other ethnic communities, and many professionals and bureaucratic agencies fail to under-
stand or accommodate their cultural patterns (Fong & Gibbs, 1996; Hoffman, 1987; Joe &
Miller, 1994; Matthews, 1996).
While ethnic groups are the most common examples of identificational communities,
other groups may also exhibit these characteristics. For example, one study described the
battered women's movement in Texas as a "community," which sought to maintain control
over the services provided to battered women, in spite of pressure from the state bureaucracy
that funded them (Reinelt, 1994).

Meeting the Special Needs of Geographic Communities

If the identificational community exhibits two of three community characteristics, the

geographic community exemplifies the third. Where a geographic community is also an
identificational community, sociological methods of approach would be the same. In many
geographic communities, however, sociological work will require an additional step. For a
geographic community to operate as a community, it must develop the other dimensions of
community. In short, it must develop the sense of identity and the close social bond that
characterize the identificational community. Ideally, this will occur prior to any other work
that needs to be done in the community. Realistically, the urgency of the problem may require
that attempts at its solution proceed concurrently with the task of community development.
Indeed, much of the work of sociologists in communities focuses on assisting the residents
of geographic areas in becoming communities.
One might question, however, why the geographic setting remains an important compo-
nent of community at all. In our highly mobile society, if most residents identify more closely
with some unit other than the geographic area-an ethnic or religious group, for example-
why not let them? Let the notion of a geographic community fall away. The answer, of course,
is that, for some purposes, the geographic setting remains a critical factor for some social
interaction. Perhaps the most obvious example of this fact is the impact of environmental
problems on a community. Whether residents identify with each other or not, the presence of
a noxious dump or a polluted stream is a threat to everyone, and this type of concern may bring
SOCIOLOGICAL WORK IN COMMUNITIES 155

together residents who would normally not identify or interact with each other (Nyden et al.,
1997a).
Equally important, however, is the fact that many health and social welfare programs are
established and/or funded on a geographic basis. A major example is the establishment of so-
called "empowerment zones" by the U.S. Department of Housing and Urban Development
(HUD) in several major cities (Gills & White, 1997). In this program funds are designated for
a specific geographic area only; if cities wish to obtain the benefits of these funds, they must
accept them on this geographic assumption, and build a structure with which to allocate them.
Other programs, such as parenting programs or services for the prevention of child abuse
or neglect (Earls et aI., 1994; Gallagher & Nahan, 1997), battered women (Sengstock, 1987),
abused elders (Sengstock et aI., 1999), and general "United Way" services (Ervin, 1997), are
also established to cover a specific geographic area. Sometimes this may be an entire city or
metropolitan area (Ervin, 1997); in other instances it may focus on a specific segment or
neighborhood (Earls et aI., 1994). While citywide or metropolitan areawide services are
common, it has been suggested that certain types of services, such as job opportunities, may be
more effective if targeted to a smaller, easily accessible geographic area (Ranney & Betancur,
1992:288, 294).
An analysis of studies of geographic "communities" indicates that many studies make
the assumption that a neighborhood, city, or other geographic region is operating as a
community, with shared values and identification, even though the validity of this assumption
may not be tested. Hence, the authors of a drug prevention program study assert that "local
constituencies have the best sense of the kinds of prevention efforts likely to be compatible
with local norms and values" (Mitchell et aI., 1996:414). References to "neighborhood
collective action" contain an implicit assumption that the geographic neighborhood is acting
as a community (Mesch & Schwirian, 1996). The assertion that cities or metropolitan areas are
"communities" may be made without analysis of the reality of the claim (Sengstock, 1987).
This assertion may be true of the programs that these authors examined. There are
numerous instances, however, in which geographic neighborhoods, particularly multicultural
ones, lack identity and consensus (Gomillion, 1988b; Nyden et aI., 1997b; Smith & Reichtell,
1997). The legitimacy of the designation "community" for a particular geographic area exists
only in the minds of its members. As Fritz (1985) points out, the boundaries of a community
may be quite subjective: one side of a street might be included while the other is not. Hence,
sociological practitioners should take care in working with geographic communities: If we
wish to handle them as communities, we should be certain at the outset that this is a valid
designation. If it is not, other steps must be taken.
What can be done with geographic areas that need to engage in communal action, but in
which a sense of community is lacking? In such areas, a special part of the community
development would be to assist concerned residents in building a community, i.e., to develop
the common values, social interaction, and identification patterns that are characteristic of
true communities.
Neighborhood organizers could make use of existing organizations, such as local
churches, to help a geographic area develop consensual norms, sense of identity, and common
values (Nash, 1993). Some activities, such as including prayers or church rituals in local
program efforts, might appear superfluous to organizational development experts, but they
may be essential to the development of a sense of community. This communal sense is critical,
not only for the residents themselves, but also in the perceptions of others. Thus, a neighbor-
hood or region that wishes to obtain public and private funding for its projects, will have to
156 MARY C. SENGSTOCK

convince the leaders of these agencies that the members share a sense of identity and commit-
ment and can work together (Nyden et at., 1997b).
As noted earlier, multiracial and multicultural neighborhoods offer particular challenges.
Organizers must be sensitive to the variant views of each of the several cultural groups, and
take care to include all of them in any development plans (Gallagher & Nahan, 1997). It should
be recognized, however, that one should not expect to achieve success with every resident of
an area. There is always the likelihood that some members of one cultural group or another
will be unwilling to cooperate or identify with persons from other groups (Gomillion, 1988b).
Organizers cannot allow such individuals to deter the work as a whole. If such persons can
be kept to a minimum, the geographic area as a whole may be able to operate effectively.

The Special Case of the Purposive Community

As their name implies, members of purposive communities come together for a special
purpose. For example, the mental hospital is frequently viewed as a "community" (Cuthbert-
son, 1989), as are other professional practice settings (Sengstock et at., 1999). Such groups are
rarely discussed in the community literature, but are typically found in the literature on formal
organizations, since this is the typical mechanism for developing them.
It has been noted, however, that formal organizations might be enhanced by the infusion
of techniques from community intervention. A strictly bureaucratic approach gives scant con-
sideration to issues such as personal identification or value consensus. Yet participants with
even the most peripheral contact can have a dramatic impact on the "community" of a
purposive organization. For example, clients who fail to observe normal standards of cleanli-
ness or sanitation can result in other clients (not to mention staff) refusing to continue their
association with the organization (Sengstock et at., 1999). And economic organizations that
incorporate such community variables as informal social interaction, common values, and
personal identification might be rewarded with greater member satisfaction and lower em-
ployee turnover and absenteeism (Gutknecht, 1984; Shepherd, 1995). While community-
related issues might be applicable to purposive communities, they are not generally considered
in the community literature, and hence will not be discussed here.

INTERVENTION STEPS:
SOCIOLOGICAL TECHNIQUES IN DEALING WITH COMMUNITIES

Community action has been defined as "the conscious, intentional, planned efforts of a
community to study itself and its relations to other communities, and to engage in activities
which the community thinks will contribute to its development or well-being" (Gomillion,
1988b, p. 36). Indeed, the observation has been made that the most effective social action
occurs at the community level, rather than at either the individual level or the level of society
as a whole (Watts, 1989). Whether we focus on communities in which the members already
engage in social interaction and share a sense of identity or belonging, or those that may need
some additional help in reaching that point, sociologists have discovered or developed a
number of techniques that may guide community development. This section includes a
summary of these approaches.
SOCIOLOGICAL WORK IN COMMUNITIES 157

Multidimensionality

Sociologists who work with communities are unanimous in recommending a multi-

dimensional approach to community work. The need to be comprehensive or to employ a wide
range of tactics appears frequently in the literature (Alinsky, 1969, 1971; Glassner & Freed-
man, 1979; Mitchell et ai., 1996). Gomillion (1988a) lists 13 questions on which a community
worker should focus, including such components as: analyzing the situation; examining the
status of group; assessing the group's desires; determining the costs of prospective programs;
determining the group's willingness to pay the costs; developing a plan for action; assigning
roles for carrying out the plan; executing the plan; and evaluating and revising the plan on an
ongoing basis (for a similar statement, see Glassner & Freedman, 1979). Hence, the first
required component of a successful community action program is that it should include a wide
variety of approaches and focus on numerous dimensions. Communities are complex social
structures; the approaches that are required to develop community action programs must be
no less complex. A successful community development plan would not simply choose one or
two approaches, but would employ several of the approaches described here.

Roles for Sociologists in Community Action

The complexity of community action work is also illustrated by the variety of roles that
sociologists in such work are described as playing. Perhaps the most obvious role of sociolo-
gists in communities is that of researcher (Ellis, 1996; Sengstock, 1987; Watts, 1989). Hence,
communities depend on our knowledge of social data and social research techniques to enrich
community development programs.
However, community work also demands that the sociologist be an activist (Alinsky,
1984b; Billson, 1984). Others suggest that the two roles of academic researcher and commu-
nity activist or organizer can be played by two different people who work closely together
(Stoecker & Beckwith, 1992). However, Glassner and Freedman (1979:386) insist that "there
is no way to do community work from a detached observer position. Your personal involve-
ment is a necessity."
Hence, sociologists in community work must be personally committed to the community
and its plans, and willing to commit their time and energy to working for it. It has been ob-
served that the clinical sociologist in community work actually plays three roles, as scientist,
citizen, and person (Gomillion, 1988b). As a scientist, a sociologist brings a specialized
knowledge of social groups and how they work, and how to research them; as a citizen, a
sociologist can exert pressure on political leaders on behalf of the community; as a person, a
sociologist has a set of values and a sense of personal commitment to them.
Sociologists may play other roles as well. These include working with individual commu-
nity members who have problems; providing assistance to various community agencies and
institutions; acting as an administrator or organizer for the community and/or its organizations;
and serving as a mediator in community conflicts (Fritz, 1985; Taylor & Randolph, 1975). This
is only a brief summary of possible roles. Clinical sociologists who become involved in
community work must be prepared to provide a wide range of assistance to community
members and their groups. There is no clear-cut job description!
158 MARY C. SENGSTOCK

Consider the Community Context

Successful community action must consider the context in which the community exists.
These include both "ecological" and sociocultural factors. In terms of community ecology, it
has been noted that the demographic composition of a community or neighborhood may make
it more or less effective in developing effective community programs; thus, higher income
neighborhoods, and those with a more stable population, tend to be more successful in
community development (Mesch & Schwirian, 1996). Certain types of external threats, such as
threats of land-use change, were more likely to help mobilize a neighborhood; others, such
as unwanted businesses, did not generate the same community solidarity (Mesch & Schwirian,
1996). In spite of expectations to the contrary, racial divisions in a community have not been
found to be significant predictors of community development success, when other factors
were controlled (Mesch & Schwirian, 1996).
On a sociocultural level, community experts remind us of the need for community work
to occur within the context of the culture of the members (Gallagher & Nahan, 1997; McCall
et aI., 1997). As noted earlier, the existing social service community is frequently criticized as
failing to accommodate the cultural beliefs and values of community members (Fong & Gibbs,
1996; Hoffman, 1987; Joe & Miller, 1994). Hence, it is critical that community workers have
a real understanding-not just a superficial knowledge-of the values and cultural patterns
of the population of the communities in which they work (Matthews, 1996).

Consider the Power Structure

A major issue in community development from its beginnings has been the issue of com-
munity power (Alinsky, 1969, 1971; Freedman, 1984; Glass, 1984). Power is not only what a
community or group actually has, but also what other people think it has (Alinsky, 1971:126).
Community development workers must be aware that community action efforts rise or fallon
the basis of the degree to which they can exert power on behalf of community projects. There
are two dimensions to the issue of power: empowering the people of the community, and
analyzing and gamering the support of the existing power structure of the community and
the society of which it is a part.

Empowering Community Members

Indeed, much of community development work consists of teaching people to be em-

powered through activism in community groups and projects (Reinelt, 1994). Such strength
can come from recognition that there is general agreement within the group about their goals
and values. Hence, community organizers usually try to achieve consensus for their decisions.
Some have suggested that it is worth the time and effort to work toward community consensus,
even if the organizers consider the issues relatively unimportant (Alinsky, 1969, 1971; Glassner
& Freedman, 1979; Nash, 1993). Hence, organizers may consider it relatively unimportant to
get everyone to hang out a flag on the Fourth of July, but if it gives members a feeling of
consensus and solidarity, it can be well worth the effort.
Power struggles within a community are common, as are struggles between the commu-
nity and outsiders. A major example of this would be the imposition of state controls over
programs in return for program funding (Reinelt, 1994). People in communities subjected to
such top-down decision-making can feel powerless and angry. To prevent community de-
SOCIOLOGICAL WORK IN COMMUNITIES 159

moralization, organizers must assist the community in determining ways to reassert their
control in the face of such pressure.

Involve Existing Community Leaders

While communities may wish to exercise control, they do not operate in a vacuum. They
must learn to work with existing power structures, both within the community itself, and with
outsiders who may control some aspects of community operation, such as funding (Alinsky,
1969, 1971; Glassner & Freedman, 1979). Community research and development is doomed to
failure if existing leaders in the community do not support the program. Numerous studies
point to the importance of involving a wide variety of community leaders.
Depending on the project, these may include political leaders, such as the mayor or
members of Congress or the state legislature; local judges; religious leaders; leaders of various
ethnic or racial minorities; directors of social and health agencies, both public and private
(Ervin, 1997; Schultz, 1996; Sengstock, 1987; Stoecker & Beckwith, 1992). Since the involve-
ment of community leaders is so critical a need, many studies focus on the techniques for
accomplishing this. Among the approaches mentioned are the following:

Individual Meetings with Local Leaders

Once specific local leaders have been identified, community organizers should hold
individual meetings with those leaders considered to be critically important (Sengstock, 1987;
Stoecker & Beckwith, 1992). As persons who have been involved with the community for
some time, they are likely to know important information about it and can be a valuable
resource to community development projects. In addition, their support is essential. Failing to
obtain the support of even one powerful informal leader could doom a community project.
Time spent here may save precious time later, by avoiding the problems that might be
encountered if support of the power players is not obtained (Ervin, 1997).

Establish Steering Committees and Task Forces

Task forces, working groups, steering committees, councils, coalitions-they are given
different names in different studies (Gallagher & Nahan, 1997; Mitchell et aI., 1996; Reinelt,
1994; Schultz, 1996; Sengstock, 1987; Stoecker & Beckwith, 1992; Watts, 1989). Whatever the
term, they refer to a mechanism for including community leaders on a central organizing group
that can be consulted periodically and kept informed of community organization activities.
This gives the community's natural leaders a feeling of being informed about the project and
also provides them with an opportunity to offer their input. In addition, certain kinds of
committees, often called task forces or working groups, may bring these leaders into the
project and actually get them involved in the community development work itself (Sengstock,
1987; Stoecker & Beckwith, 1992).

Cultivate Your Allies

In every project there will be some leaders who exhibit from the beginning a sympathetic
understanding toward the goals of the project. Such natural support should be cultivated
(Alinsky, 1969, 1971; Glassner & Freedman, 1979). These people (or their representatives) can
be included on the project's various subcommittees and task forces. Care should be taken,
160 MARY C. SENGSTOCK

however, that such participants do not subvert the project by insisting that their approval must
be obtained for all activities (Sengstock, 1987).

Coopt Your Opponents

At the same time, there are likely to be key people in the community who are the natural
opponents of the project. For example, a community mediation project may expect opposition
from lawyers, who see mediation as an incursion into their legal practices (Schultz, 1996). Or
social agency directors may consider community development projects as usurping funds that
could be used for agency services (Ervin, 1997). Contacting such possible opponents at the
outset, and attempting to convince them, if possible, that the project will not intrude on their
turf could garner their support, or, at least, minimize their opposition. At the least, it is
important to offer them the opportunity to vent their opposition (Ervin, 1997).

The Critical Role of Symbolic Interaction and Communication

Several sociologists involved in communities remind us of the importance of the micro-

processes in social interaction. Symbolic interaction and taking the role of the other are
important mechanisms for change (Schultz, 1996). This approach reminds us of the need to
focus on the relationship between the individual and the community, and the manner in which
community ideas and values are communicated from one person to another (Alinsky, 1969,
1971; Glassner & Freedman, 1979). Community development work is essentially a communi-
cation process between the professional sociologist and the members of the community in
which she or he works. Serious problems can ensue if this communication process fails, either
because the professional does not listen carefully to the community's views, or because she or
he does not communicate effectively to community members.
In order for professionals to become aware of important community symbols and values,
Bridger (1997) recommends that they pay close attention to "community stories" (see also
Johnstone, 1990). Community planners should listen to the stories that members tell about
their community; these provide the historical context in which the community chooses to view
itself; they also change as the community changes, and can provide an indicator of how the
community may have changed its perception of itself (Bridger, 1997).
Conversely, the way in which professionals communicate their ideas can make or break
their impact on the community. Professionals are often perceived as technical experts who fail
to understand the local community. This perception damages their credibility. Instead, com-
munity workers should work as community peers, not as outside authorities (Alinsky, 1969,
1971; Glassner & Freedman, 1979).

Organizational Dimensions

Communities operate through organizations, and neighborhood organizations are critical

to these efforts (Mesch & Schwirian, 1996). Anderson (1986) asserts that community action is
interorganizational action. Consequently, community sociologists must be involved in organi-
zations and knowledgeable about how they work. They will frequently have to engage in
routine organizational or administrative activities (Schultz, 1996).
SOCIOLOGICAL WORK IN COMMUNITIES 161

At the same time, Fritz (1985) cautions that community workers must be aware that
community organizations may conflict with each other, and that members of a community may
have conflicting organizational memberships. Furthermore, organizations tend to be some-
what inflexible: the existing structures of organizations may make it difficult to accommodate
new needs in the community, such as a change in its cultural composition. Even when
organizations include new workers, they tend to be at the bottom of the hierarchy, and not in a
position to effect change (Fong & Gibbs, 1996). To handle community organizations effec-
tively, sociologists must be cognizant of these rigidities and conflicts and determine ways to
deal with them.
Three types of organizations have been found to exist in communities: economic organi-
zations, both for-profit and nonprofit, which provide goods and services for sale or rent; social
order organizations, such as courts, police, and mental institutions, which deal with persons
the community defines as deviant; and cultural organizations, such as educational and reli-
gious groups, which create and preserve the community's symbols, values, and beliefs. For
effective community action, it is recommended that at least one organization of each type be
involved in community action plans (Anderson, 1986).
Several authorities have suggested that the more complex the organizational structure,
the more effective community action will be. Organizations with more roles and more
activities (such as more officers, committees, newsletters, meetings) will be more effective
(Mesch & Schwirian, 1996). The level of organization is also an issue about which community
sociological efforts should be concerned. Mitchell et al. (1996) designate two levels of change.
While organizational change and legislative advocacy are important for having an immediate
impact on community concerns, the building of community institutions and coalitions is even
more important, because they can have an impact over a longer term.

Techniques for Developing Community Programs

Perhaps the most important concern for new community workers is how to go about
developing community programs: how to get started, how to get members of the community to
work together, how to get them to focus on community needs. Unfortunately, there is no single
format that is guaranteed to work in all instances. However, a number of "hints" for effective
approaches have appeared in the literature.

Start Small

Community planning is apparently a setting in which the economies of scale do not apply.
Instead, interventions and evaluations conducted on a smaller scale for smaller areas are easier
to implement and evaluate (Ellis, 1996). Effective approaches can later be transferred to other
areas.

Set Goals and Develop a Plan

It is important to develop and follow a predetermined plan and process. Successful

community organizers stress the importance of establishing goals and setting timetables for
their accomplishment (Alinsky, 1969, 1971; Glassner & Freedman, 1979). Communityorga-
nizers should resist reacting too quickly to immediate problems or tensions (Fritz, 1985).
162 MARY C. SENGSTOCK

Share Infonnation with the Community

Numerous community development studies attest to the need for infonnation on commu-
nity needs and plans to be shared with community members on an ongoing basis. This
infonnation-sharing can be accomplished in a number of ways. Different authors describe
them as community conferences, data presentations, educational meetings, training sessions,
or hearings (Gallagher & Nahan, 1997; Reinelt, 1994; Sengstock, 1987; Stoecker & Beckwith,
1992). Whatever tenn is applied, they represent opportunities for community members and
leaders to come together with professional organizers to get infonnation, share ideas, set goals,
and express concerns. It is a critical mechanism for keeping everyone infonned. It has also
been noted that community members can play an important role as trainers or presenters in
such sessions (Gallagher & Nahan, 1997).

Using the Mass Media

Another technique for keeping people infonned is judicious use of printed or broadcast
material. Research findings and reports on community activities can be released periodically
to keep community members infonned and generate interest (Stoecker & Beckwith, 1992).
Such reports may also result in getting additional people involved in the community develop-
ment project. Learning to use the mass media to their advantage is essential for community
organizers (Alinsky, 1969, 1971; Glassner & Freedman, 1979).

Direct Service as a Community Unification Mechanism

Some members of a community may be reluctant to become involved in community

projects; yet these same people may wish to use the services provided by the community and
its various agencies. Hence, the identification of key services that can be provided to commu-
nity members helps to bring people together and can serve as a unifying factor. At the same
time such services help community agencies to satisfy funding requirements (Gallagher &
Nahan, 1997).

Use Social Movement Techniques

Sociologists are knowledgeable about the nature of collective behavior and techniques
found useful in such settings. As Smelzer (1962) indicated, successful social movements are
characterized by a number of components, including: emphasis on generalized beliefs; use of
a precipitating event to focus attention of the population; mobilize the participants; use of
social control mechanisms to focus the direction, timing, and outcome of action. Community
action workers would do well to peruse the literature on collective behavior and social
movements for additional suggestions (Fritz, 1985).

EVALUATION: ONE OF MANY USES

OF SOCIAL RESEARCH METHODS IN COMMUNITIES

Like all sociological interventions, an important component of the community develop-

ment process relates to assessing the impact of the program (Papineau & Kiely, 1996; Schultz,
1996). However, sociologists in community development have learned that social research
SOCIOLOGICAL WORK IN COMMUNITIES 163

plays a critical role in the process, not only for evaluation purposes, but also to accomplish a
variety of other goals. Social research is useful from the very earliest stages of community
development to the culmination of the project, but the quantity and type of research may vary
from one period to another.
Evaluation itself does not occur only at the end, but should be ongoing throughout the
project. Ellis (1996) cautions that data should be collected early in the project's development;
if too much time passes, it is possible that the situation may change and it will be impossible
to assess the impact of the program. It is important that community participants be involved in
the evaluation process. Considering their views makes the evaluation a community activity as
well as a research process, and is also likely to result in greater commitment of community
members to both project and community (Papineau & Kiely, 1996; Stoecker, 1999)
Sociologists should be alert to the possibility of unexpected findings such as the impact
of new programs on previously existing ones (Meyer & Budowski, 1995). Community
sociologists must also be prepared to handle negative information such as data that could show
that community or agency programs have not had the desired impact (Reinelt, 1994). In such
situations, pressure is frequently exerted on the researcher to alter or conceal the embarrassing
data. Sociologists must be prepared to deal with these difficult situations without sacrificing
professional ethical standards.

Research at the Inception of a Community Development Project

The earliest stages of a community development project should involve a considerable

amount of sociological research in a variety of forms. Community sociologists should famil-
iarize themselves with community studies conducted by others to help guide their work
(Alinsky, 1969, 1971; Glassner & Freedman, 1979). Many community development projects
begin with a needs assessment to help determine what the community members consider to be
their most pressing problems, and to form a base for the remainder of the project (Schultz,
1996).
A wide variety of sociological data can be useful. Watts (1989) describes two types of
data that should be collected: national and state data on the community's issues or problems
provide broad standards for comparison; local data, on the other hand, help to assess the level
of the local problem and mobilize the community. Such data can also be useful in the
development of an action plan. In addition, community members can usually profit from a
sociological analysis of the kinds of social structural demands and constraints that the
members may face (Sengstock, 1987).

Community Research as an Ongoing Process

After this early phase, the intensity of the research effort may decrease somewhat.
However, it is critical that it not cease altogether. Any changes that occur in the program or any
observed changes in community patterns should be carefully documented; this is especially
important to preserve a clear picture of the development process in the event of the inevitable
changes in personnel (Ellis, 1996).
New types of research can also occur during the middle phases of the project. This is the
phase during which the community will attempt to develop programs to deal with the issues or
problems noted earlier. Social research can help analyze which resources, both within and
without the community, might be accessed to resolve the problem (Alinsky, 1969, 1971;
Glassner & Freedman, 1979; Watts, 1989).
164 MARY C. SENGSTOCK

The ongoing input of persons knowledgeable about sociological research can help the
community in other ways as well. Analysis of social relations and issues is an ongoing process.
Community members will be constantly presenting and discussing their views and revising the
community's plans. Some of these may be based on invalid assumptions. Persons not familiar
with research, for example, often propose to evaluate the effectiveness of programs, such as a
drug abuse awareness program, by checking to see whether requests for assistance decrease;
however, the presence of such efforts in a community may actually cause requests for
assistance to go up, rather than down, and this does not mean the program has failed (Ellis,
1996). Community sociologists should always be on the alert for misinformation and to take
measures to provide correct data in its place (Sengstock, 1987). Sociologists should also be
aware that communities experience stress; indeed, the community development and research
processes can themselves be stressful both to the community as a whole and to its members.
Researchers need to be alert to such stresses in the course of research and assist people in
dealing with them (Sengstock, 1994).

Research as a Mechanism for Community Intervention and Involvement

Finally, social research has been found by many community workers to be a means not
only for obtaining useful and valid data on which to base community projects, but also as a
direct mechanism for community organization itself (Ellis, 1996; Fritz, 1985; Schultz, 1996;
Sengstock, 1987; Watts, 1989). Research helps to support the validity of community organiza-
tion efforts in obtaining support from political leaders and possible funding agencies (Nyden et
aI., 1997b).
Research methods are also a useful technique for involving community leaders and
members in the community organization efforts. Through participatory action research (also
called participatory research) community members see their views included in the research
plan, have the opportunity to become immersed in the community, learn more about it, and
develop personal commitment to the community through individual involvement (Sengstock,
1987; Stoecker, 1999; Stoecker & Beckwith, 1992). In an example of participatory research,
Nash (1993) used members and leaders of churches in the community as interviewers. The
experience of interviewing other community residents increased the interviewers' contact with
the community, made them more aware of residents' interests and needs, and gave them the
opportunity to generate more membership in community activities.

STRENGTHS AND WEAKNESSES

OF SOCIOLOGICAL COMMUNITY DEVELOPMENT WORK

Strengths

The most obvious strengths of sociological community work appear in its practical
aspects. Sociologists who conduct such work have made great strides and generally do a
commendable job. Most are aware that different communities must be handled in different
ways. They take care to consider the cultures and values of the communities with which they
work. They know that successful community action requires that communities have the shared
values, identity, and social interaction patterns of identificational communities. Many sociolo-
gists are involved in the process of helping communities to develop these characteristics if
they are missing.
SOCIOLOGICAL WORK IN COMMUNITIES 165

Sociologists have also developed a number of approaches for community work. The
value of a multidimensional approach for effective community work is widely accepted.
Sociologists involved in community work are prepared to assume a variety of roles and to be
active participants, not detached observers. They recognize the importance of considering the
existing power structure of the community and the environment in which it operates. A variety
of mechanisms for getting the support of these leaders and involving them in community
development projects have been developed and are reported in the literature. The importance
of keeping both members and leaders informed of community projects is acknowledged, and
mechanisms have been developed for accomplishing this as well. The importance of commu-
nity empowerment is recognized, as is the critical role that the organizational structure of the
community plays. Since communities operate through their organizations, sociological com-
munity workers know that the support of these organizations is critical.
The literature recognizes the importance of having communities set goals, develop a plan,
and keep programs within manageable limits. The role of the mass media is recognized. Other
techniques, such as the use of community service or techniques borrowed from the social
movement literature, to help communities develop, appear in some studies, as does the
importance of the symbolic communication process and the need for professional sociologists
to use this to their advantage.
The value of social research as a tool in community organization, not only as a mecha-
nism for program evaluation but at all stages of the community development process, is an
important consideration for many community sociologists. It can be used in preparing the plan,
identifying problems, accessing services, and evaluating the program. In particular, it is also
recognized as a valuable mechanism through which the community can develop its organiza-
tional structure and sense of unity.

Weaknesses

Perhaps the most glaring deficiency in sociological work with communities is the lack of
theoretical guidance in sociology to serve as a foundation. The definition and dimensions of
community have received scant attention, if any, in the sociological literature. The definition is
unclear and has not been altered to reflect changes in communities that have occurred with the
move to an urban, industrial society. Theoretical sociology appears to assume that community
means the same thing at the tum of the millennium as it did 100 years earlier. Undaunted by this
lack of clarity in sociology, clinical sociologists cope with the lack of theoretical background
in sociology by employing theory and experience from other fields, such as anthropology,
community development, and social work (see, e.g., Ervin, 1997; Fong & Gibbs, 1996; John-
stone, 1990; McCall et at., 1997).
The benefits that could be achieved by clearer guidance from sociological theory are
many, however. Many studies do not make their definitions of community clear, nor do they
distinguish among the various types of community. Clinical sociologists often retain some of
the assumptions that pertained to the traditional definition of community but that are now
inappropriate. Furthermore, these assumptions are usually implicit; they are not examined to
determine their validity.
While sociologists involved in community work have developed a number of useful
mechanisms, as detailed above, there are other areas for which no such mechanisms have been
developed. Three examples will illustrate this. First, many studies note the importance of
developing community empowerment, but the means by which to help communities feel and
166 MARY C. SENGSTOCK

act "empowered" do not appear in the literature. Second, while the value of the communica-
tion and symbolic interaction approach appears in the community literature, it is poorly
developed, and most authors do not even mention it. Third, the importance of organizational
involvement and cooperation in community work is recognized, but there is little discussion of
the manner in which such involvement and cooperation can be achieved. What is needed is
more theoretical discussion and testing of the manner in which these approaches apply to
communities. Without these discussions, community sociologists are largely on their own in
the field.
Finally, there is little organization in the area of sociological approaches to community
development. Sociologists involved in this type of activity operate, for the most part, indepen-
dently. They make their own plans, develop their own research and development approaches,
make their own mistakes, and do their own evaluations. A few of them write up their
experiences for others to examine; some of them are not sociologists, but anthropologists,
social workers, and political scientists. The present analysis is based only on those few
examples that have appeared in the published literature; undoubtedly there are many other
sociological community development projects that could contribute to our knowledge of the
area, but about which most of us have no knowledge. All community development projects
could be improved if more knowledge were shared.

SUMMARY: WHITHER SOCIOLOGICAL

COMMUNITY DEVELOPMENT WORK?

Sociologists have been studying and working with communities almost since the incep-
tion of the field. This is perhaps one of the reasons for the field's current predicament.
Community work has been around for so long, and the dimensions of community are so well
accepted in the field, that there has been little impetus to go beyond the original set of
assumptions. The definition of community as a group of people, interacting, and sharing
common territory, values, and a sense of identity was developed when many sociologists were
part of a widespread social yearning for the preindustrial society in which this definition was
an accurate description.
However, communities at the tum of the millennium are of a very different sort. The
several dimensions of community-interaction, geography, and shared values of identity-
may no longer be assumed to be coterminous. Communities differ from each other in terms of
the nature of the variables that they share, and different types of approaches are appropriate,
depending on whether the community is identificational, geographic, or purposive.
Applied and clinical sociologists who work with communities have developed a number
of useful techniques for working with communities, several of which have been summarized
in the previous sections. All of them are useful approaches that have been developed by
community development sociologists. However, a profound gap exists between theory and
practice. Applied and clinical sociologists' work in communities occurs largely in a theoretical
vacuum. Theoretical definitions and treatises on community have not advanced past the
earliest principles. There are no explicit criteria indicating which issues should be considered
in community work, nor how they should be considered.
Consequently, community work occurs on largely a case-by-case basis and with little
theoretical guidance. Few studies begin with a clear definition of community. Community
characteristics tend to be assumed, rather than delineated in a clear and concise manner. Each
study tends to focus on the aspects most obvious in the particular community in question,
while other aspects, perhaps equally important, are ignored. What is critically needed in the
SOCIOLOGICAL WORK IN COMMUNITIES 167

field is a series of theoretical considerations of a host of crucial issues. Among these are the
meaning of community in the urban, industrial, and postindustrial society; the kinds of issues
that should be considered at the outset of every community development project; and the
manner of conducting sociological work in communities. Conversely, community sociologists
should make greater efforts to use the little theory that exists, to inform their work; employ the
results from earlier studies for comparison with their community research and development
efforts; and take care to transmit the results of their efforts through the literature.

ACKNOWLEDGMENTS. The author wishes to express appreciation to Ms. Sonya Gantt,

Ph.D. student in the Department of Sociology at Wayne State University, for her careful
bibliographic work.

REFERENCES

Alinsky, S. D. (1969). Reveille for radicals. New York: Vantage Books.

A1insky, S. D. (1971). Rules for radicals. New York: Vantage Books.
Alinsky, S. D. (l984a). A sociological technique in clinical criminology. Clinical Sociology Review, 2, 12-24.
Alinsky, S. D. (1984b). Community analysis and organization. Clinical Sociology Review, 2, 25-34.
Anderson, R. C. (1986). An interorganizational approach to the explanation of community development activities.
Clinical Sociology Review, 4, 71-9.
Billson, J. M. (1984). Saul Alinsky: The contributions of a pioneer clinical sociologist. Clinical Sociology Review, 2,
7-11.
Bridger, J. C. (1997). Community stories and their relevance to planning. Applied Behavioral Science Review, 5(1),
67-80.
Broom, L., Selznick, P., & Broom, D. (1984). Essentials of sociology (3rd ed.). Itasca, IL: Peacock.
Coser, L. A., & Rosenberg, B. (Eds.). (1982). Sociological theory: A book of readings (5th ed.). Prospect Heights, IL:
Waveland Press.
Cuthbertson, B. A. (1989). The therapeutic community in a psychiatric facility: Does clinical sociology have a place?
Clinical Sociology Review, 7, 141-151.
Earls, E, McGuire, J., & Shay, S. (1994). Evaluating a community intervention to reduce the risk of child abuse:
Methodological strategies in conducting neighborhood surveys. Child Abuse and Neglect, 18(5), 473-485.
Ellis, A. M. (1996). Lessons learned from evaluating a five-year community partnership project. Clinical Sociology
Review, 14, 154-166.
Ervin, A. M. (1997). Trying the impossible: relatively 'rapid' methods in a city-wide needs assessment. Human
Organization, 56(4), 379-387.
Fong, L. G., & Gibb, 1. T. (1996).Facilitating services to multicultural communities in a dominant culture setting: An
organizational perspective. Administration in Social Work, 19(2), 1-24.
Freedman, J. (1984). Saul Alinsky: A recollection. Clinical Sociology Review, 2, 39-42.
Fritz, J. (1985). Communities: Making them work. In R. A. Strauss (Ed.), Using sociology (pp. 136-152). Bayside,
NY: General-Hall.
Gallagher, B. G., & Nahan, N. (1997). Cross-cultural parenting on Detroit's Eastside: Establishing community-based
parenting in multicultural neighborhoods. In P. Nyden, A. Figert, M. Shibley, & D. Burrows (Eds.), Building
community (pp. 141-149). Thousand Oaks, CA: Pine Forge Press.
Gills, D., & White, W. (1997). Chicago's Empowerment Zone and citizen participation. In P. Nyden, A. Figert, M.
Shibley, & D. Burrows (Eds.), Building community (pp. 211-218). Thousand Oaks, CA: Pine Forge Press.
Glass, J. E (1984). Saul Alinsky in retrospect. Clinical Sociology Review, 2, 35-38.
Glassner, B., & Freedman, J. A. (1979). Clinical sociology. New York: Longman.
Gomillion, C. G. (l988a). Questions which might be asked in planning a program of social action. Clinical Sociology
Review, 6, 33-34.
Gomillion, C. G. (1988b). The role of the sociologist in community action in the Rural South. Clinical Sociology
Review, 6, 35-41.
Gutknecht, D. B. (1984). Organizational development: An assessment with implications for clinical sociology.
Clinical Sociology Review, 2, 94-108.
Henslin, J. M. (1999). Sociology: A down to earth approach. Boston: Allyn & Bacon.
168 MARY C. SENGSTOCK

Hoffman, E (1987). An alcoholism program for Hispanics. Clinical Sociology Review, 5, 91-101.
Hongdagneu-Sotelo, P. (1994). Latina immigrant women and paid domestic work: Upgrading the occupation. Clinical
Sociology Review, 12, 257-275.
Joe, J. R., & Miller, D. L. (1994). Field-initiated research to predict work-motivation among Navajo vocational
rehabilitation clients. Clinical Sociology Review, 12, 235-256.
Johnstone, B. (1990). Stories, community, and place: Narratives from Middle America. Bloomington: Indiana
University Press.
Matthews, L. (1996). Culturally competent models in human services organizations. Journal ofMulticultural Social
Work,4(4), 131-135.
McCall, G. J., Ngeva, J., & Mbebe, M. (1997). Mapping conflict cultures: Interpersonal disputing in a South African
black township. Human Organization, 56(1), 71-78.
Mesch, G. S., & Schwirian, K. P. (1996). The effectiveness of neighborhood collective action. Social Problems, 43(4),
467-483.
Meyer, P. c., & Budowski, M. (1995). Effects of organizing voluntary help on social support, stress and health of
elderly people. Clinical Sociology Review, 13, 106-119.
Mitchell, R. E., Stevenson, J. E, & Rorin, P. (1996). A typology of prevention activities: Applications to community
coalitions. The Journal of Primary Prevention, 16(4), 413-436.
Nash, E (1993). Church-based organizing as participatory research: The Northwest Community Organization and the
Pilsen Resurrection Project. The American Sociologist, 24(1), 38-55.
Nyden, P., Figert, A., Shibley, M., & Burrows, D. (l997a) Building community. Thousand Oaks, CA: Pine Forge Press.
Nyden, P., Adams, J., & Zalent, K. (l97b). Creating and sustaining racially and ethnically diverse communities. In P.
Nyden, A. Figert, M. Shibley, & D. Burrows (Eds.), Building community (pp. 32-41). Thousand Oaks, CA: Pine
Forge Press.
Papineau, D., & Kiely, M. C. (1996). Participatory evaluation in a community organization: Fostering stakeholder
impowerment and utilization. Evaluation and Program Planning, 19(1), 79-93.
Park, R. E. (1952). Organization and the romantic temper. In Human communities. Glencoe, IL: Free Press.
Perdue, W. D. (1986). Sociological theory. Palo Alto, CA: Mayfield.
Radekop, C. (1975). Communal groups: Inside or outside the community? In J. Klinton (Ed.), The American
community, creation and revival (pp. 135-161). Aurora, IL: Social Science and Sociological Resources.
Ranney, D. C., & Betancur, J. J. (1992). Labor-force-based development: A community-oriented approach to targeting
job training and industrial development. Economic Development Quarterly, 6(3), 286-296.
Reinelt, C. (1994). Fostering empowerment, building community: The challenge for state-funded feminist organiza-
tions. Human Relations, 47(6), 685-705.
Schultz, M. (1996). Sociological applications in the development and evaluation of community mediation programs.
Journal of Applied Sociology, 13(1), 104-126.
Sengstock, M. C. (1987). Sociological strategies for developing community resources: Services for abused wives as an
example. Clinical Sociology Review, 5, 132-144.
Sengstock, M. C. (1994). Researching an Iraqi community in the midst of the U.S.-Iraq War: The researcher as
clinician. Clinical Sociology Review, 12, 59-82.
Sengstock, M. C., Thibault, J., & Zaranek, R. (1999). Community dimensions of elderly self-neglect. Journal ofElder
Abuse and Neglect 11(2), 77-93.
Shepherd, C. R. (1995). Structural, normative, and communal integration in organizations. Clinical Sociology Review,
13,70-79.
Smelzer, N. J. (1962). Theory of collective behavior. New York: Free Press.
Smith, J. L., & Reichtell, B. (1997). Changing neighborhoods and research for diversity in Cleveland. In P. Nyden, A.
Figert, M. Shibley, & D. Burrows (Eds.), Building community (pp. 58-64). Thousand Oaks, CA: Pine Forge
Press.
Stoecker, R. (1999). Making connections: Community organizing, empowerment planning and participatory research
in participatory evaluation. Sociological Practice: A Journal of Clinical and Applied Research, 1, 209-231.
Stoecker, R., & Beckwith, D. (1992). Advancing Toledo's neighborhood movement through participatory research:
Integrating activist and academic approaches. Clinical Sociology Review, 10, 198-213.
Straus, R. A. (1984). Changing the definition of the situation: Toward a theory of sociological intervention. Clinical
Sociology Review, 2, 51-63.
Sullivan, T. J., & Thompson, K. S. (1988). Introduction to social problems. New York: Macmillan Co.
Taylor, J. B., & Randolph, J. (1975). Community worker. New York: Aronson.
Waters, M. (1994). Modern sociological theory. Thousand Oaks, CA: Sage.
Watts, D. (1989). Reducing adolescent drug abuse: Sociological strategies for community practice. Clinical Sociology
Review, 7, 152-171.
 CHAPTER 10

Intervention
in Formal Organizations
Lessons from Interventions in Public Schools

BRUCE SAUNDERS

INTRODUCTION

In the early 1990s I gave up attempts to intervene in schools and school districts and instead
began to focus on interventions with small groups of teachers. In the previous Handbook of
Clinical Sociology (Saunders, 1991b), I described that work, but not the reasons that brought
me to it. Here I want to explore the clinical considerations that led me to abandon large-scale
interventions in schools and decide I would be far more effective working with small groups of
teachers in a private setting. The lesson I had finally learned, after years of large-scale
interventions, was that my services, and those of colleagues in the sociology of education
community, were ... well, unwanted, and for good reasons. Our interventions were doing more
harm than good.
In this chapter I want to show how good intentions can produce harm; how the clients that
school interventionists serve are not our real clients; how workers in schools, a ubiquitous
formal organization, can be manipulated and even controlled by professionals in another
ubiquitous formal organization, the university; and how a climate of unending interventions
can become iatrogenic and pathological. Although public schools and universities are the
formal organizations dealt with here, by extension much of this chapter will be applicable to
interventions in any type of formal organization. I want to draw attention also to the fact that
clinical sociologists are not alone in the intervention business and many of our competitors
lack the clinical skills, judgment, and ethical preparation needed to make large-scale interven-
tions successful (cf. Strauss, 1985).

BRUCE SAUNDERS* • College of Education, University of Washington, Seattle, Washington 98115. *Also a
Senior Member of CSA, an international consortium of practicing social scientists.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

169
170 BRUCE SAUNDERS

FORMAL ORGANIZATIONS: CLASSIC AND CONTEMPORARY VIEWS

Let's begin with the formal organization. In classical sociology, formal organizations are
defined by their structural features, and the work they do is seen as bureaucratized "process-
ing" of some tangible or intangible substance-forms, automobiles on an assembly line,
patients flowing through a hospital, clients in a social welfare agency, schools processing stu-
dents. Formal organizations are hierarchic, bureaucratized, have a formal division of labor, a
conforming system of norms, roles, and statuses, and a division of power and authority.
"Statuses" are hierarchically arrayed positions within the organization. "Roles" are expecta-
tions for how status incumbents will behave in their positions, held by actors themselves, or by
others who relate to them (see, e.g., Bendix, 1948; Blau and Scott, 1962; Durkheim, 1964;
Shostak, 1991; Weber, 1961, 1964, 1968). These structural features of the formal organization
are the bases for routines, which accomplish the work the organization does. Routines are the
formal organization's bedrock activity (e.g., in libraries, cataloging, shelving, circulation,
information services; or the routines of a hospital, prison, or school). These routines can be
seen as structural properties of the organization, or complementarily, as role work done by
members.
In classical sociology, little attention is paid to interactions among formal organizations,
although the necessity of such interactions has been recognized at least since Marx's analysis
of political economy (Marx, 1961:94ff) and Weber's analysis of class struggle (1946:180-195).
In contemporary sociology, econometric analyses of institutional interactions within and across
sectors are familiar (see, e.g., Becker, 1964; Campbell et aI., 1991; Hodgson, 1994). However,
the clinical implications of these institutional interactions remain mostly unexplored.
In a chapter on assessment in the previous Handbook of Clinical Sociology (Saunders,
1991a), I treated formal organizations classically, as though each were isolated in its organiza-
tional milieu. In this chapter I want to relax that constraint, and explore the clinical effects of
impacts on organizations from interventions by outsider organizations. In my chapter on
assessment I posed an obnoxiously long list of questions a competent clinician keeps in mind
when deciding on an intervention in a formal organization. I left out one question that is as
important as any: "Who else is in this game?" By this I mean, "Do actors in other organiza-
tions influence, deliberately or inadvertently, what happens in a client organization?" [Tradi-
tional organizational analyses focus on members' behavior (e.g., Stein & Kanter, 1979) but in
today's organizational climate it is the behavior of actors across organizational boundaries that
matters.] Outside actors may not even have a formal relationship with persons they influence.
If parents are raising their children with a baby book, Drs. Spock and Brazleton are in the
game. If schools are networked into a consortium, John Goodlad-a distinguished school
interventionist (see, e.g., Goodlad, 1984, 1990)-is likely to be in the game. Children in a
family may not be aware of the influence Dr. Brazleton has over the circumstances of their
lives. Similarly, staff in individual schools may be unaware of the role Goodlad and other
energetic and persistent university-based interventionists play in their lives.

CLINICAL SOCIOLOGISTS
IN THE MULTIPLY-INVOLVED ORGANIZATION

Let us consider the problems a clinician faces when planning an intervention in the
contemporary, nonclassical, universe of organizations. In this environment, innovation is
constant as intermeshed organizations penetrate and influence others' operations. Extra-
INTERVENTION IN FORMAL ORGANIZATIONS 171

organizational interventions of varying degrees of sensitiveness both support and threaten an

organization's routines. Each new "threat" from the outside challenges workers to redefine
work roles and the organization's purposes, and to preserve their routines. The risk is that
authority relationships will be undermined, staff loyalties will be divided, definitions of role
work will become idiosyncratic and unfamiliar to co-workers, while bureaucratic structure
becomes elastic and flattened. Unless managers are astute and competently respond to external
threats, the organization's routines can become estranged from production demands.
If this happens, role work becomes uncoupled from the organization's original processing
and purposes, while products of the organization are no longer easy to ascertain. When
creative role enactment takes precedence over routines, the organization's formal structure
becomes chimerical. To understand the organization's states in these circumstances, it is
necessary to penetrate the actors' minds. We are now in the realm of cultural sociology: self-
presentation, individualistic conceptions of roles, a topsy anticlassical world in which struc-
ture and role relationships are invented to serve intentions of individuals (see, e.g., Goffman,
1961; McCall & Simmons, 1966). The situation is even crazier when we consider the inter-
meshed organizational environment as a whole, and realize that players far distant in space and
responsibility are acting constantly to redefine the organization and its functions.
As an example, consider the role of the business officer in a community college. Commu-
nity colleges used to be like one-room schoolhouses: self-contained and self-sufficient, tightly
integrated institutions, accountable mainly to their governing boards, faculty, and commu-
nities. Today, community college education is an interconnected world and what happens off
campus may be of equal or greater importance than what happens on campus. The services a
community college delivers depend on cooperating relationships with local schools, commu-
nity organizations, neighboring four-year colleges and universities, accrediting agencies,
police, local planning agencies, legislatures, coordinating agencies, health and welfare organi-
zations, transportation companies, public and private utilities, private vendors and profes-
sional networks of administrators, computer systems managers, purchasing managers, athletic
directors, faculty unions, and business officers. Professional groups like the American Asso-
ciation of Community Colleges, the Society for College and University Planning, and the
Association of Governing Boards, through their research, dissemination, and advocacy func-
tions, play a role in defining the community college, as does the federal government in its
legislative and regulatory roles. Whatever the issue or need before college managers-funding
a daycare, starting a native plant garden, getting more parking or better security on weekends,
negotiating a new faculty contract, coping with a state audit, setting up a telecommunications
network, establishing a senior center-the business officer knows off-campus institutions will
be involved, often in a determining way. This is the way the organizational ecology works
today.
Now let's put the clinical sociologist into this milieu. The problem of assessment, of
learning the organization's state and its dynamics, is much more difficult, perhaps impossible.
Large formal organizations are universes of multiple cross-organized networks that penetrate
far beyond formal boundaries of the organization. The formal organization is a mere locus of
activity. Organizational boundaries are elastic and permeable. Workers have cross-organizational
loyalties and are differentially sensitive to multiple audiences and authorities. Roles are
plastic, not formally defined, and unsituated, because role-relationships extend outside the
organization. The tendency toward conformity in formal organizations, made famous by
Whyte (1956), is disappearing as both a value and a practice. In its place is a whirlpool of
shifting relationships and change-making. Contemporary formal organizations are in a con-
stant state of reinvention. In this setting, "connections," "performance," "reengineering" are
172 BRUCE SAUNDERS

prized, even when their effects are deleterious or unknowable. Organization staff are no longer
"other directed" or "inner direct" (Riesman et ai., 1956). In the new "outer directed"
organization, innovation is the primary desideratum. Today the organization man or woman is
pleased by change.
This complexity presents deep problems for clinical sociologists. Any assessment of an
organization's states is contingent and likely to soon need amending. Entwined dependencies
are hard to discover, much less document or affect. A clinical worker in a school system, for
example, has to dig to uncover the contents of phone calls between parents and teachers,
conversations that are important because they mediate the behavior of teachers, parents, or
students. Similarly, hidden from the casual observer are extended ties developed between
principals or superintendents and schools of education, ties that begin in candidates' initial or
recurrent training and certification, and are maintained and carried deeper in workshops and
joint efforts with university faculty to improve schools. Hidden too are the networks of
purchasing agents and purveyors that shape the material world of schools, or the sodality of
school district legal staff, ACLU lawyers, district attorneys, lawyers from the state attorney
general's office, and lawyers for parents and students that negotiate school policy.
It is fair to say that for most organizations elaborate cross-organization intertwining is
eufunctional and benefits participating institutions (cf. Beder, 1984; Glass, 1985; Neal, 1988).
Horizontal dissemination speeds the flow of information to the right persons within and across
organizations (while making it impossible for anyone to know the state of the organization or
describe fully its work and products). Workers benefit by becoming professionalized (Carr-
Saunders & Wilson, 1933) in this climate. They gain more control over their work, including
freedom to innovate. The problem of coordination of work is more efficiently handled by
removing most responsibility for coordination from managers and placing it in the hands of
employees. And there are potential gains in efficiency and speed of operations.
But there are unfortunate consequences too. With permeable boundaries, organizations
can become too diffuse and get themselves locked into activities that do not benefit demanding
"customers" inside or outside the organization. And a point I will want to dwell on, organiza-
tions with permeable boundaries are vulnerable to harmful interventions by persons who
sincerely want to reform or "fix" them. I saw this happening in two prominent libraries in a
western state when zeal for reinventing the organization and reform became institutionalized.
Library work, like farm work or childcare, is infinite in amount. The work of libraries is barely
managed by imposing strict routines on staff, with consequent demands for scheduling and
strict performance. In the two libraries I have in mind, something near chaos ensued when
zealous and naive directors attempted to reinvent their institutions. They joined a wave of
"reform" that had begun with policy proposals that had originated with faculty in library
schools. On the page, the ideas were promising, but in practice they created chaos. New
governance and authority structures were imposed, then changed again. There was a climate of
constant meetings to determine work roles and responsibilities and negotiate details of
cooperation. Role and status boundaries were blurred and often needed to be clarified anew.
Not surprisingly, while this went on, staff had difficulty maintaining their routines. "What am
I supposed to do?" "Who is going to take care of this?" and "Why is she allowed to do that?"
became common refrains. The constant press for reorganization ate up the staff's one para-
mount resource, its time on the job. And as undone work mounted, staff became angry,
frustrated, and surprisingly, more dedicated to making the reforms "work." Watching this
madness develop over months, then years, I was reminded of the words of Gaius Petronius
(AD 71):
INTERVENTION IN FORMAL ORGANIZATIONS 173

We trained hard-but it seemed that every time we were beginning to form up teams, we would be re-
organized. I was to learn later in life that we tend to meet any new situation by re-organizing, and a
wonderful method it can be for creating the illusion of progress, while producing confusion, ineffi-
ciency and demoralization.

REFORM MOVEMENTS IN EDUCATION I

Let us turn now to a clinical effort of my own that produced confusion, inefficiency, and
demoralization when a group of well-meaning university-based interventionists set out to
make all of the schools in one large urban district "more effective" (Saunders, 1985). What I
am working toward is two things: an understanding of where the impetus for "reorganization"
of public schools comes from, and the consequences for schools of being in a constant state of
intervention and reform. I want to show how researchers and reformers in distinguished
colleges of education create a climate of crisis that has continued for 50 years, with their
sincere efforts to reform public education.
In the 1980s I joined an interdisciplinary team of school personnel and university faculty
that was convened to make all schools in a major urban district "more effective." The
nationwide "effective schools" movement was one of tens of other "movements" that have
roiled public schools and popular sentiments about schooling since the Korean War. The
effective schools movement came after the building-based management movement, the new
math movement, the bilingual education movement, mainstrearning of persons with disability
movement, and before the restructuring and the accountability movements. All of these were
true social movements: general drifts toward reform, not formally organized and lacking
established leadership and an identifiable membership. These school reform movements, like
so many others before them and since, were episodic and short lasting, haphazard in their
targets and impacts. They followed a familiar pattern of rising and waning enthusiasm among
adherents, and they were spread by literatures as varied and ill-defined as the movements
themselves. The movements were utopian and crystallized many existing desires, hopes, and
dissatisfactions with educational outcomes. The movements created antagonist in-groups and
out-groups. They had elaborate ceremonies and rituals 2, a developing group ideology, an
end period when tactics overwhelmed goals, and invisible and umemarked finales where the
movements slipped away without bows or bravos (cf. Blumer, 1969).
I will not present much of the argument here, but I believe virtually all of these interven-
tions originated in networked colleges of education or policy organizations allied with
mainstream college of education faculty. Members of the national commission that prepared
the influential white paper, A Nation At Risk (1983), also were on or consulted with the Came-
gie Forum on Education, which wrote and distributed A Nation Prepared: Teachers for the
21st Century (1986). Some of these same people belonged to the Holmes Group, whose
members are deans of education schools and which issued an influential call for reforms in
teacher education (Holmes, 1986). The point I want to emphasize is that almost none of this
nation's major reform movements for public schooling originated within public schools

lIn tracing the research I did for this intervention, I will cite only literature available at the time. For contemporary
studies of the effects of trans-organizational interventions on schools' structure, performance, and organizational
behavior see Berliner and Biddle (1996), Cuban (1999), Ravitch (2000), and Tyack and Cuban (1995).
21 have in mind the protocols of formal educational research, which are almost absurdly stylized and ritualized from
the perspective of laypersons.
174 BRUCE SAUNDERS

themselves. In truth, teachers and other school system staff are the hapless targets of these
movements, not their organizers. Ironically, many of these school reform movements began as
rhetorical efforts to improve schools by professionalizing the occupation of teaching (cf.
Soder, 1990), a goal utterly inconsistent with the means employed, as we shall soon see.

THE EFFECTIVE SCHOOLS MOVEMENT

The effective schools movement was not much different than its predecessors or suc-
cessors. In hindsight it was ahistorical, atheoretical, rhetoric laden, driven by righteous anxiety
over the state of schools and the welfare of children, and like its fellows, had long-lasting and
not altogether salubrious effects. First, a research and policy literature gradually coalesced into
an action plan. Colleges of education around the country then recruited nearby schools and
districts to participate in a new round of school reform. Staff was hired, policy papers written,
joint meetings held, limits of the proposed work negotiated in painstaking detail with districts
and schools, and the intervention was on. Typically, district officers and some principals and
teachers participated in preliminary discussions, but with more reserve and caution than
enthusiasm for the intervention. As with other education reform movements, the cycle lasted
about 5 years. The topic of effective schools gradually disappeared from professional meetings
and research publications, and soon was a sense the intervention was passe. Faculty drifted
away from the project, and district and school people wondered what became of it, but were
glad to have it gone. Something newer and better was coming to take its place.
During the movement's life, "effectiveness" was never formally defined with a generally
accepted, stable meaning, although ways to measure "effectiveness" were operationalized at
different sites. This meant results from different interventions across the nation were not
comparable. Worse, without a stable definition of "effectiveness" it was not easy to agree
about what the intervention was meant to accomplish. While "effectiveness" was not formally
defined, 12 ad hoc characteristics that were thought to be present in every "effective" school
appeared in a burgeoning "effective schools" literature. The effective school, the argument
went, is characterized by clear goals, strong leadership, dedicated staff, high expectations,
frequent monitoring of student progress, early identification of learning difficulties, positive
learning climate, time on task, curriculum continuity (i.e., following the prescribed curricu-
lum), multicultural education, effective communication, and parent/community involvement.
Persons writing the literature appeared to accept uncritically (and perhaps unconsciously) the
correlative argument: namely, that any school must become "more effective" if efforts are
made to clarify goals, strengthen leadership, increase staff dedication, and so on. It did not
occur to movement leaders that efforts to make schools more "effective" in this way might
have an opposite result.

PLANNING THE INTERVENTION

Let us see how the intervention worked in practice. In my setting, colleagues from the
university and the school district divided into groups to develop operational definitions of
the 12 effective schools characteristics. These groups went on to design instruments to mea-
sure the "level" of every characteristic in each of the city's schools. The data obtained were
returned to individual schools and merged with other data used for "'building-based"
planning-an earlier reform meant to improve schools by giving staff more freedom to define
INTERVENTION IN FORMAL ORGANIZATIONS 175

operational goals and plans. The notion was to increase the commitment and dedication of
individual schools to self-study and renewal by giving each school diagnostic information
about itself.
This form of intervention was supported by the wisdom of the time, which held that
meaningful organizational change is likely only when school leaders and staff engage in self-
study, collect and analyze data relevant to their perceived problems, and commit themselves to
reform (Bentzen, 1974; Goodlad, 1984). Because they were academics, team leaders sought to
accomplish this by using the standard tools of educational research: survey research methods,
questionnaires and Likert scales, item and scale analysis, factor and correlation analysis.
Scales were devised to measure levels of each characteristic, district-level people and staff in
each school were surveyed, the data were tabulated and analyzed, and eventually every school
received its own data back, along with norms for schools like it in the district.
It was not plain to me what schools would do with their data, although the district issued
guidelines for wrestling with them. The district administered the questionnaires and processed
the data. Access to the data was a sensitive matter and not until the project was ending did the
university got its own copies of some of the data tapes. It was later still when the district agree
to furnish the university with other sensitive data needed to assess school "effectiveness"
(mainly individual student records and test scores with student ill numbers scr-ambled to
prevent identification of individuals). Even then research faculty did not have direct access to
tapes but had to submit requests for runs to a research assistant, who would return in several
days with boxes of fan-fold printouts. The research assistant who did runs for me developed a
sore back and had to see a chiropractor, and for a time offices were jammed with boxes of
unread data.
"Dedicated Staff" was the characteristic I agreed to be responsible for. My first concern
was to think about the sort of information that schools might wish usefully to have returned to
them. I argued to colleagues that the need to return data to schools for planning and school
improvement purposes constrained the measurement of the 12 characteristics in several ways.
Obviously, instruments for measuring the 12 characteristics had to be grounded in a substan-
tive research literature, have theoretical relevance, and be methodologically sound, but the
results must also provide diagnostic guidance to schools engaged in self-study. Information
returned to schools should be meaningful to school professionals and identify or bear on
problems they genuinely wished to solve. To put the matter differently, instruments to measure
the 12 characteristics needed to satisfy clinical as well as research requirements. It is easy to
suppose, I said to my colleagues, that the same data and analyses will serve both research and
clinical purposes, but this is a mistake. The perspectives of school personnel members are not
identical to those of educational researchers. Their felt needs are different and they resist
prescriptive, top-down attempts to mandate reforms or impose frames of reference and
analytical structures on them (Mehan, 1985; Sarason, 1974). School building staff, who have
mountains of problems to solve and too much to do in too little time, are impatient with
research results that seem unrelated to their immediate needs. The researcher who wishes to be
a clinician and "do social life" in as naturalistic a way as possible must become sensitive to the
kind of information that client organizations will use (Freedman & Rosenfield, 1983; Lofland,
1976). The point was that the problem of "knowledge utilization" is very much a part of the
problem of making schools more effective (Carter, 1985). Furnishing relevant information is
not enough. Ways must be found to send schools information they can and will use.
I wrote and circulated a document proposing strategies for preparing data we would send
to schools. I argued, for example, that individual item data would be more useful than scale
scores, and that technical analyses be offered only when schools request them. Responses from
176 BRUCE SAUNDERS

colleagues were favorable but I did not carry the day, and it may not have mattered.
Ultimately, schools got what researchers got: boxes of unanalyzed data. When I made these
arguments, I was naive in two respects: first because I foolishly expected team colleagues
would heed my warning that products of empirical research may not have clinical meaning for
school staff, and second because I did not consider what mountains of incoming information
might do to school routines and staff morale. Foolishly, I accepted without reflection the
prevailing argument that knowledge-based interventions were the way to go about changing
formal organizations (see, e.g., Argyris & Schon, 1974). With others, I failed to understand that
too many kinds of reformers, focusing different streams of knowledge on bureaucratized
employees in formal organizations might be worse than counterproductive. A wealth of
information and a multitude of seemingly sound proposals for change will bring a formal
organization into crisis.

DEDICATED STAFF

Planning the intervention was tasking because there was virtually no research literature
on staff dedication in relationship to school effectiveness. There is not even consensus on what
"dedication" is, or how it should be measured. Dedication may be defined at the individual,
group, or structural levels. At the individual level, "dedication" is a psychological propensity
or disposition that presumably varies across individuals. Defining "dedication" as a psycho-
logical property of persons would commit me to discovering the level of dedication of each
person on every school's staff. Presumably, instruments would be drawn from psychometric,
social psychological, or interactionist traditions, but this was immaterial because my team was
prevented from gathering identifying data on individuals. Principals and teachers, through
their associations, made it clear they would not stand for individual-level appraisals, which
they said would be divisive and reduce morale and commitment. There would be no witch hunt
for "undedicated" teachers in this school district.
At a group level, dedication is a property of an interacting cadre of persons and is concep-
tually distinct from the personal and private dedication of individuals. Group outcomes are
determined by group processes. If "dedication" is defined this way, the literature and research
methodologies that are relevant for the study of group processes are sources of instruments.
Among these are the organizational literature, some interactionist and social psychology lit-
erature, the motivational and leadership literature, and perhaps the communication literature.
A structural view of "dedication" leads to a search for deep regularities in the ways
schools are structured and function. Here staff dedication might be expected to vary with
school student composition; with movement of staff members along a continuum of status
ranging from salaried employee to autonomous professional; with opportunities to participate
in the establishment of organizational goals and practices; or with other structural variables
such as the degree of voluntarism in the mutual selection of staff and school.
Furthermore, the fact of dedication and the content of dedication belong to different
domains. One must ask, "dedicated to what?" To official goals? Officially sanctioned means
for reaching goals? To abstractions? To other staff members or leaders? To students? And for
how long, and under what circumstances is dedication evinced? Is it sought in publicly observ-
able acts or by inquiring into collective beliefs? Is it necessary to distinguish among intentions,
actions, and outcomes? Does dedication vary with the roles and statuses of individuals? Is
dedication a function of role definition, self- and other-expectations, grade level being taught,
subject-field orientation, staff experience, or other individual-level variables known to school
researchers?
INTERVENTION IN FORMAL ORGANIZATIONS 177

A hunt for relevant literature turned up no sustained research tradition centering on

"dedication," so one must be created. One strategy I considered would be to treat the problem
as one of determining how particular aggregate levels of commitment and dedication are
established and maintained in individual schools. That is, dedication might be seen dynam-
ically, as the end product of a process analogous to mutual goal setting, consensus making, or
other collectivizations of private purposes. This leads straight to school dynamics and sug-
gested a number of ties to the work other colleagues were doing in the effective schools
universe. School dynamics are idiosyncratic and volatile, however, and I did not want to base a
systemwide intervention on transient dynamics.
Thinking about the process by which a staff increases its collective commitment and
dedication turned out to be fruitful. This approach had the benefit of leading away from
individual performance appraisals, which were not feasible in this district. Coleman and
colleagues' (1982) work offered guidance. Coleman and his colleagues reasoned that the
political and institutional position of public schools is the source of structural variables that
influence or determine school climates and normative states. Loosely, the model is this: rising
government control over public schooling, coupled with the promulgation of conflicting goals
for schools and increasingly fragmented governance of public education, results in further
bureaucratization, lack of value consensus, a tendency to emphasize legal and rational author-
ity, and low efficiency. A direct consequence is reduced dedication of staff, principals, parents,
and students. Salganik and Karweit (1982) extend these notions by contrasting public schools
with the situation in the private sector. Dedication and commitment flow from the way schools
are organized and governed. Because private schools are differently organized and governed,
levels of dedication and commitment are higher. The central structural feature of private
schools is voluntarism, or the mutual selection of school, staff, and students. Voluntarism is a
source of legitimacy, consensus, and commitment. Because selection of heads and staff is
mutual in the independent sector there is increased trust, greater value consensus, and broader
support for school polices and goals. The apparent dedication of private school faculties
reflects these realities.
Another literature-which might be called the "phenomenology of teaching" (see, e.g.,
Jackson, 1968; Lortie, 1975; Waller, 1932)-identifies structural and normative elements of
public schooling that shape staff perceptions and commitments. First there is the pressure of
the conflict between externally determined and internally determined criteria of personal and
professional worth. The absence of a common technical culture, having to work in isolation
from one's peers, the ambiguous professional status of school occupations, the occupation's
role complexity and structural sources for role conflict, the difficulties of maintaining idealism,
and a front-loaded salary system are some of the elements that affect teachers' dedication and
commitment to their work.
Also helpful is the somewhat pragmatic literature that overtly provides strategies and
plans for increasing commitment and dedication to organizational practices and goals (e.g.,
Argyris & Schon, 1974). The weight of research evidence suggests that prescriptive manage-
ment strategies and reduced freedom of choice lessen internal commitment and risk-taking
behavior (Argyris & Schon, 1974:67ff). Conversely, internal commitment to a goal choice and
constant monitoring of its implementation are likely to take place when people can safely
expose their fears, and where there are mechanisms for acquiring mutual trust and understand-
ing. In this case the individual is dedicated, not because someone is rewarding or penalizing
him, but because doing work is intrinsically satisfying. In this pragmatic literature a typical
strategy for intervention is to make management of organizational goals a shared responsibil-
ity. Interactional patterns are recommended that help actors to mutually define goals, explore
paths to shared goals, develop their own realistic levels of aspiration, and relate goals to their
178 BRUCE SAUNDERS

central needs. In turn, this generates internal commitment and dedication to the collective
purposes (Argyris & Schon, 1974:89-90).
Another attack on the problem of a theoretical basis for "dedication" flows from the
organization and education administration streams, particularly the literature that centers
around leadership and the capacity of leaders to induce dedication and commitment. That
research attempts to link role characteristics of principals and other school managers with
behavioral outcomes for staff. For example, Hoy and Rees's (1974) work contains an extensive
and useful literature review, provocative findings of a significant negative relationship be-
tween teacher loyalty and authoritarianism, and a significant positive relationship between
teacher loyalty and both hierarchical influence and emotional detachment.
In a different theoretical tradition, "dedication" means loyalty to the organization.
Several important works have explored this theme and its implications (Caplow & McGee,
1958; Gouldner, 1957; Thornton, 1970). Also there is an extensive literature in which "dedica-
tion" refers to loyalty to the work group (e.g., Likert, 1967) or loyalty to particular superiors
(e.g., Blau & Scott, 1962).
At this point in my research, something like a viable attack on the problem of opera-
tionalizing "staff dedication" emerged. Psychological models of dedication must be discarded
because they infringe on management initiatives (the right to evaluate the staff), because they
upset contractual arrangements, and if I believed the pragmatic literature, because they risk
upsetting building-level processes that generate consensus and dedication. The import of the
several literatures I reviewed is that structural elements affect the dedication of staff by
increasing or reducing staff autonomy. The empirical research literature, the phenomenologi-
cal, school change, and pragmatic literatures converge on this fundamental point: commitment
and dedication rise when the staff acquires more voluntary control over work. Moving staff
members along the continuum from obedient employee to autonomous professional increases
dedication, and presumably effectiveness.
Dedication (I decided) must be seen contextually, with an organizational focus. The
organizational perspective, in turn, implies that we are not concerned merely with the individ-
ual school staff in isolation, but with the interaction between staff members at all levels
throughout the school system.

AN EFFECT OF THE EFFECTIVE SCHOOLS MOVEMENT

And now to a central point. In thinking about the effective schools movement I was struck
by something hidden in its goals. The movement tended to be pragmatic and atheoretical.
There were few explicit attempts to explain why adopting clear goals, converting building
managers into instructional leaders, enhancing staff dedication, establishing positive learning
climates, or spending more time on task should increase educational effectiveness. Yet em-
bedded in each of these processes is a very clear thing: the professionalization of staff. The
effective schools movement was at bottom a movement to professionalize school staff.
Furthermore, if I believed these literatures, the goals of the effective schools movement could
not be achieved without professionalizing staff. It is important to understand that the means
that have been used to make schools more "effective" in fact tend to increase staff profes-
sionalization. This realization took me to the professionalization literature for theoretical
underpinnings for "dedication." The professionalization literature is contextual, has an orga-
nizational focus, and is a source of fruitful hypotheses about dedication and school outcomes.
INTERVENTION IN FORMAL ORGANIZATIONS 179

PROFESSIONALIZATION

Sociologists have written about the professionalization of school occupations at least

since the days of Waller (1932). Virtually every standard text in the field devotes one or more
chapters to the topic (cf. Banks, 1972; Boocock, 1972; Parelius & Parelius, 1978). The
literature of professionalization of occupations was first drawn together and defined by Carr-
Saunders and Wilson (1933) and has grown to enormous proportions. A very large amount of
this literature has a school focus (Lieberman, 1956), but some of it is quite general (e.g.,
Vollmer & Mills, 1966). Professionalization has been seen as a consequence of social change
(Meyers, 1976) or as part of a broad movement of occupations to professionalize themselves
(Pavalko, 1971; Wilensky, 1964). The professionalization of superintendents has been ex-
plored (Gross et ai., 1958) as has that of school psychologists (Starkman, 1971). The conse-
quences of professionalization for schools have also been researched and the findings point to
increased conflicts between districts and school staff as professionalized staff members,
working within bureaucratically structured organizations, struggle for autonomy (Hall, 1968;
Lortie, 1969).
Pavalko (1971), Starkman (1971), Vollmer and Mills (1966) and others identify charac-
teristics that are crucial for distinguishing a profession from other occupations. Salient are
autonomy, self-regulation and self-control over work behavior, a sense of community, a sense
of commitment, and a service-oriented motivational base (Pavalko, 1971). Corwin has written
more about professionalization and schooling than anyone (e.g., 1961, 1965, 1970, 1974) and
it is to him I turned for basic understandings in planning the intervention.
A long-standing tradition of local control over education helps to confirm teachers' status
as bureaucratized employees. School districts are locally oriented and local determination of
policy conflicts with professionalization of staff (Corwin, 1965:218-220). Initial selection,
preservice preparation, and job-related socialization tend to produce an employee orientation
among school staff members. Loyalty to the principal or district supersedes professional
judgment (Corwin, 1965:221). Schools offer both professional and bureaucratically defined
roles, often to the same person; but workers who subscribe to both orientations have trouble
carrying out their roles (Corwin, 1961). The expectations of teachers with employee (bureau-
cratic) orientations conflict with the expectations of teachers holding professional orientations.
Professionally oriented staff members are cosmopolitan in outlook and oriented to the opin-
ions of professional colleagues. Bureaucratic employees expect uniformity in role duties and
routines, and want governing rules to be universal and comprehensive. They are task oriented
and do their work by applying a set of rules they did not make to the solution of routine
problems. Bureaucratically oriented teachers expect supervision to be punishment centered,
and their loyalty is to the organization and to superiors.
Professionally oriented teachers see each work problem as unique and tend to take the
roles of clients. They expect (and perhaps desire) changes in work routines. For them, work
rules are guidelines and not binding. Professionally oriented teachers prefer to choose rules in
each situation from a set of alternatives. They stress achievement of goals rather than
accomplishment of tasks. Decisions about how to do their jobs flow out of their knowledge,
from their professional judgment, and from consultations with colleagues. Professionally
oriented teachers want representative administration and expect rules that govern their work to
be sanctioned by their professional group. They are most loyal to their professional associa-
tions and to their students (adapted from Corwin, 1965:233).
School governance is affected by the tension between employee and professional modes
180 BRUCE SAUNDERS

of organization. There is a dual basis for authority in schools. On one side there is administra-
tion based on expertise, and on the other there is administration based on rule-following and
discipline. The result is that school personnel members frequently are forced to choose
between rule compliance and their expert judgment (Corwin, 1965:238). In their bureau-
cratized schools, teachers do not gain power by trying to professionalize themselves. In highly
bureaucratized systems power is not associated with initiative, leadership, or independent
judgment but instead with union or organizational memberships (such as local teachers'
associations) or with personal ties to the administration.
Corwin, quoting Moeller (1962), concluded that only in an orderly, understandable, and
predictable organization can any individual expect to influence the direction the organization
will take. If teachers know what the prescribed course of action and lines of communication
are and what the policy is on particular issues, they are in a better position to influence events
or predict their course. However, this is true only if teachers have a professional orientation
and they are in a school setting that is not too bureaucratized. Knowledge of policy and process
may itself be a form of power (Corwin, 1965:240), but only for those who have license to
invent and bend rules.
Both teachers and administrators tend to manipulate the professional versus employee
status system for their own advantage. Teachers resist rules that infringe on their freedom
(such as rules about when they must be in the building) and they also resist when administra-
tors try to define them as professionals in order to compel them to accept unwanted obligations
(such as doing extra work in the evening and on weekends) (Corwin, 1965:240). With em-
ployee status thrust on them, teachers are limited in what they can do for their students, since
they are bound to their employers' instructions. Professionalization loosens employers' stric-
tures but this may not necessarily help students. As Corwin says: while it may be true in some
cases that "what is good for teachers is good for education," it is more certain that what is
good for the student is good for education. Therefore, the quality of education depends on the
extent to which teachers' professionalization gives primacy to the welfare of students
(1965:245). Corwin's pessimistic conclusion is that teachers will never move on to the ques-
tion of what is good for students until the question of what is good for teachers is laid to rest.
The implication of this argument is plain. Resolving the status problems of teachers, the
underlying tension between bureaucratized and professionalized status is fundamental to
making schools more effective for students. Bureaucratized teachers, or professionalized
teachers in very bureaucratized settings, are not able or willing to do what must be done to
make schools more effective. If "dedicated" means anything, it means, "dedicated to the well-
being of students." Under what conditions, then, are teachers and other school staff motivated
to be dedicated to their students' well-being? The answer is not until teachers escape the
necessity of choosing between two role orientations and being compromised by the choices
they make. The tension created by the two inconsistent role orientations is very relevant to the
questions of how teachers are to be treated, how much authority is to be delegated to them, how
much conflict administrators and teachers can expect, and how dedicated teachers will be to
their work. The inevitable professionalization of teachers also implies growing conflict be-
tween the school staff and higher administration. This conflict, in tum, is a displacement
activity that cools out coordinated attempts across all levels in a district to do what is best for
students.
Furthermore, as Corwin said, the professional versus bureaucratized employee tension
should not be construed as a conflict between individuals and their organizations. The funda-
mental tension is between one part of the system and another-between the professional and
INTERVENTION IN FORMAL ORGANIZATIONS 181

bureaucratic principles of organization that teachers and other professional employees are
expected to subscribe to. Conformity to professional principles requires that professional
groups resist some bureaucratic expectations. In that sense, what appears to be lack of dedica-
tion in some teachers in schools may actually reflect organizational problems rather than
personality problems (Corwin, 1965:263).

PROFESSIONALS WORKING IN A BUREAUCRATIZED

ORGANIZATION: LOOSE COUPLING

There is a mechanism that reduces the stress between professional and bureaucratic role
presses in formal organizations and this is the structural loose coupling that links components
of the formal organization. The conflict between the two role orientations can be managed if
not solved by moving role enactments to locations where discrepancies may be hidden-to
examining rooms in the healthcare system for instance, or behind classroom doors in schools.
Increasingly, professionals work in complex organizations. There, power is split among
managers, professional experts, and lay boards of directors. Managers, not colleagues, are
likely to have the upper hand. In principle, the salaried professional may have neither the
exclusive nor the final responsibility for his work. In classic sociology the professional must
accept the ultimate authority of nonprofessionals in the assessment of both process and
product (see, e.g., Wilensky, 1964:146). But in the environment of today's complex formal
organizations, there are numerous backstage areas in which nonconforming role work can be
hidden.
In a heteronomous system like the public schools, staff members have to seek protection
for professional identities wherever they can find it. Moeller's work (1962) suggested they
seek it in the orderliness and predictable routines of bureaucracy and in the protection of
principals with hierarchical influence. Hierarchical influence reflects the extent to which the
principal is able and willing to exert an influential voice to higher authorities on the staff's
behalf. The most important mechanism that helps teachers cope with the role strains caused by
being professionalized workers in a bureaucratized organization is structural looseness. Work
like Corwin's, or the work of Bidwell (1965), which is conceptually similar, assumed tightness
of linkages across the hierarchical levels of a school system. The organization's ability to
coordinate and control the activities of the staff was thought to preclude the striving of teachers
for autonomy to conduct their work as professionals. Bidwell, for example, argued that orga-
nizational control over the staff breaks down only when the teachers go into their classrooms
and shut the doors.
Bidwell's notion of limited structural looseness was refined by Weick (1976), who argued
in a celebrated paper that the elements of a school system are in fact loosely coupled, bound
together neither by a common technology, nor by the authority of offices, as one would expect
in complex organizations. In Weick's view, offices in the bureaucratic structure of school
systems are weakly joined. Information and directives are slow to cross hierarchical barriers.
And school systems are less rationalized, less orderly than they appear. Loose coupling can be
conceptualized as a mechanism that facilitates the maintenance of the contradiction of profes-
sional and bureaucratic role orientations in the same person, while also reducing the role strain
of professionals in a bureaucratized environment (see Spence et ai., 1978). There is a fair
amount of evidence that schools are loosely coupled, at least where supervision of teachers is
concerned. Dreeben (1970), for example, shows that evaluation and supervision of the staff is
182 BRUCE SAUNDERS

minimal and largely ceremonial, while Meyer and Rowan (1977) find little or no direct inspec-
tion of classroom activities, pupils' achievement, or the relationship of achievement to teacher
performance. The administrative apparatus of educational bureaucracies is inattentive to
teaching. There is tight coupling around student management (children seldom get lost),
placement, certification, hiring, scheduling, space allocation, resource allocation, and record-
keeping, but "teaching" is loosely supervised (Spence et al., 1978).

MAKING THE INTERVENTION

The way ahead now seemed clear. Dedication will rise if staff become more profes-
sionalized, provided loose coupling is maintained. But there is the rub. The effective schools
movement professionalizes staff by imposing a bureaucratic press for professionalization on
them, and by tightening coupling between district and schools and within schools. My job
would be to help schools and districts measure and increase their progress toward profes-
sionalization, while somehow mitigating the bureaucratic press that my team and others were
imposing on them. This would be a very narrow tightrope to walk. Tightening the coupling
very much, or pressing staff more deeply into the bureaucratic role orientation, would thwart
any possibility to increase dedication.
Like groups working on the other characteristics of effective schools, my team worked on
its own to operationalize a definition of dedication and design instruments to measure
dedication. Every group had members from the district and university but, predictably,
university people dominated the meetings, and participation by district people diminished to
near zero. Not atypically, I found myself working alone on the problem of staff dedication and
though I made sincere efforts to communicate and involve my district colleagues, they were
not very responsive. District colleagues were wary and apprehensive and would have termi-
nated work on staff dedication, if they had their way. This was a warning signal I should have
heeded. I wrote several papers, some quite technical, giving a formal statement of the problem,
synopses of research literature, the nature of the intervention I proposed, the logic behind the
instruments I was developing, the sorts of results we might expect, and how I intended to
disseminate and interpret these results to schoql faculties. Groups working on other charac-
teristics were generating similar schemes-and volumes of paper. When the time came to
present this work and proposals for intervention, the mass of material was too unwieldy for
anyone to comprehend in any detail. In a two-day gathering of decision-makers, participants
talked past one another, emotions were barely controlled, and when at last a decision was made
to go ahead with the project, no one had a clear sense of what this entailed.
So, instruments were created, tested, administered, and a stream of data began flowing to
project leaders, school administrators, and eventually to principals and teachers. Each team
developed its own instruments, and although these were shown to everyone, there were no
attempts to coordinate and rationalize the complete set of instruments. As a result, question-
naires going to schools and district leaders were needlessly long and many items were
duplicates. Teachers, principals, and district staff quickly came to loathe the questionnaires.
Methodologically, most of the instruments were flawless, but my own items would not
scale, and this was another clue that I did not really understand the situation. My items were the
most sensitive ones and as a result response rates were highly variable across schools and
individuals. The items were logically consistent and theoretically sound, but results were
sufficiently unpatterned that I began to suspect respondents were sabotaging the survey which,
as it turns out, was happening.
INTERVENTION IN FORMAL ORGANIZATIONS 183

AN EPIPHANY

When my data was analyzed and returned to schools, I tried to go with it, and met with
whole school faculties to discuss the results and possible implications. Many faculty refused to
attend these meetings. As time went on civility began evaporating and I had a pointed sense
my efforts were unwelcome. And then I made an illuminating mistake. I asked a research
assistant to run a series of analyses for a certain school, and allowed the data to go out without
examining them first. This particular school was struggling sincerely to master the flood of
data it received about itself and find something meaningful to do with them. When I arrived at
the school, late for a meeting, staff people were avidly debating the meaning of the data I had
sent. I listened to them for several minutes and could not make any sense of the conversation.
When I looked at the handouts I saw why. The tables and other materials were gibberish. My
assistant had run and sent off tables meant for a very technical analysis I was doing for another
project. But the point that arrested me was that these very good people, twenty or so of them,
had spent over an hour of their very precious work time, struggling to make sense of nonsense
in a way that instantly reminded me of Garfinkel's (1967) "breaching" paradigm. We discover
the "real" rules in a social system, Garfinkel said, by breaking everyday rules and watching
what happens. My mistake uncovered an unpleasant truth: the project was turning staff in this
school into automatons, who wasted their most valuable resource, their time, trying to find
meaning in what was for them patent nonsense. I had solved nothing and made a lot of trouble
for people I wanted to help, who were already pressed from many sides. This was an epiphany.
In the next several weeks I told the story at schools I visited to see what this teased out
from staff. Universally, the response was knowing agreement, and often anger. One man,
almost in tears, spoke for many of the district's staff when he said, "We've tried to do what you
want and now you admit what you want doesn't make sense. You are making us so fucking
crazy we can't even follow your rules." He was right. With my colleagues, I had disrupted
staff routines, demoralized teachers, wasted their time, and fed research data-much of them
unvetted, cleaned, or analyzed-to schools. In spite of my efforts to make the data stream
clinically useful schools were awash with data and analyses that were barely comprehensible,
much less useful for self-study. Whatever the merits of my theoretical approach to a difficult
problem, it was a problem posed by researchers at the national level and unrelated to any
problems staff at my schools might genuinely wish to solve. No wonder people in schools were
confused and angry. The intervention itself exposed and magnified the very internal tensions
it was intended to reduce. School staff were "acted upon" rather than liberated to act. In effect
I was trying to professionalize school staff by imposing a strong bureaucratic press on them.
This was the mistake I was most afraid to make, the mistake that would most surely reduce
staff dedication rather than raise it.

STOPPING THE JUGGERNAUT

Project staff could not throttle the flow of data to schools, even if they were aware of the
harm they were causing. It is almost impossible to abort large-scale school reform projects
before they dribble away. Research faculty must have data for reports and publications,
contracts must be honored, project leaders must protect reputations, and funding agencies
must be given what they have paid for. Together, these imperatives give enough momentum to
overturn any objections-even profound ones such as the project is not working, and we are
harming schools by proceeding. In private meetings with involved faculty I made noises,
184 BRUCE SAUNDERS

wrote and circulated appraisals, tried to negotiate modifications. But nothing could be done
and the generation of new items, scales, and large unwieldy questionnaires went on. School
district leaders were helpless to act, though principals and teachers were complaining loudly.
A misplaced determination to keep everyone in the loop meant that far more information
flowed to schools than they effectively could handle. So a vast number of tables, school-level,
and system-level reports were generated and distributed, most of them never read, to my
knowledge. These reams of paper distributed to schools generated a very large bureaucratic
press. Because project leaders had no control over what was done with the materials we
produced, at the school level the project came to be defined by the materials schools received.
Some of us visited schools often, but for the most part the questionnaires and the flow of data
into schools was the project from staffs' point of view. Lofty aims for reform were forgotten.
After distributing, and perhaps reading some items in the paper river, staff thought they had
done everything they were supposed to do.
So why were we doing this? In the remainder of this chapter I want to answer this ques-
tion and point the finger at my community, researchers in universities, who can be driven by
their own imperatives to harm public schools.

THE REFORMERS

For half a century, surveys of school staff have yielded consistent results when teachers
are asked what they need to conduct education. They need safe schools, parent support, small
enough classes, manageable work loads, curricula that work, instructional support, adequate
resources, help with difficult problems in classroom management, respect from parents and the
public, backup support from principals and district leaders, and much less of the ever-growing
mountain of paperwork that eats up instructional time. Calls for accountability, bilingual
education, mainstrearning, values education, vouchers, charter schools, national academic
standards, staff dedication, site-based planning, and all the other reforms that have been sent
schools' way originate, not with public school staff, but ultimately with faculty in colleges of
education and schools of public affairs in this country and abroad. Reading back issues of
major journals in the field (e.g., Harvard Educational Review, Journal of Education Re-
search), one is struck by the extent to which a climate of criticism and zeal for reform that
developed in education schools in the late 1950s has spread throughout the entire nation (see,
e.g., Getzels, 1978). In the 1960s and 1970s there was considerable concern about the "radi-
cals" in education schools who wanted to remake our society by changing schooling (Clifford
& Guthrie, 1988:120). I think the worry was misplaced. Joseph Schumpeter famously said,
"Under capitalism, capitalists are the real revolutionaries." In colleges of education, the real
revolutionaries are ordinary faculty in their inquiry, proselytizing, and clinical roles.
In the fairest reading, zeal for reform of public education is driven by deep-seated,
continuing disparities in test scores, and graduation, college-going, and discipline/expulsion
rates that vary with social class, race/ethnicity, religion, and residence. Historically, these
disparities are changed little by school reforms. There is no convincing empirical evidence that
reform movements have significantly reduced inequalities in school outcomes. Nor would we
expect them to. Thirty-five years of accumulated, sophisticated empirical sociological re-
search demonstrates beyond reasoned doubt that variables that can be manipulated at the
classroom, district, state, or national levels are not sufficiently powerful to meaningfully alter
schooling's outcomes (see, e.g., Campbell, 1983; Coleman et ai., 1966, 1982; Hedges &
Nowell, 1999; Jencks et ai. ,1979). In the very long term, the demographic transition, economic
INTERVENTION IN FORMAL ORGANIZATIONS 185

expansion, and expansion of higher education opportunities are the forces that reduce inequal-
ities in schooling outcomes. This has not stopped reformers who are ignorant of this research,
or repudiate it, from trying to speed things up. I see no signs that reformist fever is abating in
colleges of education, or the power of reformers to intervene in public education is being
curtailed.
The intimate relation between schools of education and public schools is described in a
detailed history of education schools by Clifford and Guthrie (1988), and at a political level by
Ravitch (1983). These works show the astonishing extent to which the two systems of formal
organizations are intertwined. The mechanisms of connection are easy to establish. Research
studies become the bases of policy papers, which are fed in endless streams to citizens'
advisory boards, commissions on education, national movers and shakers like the Carnegie
Foundation and Ford Foundation, and the nation's media. Links to schools are both direct and
indirect. Education school faculty, who train the nation's teachers, principals, and superinten-
dents, have ongoing relationships with districts, particular schools, and state education regula-
tors. Since 1940 there has been an explosion in the number of doctoral degrees in education
granted (see Clifford & Guthrie, 1988:38ff), and many of these PhDs found jobs in schools of
education. Expansion of higher education expanded opportunities for school reform. All the
disciplines of education (e.g., philosophy, education psychology, curriculum and instruction,
early childhood education, higher education, educational sociology) have critical and reform-
ist components. Ironically, the richest and most inftuentialliterature advocating public school
reform was created by sociologists in a golden age following the Second World War, when
American, British, French, and German sociologists generated powerful and persuasive
arguments for changing the functions and purposes of common schooling (e.g., Berg, 1970;
Bourdieu & Passeron, 1977; Bowles & Gintis, 1976; Carnoy, 1974; Collins, 1979; Giddens,
1975; Habermas, 1970; Persell, 1977). This is not the place to describe that literature, but the
point I need to make is that one system of formal organizations, graduate schools of education,
gradually absorbed this literature, took it to heart, and evolved to focus increasing power on
another system of formal organizations, public schools.
Historical precedents teach us that all may not go well when a climate of crisis becomes
institutionalized and no amount of interventions seems able to quell it. What has happened in
public education has happened before in other branches of social and policy sciences. Con-
sider, for example, the frantic days during the War on Poverty between 1964 and 1968, when
field workers rebelled because they felt jerked around by faculty in the social science, social
welfare, and policy communities. From the workers' viewpoint, just as a program would be
settling in and beginning to get some results there would be calls for change. New paradigms,
new action proposals, damning critical assessments, and conflicting research results would
pour from the academy, frustrating and overwhelming foot soldiers in the trenches. I was
working in Community Action Programs at the time, and I remember one meeting at which
researchers presented unrelated technical papers one after another to an audience of field
workers who were actively struggling to help poor people. After several hours of this, a
woman, Mrs. Osceola Washington, stood up and said: "You researchers have made so many
studies and done so much research, that the only thing left to do is to research the studies and
study the research." Mrs. Washington sat down to thunderous applause, the conference
resumed, and another half-dozen papers were read. I carried away a valuable insight: academic
practice is at odds with-and probably indifferent to-clinical work. Mrs. Washington under-
stood in 1965 what most of us have not figured out yet, that researchers and policymakers are
deeply involved in the construction of social problems and we will never understand what is
going on until we study the people who study the issues.
186 BRUCE SAUNDERS

ASSESSING THE INTERVENTION

My intervention was well thought out except for two matters: Who were the clients? And,
who else was in the game? At the outset I naively thought that school and district personnel
were my clients. I wanted them to be my clients. After my epiphany I put the clinical lens on
myself and probed my own orientation. Honest answers to a few simple questions gave an
unambiguous picture. Who paid me? Who did I report to? Whose permission did I seek? Who
did I try to please? Whose esteem did I try to retain? Clearly, I was an academic, embedded in
the university community, and my clients were my colleagues. Thinking about this it became
clear to me that faculty leaders in the effective schools movement were the only real players in
the game. School and district leaders were the playing pieces, schools were the game board,
and university people like me made the moves that mattered. Playing the game, our teams
alienated school people, objectified them, ignored their true concerns, and redefined their work
roles using analytical schemes that were barely intelligible to them. Without regard for the
demands already felt by school staff, we interfered with their schedules, added to their
anxieties. and increased tensions among staff. We also disattended to their complaints, and
when we lost interest in the project we blew them off without a handshake, a letter of farewell,
or a summary of what we had accomplished. At first, school staff was flattered by the attention
university people showered on them. Friendships and partnerships were founded that continue
today. But that was about all the good that came from this project. The district and its teachers
were not our clients. And the district and its teachers were not players in the game.
Thinking the matter through, I decided I wanted to workfor schools, not against them
and that I could never do this freely if I did my clinical work under the aegis of large-scale,
university-driven projects. So I embarked on the small-scale work that I described in my
chapter on education in the last Handbook ofClinical Sociology (Saunders, 1991b). I used my
contacts to form new relationships with teachers, principals, and leaders in some school
districts. The central issue for clinical sociologists in education, I realized, is not how to reform
public schools, but rather how to protect schools from misguided and iatrogenic reforms
imposed on them by all the players who want to change schooling. Among these are legislative
bodies, jurists, regulatory agencies, foundations, citizens' commissions, and, especially, fac-
ulty at prestigious universities who, I am convinced, are the greatest mischief makers.

PROTECTING SCHOOLS IS THE MOST

IMPORTANT CLINICAL WORK

What do I do in this new clinical work? The obvious work is to help schools protect
themselves from interventions that would bureaucratize professional staff, reduce autonomy,
complicate work roles, injure established social and authority relationships, narrow the curric-
ulum or means to deliver it, make education stultifying or boring. I come to clients with the
strong opinion that schools are not broken, do know how to conduct education, and are more
likely to be harmed by interventions than helped. The moral climate prevalent in colleges of
education is that public schools are in such terrible shape that any intervention will be an
improvement. This is a false and crazy belief, which legitimates the unethical and uninformed
practices I describe in this chapter (cf. Bruhn, 1991). Though it seems conservative and un-
imaginative, the real clinical work in education is to slow the pace of reform and mitigate the
effects of bad reforms. The main objective is to protect schools from misguided or patholog-
ical interventions that are certain to have outcomes that are bad for staff and students.
INTERVENTION IN FORMAL ORGANIZATIONS 187

In each setting I begin by assessing the threats to effective educational practice looming at
this unique moment and place. Many attempts by outsiders to change school practice or policy
are eufunctional for schools. With these, my principal concern is to bring change about with as
little fuss as possible. When I have doubts about an intervention, whatever its source, my
clients and I take a good look in the horse's mouth. I ask that we weigh expected gains against
certain losses. If the balance is at all in doubt, we get a second opinion, from districts or schools
that have experience with the intervention, or from respected clinicians whose judgment I
trust. If we are still not sure, I urge we do nothing. This is the most certain way to do no harm.
Much can be done to mitigate the bad effects of a pathological intervention that is already
adopted. It is better, however, to help school clients develop a sharp nose to smell out patho-
logical interventions before these are agreed to. What interventions are likely to be patholog-
ical? Let me close this chapter with a description of some suspect interventions and the threats
each presents. 3

PATHOLOGICAL INTERVENTIONS

Beware of interventions that multiply programs. Program differentiation (e.g., gifted

programs, alternative schools, magnet schools, bilingual and bicultural education, special
education) increases staff differentiation. But program multiplication has a larger effect: it
differentiates the educational system as a whole by multiplying constituencies and generating
advocates for particular programs. Adoption of special programs produces syndicates of
parents and staff members who are committed to the perpetuation of these programs at any
price. Districts find themselves in a trap. Pressure to change schools is unrelenting but re-
sources needed for the next round of change are unavailable if these are committed to existing
programs that districts are not allowed to drop.
Proposed interventions are pathological when implications for funding are not made
explicit. In addition to immediate costs, every intervention absorbs funds that would otherwise
be available for future uses. What my clients need to know is what they must give up, now and
in the future, if they accept an intervention or one is thrust on them. For the foreseeable future,
more reforms are inescapable. School people need to learn to think forward, not to the next
round or the one after that, but to the Nth round of reform. Educational reform is both
processual and incomplete. Each round of reforms only partially achieves its purposes, and
each round of reforms leaves residues (often unseen) that contaminate new efforts. For
example, in the 1980s a series of reforms in educational finance created a string of crises that
could be resolved only with more reforms. In this climate schools must inch forward and try
not to tie their hands unnecessarily in the future. Thinking ahead to the Nth round forces us to
pay attention to difficult sciences like demography, economics, forecasting college enroll-
ments and demands for labor, and the study of social movements and fads.
Clinical sociologists need to be wary of interventions based on sophisticated models in
which slight changes in specification or naive errors in design give very different or even
opposite results. Major interventions should never be based on research that is not robust and
supported by multiple, triangulated studies. Be especially careful of interventions that are
associated with ad hoc theories or have no theoretical foundation at all. Get the causal train

3A longer list and more thorough analysis of pathological interventions is found in Saunders (1990), available from
the author.
188 BRUCE SAUNDERS

straight before you recommend any intervention, and if reported empirical results are not
robust or are ambiguous, or the causal train is unclear, do not do anything.
Interventions that do not explicitly calculate the magnitude ofexpected effects are usually
pathological. Doing the calculations needed to estimate benefits gives us a chance to look over
the reasoning, theory, mechanics, and empirical results behind the proposal. But there is
another benefit. I ask clients especially to beware of interventions based on well-substantiated
research efforts that suggest only slight gains can possibly result from the proposed interven-
tion. Let us take Coleman's work as an example of what I have in mind. In the Coleman Report
(1966) estimates are given for how variance in achievement is distributed among student
background, school composition, and measured school characteristics variables. If we con-
sider just Southern pupils, in his data about 20% of black students' and 10% of white students'
achievement is associated with the particular schools they attend. The inference is that the
gains in achievement we could expect by moving children from one school to another are
slight, other things remaining unchanged. In the Coleman data, variations in the facilities and
curricula of schools account for much less variation in pupil achievement than teacher quality
variables, so there are even greater limits on the gains that can be expected by manipulating
facilities and curriculum. The point is not that the Coleman estimates are correct! but that
clinicians should base rational decisions to intervene only on empirical results that promise
substantial gains. An intervention based on the Coleman results, for example, would be
expected to produce only a slight reduction in the disparity between white and minority
achievement from manipulations of patterns of school attendance or new investments in
school facilities. In the Coleman Report, compositional effects were somewhat stronger for
blacks than for whites and one might use this as a basis for sound intervention. A problem,
though, is that in urban schools the supply of children from homes that strongly and effectively
support education is limited, and planners do not have the human capital needed to construct
desirably composed schools for every student to attend. Another example of small expectable
gains can be taken from Coleman, Hoffer, and Kilgore's analyses (1982) of High School and
Beyond data. Their analyses provide evidence for a claim of greater achievement for students
in Catholic and other private schools than for comparable students in public schools in
vocabulary and mathematics, but perhaps not reading. One of the several estimates given for
the magnitude of school treatment differences between the public and private sectors is a little
over a grade level difference between the sophomore and senior years in vocabulary and
mathematics, and something less than a grade level in reading. Again, my point is not to assert
the correctness of these estimates or denigrate those who have challenged CHK's analyses, but
to show the magnitude of the gains that might be expected as a limit if one took CHK's work
seriously and embarked on an intervention to move public school children into Catholic or
other private schools. Children several grade levels behind by their sophomore year might be
expected to show gains, but not catch up with the main cohort. Generally, any intervention
meant to reduce disparities in achievement ought to be accompanied by similar calculations,
so that we have a clear sense of the best we can hope to achieve and can weigh costs against
expected benefits.
Interventions that stem from state or federal reform legislation are likely to be patholog-
ical. Legislatures are unwieldy instruments for policy formation and clinical work. The
political process is too sensitive to vagrant inputs and accepts too many compromises. Also
there are too many opportunities for persons who know or care little about schooling to make
devastating contributions. Something like a thousand teacher reform bills have been intro-

4Data from actual school reforms over the intervening years fit Coleman's estimates well.
INTERVENTION IN FORMAL ORGANIZATIONS 189

duced in legislatures across the country in response to reformist writings, and few of these are
worth much. Some are real threats.
Interventions are reactionary and pathological if the sole reason for making them is to get
an angry or critical public off a school system's back. The climate of never-ending crisis
fomented by mandarins of the educational establishment increases the public's hostility to
schools. The essence of this climate is that no intervention can get all of a school system's
publics off its back for long. When responding to public pressure for reform, the first step is to
determine whether any conceivable change would stop the ongoing noise and criticism
completely. If we cannot propose such an intervention, what are the implications? Usually it is
better for schools to take heat, even if it costs someone an election or a job, than pile another
pathological intervention on the heap that is burying public schools.
Any intervention is pathological and must be resisted if it strips schools of legitimacy or
authority for compelling students to perform their role duties. As organizations, schools need
authority and machinery sufficient for mandated work. Kids must be coerced to do many
things they may not wish to do. Schools need authority to compel children to obey school
rules. Loss of authority risks loss of legitimacy.
An intervention is pathological if it undermines established social relations in schools.
Schools are sodalities and communities as well as bureaucratized workplaces. Interfering with
social relations will have spill down effects for morale and working relationships. Wantonly
moving staff around the district, for instance, or increasing the power of principals at staff's
expense may result in more effective instruction, but more likely these interventions will
increase role conflict and role strain in schools. Similarly, tightening coupling always draws
attention to the strategies teachers and principals use to exploit the loose coupling that exists
between school and district, and within individual schools. Social relations are harmed when
staff is made to spill all the tricks and secret ways they have developed over decades to work
around the professional-employee tension.
An intervention is pathological if it commits schools to work they cannot do. For example,
mandating greater work loads without giving the means to hire more teachers or assistants is
pathological. Mandating programs or curricula that eat up more hours than can be found in the
school year is pathological. Any program or policy initiative that promises great changes in
familiar outcomes with no infusion of new resources must be viewed with suspicion.
Interventions proposed by fanatics are always pathological. "A fanatic is someone who
redoubles his efforts when he has forgotten his aim." 5 People who have forgotten their aims or
never had an aim in mind, or who fanatically cling to their intervention whatever the evidence,
propose many interventions. Arguments of the form "It will work if 'they' will just [try it,
work harder, be more dedicated, obey the rules, love children ... ]" are sure indicators of
pathology.
Some of the most dangerous interventions are aimed at changing the purposes of
schooling (e.g., use schools to end war, spread the Ten Commandments, "save" the American
family, end teen pregnancies, make this country competitive in world markets). Whatever the
merits of the goal, the clinical problem is the likelihood of creating a mismatch of structure and
purpose. Organizations that are given new functions, but without altering existing structure,
are likely to wind up frustrated. I want clients to stick to their official and unofficial goals like
dried bubble gum. Goal-changing should be an infrequent, deliberate, and self-conscious
process, because so much else must change if a formal organization sets new goals. If every
new intervention brings new goals and missions, the organization will be in chaos.

SAttributed to Santayana by Chuck Jones (cartoonist).

190 BRUCE SAUNDERS

An intervention is likely to be pathological if it increases the scale of the schooling

enterprise, links educational units together without good reason, or creates new superstruc-
ture. As public schools evolve from one-room schools to state and national systems, there is
little evidence that increases in scale, connectedness, and superstructure, by themselves, bring
more desirable student outcomes. If an intervention requires scaling up a unit or the creation of
overarching structures (such as bigger high schools, centralized state funding, national creden-
tialing of teachers, state coordinating boards, district consortia), it should be resisted unless
there is a compelling reason to adopt it. Principal threats are the likelihood of overspecification
and overelaboration; disruption of routines; multiplication of lines of authority; the creation of
new functions that are incompatible with existing structure; need for elaborate systems of
coordination; increased demands for information sharing; more competition for scarce re-
sources; a decline of status ofteachers and others who work with kids (who suddenly find more
organization above them); and a global tendency to lose sight of simple truths and basic
purposes.
I tell clients to resist the temptation to make a change simply because "it is a good idea."
School people need to recognize that there will always be more good ideas than can be
implemented. Because an idea is good is not a sufficient reason to adopt it. The set of good
ideas must be winnowed to a manageable few-and there must be a conscious process for
winnowing that is not swamped with the abundance of good ideas.
An intervention is pathological if its framers substitute haste for reasoned action. A
climate of misplaced urgency helped to create the mess we have. I ask clients, if you are not
sure what to do, do not do anything. Resist haste. Reformers are like used car salesmen. They
want us to move quickly and try to get us to believe there is no time to consider the alternatives.
Do things that way and your schools will run as badly and need as much fixing as your used
cars.
Insist on accountability for those who propose reforms or interventions. There must be a
paper trail connecting proposals with their authors, and there must be consequences for the
initiators if they get it wrong. School interventions are curiously dissociated from the seem-
ingly anonymous persons who create or propose new interventions. In the aftermath, when
things have gotten messy, there is often no one around to blame except the poor people who
got stuck with trying to make a bad idea work. Initiators must have a stake in what they pro-
pose and there must be consequences for them to suffer if the reforms fail. School personnel
need a report card on the track records of groups and persons pushing for an intervention. And
do check references. Scrupulously.
I warn clients to be wary of sentimental schemes or proposals that are expressions of
sentiment and lack theoretical and empirical grounding. Sentimental proposals are unscien-
tific, intuitive, common sense, and that is often touted as their strengths. The most seductive
schemes are very simple, very emotional, and very wrongheaded because they take absolutely
no account of the realities of public schooling. Examples: "Let's fire all the bad teachers."
"Every child will read at grade level if we go back to phonics." Or, "test scores will improve if
your school has a game plan to address weaknesses; tries to work smarter, not necessarily
harder; has high expectations of pupils and staff; focuses on specific needs; and nurtures
collaboration of teachers, pupils, administrations, and parents." Though this is difficult to see,
the last example is just as much sentimental rhetoric as the first two examples. Interventions
stop being rhetorical when they are coupled with very clear plans of action. Abjuring a school
to "work smarter" would not be a sentimental intervention if, for example, principals and
teachers were invited to analyze test scores and follow trends over a period of years, shift
resources to academic areas where students score poorly, use peer role models to explain the
INTERVENTION IN FORMAL ORGANIZATIONS 191

importance of testing to students, safeguard and refocus staff time, form homework clubs, get
parents to create a math championship team, and hold forums in which pupils teach parents
what is going on in the classroom6 I'm not claiming these ideas are necessarily good-only
their consequences can be foreseen and reckoned with.
An intervention is always pathological when it lacks a clear plan of how it will be
monitored. To be useful, this plan must specify indicators that will be watched, the frequency
of monitoring, and be associated with an enforceable statement of what will be done if
expected results are not achieved.
Interventions are liable to be pathological if they are not buttressed with an assessment of
expectable adverse effects, a plan to monitor adverse and unforeseen effects, and clear rules for
breaking off the intervention if things get out of hand. An example of an unforeseen effect that
got out of hand comes from the Effective Schools program. Team leaders insisted that
principals become educational leaders in their schools, while multiplying meetings for princi-
pals that took them away from their schools day after day. One unanticipated result was the
creation of a strong cadre of principals whose loyalties were to one another and the strengthen-
ing of their bargaining unit. An intervention that puts principals together to hash out problems
day after day creates a tough focused group, but may not create the intense exchanges within
schools that lead to more effective school leadership.
An intervention is probably pathological if there is no explicit assessment of sources of
resistance to the enactments and no stipulated means to manage resistance. One can manage
resistance by finessing the opposition, by seeking consensus, by providing incentives for
compliance, by applying authority and power, and in other ways. Only foolish clinical
sociologists do not expect resistance, do not identify where it is coming from, and do not have
evolving plans for dealing with it.
Finally, an intervention is pathological when it erodes confidence in schools as institu-
tions. The flood of critiques and proposed interventions that swamps the national discourse on
schooling can be seen as a river of indictments of public schools. Calls for interventions that
breed mistrust for schools can spread like hysterical contagion and become institutionalized.
Public schools are always on the verge of being escalated to deviant status. The lesson here is
to work softly. If there are problems, deal with them quietly. Be restrained. Always support
your clients in public forums. Build confidence in the institution and help schools develop their
own critical instinct for pathological interventions and resist these, wherever they come from.

REFERENCES
Argyris, C., & Schon, D. A. (1974). Theory in practice: Increasing professional effectiveness. San Francisco: Jossey-
Bass.
Banks, O. (1972). The sociology of education. New York: Schocken.
Becker, G. S. (1964). Human capital: A theoretical and empirical analysis, with special reference to education. New
York: Columbia University Press.
Beder, H. (Ed.). (1984). Realizing the potential of interorganizational cooperation. San Francisco: Jossey-Bass.
Bendix, R. (1948). Bureaucracy: The problem and its setting. American Sociology Review, 12, 493-507.
Bentzen, M. M. (1974). Changing schools. New York: McGraw-HilI.
Berg, I. E. (1970). Education and jobs: The great training robbery. New York: Praeger.
Berliner, D., & Biddle, B. (1996). The manufactured crisis: Myths, frauds and the auack on America S public schools.
Boulder, CO: Perseus Press.

6These examples are from a 2000 University of Washington study sponsored by the Seattle-based Partnership for
Learning.
192 BRUCE SAUNDERS

Bidwell, C. (1965). The school as a formal organization. In J. D. March (Ed.), Handbook of organizations. Chicago:
Rand McNally.
Blau, P, & Meyer, M. W. (1971). Bureaucracy in modern society. New York: Random House.
Blau, PM., & Scott, W. R. (1962). Formal organizations. San Francisco: Chandler.
Blumer, H. (1969). Social movements. In B. McLaughlin (Ed.), Studies in social movements: A social psychological
perspective (pp. 8-29). New York: Free Press.
Boocock, S. S. (1972). An introduction to the sociology of learning. Boston: Houghton Mifflin.
Bourdieu, P., & Passeron, J. (1977). Reproduction in education, society, and culture. Thousand Oaks, CA: Sage.
Bowles, S., & Gintis, H. (1976). Schooling in capitalist America. New York: Basic Books.
Bruhn, J. G. (1991). Ethics in clinical sociology. In H. M. Rebach & J. G. Bruhn (Eds.), Handbook ofclinical sociology
(pp. 99-123). New York: Plenum Press.
Campbell, J. L., Hollingsworth, J. R, & Lindberg, L. N. (1991). Governance of the American economy. London:
Cambridge University Press.
Campbell, R T. (1983). Status attainment research: End of the beginning or beginning of the end? Sociology of
Education, 56, 1.
Caplow, T., & McGee, R J. (1958). The academic market place. New York: Basic Books.
Carnegie Forum on Education and the Economy. (1986). A national prepared; teachers for the 21st century.
Washington, DC: Author.
Carnoy, M. (1974). Education as cultural imperialism. Chicago: University of Chicago Press.
Carr-Saunders, A. M., & Wilson, P. A. (1933). The professions. Oxford: Clarendon Press.
Carter, T. (1985). Why change is difficult. Paper presented at the Annual Conference of the Sociology of Education
Association. Asilomar, CA.
Clifford, C. J., & Guthrie, J. W. (1988). Ed school: A brieffor professional education. Chicago: University of Chicago
Press.
Coleman, J. S., & Campbell, E. Q., et al. (1966). Equality of educational opportunity. Washington, DC: U.S.
Government Printing Office.
Coleman, J. S., Hoffer, T., & Kilgore, S. (1982). Cognitive outcomes in public and private schools. Sociology of
Education, 55, 65-76.
Collins, R. (1979). The credential society. New York: Academic Press.
Corwin, R G. (1961). The professional employee: A study of conflict in nursing roles. The American Journal of
Sociology, 66, 604-615.
Corwin, R G. (1965). A sociology of education. New York: Appleton-Century-Crofts.
Corwin, R G. (1970). Militant professionalism: A study of bureaucratic conflict in high schools. New York:
Appleton-Century-Crofts.
Corwin, R G. (1974). Education in crisis: A sociological analysis ofschools and universities in transition. New York:
Wiley.
Cuban, L. (1999). How scholars trumped teachers: Change without reform in university curriculum, teaching and
research, 1890-/990. New York: Teachers College Press.
Dreeben, R. (1970). The nature of teaching: Schools and the work of teachers. Glenview, IL: Scott Foresman.
Durkheim, E. (1964). The division of labor in society. New York: Free Press.
Freedman, J. A., & Rosenfeld, P. (1983). Clinical sociology: The system as client. Paper presented at the Eastern
Sociological Society, Baltimore.
Garfinkel, H. (1967). Studies in ethnomethodology. Englewood Cliffs, NJ: Prentice-Hall.
Getzels, J. W. (1978). Paradigm and practice: On the impact of basic research in education. In P. W. Suppes (Ed.),
Impact of research on education: Some case studies. Washington, DC: National Academy of Education.
Giddens, A. (1975). The class structure of the advanced societies. New York: Harper Torchbooks.
Glass, 1. F. (1985). Understanding organizations and the workplace. In R. A. Strauss (Ed.), Using sociology (pp. 81-
99). Bayside, NY: General Hall.
Goffman, E. (196/). Encounters: Two studies in the sociology of interaction. New York: Bobbs-Merrill.
Goodlad, J. I. (1984). A place called school: Prospects for the future. New York: McGraw-Hili.
Goodlad, J. 1. (1990). The occupation of teaching in schools. In J. 1. Goodlad, R. Soder, & K. A. Sirotnik (Eds.), The
moral dimensions of teaching (pp. 3-34). San Francisco: Jossey-Bass.
Gouldner, A. W. (1957). Cosmopolitans and locals: Toward an analysis of latent social roles. Administration Science
Quarterly, 2(December), 281-306.
Gross, N., Mason, W., & McEachern, A. W. (1958). Explorations in role analysis: Studies of the school superinten-
dency role. New York: Wiley.
Habermas, J. (1970). Toward a rational society. Boston: Beacon.
Hall, R. H. (1968). Professionalization and bureaucratization. American Sociological Review, 33, 91-104.
INTERVENTION IN FORMAL ORGANIZATIONS 193

Hedges, L. v., & Nowell, A. (1999). Changes in black-white gap in achievement test scores. Sociology ofEducation,
72,2.
Hodgson, G. M. (1994). The return of institutional economics. In N. J. Smelser & R. Swedberg (Eds.), The handbook
of economic sociology (pp. 58-76). Princeton NJ: Princeton University Press.
Holmes Group. (1986). Tomorrow's teachers. East Lansing, MI: Author.
Hoy, W. K., & Rees, R. (1974). Subordinate loyalty to immediate superior: A neglected conception in the study of
educational administration. Sociology of Education, 47, 268-286.
Jackson, P. W. (1968). Life in classrooms. New York: Holt, Rinehart & Winston.
Jencks, c., Bartlett, S., Corcoran, M., Crouse, J., Eaglesfield, D., Jackson, G., McClelland, K., Mueser, P., Olneck, M.,
Schwartz, J., Ward, S., & Williams, J. (1979). Who gets ahead? The determinants of economic success in
America. New York: Basic Books.
Lieberman, M. (1956). Education as a profession. Englewood Cliffs, NJ: Prentice-Hall.
Likert, R. (1967). The human organization. New York: McGraw-Hill.
Lofland, J. (1976). Doing social life. New York: Wiley-Interscience.
Lortie, D. C. (1969). The balance of control and autonomy in elementary school teaching. In A. Etzioni (Ed.), The
semi-professions and their organization. New York: Free Press.
Lortie, D. C. (1975). School teacher. Chicago: University of Chicago Press.
Marx, K. (1961). Economic and philosophical manuscripts, 1844. Reprinted in E. Fromm (Ed.), Marx's concept ofman
(T. B. Bottomore, Trans.). New York: Frederick Ungar.
McCall, G. J., & Simmons, J. L. (1966). Identities and interactions. New York: Collier-Macmillan.
Mehan, H. (1985). Top down and bottom up approaches to educational change. Paper presented at the meeting of the
Sociology of Education Association, Asilomar, CA.
Meyer, J. W., & Rowan, B. (1977). Institutionalized organizations: Formal structure as myth and ceremony. American
Journal of Sociology, 83, 340-363.
Meyers, P. V. (1976). Professionalization and societal change: Rural teachers in nineteenth century France. Journal of
Social History, 9, 542-558.
Moeller, G. H. (1962). Bureaucracy and teachers' sense of power. Administrator's Notebook, 11.
National Commission on Excellence in Education. (1983). A nation at risk. Washington, DC: U.S. Government
Printing Office.
Neal, D. C. (1988). Consortia and interinstitutional cooperation. New York: Macmillan Co.
Parelius, A. P., & Parelius, R. J. (1978). The sociology of education. Englewood Cliffs, NJ: Prentice-Hall.
Pavalko, R. M. (1971). Sociology of occupations and professions. Itasca, IL: Peacock.
Persell, C. H. (1977). Education and inequality: The roots and results ofstratification in America's schools. New York:
Free Press.
Ravitch, D. (1983). The troubled crusade: American education, 1945-1980. New York: Basic Books.
Ravitch, D. (2000). Left back: A century offailed school reforms. New York: Simon and Schuster.
Rebach, H. M., & Bruhn, J. G. (Eds.). (1991) Handbook of clinical sociology. New York: Plenum Press.
Riesman, D., Denney, R., & Glazer, N. (1956). The lonely crowd. New York: Doubleday.
Salganik, L. H., & Karweit, N. (1982). Voluntarism and governance in education. Sociology of Education, 55, 152-161.
Sarason, S. B. (1974). The culture of the school and the problem of change. Boston: Allyn & Bacon.
Saunders, B. (1985). Dedicated staff: Professionalization, bureaucratization, and vertical structure. Paper presented
at the Annual Meeting of the American Educational Research Association, Chicago.
Saunders, B. (1990). Pathological educational policy. Paper presented at the meeting of the Sociology of Education
Association, Asilomar, CA.
Saunders, B. (199Ia). Assessment in clinical sociology. In H. M. Rebach & J. G. Bruhn (Eds.), Handbook of clinical
sociology (pp. 33-47). New York: Plenum Press.
Saunders, B. (199Ib). Clinical educational sociology: Interventions for school staff. In H. M. Rebach & J. G. Bruhn
(Eds.), Handbook of clinical sociology (pp. 291-305). New York: Plenum Press.
Shostak, A. B. (1991). Clinical sociology in the workplace. In H. M. Rebach & 1. G. Bruhn (Eds.), Handbook of
clinical sociology (pp. 279-289). New York: Plenum Press.
Soder, R. (1990). The rhetoric of teacher professionalization. In J. I. Goodlad, R. Soder, & K. A. Sirotnik (Eds.), The
moral dimensions of teaching (pp. 35-86). San Francisco: Jossey-Bass.
Spence, L. D., Takei, Y., & Sim, F. M. (1978). Conceptualizing loose coupling. Paper presented at the Annual Meeting
of the American Sociological Association, San Francisco.
Starkman, S. (1971). Sociological criteria of professionalization with comments regarding school psychology. Psy-
chology in Schools, 8, 15-23.
Stein, B. A., & Kanter, R. M. (Eds.). (1979). Life in organizations. New York: Basic Books.
Strauss, R. A. (Ed.). (1985). Using sociology. Bayside, NY: General Hall.
194 BRUCE SAUNDERS

Thornton, R. (1970). Organizational involvement and commitment to organization and profession. Administrative
Science Quarterly, 15, 417-426.
Tyack, D. 8., & Cuban, L. (1995). Tinkering toward utopia: A century of public school reform. Cambridge, MA:
Harvard University Press.
Vollmer, H. M., & Mills, D. L. (1966). Professionalization. Englewood Cliffs, NJ: Prentice-Hall.
Waller, W. (1932). The sociology of teaching. New York: Wiley.
Weber, M. (1961). Wirtschaft und Gesselschaft, 1922. Reprinted in H. Gerth & C. W. Mills (Eds. and Trans.), From
Max Weber: Essays in sociology. Oxford University Press, 1946.
Weber, M. (1964). The theory of social and economic organization (edited by T. Parsons. New York: Free Press.
Weber, M. (1968). Economy and society: An outline ofinterpretive sociology, Vol. 1 (translated and edited by G. Roth
and C. Wittich). New York: Bedminster Press.
Weick, K. (1976). Educational organizations as loosely coupled systems. Administrative Science Quarterly, 21.
White, W. H. (1956). The organization man. New York: Simon & Schuster.
Wilensky, H. L. (1964). The professionalization of everyone? American Journal of Sociology, 70, 137-158.
 PART ill

TOOLS OF PRACTICE

This section of the book is concerned with some of the tools practitioners use: mediation and
conflict resolution, program evaluation, creating and shaping social policy, and preventive
programming. Chapters 11-14 are written by practitioners who use these tools. Some practi-
tioners may be eclectic but most gravitate toward and specialize in techniques, methods, or
approaches with which they feel most comfortable. Often, however, current problems are so
complex that they are untouched by single approaches. Thus, the team approach-sociologist
working with others-is needed to design and plan intervention.
Human problems have a tendency to reappear in new forms. Approaches to prevention
and problem solving must adapt to change. Social change reshapes the social fabric; those who
work for social change are constantly challenged to learn new techniques and refine old ones to
make their tools appropriate. Readers may feel overwhelmed by the enormity and complexity
of current social problems, feeling that they do not know where to start. Indeed, one of the
rules of thumb in clinical sociology is that an intervention cannot be limited in its efforts
because individuals, families, groups, and organizations are linked and networked. As such,
we must look at seemingly small problems in their broader context and large problems need to
be broken down into manageable subsystems for analysis. Part III should challenge readers to
a serous dialogue about "what works and does not work" with different types of problems.

195
 CHAPTER 11

Mediation and Alternative

Dispute Resolution
HOWARD M. REBACH

INTRODUCTION

Sociologists know that conflict is an integral part of social life. We also know that a key issue
is how conflict is handled. Disputants may practice denial and avoidance, may continue an
acrimonious ongoing argument, or resort to either violence or litigation. For example, teens
may get into fights that could escalate from words to fists to weapons. Divorcing couples may
be drawn into bitter long-term legal battles over child custody and support or division of
marital property. Parents of a learning-disabled child may be drawn into a conflict with a
school system over education for their child. Workers and management, environmental
activists and developers, neighbors, community groups, and governments, as well as ethnic
groups and nations may find their interests at odds and find themselves in the role of opponents
in a conflict.
The purpose of this chapter is to provide an introduction to mediation as an alternative
approach to dispute resolution and a practice option for clinical sociologists. The chapter
begins with some basic definitions followed by a discussion of mediation models. The third
section presents a generic description of the conduct of a case, and the fourth section offers a
discussion of interaction and mediation strategies. The fifth section describes applications:
divorce/family mediation as a microlevel intervention and peer mediation in schools and
victim-offender mediations as mesolevel interventions. The last section will touch on becom-
ing a mediator.

Definitions

Social conflict can be understood as opposition on the basis of competing interests,

different identities, or differing attitudes (Schellenberg, 1996;8). If conflict is an inevitable part
of social life, what are disputants' choices? Denial and avoidance have already been men-

HOWARD M. REBACH • Department of Social Science, University of Maryland Eastern Shore, Princess Anne,
Maryland 21853.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

197
198 HOWARD M. REBACH

tioned. On the other hand, one of the parties that has greater power or other resources may be
able to impose their will or cause the other party to surrender. Or, the parties may engage in an
adversarial process such as litigation or appeal to authority or tradition to have their dispute
settled. More recently, disputants have alternative dispute resolution (ADR) options to assist
them in resolving conflicts.
ADR is considered a nonjudicial collection of processes for dispute resolution without
having a court decide and without violence. There are a variety of such methods for managing
conflict and finding creative ways to resolve disputes. These methods include arbitration,
settlement conference, consensus building, neutral case evaluation, collaborative problem
solving, and mediation. The forms share characteristics that differentiate them from judicial
proceedings: they give participants a more active role in conflict resolution, they are more
private, faster, less expensive, and the decision-making process is more voluntary than
imposed.
• Arbitration. Disputants present their positions with supporting argument and evidence
to one or more impartial arbitrators who decide the outcome. Typically, arbitrators have
expertise in the matter under dispute. In some cases disputants may submit to "binding
arbitration" in which they agree or are required to accept the decision of the arbitrator
(Maryland ADR Commission, 1999).
• Neutral case evaluation. Disputants submit their positions to a neutral person who has
knowledge and experience with the issues and court experience. The neutral person
expresses an opinion on how the court is likely to decide, which may encourage
disputants to reach an out-of-court settlement (Maryland ADR Commission, 1999).
• Settlement conference. Disputants present their positions to a knowledgeable third
party who suggests ways to settle the dispute without a trial. The third party usually can
give informed opinion about how the court is likely to decide or how similar cases have
been decided. The facilitator can also provide advice and suggestions for settlements
(Maryland ADR Commission, 1999).
• Consensus building or collaborative problem solving. A neutral party brings stake-
holders together and facilitates discussion of a common problem, issue, or matter of
public policy. This approach is often used when there are more than two sides and/or
the sides are represented by various groups as well as individuals. The goal is for all
parties to develop options and reach a mutually agreeable solution (Maryland ADR
Commission, 1999).
• Conciliation. This is the "shuttle diplomacy" idea. Disputants try to reach agreement
but do not meet face to face. They negotiate through the neutral third party who acts as a
go-between and who does not judge or offer or impose a solution (NIDR, 1991).
• Mediation. A trained neutral third party facilitates communication between disputants and
helps them reach a solution to the dispute that is mutually acceptable. Parties speak for
themselves and make the decisions. Mediators provide no advice, legal or other, and make
no recommendations but use their skills to facilitate the process of interaction. Problem
solution is left up to the parties to the dispute (Maryland ADR Commission, 1999).

History

The Chinese have a history with mediation that goes back to Confucius who emphasized
harmony as a desired condition. When harmony is disturbed by conflict, it is best restored by
compromise and persuasion using intermediaries if necessary. In the United States in 1947, the
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 199

U.S. Congress established the Federal Mediation and Conciliation Service to replace the U.S.
Conciliation Service, which had been mediating labor-management disputes since before
World War I (Barrett, 1999). About a decade ago, Crohn (NIDR, 1991) as president of the
National Institute for Dispute Resolution observed:
In the 19708 the resolution of disputes at the community level was labeled a fad; by the 1980s it was
described as a social movement. Over the past two decades, hundreds of communities around the
country have embraced the concept that mediation ... could fairly and equitably resolve many
neighborhood conflicts that once were the sole domain of the courts or police. (p. v)

NIDR traced the roots of the ADR movement to the activism of the 1960s and efforts to
reform the U.S. judicial system. In 1965, the President's Commission on Law Enforcement and
the Administration of Justice called attention to the overburdened court system and the need
for reform. In 1964, the U.S. Community Relations Service was established to prevent
violence and open communication between conflicting parties to empower communities and
to mediate school, police, prison, and governmental disputes at the community level. In 1969,
the Philadelphia Municipal Court started a program that offered disputants the option to
resolve their disputes through arbitration. This was followed in 1970 by a model program in
Columbus. With these two programs as models of arbitration and mediation, similar programs
were started in other major cities, often aided by federal funds from the Law Enforcement
Assistance Administration (LEAA). These programs, staffed by trained personnel, allowed
disputants to choose, voluntarily, to settle their cases through mediation. By 1976, the
American Bar Association (ABA) took recognition of the movement establishing a committee
on dispute resolution, and in 1982, NIDR was formed (NIDR, 1991). Box 1 presents a typical
example of one type of case that can be referred for mediation.

MEDIATION MODELS

In mediation, a neutral third party meets with the disputing parties and they work toward a
resolution of the dispute. Schellenberg (1996:182) provided a more detailed description and
identified key characteristics of mediation:

• Mediation is assisted negotiation.

• The mediator is a neutral third party. The mediator's role is to encourage and assist
communication and negotiation between the parties without taking sides.
• Mediation is voluntary.
• Disputants retain responsibility. While some parties may be mandated to mediation
under a court order, continuation in mediation remains voluntary. Parties generally
make the decisions and agreements reached must be mutually acceptable.
• Mediation is private and confidential.
• There are no sanctions for failing to reach an agreement.
• The negotiation process is informal. Unlike judicial hearings, no records are kept, there
are usually no formal rules for procedure, and mediation may end without a decision or
agreement.
• A written agreement is usually the objective.
• Litigation is viewed as an alternative to mediation.
• Clients generally pay for the service.
• The mediator is a trained professional.
• The mediator facilitates clear communication and emphasizes mutual problem solving
as the objective.
200 HOWARD M. REBACH

BOX 1: A SAMPLE CASE FOR COMMUNITY MEDIATION

Mr. Allen hired Mr. Burke of Burke's Home Improvemenl Co. to
take down a crumbling wooden set of steps and platform at the
entranoe to Mr. Allen's home and replace Hwith a masonry
structure. They agreed on a prioe of $3500 which was record-
ed on awork order that both signed. The work order stated
that the work was to remove the wooden structure and build
steps and landing of brick from the walkway up to the front
door of the house and to complete the work in a timely manner.
Adate was set for work to begin and payment was to be given
upon completion of the work.
On the date agreed upon for the work to begin, Burke and
his workers removed the wooden porch and over the next two
days prepared the sHe by digging out for and pouring concrete
for the base" on which the steps and stoop would be built. Allen
was told that the base needed to set up and the work would
continue in 4 days.
Ten days later, wilh no communication from Burke, Allen
began calling Burke to find out when he would return to finish
the job. Most calls were reoeived by an answering machine
though the few times a person answered, Allen was told that
Burke was out of town, it was not clear when he would retum,
and thai he could not be reached. Allen left repeated mes-
sages that were never returned.
After two more months of repeated calls and with increasing
exasperation, Allen called another builder, Collins, who saw
that the preparatory work was done and agreed to complete
the job for $2500. Allen, based on his experienoe with Burke,
insisted that the work be completed within 10 days. Collins
agreed and complied. When Collins finished, Allen paid the
$2500.
About one week later, Burke showed up with workers and
materials prepared to finish the job, only to find Hdone. Burke
demanded that he be paid Ihe full $3500 sinoe he had pur·
chased materials and was prepared to finish the job and that at
no time had he and Allen agreed on a specific time frame nor
had they ever agreed thai anyone other than Burke should fin-
ish the job or that Burke's involvement had been tenminated.
The case went to Small Claims COIJrt where Hwas referred for
mediation. Both Mr. Burke and Mr. Allen agreed to mediate.
In the mediation, Burke, in his opening statement, explained
thai his was a small company and that workers cannot be idle
while they waH for concrete to set up. They had gone on to
other jobs waHing for a lull to return and finish this job. Burke
also slaled that he stood to lose money for having purchased
the materials for this job and needed to get paid so that he
could settle his bill for the materials. Burke said that they did
not contract for a completion date, only that the work was to be
completed 'in a timely man~er.' Sinoe only about three
months had elapsed, this was still, in Burke's opinion, 'timely.'
He demanded that he be paid.
Allen countered that when Burke and his workers disap-
peared and there was no response to his calls, Happeared that
Burke was not going to complete the work. Allen said that he
feil he had been quHe patient but that after three months and
no communication, he needed to act. Allen described his sense
of exasperation and his growing irritation at having the half-
done front porch and having to go in and out the back door
and having visitors use the back door. Allen asserted that
Burke did not deliver on his 'contract' and therefore had not
earned the payment.
Both parties appeared to have solidified positions that would
lead to awin-lose OIJtcome. If Allen pays, Burke wins, If Burke
does not get paid, Allen wins. The mediator helped each party
clarify their own positions and understand each others feelings,
The issue for discussion then revolved around the meaning of
·timely.' As Burke heard Allen's expression of feelings he was
eventually able to admit he understood them; that 3 months
wHhout word was excessive (though Burke did not explain why
he did not respond). Allen was eventually able to recognize
thai Burke and his workers did, in fact, do the preparatory work
that reduced his oost by $1,000. As they continued to discuss
the issue, Allen was also able to acoepl his own responsibilHy
for the vague specification of 'timely.' Allen offered to pay
Burke $1,200 to cover the preparatory work. Burke expressed
that he found this acoeptable and that he may be able to
recover his oosts of materials by using them in other jobs.

The Schellenberg model is, more or less, the "mainstream" model, but this definition
does not capture the diversity of practice. As Etcheson (1999) explained, models of mediation
can be arrayed on a continuum from the most to the least interventionist. At the most inter-
ventionist-called evaluative mediation-the mediator offers advice about the strengths and
weaknesses of each side's positions and suggests possible outcomes. The least intervention-
ist-calledfacilitative mediation-comes closer to the model described by Schellenberg. The
mediator helps the disputants reach agreement without making recommendations, expressing
opinions, or giving advice.
The interventionist end of the continuum is exemplified by mediation as practiced in
Asian cultures. In modem China, mediation services are a public service like fire protection,
law enforcement, and public utilities. Mediators are recognized community officials. Media-
tors, as members of the community, know the people well and have a close relationship with
them. Usually, mediators in the United States will not mediate in cases where they know the
parties. In the Chinese model, mediators do not always wait for the parties to contact them but
seek out controversies and get involved. Neutrality is not a concern for Chinese mediators.
Their goal is to eliminate conflict and restore harmony. Thus, Chinese mediators try to
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 201

detennine who is right and often instruct parties on "proper" behavior and how to resolve
their dispute (Wall & Blum, 1991).
Mediation in South Korea, a cultural diffusion from China, follows the Chinese model
and is widely practiced within Korean society (Sohn & Wall, 1993). The same holds in Japan,
though Japanese mediators were found to be less assertive than their Chinese and Korean
counterparts (Callister & Wall, 1997). Research evidence from a Cambodian community in the
United States shows similar patterns (Welsh & Lewis, 1998). Following the Chinese model
and philosophy of harmony, third parties of higher status than the disputants were preferred.
They were expected to be evaluative, not just facilitative. The mediator was expected to render
a decision.
These examples call our attention to the cultural dimension. Welsh and Lewis (1998)
found that members of the Cambodian community in the Twin Cities were likely to persist in
attempts to resolve the dispute when the other party was also Cambodian. Withdrawal was a
frequent choice when the other party was not Cambodian. For community mediation centers,
such as the one studied in the Twin Cities area (Minnesota) , centers that may be open to all
comers, it may be best to detennine clients' expectations about the mediation and the
mediators' approach prior to entering the case. The same model may not be broadly appropri-
ate for all. Mediators may need to decide if they can work within the framework of clients'
expectations or if clients are willing to work within their framework.
A somewhat less interventionist approach was used in a divorce mediation case described
by Bernard et at. (1984). In this case, the mediator felt that the custody, visitation, and property
settlement agreed to by the couple was unfair to the husband. The mediator, an attorney, knew
that if the couple went to court, a more equitable decision would result. She urged the husband
to see an attorney and added that, if he did not, she would add a note of nonconcurrence with
the agreement. A neutral mediator would have drafted the settlement agreed to by the couple.
But this mediator felt that neutrality was inappropriate because of her values, her professional
knowledge, and her judgment that the husband was the weaker party and not able to protect his
best interests. The mediator felt she was power-balancing, not advocating for the husband. In
this case, the couple continued in mediation, which suggests that they may have seen this
intervention by the mediator as fair and acceptable. Commenting on this approach, Bernard et
at. described the strategy as one in which "the mediator actively shapes an agreement that is
acceptable both to the parties and to the mediator's values of adequacy, fairness, and justice"
(1984:65).
The facilitative model was developed in the 1950s and 1960s. The mediator uses active
listening, asks directive questions, tries to validate and normalize each party's point of view,
identifies common concerns, and helps the parties develop alternatives. The mediator does not
make recommendations, offer advice or opinions, but remains neutral and more or less
nondirective. Unlike the mediator described in the above case, a neutral mediator accepts the
decisions and agreements of the parties and does not try to change any agreement regardless of
the mediator's private opinion. The neutral mediator presents self as a process facilitator and
does not intrude on the content of the negotiations.
Bernard et at. also discussed what they called a midrange strategy, between the neutral
and the interventionist approaches. One such strategy was called an option enhancing strategy.
The mediator helps the parties expand their options and their understanding of their options by
introducing options not considered or options of which the parties may not have been aware. In
another midrange strategy, empowerment through information, the mediator provides
information-not advice-which may encourage developing alternatives and expand parties'
202 HOWARD M. REBACH

options. Though more interventionist than the neutral strategy, the mediator does not chal-
lenge choices, decisions, or settlements agreed to by the disputants.
Pope and Ganong (2000) considered facilitative and evaluative mediation and noted that
mediation is more than a set of techniques. There are underlying beliefs and goals that guide
practice. Thus, another model, one that may not fit conveniently on a continuum from
interventionist to neutrality, is called transformative mediation (Bush & Folger, 1994). The
transformative approach recognizes that the entrance of a third party into the relationship
between the disputants creates a new social system and significantly affects communication
and the interaction process. Mediation is thought of as "an 'orchestrated encounter,' ... one in
which social interaction is organized predominantly by one participant according to a particu-
lar frame" (Della Noce, 1999:273). Mediators may ask questions, ask for or provide clarifica-
tion, reframe, and direct attention; they may call for parties to explore issues, and so on. They
organize and therefore influence the course of the interaction. Transformative mediation
recognizes the importance of mediators' ideology as the basis on which they select responses
and guide the process.
Transformative mediation distinguishes between individualist and relational ideologies.
The individualist view considers the individual the action center, the source of all meaning and
social interaction. Autonomy and independence are emphasized, satisfaction of individual
self-interest is the goal of individuals in a conflict situation. On the other hand, the relational
ideology assumes that people are fundamentally social, that social interaction is a basic
process. It challenges the existence of an absolute boundary between self and the social and
sees individuals as socially constructed (Della Noce, 1999). "Thus, although circumstances
(such as conflict) may produce separateness and self-absorption, these are viewed as socially
constructed phenomena which are therefore susceptible to change through constructive social
interaction" (p. 276).
Individualist or relational ideologies structure mediators' approach to practice. The
individualist view is associated with interest-based bargaining and problem solving. Success
for the mediator is the production of a settlement agreement mutually acceptable to both
parties, that meets the individual needs of the disputants through problem solving. One of the
mediator's tasks is to help parties reframe the conflict as a problem to be solved. For the
relational view, the goal is transforming the nature of the conflict. The goals of transformative
mediation are empowerment and recognition. "In the transformative orientation, conflict is
viewed as a crisis in human interaction, which provides an opportunity for interactional
transformation and individual moral growth in both strength of self (empowerment) and
concern for other (recognition)" (Bush & Folger, 1994 cited in Della Noce, 1999:279).
Conflict resolution and a settlement agreement, while desirable, are not the primary goals.
The mediator's role is to help disputants both gain personal strength and realize their ability to
handle life's problems. It is also meant to help them gain an appreciation for the feelings and
position of the other party, to acknowledge and empathize with the situation and problems of
the other party (Etcheson, 1999).
In McCormick's view (1997), the value of neutrality should be joined with other values;
mediators must confront social injustice, challenge power imbalances, and appeal to moral
authority. For McCormick, the transformative idea of recognition includes helping disputants
recognize the harm they may have done to the other party and to empathize with the harm
done. Etcheson (1999) explained that to do transformative mediation, the mediator must
actively seek out opportunities to create empowerment and recognition. These are the goals of
mediation-they transform the nature and ways of doing conflict. This goal transcends the
formulation of a settlement agreement. Bush and Folger (1994) have argued that if empower-
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 203

ment and recognition are achieved, settlement will follow if it is appropriate. Not all conflicts
are immediately settleable, but transformative mediation adherents such as Burgess and
Burgess (1996) see value in pursuing empowerment and recognition rather than settlement
agreements when faced with intractable conflicts. The mediator's goal is to change the conflict
process itself, from destructive to constructive, from one of competing self-interests to one
guided by concern for justice and mutual concern and responsiveness to the other.
The issues discussed in this section direct our attention to choices for the mediator's role:
neutralist or interventionist (and if interventionist, to what degree); individualist or rela-
tional. These issues are much in evidence throughout the mediation literature with articulate
proponents and persuasive arguments to be found on all sides. My own experience has drawn
me closer to the transformative approach because of the emphasis on changing the nature of
the conflict. The next section will provide a generic description of the steps in a mediation
case.

CONDUCTING MEDIATION

The actual conduct of a case for mediation will, of course, depend on the nature of the
dispute-whether neighbors, employees and management, divorcing spouses, and so on.
However, there are some key steps in practice that may be useful in providing a sense of how
mediation proceeds. Box 2 provides a flowchart as an overview of how a case might proceed.

Referrals

Referrals may come from a variety of sources-self-referrals, courts, lawyers, therapists,

and the like. Parties may be voluntary or nonvoluntary such as court-ordered mediation.
Others may be somewhat less than voluntary as in the case of those "strongly urged" or
assigned to mediation by their employers or some other authority. For example, one of my
cases was a conflict between a line supervisor in an assembly plant and the quality assurance
supervisor. The company "strongly urged" them to try mediation before having upper
management step in and "solve" the problem. The employees chose mediation (and were able
to establish a new format for coordinating their work that met their needs and the company's).
Self-referral and other voluntary participation is a good indicator of parties' readiness for
mediation. In nonvoluntary cases, most such clients, once present, do seem to get involved in
the process. However, some clients only go through the motions indicating their willingness to
try alternative resolutions just so they can later say they tried, not really making a good faith
effort. Nonvoluntary clients seem somewhat more likely to adopt this stance, although it may
sometimes even be true of voluntary clients.

Making Contact

Following referral, the next step is to contact the parties. With voluntary clients, I usually
begin with a telephone call, explain who I am and why I am calling, and offer to briefly explain
mediation. They need to know that it is confidential, and that they do not relinquish other
options (such as litigation) by choosing to participate in mediation. If they are interested and
want to continue, it is useful to get some basic information regarding the parties' relationship
204 HOWARD M. REBACH

BOX 2: FLOW CHART OF MEDIATION CASE

SELECT CONTINUE
LITIGATE ADVERSARIAL
MEDIATION
PROCESS

OFFERED OR
MANDATED TO
MEDIATION

MAKE CONTRACT
• Explain mediation
• Identify parties & issues

PARTIES PARTIES NOT

AGREE TO WILLING TO
PARTICIPATE PARTICIPATE

PRE-MEDIATION SESSION
(if necessary)
• Detennine suitability NOT APPROPRIATE
• Infonnation gathering
• Prepare for mediation

MEDIATION
SESSION

and the general issue. It may also be useful to determine how they came to select mediation,
whose idea it was, and whether their participation is truly voluntary.
It is also useful at the time of referral to identify the stakeholders and clarify who should
participate in the mediation sessions. For example, in one case referred by hospital manage-
ment regarding a dispute among certain professional staff of a particular unit, it became clear
that at least three others from outside this unit needed to be present for meaningful negotiations
to proceed.
Sometimes, one of the parties in a dispute calls for mediation services without having
discussed the idea with the other party. The mediator's task here is to determine whether to
call the other party or to suggest that the caller discuss the issue with them to determine their
willingness. The latter course is probably best, but in some cases it may work better if the
mediator makes the contact. The mediator can approach the other party in a more neutral and
dispassionate way and can better describe the mediation process. Having described the
process, it is again useful to clarify confidentiality and that they do not give up other options. It
is useful to suggest that they consult with an attorney if they have not. It may also be useful
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 205

to detennine where they are in the legal process. The purpose is not necessarily to persuade
them to join in mediation, but to offer mediation as an alternative.
Often, at the initial contact, parties begin their side of the story. I have found it useful to
practice active listening at this time, allow them to vent, and establish that they will be listened
to. I eventually clarify that my role is not that of a judge, that it is not my place to take sides or
decide who is right, but to facilitate their negotiation with the other party.
With nonvoluntary clients, I have come to use a slightly different approach. Each party is
sent a copy of the court order with a cover letter asking them to call and a pamphlet I have
devised that describes the mediation process and offers some points for them to consider. Most
usually call; if they do not after a reasonable period, I follow up with a call to them and proceed
as described above.
The initial contact includes scheduling. This may take several telephone calls to mesh
each party's schedule with my own. Parties also need to know what to do to prepare for the
mediation session, what to bring, and who should attend. For example, in divorce mediation
that includes the property division, each party should prepare a detailed statement of marital
assets and liabilities. If need be, forms that will help spouses identify these can be mailed to
them. Haynes (1994) has examples of such forms. More generally, the mediation process relies
on all parties sharing all relevant information and parties should be instructed to bring
whatever information they have that bears on the issues. As for who should attend, my
preference is to limit attendance to the disputants themselves although they are urged to obtain
whatever advice they need from their advisers and attorneys prior to coming to the session or if
they need to consult such sources between sessions.

Premediation Sessions

Some cases require premediation sessions where the mediator meets with each party
individually. Generally, the purpose is to detennine the suitability of the case or the parties for
mediation, for information gathering, and/or to prepare the parties for the mediation sessions.
Examples are discussed below with regard to divorce cases that involve spousal abuse or
victim-offender mediations.

Mediation Sessions

The mediation sessions themselves should take place in a safe, comfortable setting, one
that can ensure privacy and confidentiality. I have found it very useful to have a flipchart or
chalkboard available for posting various things for all participants to see such as the agenda,
and issues. Notepads and pens are available for clients to take notes since they will be
instructed not to interrupt each other. It is also handy to have a computer with word processor
and printer ready to go in the event that the parties are ready to prepare a settlement statement.
Box 3 presents a flow diagram of mediation sessions.
Steps in the session are as follows.
1. Mediator's opening statement. The mediator's opening statement sets the context and
establishes the norms for the sessions. In my practice I give each party a one-page handuut
with an outline of the key points. The key points start with commending the parties for having
206 HOWARD M. REBACH

BOX 3: FLOW CHART OF MEDIATION SESSION

MEDIATOR'S OPENING STATEMENT

• Commend parties for chOOSing mediation
• Explain mediation & invite cooperation ( NO )
•set ground rules/norms/expectations
• Explain mediator's role

SECOND SPEAKER'S OPENING STATEMENT

PREPARE WRITTEN
AGREEMENT

made a wise choice in selecting mediation. They are told that our purpose for meeting is to
construct a solution to a shared problem about which they have disagreed in the past. They are
also told that mediation is a voluntary process. Even court-ordered clients are told that they can
elect to end the process and leave at any time. They are informed that mediation is strictly
confidential and the limits of confidentiality are explained-reporting of child abuse and elder
abuse is required, and our duty to warn anyone who is threatened. The mediator's role as an
impartial facilitator, not an advocate or judge, is explained. The mediator's role is to help them
arrive at a mutually acceptable outcome and the mediator cannot and will not offer legal or any
other advice. They are encouraged to obtain advice from anyone they wish at any point in the
process.
Parties are asked to negotiate in good faith: be willing to listen to each other, share all
relevant information, keep an open mind, focus on the future, be willing to take personal
responsibility for what they say and for the outcome, and work together to create a new way of
relating. There is to be no interrupting and no inflammatory language. They are told that each
party will be asked for an opening statement and that we will proceed from there to the other
steps. When all of their questions about the process are answered, I ask all parties to sign an
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 207

"Agreement to Mediate," which contains all of the points just discussed. Then we are ready
for their opening statements.
Again, the purpose of the mediator's opening statement is to establish that the present
interaction process is different from day-to-day disputing, has a structure, and a few norms.
It is a critical part of the process.
2. Clients' opening statements. Choosing who speaks first is sometimes useful. Often the
first speaker will be able to direct attention to or away from certain issues or define the terms of
the disagreement. I prefer to let them decide who goes first. The other party is reminded about
not interrupting and is suggested to take notes if they like. They are urged to provide their own
perspective, not just respond to what the first speaker has said.
The parties' opening statements are a part of the fact-finding stage. It is essential that both
parties work from the same set of facts if possible. As clients make their opening statements,
mediators must listen carefully for statements that identify issues and problems as well as
statements of feelings, values, and needs. While the mediator makes it clearthat the other party
is not to interrupt, the mediator may interrupt to ask for clarification or additional facts and
information, reflect and acknowledge feelings, emphasize and summarize various points as
well as note areas where the speaker expresses doubt or lack of information that the other party
might later be asked to supply.
If an interruption occurs, mediators may want to shut it off immediately. Or it may be
permitted to continue, at least briefly. It might provide some useful insight. But, be careful not
to let it escalate. The mediator should maintain control of the process.
When a speaker finishes, the mediator may want to ask for further clarification of issues
or have follow-up questions to help the speaker provide a full and clear account.
3. Identifying issues/defining the problem. From the opening statements, the mediator
should be able to lead the parties into listing problems and issues. This is where a chalkboard
or flip chart comes in handy. The mediator may introduce this part by stating, "As I listen to
each of you, some of the issues seem to be ... " Work with the parties; guide rather than tell
them what their issues are. They know them better than you do. Try to have them work
together to list issues, needs, and problems. This takes their focus off of each other and starts
them working together and directed outward. It can help them redefine positions from those of
self-interests to those of shared interests. It also invites their ownership of the problem. The
mediator may help them to identify needs and interests and put them into concrete statements.
The mediator is also a participant and may note a concern they did not address. Ask them if you
got it right and if it is worth addressing.
4. Agenda setting. Having identified issues and posted them, ask the parties in what order
they would like to take the items. Again, this promotes their joint decision making, gets them
working together and taking ownership of the process. When they jointly create the agenda,
point out that this has been one area of agreement. Here the mediator may provide a little
guidance by asking either which issues are easiest or which are most basic to the other issues.
Remember that early success in finding a mutually acceptable outcome can get them more
deeply involved in the process and reinforce their work.
Emphasize that the agenda is not etched in stone. They have the right to add items or
change the agenda-it is theirs. They may discover that some issues need to be tabled until the
next session for additional information or simply deeper reflection.
5. Brainstorming. As issues are addressed, it is useful to teach the parties about brain-
storming, the development and listing of possible courses of action. Emphasize that brain-
storming is simply the collection of as many options as possible without pausing to evaluate or
criticize any of them. Have them develop as many as they can. Then, in the follow-up dis-
208 HOWARD M. REBACH

cussion, have them jointly agree to rule out any that are simply unrealistic for good reasons.
The remainder form the basis for further negotiation.
6. Negotiation. As negotiation begins, it may help for the mediator to remind the parties
that this is not an occasion for debate but for deliberation as they evaluate their options. The
mediator must not negotiate for the parties but facilitate and guide. Ask pointed questions; help
them establish criteria for whatever the outcome is to be. Do not allow either party to resort to
coercion or threats. Emphasize, as needed, their interdependence and the need for a shared
solution that shows concern for each other and that can be mutually agreeable. Point out when
parties throw up barriers to negotiation such as accusations or reminders of past "injustices"
or lack of willingness to trust.
As the parties negotiate, be alert again to power imbalances and attempts to coerce. As
they agree on options, encourage them to reality check: Will this course of action work? Is it
possible? Does it rely on actions of others who have yet to sign on? And so on. Are there vague
statements or statements that are not well formed that will lead to problems later or are there
ambiguities that may be subject to a variety of interpretations later? Again, this is where a
ftipchart or chalkboard comes in handy. Trial wording of statements can be posted and edited
by all until they are satisfied with them and share meaning for them. When they do agree,
frequent reminders and restatement of points agreed on serve to reinforce them. If there is
more disagreement than agreement, it may be necessary to return to identification of issues or
to more brainstorming.
7. Writing up the agreement. When/if agreement has been reached, the next step is to
produce a document that details the agreement. My preference is to write it up while the parties
are present, print it out, have them go over it, offer their critiques, renegotiate parts as
necessary, and, if necessary, produce as many drafts as it takes to get the wording and content
as they would have it. Discussion is valuable but a written agreement is concrete. There is
nothing like being able to read it over that can get their attention to the minutiae of the
agreement. This also gives them something to take with them and reflect on for the next
session.
8. Ending. Parties that end with a written agreement usually want to know what the next
step is. For those who are somehow court-involved, they are advised to return to their attorneys
with the mediated agreements and have their attorneys review the agreement and advise them
on next steps such as having the agreement incorporated into court documents. If employers
are involved instead, it is important to negotiate with clients about informing the employer or,
preferably, that they share the document with their employer. If this is just between the parties,
it is important to discuss implementation and check points that each can observe to determine
that things are going as planned. It is useful to offer a follow-up session, say a month later, to
assess their progress. It is also useful to have them agree to return for further mediation if
conditions change and they are unable to negotiate around the changes. Sometimes, this is
written into the settlement agreement as well.
For parties that cannot or do not reach agreement, it is important to end on a positive note.
The mediator can note that they did try and can summarize whatever they did achieve.
Completion of a written agreement, while desirable, is not the only indicator of success in
mediation. If parties have grown in their understanding of each other and in their ability to take
the role of the other, and in their ways of dealing with each other, then mediation has achieved
a useful objective.
Follow-up. Sometimes it is useful to ask parties to agree to a follow-up session to monitor
their progress at carrying out what was agreed to, identify problems, and develop ways of work-
ing through them. It is also a time when the mediator can possibly obtain feedback on the process.
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 209

THE INTERACTIVE PROCESS ITSELF MAKES IT WORK

Barrett (1999) referred to what he called the mystique theory of mediation held by early
mediators. That is, the "mystique of the process is crucial to making it work." My own
opinion is that the interactive process itself has an effect on the disputants. I get the same
feeling in mediation as when I have observed group therapy or other group processes at work.
In mediation, we change the dynamic of the interaction process from the dyadic confrontation
of the disputants to a group process more or less controlled by the mediator. Disputants are
placed in different roles with different role demands placed on them. Mediators, who have a
certain professional status and demeanor, communicate the expectation of rationality, fairness,
and cooperation and that parties will make a good-faith effort to resolve their dispute. The
expectation is an implicit demand for behavioral changes in interaction and a "demand" for
interaction that parties generally respond to and with which they find satisfaction.
Ultimately, mediation is a dynamic small-group process involving the disputing parties
and the mediator. Each of these actors, including the mediator, enters the situation with goals
and objectives and strategies that might be used to achieve them. Each begins the interaction
with established sets of cognitions, predispositions to perceive, interpret, and respond to the
situation and the other participants. Each party has some definition of their needs. The
disputants have their beliefs and knowledge about the issues and each other. Morris and Su
(1999) have discussed the ways in which well-known social psychological processes affect
mediation.
Where uncertainty and complexity exist, people have a need for closure. This tendency is
supported by selective attention and selective recall of information, which can be a barrier to
ascertaining all of the facts in a conflict. There is also a tendency to displace an opposing
position further away from one's own than it actually is. Shared interests, positions, beliefs, or
values are ignored, differences magnified and perceived as more discrepant than they are in
fact. Finally, there is a "tendency to reject settlements that serve one's interests because they
seem to benefit the opponent to an unfair extent." This is the failure of perceived distributive
justice.
The "fundamental attribution error" is the tendency to overemphasize dispositional and
underemphasize situational causes of the other's actions (while underemphasizing disposi-
tional and overemphasizing situational causes of one's own actions). Thus, in negotiation,
parties may interpret other's actions and lack of cooperation or understanding as due to
unmovable personality characteristics. This may be helped if parties clarify their situational
constraints as they interact.
One approach to bringing the two sides together over the facts is for noninvolved parties
to present impartial information. The problem, of course, is that this does not prevent
discounting data. For example, in environmental conflict over global warming, partisans can
find respected scientists who warn about it and others who remain unconvinced and question
the research supporting it. Controversy here might pit "our scientists" against "their scien-
tists. "
Thus, Morris and Su (1999) suggested highlighting the differences. They found that when
parties knew each had beliefs based on different information, they were less likely to get hung
up in arguing fact and may learn more about each other's assumptions and interests. Parties'
awareness that they base their conclusions on different data may reduce the tendency to
attribute negative motives to the opponent. "Misinformed" others are easier to deal with than
others defined as "evil" or selfishly motivated.
Displacement of the opponent may be handled by having each side present their views
210 HOWARD M. REBACH

and interests in a noncontentious way prior to starting negotiations. This was found to help
parties achieve a more integrative result (Keltner & Robinson, 1993).
Parties in conflict may have little trust of each other but successful negotiation may need
it. While there is wide variability in individual propensity to trust, situational factors also
appear. Two key situational factors identified by Tenbrunsel (1999) were uncertainty and
power differentials. Uncertainty increases the likelihood that parties will assert and stick to
their positions and self-interest. They will selectively attend to and choose information
supporting their views, neglect information that supports the other side, and are more likely to
see the other side as misrepresenting facts and therefore untrustworthy. Power differentials,
real or perceived, affect trust and therefore affect negotiation. The more powerful party may be
perceived as using (or may actually have used) coercive methods or may be perceived as
misrepresenting or withholding information. An understanding of the other side's perspective-
necessary in working toward agreement and cooperation-may also be disrupted by power
differentials.
These situational factors further affect parties' definitions of the situation. Parties facing
each other with different definitions may attribute negative motives and a self-serving interest,
thus decreasing trust. Tenbrunsel suggested that the interaction process itself-bringing
parties together with the neutral facilitator in a safe environment-may be a first step. Tech-
niques such as active listening, eliciting and allowing expressions of feelings, establishment
of a superordinate goal, allowing each side to clearly express their interests, recognitions of the
other side's values, sharing information openly, and balancing power differences may help
foster trust. In addition, the mediator should focus on building trust and the means to do so
rather than try to address past violations of trust.
The interaction can transform the dispute by developing shared frameworks. Helping
parties identify shared concerns, values, and identities can help transform the dispute and
change the focus from disputed positions to joint problem solving. The mediator may help by
helping parties define the problem. The mediator's task is also to help parties reframe the
nature of the dispute, elicit more cooperative than conflictual behaviors, and thereby have
parties work toward understanding each other and arrive at an outcome that is mutually
acceptable.
The process of interaction, the mediator's presence, and the fact that the session is taking
place in the mediator's office-on the mediator's "stage" to use a dramaturgic concept-
begin the process of reframing. The mediator and the setting place the parties in new roles with
a new definition of the situation. The structure of the interaction and communication between
the parties is different from what they have been used to. Thus, as Amo (1985) reminds us,
forms of social behavior and relationships are produced by the patterns and sequences of
interaction. The institutional arrangements established for interaction have a "coercive" effect
on the interactants. Actors derive their roles in the interaction from the interaction itself. Roles
are defined and enacted according to their definitions. The presence of the mediator, the
disputants' usually voluntary presence, and the fact that the scene is being played on the
mediator's stage with the mediator orchestrating the encounter begin a new social process for
the disputants. People draw their definitions of self and situation from the interaction.
Garcia (1991) suggested that mediation and everyday disagreements differ in that media-
tion provides an interactional structure that actually minimizes disputing. One major differ-
ence is in the speech exchange system and turn taking. This has to do with who speaks, who
speaks next, and how the next speaker is chosen (e.g., self-selection is often the way in
everyday situations or if the speaker directs a question to someone, he or she is being selected).
In arguments in ordinary conversations, patterns of accusations and denial structure turn
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 211

taking. Exchanges occur as oppositions in which each speaker negates what the previous
speaker said. Certain types of utterances call forth certain types of responses. Accusations, for
example, bring forth denials, return accusations, or counterassertions. Each party must deny
the accusation. Not to do so may be seen as accepting it. But denials lack explanation that
could lead to resolution of the dispute. And denials place the original speaker in the position of
either backing down and losing face, or reasserting their position. Each disputant places their
utterance right next to that of the previous speaker. And the turn-taking system of ordinary
speech does not limit when a speaker can take their turn (e.g., we interrupt and overtop others,
especially in a heated argument-we do not always wait for the other speaker to conclude).
In contrast, Garcia suggested that "the advantage of mediation ... [may be] in the inter-
actional organization of mediation itself" (1991:833). The interaction structure of everyday
argument is significantly altered. Turn-taking is controlled by the mediator, which means that
the alternating pattern of opposing statements, accusations and denials, and counteraccusa-
tions is disrupted. In my practice, I open the sessions by explaining how the course of
mediation proceeds and I set the ground rules. There is to be no interrupting and no name
calling or other inflammatory speech. However, I can and do interrupt to ask questions, clarify
points, and keep the focus. Not only do I control turn-taking, when one party interrupts to
respond to an accusation, they are reminded that there is to be no interrupting and that they will
get their turn.
Soon, the parties address their remarks to the mediator rather than directly confronting
each other. Eventually, the session enters the discussion period also controlled by the mediator.
Parties continue to address their remarks to the mediator. Again, when parties depart from the
framework established-they may trade accusations and bicker directly with each other-the
mediator may change the focus and ask a question directed at one of the parties.
Thus, as Garcia explained, mediation structures a predetermined speech exchange system
and participation rules that are guided by and maintained by the mediators. Among other
things, this takes the "heat" off of someone being accused. They do not have to answer with a
denial and no face is lost. The nonadjacent aspect of disputants' speech displaces argumenta-
tive sequences and allows the substantive issues to be discussed without argument. The central
role of the mediator-when all remarks are addressed to the mediator-also reduces both
direct challenges to and blaming of the other party, reducing their need to save face. The
advantage of mediation may be in the interactional organization provided by mediation rather
than in characteristics of mediators or the dispute.
Hale (1998) applied symbolic interactionist and dramaturgical perspectives to mediation.
She noted that we actively construct our experiences and define them linguistically. That is, we
use words to label or frame our definitions of situations and act according to our definitions.
Thus, mediators should learn to understand the negotiation frames of disputants (as well as
their own) and develop skills at helping parties transform them "into more generative dynamic
frames. Such intervention is not accomplished through force or deception ... but through the
transparent application of and invitation to more beneficial frames" (1998:149).
Hale identified problematic frames: the tragic frame, the euphemistic frame, and the
debunking frame. In the tragic frame, the person presents self as heroically battling, driving for
victory, alone against powerful forces over which they have no control. The other side is evil
and has no legitimate concerns. The tragic negotiator sees others as people to outwit, manipu-
late, and sees self as a victim. The euphemistic frame has a narrow, shallow focus. It restricts
opportunities for change and keeps people from identifying with each other. The party tries to
eliminate conflict by appeal to authority, a moral order, or the status quo. Conflict is not seen as
substantive but relational or procedural. The debunking frame finds self-serving motives
212 HOWARD M. REBACH

BOX 4: CHARACTERISTICS AND STRATEGIES WITH PROBLEMATIC FRAMES

IDENTIFY FRAMES STRATEGIES

THE TRAGIC FRAME
• GOOD AND BAD POLARIZATION
• SELF IS REASONABLE BUT VICTIMIZED BY
OTHER
• IS SELF-SACRIFICING, OTHER IS MALICIOUS AND
AGGRESSIVE
• FORCING, THREATENING LANGUAGE& TACTICS
• TAKES NO RESPONSIBILITY FOR PROBLEM
• HAS NO EMPATHY
• PROVOKES SYMPATHY, PITY, GUILT
• CANNOT LISTEN TO OTHERS
• FEELS LACK OF CONTROL
THE TRAGIC FRAME
• EXPLORE FEELINGS, NEEDS, VALUES BEHIND
TRAGIC LANGUAGE
• REFRAME TO LESS TRAGIC
• CALLATIENTION TO SUCCESSES IN CLARIFYING
CONCERNS, INTERESTS, OPTIONS OR NEEDS
• HELP PERSON SEE THE PERSPECTIVE OF THE
OTHER
• HELP PERSON ACKNOWLEDGE OTHER AS LESS
THAN AVILLAIN
• HELP PERSON ACKNOWLEDGE THEIR OWN CON-
TRIBUTION TO PROBLEM

THE EUPHEMISTIC FRAME THE EUPHEMISTIC FRAME

• EXCESSIVE DENIAL OF PAYOFF TO SELF; OTH-
ERS WILL BE PRIMARY BENEFICIARIES
• EXCESSIVE OPPOSITION TO CHANGE
• ACTS AS THOUGH MAJOR DECISIONS ARE
GIVEN, ONLY DETAILS NEED TO BE WORKED OUT
• JUSTIFIES DEMANDS BY CITING AUTHORITIES
• USES CLICHES AND CONVENTIONAL WISDOM TO
SUPPORT POSITIONS
• SEE IF BOTH PARTIES SHARE THIS FRAME
• USE BROADER FRAMES OR REFRAME WITH
BROADER INTERPRETATION
• EXPLORE POSITIVE AND NEGATIVE OUTCOMES
OF CHOICES
• LOOK FOR DEEPER UNDERSTANDING OF BENE-
FITS OF STATUS QUO AND ACKNOWLEDGE
• HELP PARTIES LOOK FOR SHARED VALUES

THE DEBUNKING FRAME THE DEBUNKING FRAME

• IMPLIES HIDDEN REASONS BEHIND OTHERS
CLAIMS, THE PROCESS, OR OTHER SYSTEMS
• RIDICULES & BELITTLES OTHERS VALUES AND
BELIEFS
• DRAWS RIGID GUIDELINES FOR OTHERS BUT
LEAVES LOOPHOLES FOR SELF
• FRAMES COMMON ACTIONS OF BOTH PARTIES
POSITIVE FOR SELF, NEGATIVE FOR OTHERS
• WANTS EXCESSIVE CHANGE; ALL OF PAST
UNACCEPTABLE
• EXPLORE LEGITIMACY OF CONCERNS ABOUT
UNSTATED INTERESTS
• CREATE CHANCES FOR DEBUNKER TO SEE OTH·
ERSVIEWS
• PROVIDE OPPORTUNITIES TO HEAR NEEDS &
INTERESTS OF OTHER
• HELP DEBUNKER RESTATE AND ADDRESS
NEEDS, INTERESTS OF OTHER
• HELP DEBUNKER CLARIFY DIFFERENCES
BETWEEN OWN AND OTHERS ACTIONS

everywhere. Everyone and everything is falsely represented. Others operate from low ethical
and moral standards or are irrational. The debunker is distrustful and discounts others'
humanity and emotions. See Box 4 for more detailed description of these frames and strategies
for dealing with them in mediation.
Finally, Hale offered what she called the comic or hopeful frame for the mediator. It
assumes that people can change and can make better choices in the future than they made in
the past. The mediator communicates an expectation that parties can negotiate effectively and
that their outcomes are in their hands, working together. It also includes helping parties change
conceptions of each other from one who is evil to one who may, perhaps, be mistaken or
misinformed. Perhaps by giving accounts for their decisions they may be better able to
understand each other's motives. The desired outcome is cooperative work toward a settle-
ment of their dispute. The mediator can help by helping parties reframe their definitions of self,
the other, and foster mutual understanding.
Mediation works because of the interaction patterns that exist in a setting of small group
interaction that changes the roles-in-interaction of the disputants. Mediators use a variety of
interventions in their interaction with disputants to further the process. In the next section
some specific applications of mediation are discussed.
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 213

APPLICATIONS IN PRACTICE

Divorce Mediation

Divorcing couples have an alternative to expensive and time-consuming litigation in di-

vorce mediation. Issues for divorcing couples include (1) division of marital property, (2) child
support, (3) spousal support (sometimes called alimony, and (4) child custody and visitation.
Mediation can establish a more amicable and personally productive basis for the separation
and ease the postdivorce adjustment for divorcing persons, whereas a more adversarial process
continues the battle (Haynes, 1981). In mediation, the parties retain control over the decision-
making process and the decisions themselves.
One benefit of mediation for divorcing couples is cost and time savings. Studies have
shown both a substantial monetary savings and fewer hours of professional services with
mediation compared with litigation (Benjamin & Irving, 1995; Emery & Wyer, 1987; Pearson
& Thoennes, 1985). In addition, mediation was found to be a substantial cost-saving approach
from the point of view of the public, which supports the courts through taxes (Benjamin &
Irving, 1995; Pearson & Thoennes, 1985). A high percentage of mediated cases reached a
mutual settlement clearing cases from court dockets in less time. Court savings of 50% have
been reported (Koch & Lowery, 1984) and data have also shown low re-litigation rates-about
10% for mediated cases compared with 26-34% for nonrnediated cases (Bahr, 1981). Media-
tion benefits courts in another way, namely, by helping to deal with crowded court dockets.
The following description from New York City (Reiniger & Tudy-Jackson, 1997) may be
typical and illustrative.
In 1988, 2032 child custody and visitation cases came before the Manhattan Family
Court. This increased almost threefold to 5702 such cases by 1996. In all of New York City in
the same period the number of cases went from 12,663 in 1988 to 36,404 in 1996. There was
a 24% increase in one year, from 1995 to 1996. Through the collaboration of several
organizations-the city Bar association, the New York Society for Prevention of Cruelty to
Children, and the Victim Services Manhattan Mediation Program-the Court Annexed Medi-
ation Services Project began planning in 1991 and started in 1995. Couples asking for media-
tion are screened for child abuse, domestic violence, or substance abuse. If these are absent,
mediation is started. The program apparently started slowly. Reiniger and Tudy-Jackson
reported that in its first year there were only 300 referrals, "a mere drop in the bucket." They
go on to assert that for mediation to be more widely used, increased public awareness and
support of both the courts and attorneys are necessary.
Some states have made mediation mandatory for child custody and visitation disputes for
divorcing couples (e.g., California, Maryland). In Maryland, where I live and work, mediation
is mandatory in all contested child custody and visitation cases except those in which domestic
violence has taken place. Couples in dispute over custody and visitation, whether previously
married, divorcing, or previously cohabiting, are required to participate in a minimum of two
sessions with a mediator who has received training in mediation and in divorce mediation
specifically and has been approved by the Court. One court-referred case that came to me was
between a grandmother seeking an agreement for visitation of her grandson from her former
daughter-in-law.
As much as any other kind of mediation, divorce mediation creates a values dilemma for
mediators. The issue concerns the mediator's neutrality, as having to "choose~to act either as a
neutral, facilitative third party, as a proponent of a just and fair settlement, as protector of the
weak party, or some combination of these positions" (Bernard et al., 1984:62). This is the
neutrality-interventionist distinction mentioned earlier in this chapter.
214 HOWARD M. REBACH

On the one hand, the mediator who uses a strict neutrality strategy, accepting whatever
agreement the parties come to, may consider this value neutral, when, in fact, it is not. Such a
value position may allow prior power imbalances between the parties to continue and yield an
unfair settlement. On the other hand, an interventionist approach raises other questions. What
is a fair mediation process? As de Mayo (1996) pointed out, there are at least three perspectives
present: the husband's, the wife's, and the mediator's. The mediator's personal experiences,
religious and moral beliefs, beliefs about the nature of family and parenting, and sense of what
is just, may influence the mediator's views of the disputants and their dispute and, thus, the
mediator's interventions.
Reiniger and Tudy-Jackson (1997) pointed specifically to the challenge to mediators'
impartiality because of the consequences of the outcomes of custody and visitation disputes on
children. Mediators may have ideas about parenting that could intrude. They recommend that
mediators be impartial. Others, more interventionist, point to societal gender inequality, which
ordinarily puts the woman in the weaker role in divorce negotiations. They advise mediators to
take a pro-woman approach in power-balancing, at least until it appears unnecessary. More
generally, protection of weaker parties is necessary and power-balancing empowers these
parties.
Mediators must approach divorce mediation with patience and sensitivity. The spouses
may be at different stages of acceptance of the separation and divorce process. Coming to
mediation is an acute reminder of the divorce (Parkinson, 2000). Some spouses would more
like to cry or shout than discuss. Some need to argue and fight. Some may want to punish their
partner. The one who initiated the breakup is usually more able to cope with the changes. One
partner may not have been prepared, may show denial, then anger, then depression, and each
phase may take some time. One partner may not want the divorce, feel that there is still hope,
that they can repair the breach. Thus, as Parkinson wrote, "When one partner is spiraling
downward and the other partner who can still fly is impatient to move on, the challenge for
mediators is how to help them both equally and prevent the gap between them from widening
still further" (2000:71).
Divorce is usually a very stressful time with heightened emotions and, perhaps, feelings
of vulnerability for the spouses. Couples ending their relationship may experience a mixture of
strong emotions that include anger, guilt, pain, sadness, remorse, and a sense of loss at losing
their family system. They may feel anxiety about change, about their future economic well-
being and anxiety about their relationship with their children and their future roles as parents.
As these emotions converge, mediation asks couples to think and act rationally, cooperate,
negotiate differences, and engage in mutual problem solving and decision making when their
cognitive processes may be overwhelmed. Mediators need to be attuned to the potential for
emotion, understand it, be prepared for a certain amount of emotional expression, but avoid
being inappropriately drawn into it.
Approaches to the emotional aspect differ. Tjersland (1997) drew a distinction between
structuring approaches and confirming and meaning-expanding approaches. In the former,
the mediator adopts the view that emotional outbursts tend to escalate, lead nowhere, leave the
parties feeling helpless, and hinder the goals of mediation. One way to prevent this is in
structuring the session at the outset by establishing rules including a focus on the present and
future, not the past. This approach includes reminding the parties when they depart from the
rules or simply deflecting argument by topic shifts, directed questions, or some other interven-
tion. The second approach is to acknowledge the feelings expressed and reframe them.
Spouses need to feel understood, which may lessen their combativeness. The mediator's role is
to help the spouses overcome emotional obstacles to make progress toward joint decision
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 215

making. Using active listening techniques, the mediator may clarify an expressed emotion and
emphasize the party's needs and concerns. Reframing should clarify each party's concerns,
accurately and in a positive way, so that both parties hear and understand each other, and
identify objectives.
Ellis and Wight (1998) described stages of divorce mediation and the "transition skills,"
useful to mediators in helping/leading the parties through the stages, from "victim-warrior" to
"position bargaining" to "principled negotiators" and finally to "joint planners." The latter
stage is the most productive of fair and workable settlements. To transition from victim-
warriors to positional bargainers, Ellis and Wight suggest the practice of objectifying
passions-reframe emotional statements as cooler, more objective statements-using open-
ended questions to clarify differences and to focus on interests of children. To move from
position bargaining where both parties focus primarily on what they want, to principled
negotiators who focus on shared and each other's interests and concerns, mediator interven-
tions should separate people from problems. Mediators acknowledge the parties' positions, try
to reframe to make perspectives accurate and avoid misunderstanding, and acknowledge,
affirm, but reframe hurtful, blaming, or belittling statements of parties. Shift the focus to
interests, especially shared interests, rather than positions, and have the parties try to brain-
storm options that meet their own and the other's interests. Then help parties evaluate the
options based on objective criteria, which makes them ready for the last stage-joint planning.
In this stage mediators help parties focus on preparing for and planning for the future and their
new relationship as no longer married but, if children are involved, as cooperative co-parents.
One partner may see mediation as a way to hasten the process while the other is reluctant
or wants their day in court. Some spouses may be nervous about the session with their partner;
they may fear their partner's way with words and persuasiveness. Or some may feel that they
cannot bear to even be in the same room with their divorcing spouse. It is the mediator's task to
determine the appropriateness of mediation in each case and be able to discuss this with
clients. Mediators should remember, however, that mediation is not couples or family therapy
or divorce therapy. In some cases it may be appropriate to suggest and discuss a referral for
such therapy.
Cases involving domestic violence are of particular concern. In Maryland all custody
cases are court mandated to mediation with the exception of cases of spousal or child abuse.
The New York Office for the Prevention of Domestic Violence has also recommended that
mediation or ADR referrals not take place in cases that have a history of domestic violence
(Maxwell, 1999). My own experience as a mediator in divorce and child custody and visitation
cases has convinced me that these are sound rules. I concur with Maxwell who stated that "the
violence in the relationship cannot be mediated ... when domestic violence is present in a
relationship, there is a disparity of power. Violence and coercion cannot be mediated"
(1999:345). Asking a woman (usually) to face her abusive spouse and negotiate as an equal
partner is an impossibility. Mediation assumes equal power, but with abuse, the power
imbalance and the coercive nature of abusive relationships makes a fair, safe, mutually
agreeable resolution problematic. This was also Chandler's view, noting that "battered women
are both openly and subtly intimidated by their batterers. This makes negotiation on an equal
basis difficult and may lead to unfair results" (1990:334).
Maxwell reported research showing that from 50 to 80% of marriages referred to court-
based mediation services involved domestic violence though relatively few-about 5%-
were excluded from mediation because of domestic violence. One reason for this is the
relatively low percentage-about 1O%-of cases that get reported to the police and become a
matter of court record. Another reason is that abused spouses rarely announce the abuse and it
216 HOWARD M. REBACH

is even less likely that their abuser will. Thus, Maxwell advises mediators to prescreen cases
by specifically asking. One study (MacFarlane et at., 1991) showed that asking in a medical
setting increased reporting from 7% on written self-reports to 29%. In addition, mediators
should be alert to nonverbal cues and veiled verbal references. Kelly (1995) described some
things to watch for: the presence of threats, nonnegotiable demands, and other attempts to
coerce. These should be interrupted by the mediator who should label and discuss the behavior.
If change is not possible, the mediation can be ended: "When parties' safety is threatened, or
they are too fearful to voice their ideas, or fear reprisal outside the mediation, they do not
belong in the mediation process" (Kelly, 1995:91). Some cues that might indicate an abusive
relationship are the following: an angry husband who blames the wife for the problems, the
wife initiates the divorce but the husband does not want it; the wife speaks in measured tones
careful not to disagree with the husband; the husband insists that she should be the one to move
out since she's the one who wants the divorce; the wife has difficulty expressing her needs
and uses masked comments about prior "difficulties" that are hard on the children and can-
not go on; the wife's body language shows fear and tension (Chandler, 1990).
However, couples may not be able to end all contact; they continue to be parents.
Erickson and McKnight (1990) expressed an alternative view: that mediation sessions can
reduce the likelihood of future abuse. They wrote from over a decade of experience with
voluntary rather than mandated clients but noted that abuse occurred in "more than one-half of
all our cases." Erickson and McKnight used an intake questionnaire as a screening device.
They explained that their experience led them to conclude that mediation resulted in couples
agreeing to detailed rules and boundaries in postdivorce interaction, Indeed, Ellis & Wight
(1998) reported that physically and emotionally abused women were as likely to achieve the
outcomes they wanted in mediation as were comparison women who had not been abused.
Chandler (1990) studied a mediation program in Hawaii associated with a family court.
The couples were court referred, but they could opt not to use mediation services, making the
program virtually voluntary. The program used screening questionnaires and interviews to
determine if domestic violence had taken place. Chandler suggested that reports of the
frequency of cases involving domestic violence were overestimated. He reported data that
disagreed with those reported by Maxwell; 23% of cases in his study and 17% of cases in one
large California study of mandatory mediation. In the Hawaii program studied by Chandler,
staff held premediations to check if the woman was intimidated, felt safe, or needed special
arrangements during and after the mediation. Premediation counseling was made available to
all battered women. About half of all cases, both the domestic violence group and the
comparison group, went ahead with mediation. Generally, it was found that cases involving
domestic violence had higher agreement rates than the comparison group where no abuse had
taken place. Further analyses of content showed that agreements seemed equitable and not
coerced. We can conclude that it is possible in some cases when care is taken to screen, and
screen out those who cannot or will not participate, and mediators are well prepared to deal
with these cases and agreements include safety issues such as strict rules for the exchange of
children, parental communication, and other boundary-maintaining measures.
Outcome research on family and divorce mediation shows a wide variability in practice:
voluntary versus mandated, private versus public agency, and variations in cost and time as
well as variations in mediators' training and approach. Still, the following generalizations
drawn from the review by Benjamin and Irving (1995) are encouraging:

• Rates of 40-60% of complete agreement plus 10-20% of partial agreement were found
across court-based or private, voluntary or court-ordered, and even with couples with a
history of violence or intense conflict.
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 217

• Couples were more likely to reach voluntary agreements than their counterparts in
litigation, and with fewer sessions and in less time.
• Compared with counterparts who were in litigation, mediated agreements were differ-
ent and better, more comprehensive, favored shared parenting, and the noncustodial
parent got more visitation.
• Results showed that couples that reach agreement are diverted from court.
• Client satisfaction was high-in the 60-80% range-both with the services and with
the outcomes. Those who reached agreement were more likely to be satisfied though
40-60% satisfaction was found among those failing to reach an agreement.
• Some researchers found marked improvement in co-parental relations, less conflict,
improved communication, trust, and understanding though other researchers failed to
find improvement in co-parental relations.

Peer Mediation

One interesting and useful mesolevel application is peer mediation introduced in schools
as prevention programs. Peer mediation has been prompted by concern for in-school violence
with programs started and tested from elementary schools through high school (Humphries,
1999). Jason and Rhodes (1989) stressed the need for students to be role models for other
students. Peer mediation is also supported by research that showed involving students in
prevention programming improves the chances for positive outcomes.
The purpose of these programs has been to reduce violence and teach students to manage
conflict in a constructive manner. There is great diversity in the details of programs, but they
generally involve orienting a student body to alternative conflict resolution and training small
groups of students in mediation techniques who then become involved in mediating disputes
among other students within the school. Araki (1990) reported on one such program in Hawaii,
the Dispute Management in the Schools Project (DMSP).
The study involved a high school, an intermediate school, and an elementary school in
one district. Questionnaire data as well as in-depth interviews and unobtrusive measures were
used. The study spanned 2 years. During the first year of the project a full-time coordinator was
hired, discussion sessions were held with teachers and counselors for orientation, and 20-hour
training sessions were provided for students and school staff. The start-up activities also
included orientation for all school staff, communication with Board of Education personnel,
key leaders in the school system, unions, and parents. The research showed that coordinating
the project with the school program was vital to its success.
Student mediators were identified "leaders" who volunteered and received 20 hours of
training in mediation. They were trained to act as neutral third parties, were on call throughout
the school day, and agreed to make up any schoolwork missed. Training involved questioning
for feelings and facts, analyzing problems, supportive listening, communication skills, and
writing agreements. Results showed that of 136 cases mediated in the 2 years, all but 3 resulted
in agreements (7 of the agreements were later broken). These included 12 student-teacher
disputes-an adult comediator was required for these. Araki concluded from the research that
"staff, mediators, and disputants indicated that mediation was effective for managing student-
student disputes" (1990:55). Students were able to learn and apply the principles of mediation.
Cunningham et at. (1998) studied peer mediation of playground conflict in primary
schools (up to fifth grade, students aged 10 and under). Prior to starting, the project was
presented to parents, teachers, and students. All fifth-grade students who received permission
from their parents were given 15 hours of mediation training that included instruction on
218 HOWARD M. REBACH

mediation, modeling, and role-playing exercises. Mediators were then introduced to the
student body at a schoolwide assembly that included school staff who discussed the impor-
tance of the program. Groups of three mediators met with each class, further explained
mediation, and gave a brief demonstration. The student mediators were then assigned in pairs
to various parts of the school playground where they tried to intervene within 10 seconds of the
start of a conflict. They conducted mediation if the disputants agreed and referred them to the
playground supervisor if they did not.
The study used a multiple baseline design with baselines of 7 weeks at one school, 11
weeks at a second school, and 14 weeks at a third school. Data were obtained from direct
observation on the playgrounds. Instances of physical aggression were recorded as were
instances of adult and peer mediator intervention. Data also included a 6-month and I-year
scale of staff satisfaction with the project. Data showed that "mediation produced an abrupt
and sustained reduction in direct observation of physically aggressive behavior" (Cunning-
ham et al., 1998:658): from a baseline average of 71% to an average of 25% of observations
after mediation began. Follow-up observations showed the effect continued the following
year. Ninety to ninety-five percent of school staff reported that they felt the program was
implemented successfully with adequate training and support for the students and that students
intervened appropriately. Ninety percent of mediations were resolved successfully. Other
students sought and cooperated with the mediators. Teachers reported that mediators benefited
as well.
Johnson et al. (1994) also studied peer mediation among elementary school students,
grades 3-6. The children received 30 minutes of training per day for 6 weeks. Results showed
that training successfully taught negotiation and mediation skills. Students were able to
transfer training and apply the skills in practice. The project was found to have dramatically
decreased the number of disputes referred to teachers and counselors and discipline problems
were reduced as the children became more able to handle their conflicts constructively.
Similarly, Thompson (1996) studied a peer mediation project in a middle school in Georgia.
The program objective was to reduce discipline problems as well as promote a positive school
climate, promote student empowerment and responsibility, increase self-esteem, and commu-
nication skills. Student mediators were selected and trained. Results showed a decrease in
suspensions, an increase in students' requests for mediation, and the belief that it works.
Overall school morale also improved.
Humphries (1999) studied a peer mediation program at a Utah middle school. Peer
mediators received training in active listening, problem solving, critical thinking, team work,
assertiveness, and conflict management. Mediators were taught to employ a series of steps:
• Introduce yourself as mediators
• Establish mediation rules: no interruptions, no name calling, tell the truth, and agree to
solve the problem.
• Define the problem as each disputant sees it and discuss their feelings
• Work for a mutually satisfying solution.
Results indicated that these children could learn the steps and implement them. The peer
mediators helped other students reach mutually acceptable agreements 71 % of the time.
Humphries suggested that regular meetings with peer mediators improve the overall program
if students have continued practice, instruction, and supervision. Teaching the rest of the
student body about mediation may also help the program work better.
Dudley et at. (1996) were particularly interested in whether middle school students could
learn and use an integrative as opposed to a distributive negotiation style. A distributive style
involves maximizing one's own outcomes-a win-lose style-while an integrative style
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 219

maximizes joint outcomes-a win-win style. Compared with the no-training controls, stu-
dents who received conflict resolution and peer mediation training increased their use of
integrative negotiation. A similar study was conducted by Stevahn et al. (1996) and produced
similar results. Trained students retained the conflict resolution procedures, and applied them
in conflict situations. In addition, students who received training also showed academic
achievement gains as well.
Lindsay (1998) evaluated a peer mediation program and studied those features of pro-
grams that make them successful. The research involved 17 schools from four school districts:
6 elementary schools, 6 middle schools, and 5 high schools. Fourteen of the schools had
conflict resolution and peer mediation programs and 3 schools, used as comparison, had no
programs. In schools with programs, the whole student body was trained in conflict
resolution-negotiation, collaborative problem solving, communication skills, and listening
skills. Students selected as peer mediators received 12-15 hours of additional training. They
then worked in teams helping other students resolve disputes, sometimes in informal settings
but mostly in scheduled sessions. Students could ask for mediation or be referred by teachers
or other staff. All staff responded to questionnaire items and most were interviewed as well.
Recognizing that the effects of the peer mediation program were affected by other factors
(e.g., management styles of teachers and administrators), school staff felt that in-school
discipline showed overall improvement. There were fewer fights and suspensions. Schools
with peer mediation programs also found they had a positive effect on the curriculum and on
the school "culture." Teachers commented that the programs encouraged students to take
responsibility for their actions. Students were solving their own problems and were using
communication skills. And they learned and used skills beyond school.
Finally, Lindsay's research led him to draw some conclusions about successful programs.
First, it should be recognized that "school programs alone are no panacea given the influence
of family and communities" (1998:97).High-quality programs should also address conflict
resolution at home and in communities. Second, it takes a long-term commitment to develop
and institutionalize a program. Successful programs make such a commitment. Third, pro-
grams need to be designed for both high-risk and average students. Since most of the most
severe problems are caused by a small proportion of students, their needs may be different
from the rest and special strategies may need to be designed for these students. Fourth,
successful programs had "support from school administrators who understand the philosophy
of conflict resolution, encourage teachers to include it in their teaching methods and curricu-
lum, and refer students to mediation" (p. 98). Fifth, "high quality training and refresher
workshops for school personnel who are teaching conflict resolution and coordinating media-
tion programs" (p. 98) build and maintain a core leadership group. Finally, continued support
from community mediation center staff and volunteers helps achieve success for programs.
In summary, peer mediation programs in schools have been found to have a positive
effect on school discipline and the school environment generally. In addition, they seem to
have a particularly positive impact on the student mediators that includes enhanced academic
performance, social skills, communication skills, and reduced conflict and skills transfer into
their peer and family relations (Hall, 1999).

Victim-Offender Mediation

Victim-offender mediation dates back to 1974 with the first known program initiated in
Ontario, which became a model for a similar program, 4 years later, in Indiana. By the late
1990s, over 325 programs were operating in the United States and Canada. More than 700
220 HOWARD M. REBACH

similar programs were found throughout Europe. Zehr (1990, 1995) argued for a "paradigm
shift" from retributive justice to restorative justice. This is not the place to review Zehr's
argument, and interested readers are encouraged to consult the references mentioned in this
section. Retributive justice, according to Zehr and others, focuses on the offender and the state;
the offender has violated the state and its laws and thus must be punished. The state is defined
as the "victim" and the state exacts retribution. As Zehr and others argue, the actual victim is
generally neglected. The retributive paradigm emphasizes the past and fixing blame and
emphasizes conflict and an adversarial process where the primary parties are the offender and
the state. Zehr described restorative justice as follows:
This restorative paradigm emphasizes the existential reality of crime: that it represents a violation of
people and their relationships. The proper response, then, should heal and restore.
The restorative paradigm ... defines crime in interpersonal terms as harm. It puts the individuals, their
needs, and their relationships center stage. Accountability is defined as taking responsibility to make
things right.
The new paradigm recognizes that the essential conflict is between individuals and that conflict
resolution processes are therefore important. It encourages victim and offender to see one another as
individuals rather than as stereotypes.
[The restorative justice paradigm] encourages responsibility for past behavior, its focus is on the future,
on problem solving, and on the obligations created by the offence ... transformation (... making things
right) replaces the imposition of pain as the primary outcome.

Victim-offender mediation is associated with the restorative justice paradigm. Strictly

speaking, parties are not disputants. Most programs do not handle cases involving violence or
armed robbery. Many programs focus primarily on juvenile offenders. The sessions allow
interested victims of property crimes the chance to meet with the offenders in a safe and secure
setting in which the offenders are held accountable for their acts. Victims must consent to the
process and if they do, they are given "maximum input into the plan for holding the offender
accountable, referred for needed help and assistance, allowed to tell the offender how the
crime has affected them, and, to the largest extent possible, are repaid for their losses"
(Bazemore & Umbreit, 1998:10). A plan for restitution is often worked out as part of the
mediation (Umbreit, 1999).
Programs generally begin the process with extensive preparation in premediation individ-
ual sessions with both the offender and the victim, which are regarded as necessary for a
successful result. With the victim, the mediator listens to how the crime affected the person,
explains the process, and helps the person prepare for the session. It is the mediator's task to
see that the victim is safe, feels safe, and that the time and location of sessions are appropriate
and convenient. Offenders' participation should be voluntary. The offender, often a juvenile or
young adult, also needs to be prepared, not in the sense of developing a script but in thinking
through some of the issues that might be discussed. Role-playing between the mediator and the
offender may provide a chance for the young persons, some of whom may be inarticulate, to
learn to express their thoughts and feelings for later interaction in the joint session (Umbreit,
1995) The joint sessions should allow for as much dialog between the parties as possible with
as little interference from the mediator as possible.
Studies of the results of victim-offender mediation have shown high levels of satisfac-
tion with the process on the part of both victims and offenders. Umbreit (1995) reported on a
large, multisite study of victim-offender mediation programs in the United States that in-
cluded over 1100 interviews with both victims and offenders in four cities. In addition to high
levels of satisfaction, over 90% of mediated sessions produced a negotiated restitution plan to
compensate the victims and over 80% of offenders complied with their obligations. Fear and
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 221

anxiety about crime among victims was reduced. Relative to a comparison group of juvenile
offenders who did not participate in the mediation session, fewer and less serious additional
crimes were found at a I-year follow-up among those who did participate in mediation.
The idea of victim-offender mediation may be counterintuitive: who would want to sit
down and dialog with someone who had committed a crime against them? Evidence and
experience have now shown that it does work for those who have participated. However,
careful screening and preparation of both parties seem to be the key to the benefits that have
been suggested.

Other Applications

In 1975, California and Massachusetts offered parents ADR options in disputes over
special education issues (Mills & Duff-Mallams, 1999). By 1994, 39 states offered mediation.
In 1990, Congress enacted the Individuals with Disabilities Education Act (IDEA), which
included parents' right to a due process hearing for parents who had difficulties with local
school systems in obtaining an appropriate education for their child. IDEA was amended in
1997 and now requires all states to offer mediation in these disputes since the due process
hearings were found to have taken an emotional toll on parents and school personnel alike and
often produced disappointing results. They required a lot of time, established an adversarial
process, and parents felt that they were unfair. While parents may still opt for a due process
hearing, mediation has been found effective in most instances (Mills & Duff-Mallams, 1999)
Wilson (1999) reported on the use of mediation in the Australian Health Service to deal
with patients' complaints about providers. Health Complaints Commissioners, established in
all states and territories, mediate disputes between physicians and patients outside the courts.
This allows providers of healthcare services to be called to account for their actions including
violations of the guiding principles of healthcare. The process is voluntary and nonadversarial
and free of charge-three characteristics that seem to account for the success of the program.
Mediators act as neutral parties; they do not direct the disputants on how to proceed nor do
they make decisions. But they provide an opportunity for parties to resolve their dispute.
Mediation in medical practice cases has also been tried in the United States. The first
known attempt was in New York City in 1971. During the next year the 232 medical liability
cases that came before the court were referred to a mediation panel consisting of a physician,
ajudge, and an attorney (Currie, 1998). These panels held to be relatively successful in settling
cases (Bergen, 1972). Florida, Rhode Island, Wisconsin, and Washington State have all at
one time or another tried to mandate that such cases be mediated using similar panels. The
Florida State Supreme Court ruled these unconstitutional and the practice was discontinued.
More generally, as Currie's review (1998) concludes, the evidence concerning mediation in
medical practice disputes is not encouraging. In general, mediation calls for negotiation while
disputants seem to feel that the issues should be decided by neutral scientific experts.
ADR has also become an accepted part of real estate and property management (Blatt &
Wollert, 1999) where both arbitration and mediation have been used for many years in
landlord-tenant conflict and contract disputes of all kinds. ADR, mediation, and arbitration
are also well known in labor-management disputes and may be especially useful in cases
where employees lack union representation (Zack, 1997). A special case of worker-employer
conflict involves resolution of Americans with Disabilities Act cases. The Act requires that
employers and employees try an informal dispute resolution in accommodating an employee's
disability. Phelan (1998) described mediation as an excellent and effective way of accomplish-
222 HOWARD M. REBACH

ing the intent and goals of the Act. Mediation is certainly quicker, more direct, incurs less cost
and less loss of employee productivity, and creates less hostility among workers than does
protracted litigation.
Finally, it is worth mentioning community mediation as a part of the growing ADR
movement. The typical model involves a community mediation center, usually run by a board
of directors who are local community persons and staffed by either trained volunteers or paid
staff. Centers may differ on the types of cases they take, but generally, members of a local
community may contact the center for help with a wide range of issues. For example, the
Community Mediation Service (CMS) of Boulder, Colorado, started in 1981 to handle
landlord-tenant disputes. CMS is funded and staffed by the city as a public agency. Over the
years it has expanded the service and now includes any community disputes, conflicts between
citizens and city departments, conflicts within nonprofit agencies, race relations, youth ser-
vices, divorce and child custody cases, and even roommate issues. The center also conducts
mediation of parent-adolescent conflicts (Coates & Damas, 1997). Another example is
Cooperative Solutions Inc. (CSI), a nonprofit mediation program serving a culturally diverse,
low income, rural population in Minnesota. CSI uses professional mediators, works with local
community agencies, and also helps other communities set up mediation centers to create
access to services (McKnight, 1997). Other programs exist throughout the country in many
locales, usually major cities such as Honolulu, Washington, D.C., and Chicago (NIDR, 1991).
Communities interested in starting a community mediation center may obtain technical
assistance from NIDR.

CONCLUSION

Mediation and other ADR methods appear to be a social movement that is catching on.
Community dispute resolution centers have been springing up and mediation is being applied
in a wide variety of settings and disputes. And, according to researchers and practitioners, it
works.
Mediation and ADR generally offer a rich field for practice in applying their sociological
background for clinical sociologists. As Volpe noted, "sociology has had a rich history in
advancing an understanding of conflict and its resolution" (1985:5). She went on to express
her opinion that sociologists have much to contribute and that conflict and its resolution and
ADR offer a challenge for sociologists. It can be a challenge for research and theory and for
practice.
For sociologists who are interested in developing practice skills, specific ADR and/or
mediation training is a necessity. The field is rapidly professionalizing and credentials have
become a requirement in many jurisdictions. Fortunately, most interested parties should have
no trouble finding high-quality training programs conveniently located. They are developing
allover the country

REFERENCES
Araki, C. T. (1990). Dispute management in the schools. Mediation Quarterly, 8, 51-62.
Arno, A. (1985). Structural communication and control communication: An interactionist perspective on legal and
customary procedures for conflict management. American Anthropologist, 87, 40-55.
Bahr, S. (1981). An evaluation of court mediation: A comparison in divorce cases with children. Journal of Family
Issues, 2, 39-60.
MEDIATION AND ALTERNATIVE DISPUTE RESOLUTION 223

Barrett,1. T. (1999). In search of the Rosetta Stone on the mediation profession. Negotiation Journal, 15, 219-226.
Bazemore, G., & Umbreit, M. (1998). Conferences, circles, boards, & mediations: Restorative justice and citizen
involvement in the response to youth crime. Balanced and Restorative Justice Project, OJJDP, U.S. Department
of Justice.
Benjamin, M., & Irving, H. H. (1995). Research in family mediation: Review and implications. Mediation Quarterly,
13,53-82.
Bergen, R. P. (1972). Mediation of liability claims. Journal of the American Medical Association, 222, 241-242.
Bernard, S. E., Folger, J. P., Weingarten, H. R., & Zumeta, Z. R. (1984). The neutral mediator: Value dilemmas in
divorce mediation. In J. A. Lemmon (Ed.) Ethics, standards, and professional challenges (pp. 61-74). Mediation
Quarterly. San Francisco: Jossey-Bass.
Blatt, E. K, & Wollert n, L. (1999). Resolving disputes. Journal of Property Management, 64, 46-50.
Burgess, H., & Burgess, G. (1996). Constructive confrontation: A transformative approach to intractable conflicts.
Mediation Quarterly, 13, 305-322.
Bush, R. A. B., & Folger, J. P. (1994). The promise of mediation: Responding to conflict through empowerment and
recognition. San Francisco: Jossey-Bass.
Callister, R. R., & Wall, J. A. (1997). Japanese community and organizational mediation. Journal of Conflict
Resolution, 41, 311-328.
Chandler, D. B. (1990). Violence, fear, and communication: The variable impact of domestic violence on mediation.
Mediation Quarterly, 7, 331-346.
Coates, C. A., & Damas, K (1997). Family mediation by the Community Mediation Service in Boulder, Colorado.
Mediation Quarterly, 15, 29-38.
Cunningham, C. E., Cunningham, L. J., Martorelli, V., Tran, A., Young, J., & Zacharias, R. (1998). The effects of
primary division, student-mediated conflict resolution programs on playground aggression. Journal of Child
Psychology and Psychiatry, 39, 653-662.
Currie, C. M. (1998). Mediation and medical practice disputes, Mediation Quarterly, 15, 215-226.
Della Noce, D. J. (1999). Seeing theory in practice: An analysis of empathy in mediation. Negotiation Journal, 15,
271-295.
de Mayo, R. A. (1996). Practical and ethical concerns in divorce mediation: Attending to emotional factors affecting
mediator judgment. Mediation Quarterly, 13, 217-227.
Dudley, B. L., Johnson, D. w., & Johnson, R. T. (1996). Conflict resolution training and middle school students
integrative negotiation behavior. Journal of Applied Social Psychology, 26, 2038-2052.
Ellis, D., & Wight, L. (1998). Theorizing power in divorce negotiations: Implications for practice. Mediation
Quarterly, 15, 227-244.
Emery, R. E., & Wyer, M. M. (1987). Child custody mediation and litigation: An experimental evaluation of the
experiences of parents. Journal of Consulting and Clinical Psychology, 55, 179-186.
Erickson, S. K, & McKnight, M. S. (1990). Mediating spousal abuse divorces. Mediation Quarterly, 7, 377-389.
Etcheson, S. C. (1999). Transformative mediation: A new current in the mainstream. Policy Studies Journal, 27, 393-396.
Garcia, A. (1991). Dispute resolution without disputing: How the interactional organization of mediation hearings
minimizes argument. American Sociological Review, 56, 818-835.
Hale, K (1998). The language of cooperation: Negotiation frames. Mediation Quarterly, 16, 147-162
Hall, R. (1999). Learning conflict management through peer mediation. In How children understand war and peace: A
call for international peace education (pp. 281-298). San Francisco: Jossey-Bass.
Haynes, J. M. (1981). Divorce mediation: A practical guide for therapists and counselors. Berlin: Springer.
Haynes, J. M. (1994). The fundamentals offamily mediation. Albany: State University of New York Press.
Humphries, T. L. (1999). Improving peer mediation programs: Student experiences and suggestions. Professional
School Counseling, 3, 13-20.
Jason, L. A., & Rhodes, J. E. (1989). Children helping children: Implication for prevention. Journal of Primary
Prevention, 9, 203-211.
Johnson, D. W., Johnson, R., & Dudley, B. (1994). Effects of conflict resolution training on elementary school
students. Journal of Social Psychology, 134, 803-817.
Kelly, J. B. (1995). Power imbalance in divorce and interpersonal mediation: Assessment and intervention. Mediation
Quarterly, 13, 85-98.
Keltner, D., & Robinson, R. J. (1993). Imagined ideological differences in conflict escalation and resolution.
1nternational Journal of Conflict Management, 4, 249-262.
Koch, M. A. P., & Lowery, C. R. (1984). Evaluation of mediation as an alternative to divorce litigation. Professional
Psychology: Research & Practice, 15, 109-120.
Lindsay, P. (1998). Conflict resolution and peer mediation in public schools: What works? Mediation Quarterly, 16,
85-99.
224 HOWARD M. REBACH

MacFarlane, J., Christoffel, K., Bateman, L., Miller, v., & Bullock, L. (1991). Assessing for abuse: Self report versus
nurse interview. Public Health Nursing, 8, 245-250.
Maryland ADR Commission (1999). Join the resolution: The Maryland ADR Commission s Practical Action Plan.
Towson, MD: Author.
Maxwell, J. P. (1999). Mandatory mediation of custody in the face of domestic violence: Suggestions for courts and
mediators. Family & Conciliation Courts Review, 37, 335-356.
McCormick, M. (1997). Confronting social injustice as a mediator. Mediation Quarterly, 14, 293-307.
McKnight, M. S. (1997). Access to mediation services for rural, low-income, and culturally diverse populations.
Mediation Quarterly, 15, 39-50.
Mills, G. E., & Duff-Mallams, K. (1999). A mediation strategy for special education disputes. Intervention in School
and Clinic, 35, 87-93.
Morris, M. W., & Su, S. K. (1999). Social psychological obstacles in environmental conflict resolution. American
Behavioral Scientist, 42, 1322-1349.
National Institute for Dispute Resolution. (1991). Community dispute resolution manual: Insights & guidance from
two decades of practice. Washington, DC: Author.
Parkinson, L. (2000). Mediating with high conflict couples. Family & Conciliation Courts Review, 38, 69-76.
Pearson, J., & Thoennes, N. (1985). A preliminary portrait of client reactions to three court mediation programs.
Conciliation Courts Review, 23, 1-14.
Phelan, G. (1998). Resolving ADA cases through mediation. Trial: Employment Law, 34, 56-59.
Pope, B. B., & Ganong, S. (2000). Understanding conflict and human capacity: The role of premises in mediation
training. Family & Conciliation Courts Review, 38, 41-48.
Reiniger, A, & Tudy-Jackson, J. (1997). Court-annexed child custody mediation in New York City: A collaboration
among three organizations. Mediation Quarterly, 15, 61-70
Schellenberg, 1. A. (1996). Conflict resolution: Theory, research, and practice. Albany: State University of New York
Press.
Sohn, D., & Wall, J. A (1993). Community mediation in South Korea. Journal ofConftict Resolution, 37, 536-543.
Stevahn, L., Johnson, D. w., Johnson, R. T., Laginski, AM., & O'Coin, I. (1996). Effects on high school students of
integrating conflict resolution and peer mediation training into an academic unit. Mediation Quarterly, 14, 21-36.
Tenbrunsel, A. E. (1999). Trust as an obstacle in environmental-economic disputes. American Behavioral Scientist,
42, 1350-1367.
Thompson, S. M. (1996). Peer mediation: A peaceful solution. School Counselor, 44, 151-154.
Tjersland, O. A. (1997). Strategies in mediation explored and developed during a research project. Mediation
Quarterly, 15, 105-117.
Umbreit, M. S. (1995). The development and impact of victim-offender mediation in the United States. Mediation
Quarterly, 12, 263-276.
Umbreit, M. S. (1999). Victim-offender mediation in Canada. International Social Work, 42, 215-227.
Volpe, M. R. (1985 April). Dispute resolution gains ground. Footnotes. ASA Publication.
Wall, J. A, & Blum, M. (1991). Community mediation in the People's Republic of China. Journal of Conflict
Resolution, 35, 3-20.
Welsh, N. A., & Lewis, D. (1998). Adaptations to the civil mediation model: Suggestions from research into the
approaches to conflict resolution used in the Twin Cities Cambodian community. Mediation Quarterly, 15,
345-356.
Wilson, B. (1999). Mediation/alternative dispute resolution and health complaints. Legaldate, n, 5-8.
Zack, A. M. (1997). Can alternative dispute resolution help resolve employment disputes? International Labour
Review, 136, 95-108.
Zehr, H. (1990). Changing lenses: A new focus for crime and justice. Scottsdale, PA: Herald Press.
Zehr, H. (1995). Justice paradigm shift? Values and visions in the reform process. Mediation Quarterly, 12, 207-216.
 CHAPTER 12

Evaluation
Ross KOPPEL

PREVIEW

Evaluation is not just for experts. You already know a lot about it. You evaluate people,
programs, and organizations all the time. You evaluate teachers, restaurants, possible dates,
former relationships, cars, school, sports teams, local policies, and probably, yourself.
Think about what you consider when you evaluate anything:
1. Did you get the product, outcome, or service you thought you would get?
a. How did it work? Does it still work?
b. Did you get more, less, or something different than what you expected?
c. Which issues, characteristics, or aspects were more important to you in your
evaluation? Which were less important to you?
2. What about the process?
a. Was it timely, thoughtful, responsive, nasty, helpful?
b. Did you have any say over what went on?
3. Did you fully understand the goals of the persons or organization? For example:
a. Were the school's aims clear to you?
b. Did you understand if the restaurant was interested more in entertainment than in
food?
c. Did you know your date's goals?
4. Did the goals of the persons or organizations change sometime after you started? For
example:
a. You could have wanted a fast car at first but concluded you preferred a comfortable
one.
b. Your school could have shifted orientation to favor business programs.
c. Your dates could have decided they wanted something different from what they
sought in the first flowering of the relationships.
5. Did you use systematic data collection and analysis? For example:
a. Some car evaluations are based on surveys of former owners.
b. Many schools use student evaluations in considering professors' promotions.

ROSS KOPPEL • Social Research Corporation, Wyncote, Pennsylvania 19095.

Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

225
226 ROSS KOPPEL

c. Many colleges are evaluated in tenns of the job successes of their graduates, the
number of publications of their faculty, the sizes of their libraries, and other
seemingly numeric infonnation.
6. You have probably employed "expert" evaluations. For example:
a. Consumer reports on cars.
b. Newspaper reviews for restaurants and movies.
c. Friends' insights on possible dates (recognizing the serious methodological and
other dangers in such practices).
You have also undoubtedly recognized that most evaluation tasks are not "yes" or "no,"
but rather are more nuanced or contingent, as in: "good for X but not for Y," or "ideal for
beginners but boring for experts," or "fun if in that kind of mood." For example, think about
the following statements:
"Ideal car if you commute across the Mojave Desert but lousy around town."
"Not someone for me now but perfect for those who want to feel bad about themselves."
"Great clothes for people who are over 6'2" and are under 90 pounds."
As part of this natural evaluation, you have undoubtedly weighed several different
factors-recognizing that there are many characteristics you might seek or seek to avoid. In
restaurants, you might seek value for the money and convenience. You might want a school
with access to skiing or with access to beaches. In selecting a class, you might seek a subject in
which you have some interest and one that fits into your schedule and one that has a dynamic
teacher. How you balance, or weigh, each of these factors reflects your needs, values, and
constraints.
Last, in our preview of evaluation methods, you have almost certainly communicated, or
responded to, the findings of your assessments:
1. You've probably told a waiter the food was not great, and hopefully found other places
to eat.
2. You may have realized that trying to learn an entire course the night before a final is
not a wise pedagogic policy.
3. You've told friend X that he can keep his movie recommendations to himself but
sought the opinion of friend Y on films.
4. You've probably concluded that some dates are not worth another evening-and
made those feelings clear to your dates.

INTRODUCTION

All of the issues and trade-offs we have just discussed come into play in evaluation
research. Of course the question is not about which restaurant, car, or date. It is about under-
standing how a policy, program, or organization is helping (or failing to help) some group of
people or, perhaps, society in general. But the concerns we just discussed have exact parallels
in evaluation research. Consider these examples of evaluation questions:
1. Could the state have spent its money more wisely in helping the elderly? Did anyone
find out what the elderly clients of the program needed or wanted? Do the clients know
the available options?
2. Did the policy to assist people in the transition fonn welfare to work have clear goals
and strategies? That is, did the effort pay attention to the kind of work people might
EVALUATION 227

get? Do the jobs pay enough to get a family out of poverty? How long do people stay
in those jobs? Do the former welfare recipients lose so many benefits that the jobs fail
to make sense for them?
3. Did the policy to reduce the cost of long-distance calls help the average person if we
remember that most calls are local? Perhaps businesses benefit most?
4. Did stakeholders l involved in a program share the program's goals? Were the plans to
accomplish those goals well articulated? Did they make sense? Did the organization
have the funding and resources needed to run the program? Did someone try this
before? Are we learning from the efforts of others and of this program?
5. How many people are helped by an alcohol treatment program? For how long are they
helped (for how long do they stay sober)? What proportion are helped? Which types of
people are more likely to be helped?
With any program, agency, or policy, we ask: What does it cost? What are the benefits?
What is the value of the benefits? Who benefits? What are the incentives for making alternative
choices?

Why You Should Read about Evaluation

Evaluation research-of programs, policies, agencies, and of any "intervention" -is

increasingly required by all sponsors. Governments and foundations demand it, leaders use it
to justify their work, community groups use it to determined if they are being well served, and
wise administrators request it for feedback on improvements and on allocation of resources.
You will undoubtedly be involved in some work that is being evaluated or is evaluating some
other project. Even if you will not conduct an evaluation yourself, you must be able to read and
respond to evaluation reports and methods. By learning about evaluation methods you will
know what to look for, how to defend yourself, who to hire, and what to request. Note also that
evaluations are increasingly ongoing events, not just something that comes at the end to see if
the work was acceptable. They can provide frequent feedback to help long-range strategy and
immediate plans. Last, understanding the principles and practices of evaluation research will
probably help you make better decisions in your own life.

Outline of the Chapter

We have already introduced the basic concepts of evaluation. In the remaining pages of
this chapter we elaborate on these concepts.
In the next section we revisit our short definition of evaluation, offering, we hope, more
clarity. Then, we very briefly indicate some of the history of evaluation. In the fifth section, we
provide an overview of four different types of evaluation. This is the major portion of this
chapter and we also examine the purposes of evaluation, looking at the differing needs of
stakeholders, clients of the programs or agencies, and so on. We provide examples throughout
this discussion from some of the evaluations we and others have conducted.
Good evaluation is based on rigorous research methods and research designs. In the sixth
section we discuss the relevant designs and methods of evaluation research. We also look at

IStakeholders in the this context are the people, groups, neighbors, or organizations that are affected by the actions of
the policy, program, intervention, or agency. This includes clients, staff, funders, and administrators.
228 ROSS KOPPEL

some of the adjustments and threats to research design that evaluation involves. In the last
section we discuss evaluation in context: the political and value conflicts implicit in any
evaluation and the audiences for the reports and findings. Throughout the discussion we
include short sidebars (boxed texts) about the work of a few evaluators.

DEFINITIONS

Weiss (1998) and Rossi et al. (1999) offer useful, if not graceful, definitions of evaluation
research.
Weiss: [E]valuation is the systematic assessment of the operation and/or the outcomes of a program or
policy, compared to a set of explicit or implicit standards, as a means of contributing to the improve-
ment of the program or policy.
Rossi et at.: [Evaluation is] the use of social research procedures to systematically investigate the
effectiveness of social intervention programs that is adapted to their political and organizational
environments and designed to infonn social action in ways that improve social conditions.

Let us examine the key terms in these definitions (in italics). To save time and space, we
discuss the terms in both quotations together, whenever possible. 2
Systematic assessment or systematically investigate: While some evaluations may consist
of casual observations, the kinds of evaluation research that are most compelling for program
administrators and participants and for funders involve rigorous research design, clear mea-
surement, careful data collection, and intelligent analysis. Good evaluation incorporates good
and systematic research procedures.
Operation of the program refers to analysis of process-how the program or agency
conducts its work. While not all evaluations focus exclusively on process or operations, all
evaluations address process because one cannot improve outcomes just by wishing them to be
better. The outcome is the result of what the agency or program is doing-its operations or
process. Note that many evaluations examine both outcomes and operations.
Outcomes or effectiveness of social intervention programs: The product or service the
program, intervention, or agency provides is a critical measure in any evaluation. As we have
seen and will see again very soon, what is defined as a good outcome can vary greatly for
different observers, audiences, and stakeholders. Also the assessment of the outcome will
always depend on how it is measured.
Compared to a set of standards: As in most research, one is making a comparison
between something and another thing, including possibly a comparison between a service or
product and some standard. What did we expect to happen? What happened? Assuming we
can agree on measurement (never easy) and on a set of goals (often fuzzy), we can see how
close the program or policy came to meeting its promises. Remember, too, that goals change.
Perceived needs change. We also improve our ability to measure outcome when we collect
data over time andlor when we learn from our previous efforts.
Adapted to their political and organizational environments: Programs, agencies, policies
exist in the real world. They must negotiate their actions and goals in a dynamic setting of
other agencies, legislators, regulations, staff, neighborhood groups, and so on. While this is
happening and while the service or product is being offered, the norms of what is acceptable
and appropriate may change. We increasingly seek to include the views of participants and
21 am following Weiss's format of explicating the definition, although 1 do not necessarily use her explanations or
examples.
EVALUATION 229

other stakeholders; to include the perceptions of clients and others who have been without a
voice in the design and evaluation of programs. All research, and especially evaluation re-
search, is political and is embedded in the complexities of previous interventions, of economic
power, of clients' experiences, and of the programs' inertia, plans, and internal conflicts.
Improvement: One's view of improvement is entirely related to one's views of the
program's or the policy's goals, outcomes, and constraints. If you think your program or
agency is doing wonderful work under difficult circumstances, your recommendation for
improvement would be to give it more resources. If you think the program or agency is beyond
repair-a total waste of money and time-your view of improvement may be to terminate the
program or agency. In short, all of the issues raised in the definitions must be confronted before
we can address the ultimate goal of improvement.
Designed to inform social action: In general, people do not like to be evaluated, and even
friendly evaluators and evaluation reports are viewed with trepidation. You may have a
carefully researched and insightful analysis of a program or policy, but the people in charge
think it is a threat to their jobs, to their good work, to their clients. Evaluation research is
supposed to provide information for a useful purpose. Based on the evaluation, administrators
can change the target population to those with greater needs; staff can be more responsive to
clients; neighbors and funders can consider the best uses of a resource. Programs can benefit
significantly from evaluation, and evaluation reports are often welcomed with great apprecia-
tion. But not always. While not common, evaluation findings can be used to end a program or
to seek very new goals, even if those in charge are vigorously opposed to such changes.
Too gloomy? While we have used these definitions to discuss several challenges faced by
evaluators, we do not want to suggest that good evaluation research is unattainable or even
rare. Under recent federal and private funder guidelines, almost every program must be
evaluated. Most evaluations provide useful insights and recommendations, helpful discussions
of measurement, and a chance for programs and agencies to examine their goals and outcomes
in light of additional data and analysis. Most evaluations, in short, are very beneficial.

A VERY SHORT HISTORY OF EVALUATION

The idea of figuring out if some program, organization, or policy is doing anything useful
did not require modem methods or even modem ways of thinking. However, the widespread
use of social science research methods in evaluation-for example, large surveys, systematic
data collection, and statistical analysis-is usually thought to have begun around the 1930s,
with the growth of social programs of the New Deal (Rossi et at., 1999). The need to better
understand morale and propaganda during the Second World War (1939-1945) was another
impetus for evaluation research. By the late 1950s, evaluations were routine for programs in
public health, housing, occupational training, and delinquency prevention (Rossi et at., 1999).
The greatest spur for evaluation, however, came with the War on Poverty-Great Society
programs of the late 1960s and early 1970s, when the federal government devoted considerable
economic and political resources to addressing income and racial inequalities. Programs like
Head Start, affirmative action efforts, urban renewal, job training, and federal aid to education
increasingly required evaluation. Evaluation research, perhaps ironically, was also encouraged
by those who sought to end these meliorative programs. Foes of "big government," a term
usually used by those opposed to programs for the poor, sought evaluation as a way to justify
ending programs feared to be inefficient, wasteful, corrupt, or just unwanted. Thus, evaluation
research-which is ideally used to improve programs, help them target their services to the
230 ROSS KOPPEL

Journals:
Evaluation Practice, renamed in 1998 to American Journal of Evaluation
Evaluation Review: A Journal of Applied Social Research
Sociological Practice: A Journal of Clinical and Applied Sociology
New Directions for Evaluation
Evaluation: The International Journal of Theory, Research and Practice
Evaluation and Program Planning
Journal of Policy Analysis
Administration Science Quarterly
Professional organizations:
American Evaluation Association
Association for Public Policy Analsysis and Management
Sociological Practice Association
American Sociological Association
Society of Applied Sociologists
FIGURE n.l. Evaluation journals and professional associations.

most appropriate clients, and make them more efficient and effective-was further promoted
by those who wanted to extinguish or diminish those programs.
As this is being written, the United States is engaged in reform of the national welfare
structure, having shifted from an entitlement program (Aid to Families with Dependent
Children), to a system with greater requirements for work outside the home and limitations on
the duration of welfare assistance (Temporary Assistance to Needy Families). Evaluation is
frequently emphasized with the new system. But meaningful evaluation has been hampered by
the difficulties of collecting data on those who appear to have dropped out of the welfare
system and by the often temporary nature of work among the poor. But the lack of clear evalua-
tion data does not limit the enthusiasm for reform. It is a safe bet that evaluation reports will
continue to be cited by all sides in this national experiment.
The demand for evaluation research is also assisted by the many educational institutions
that produce people skilled in evaluation research methods. In addition to sociologists,
graduates of sister disciplines, such as anthropology, psychology, and political science, are
sometimes taught and often practice the methods used in evaluation research. Schools of
education, social work, public administration, public health, and management often include
evaluation methods in their curricula. Statisticians and engineers, also, are often evaluators.
We now have tens of thousands of evaluation results based on studies of tens of thousands
of interventions. Some evaluation reports have been very influential, the basis for billions of
dollars in funding and effort. Some reports have probably never been read by more than a few
administrators. In all cases, the numbers never speak for themselves. Data and findings are
interpreted through the lens of political and social orientation; the fate of programs is almost
always determined in the political arena, not on the desks of statistical experts or of policy
analysts.

FOUR MODELS OF EVALUATION RESEARCH

Evaluation research is often presented within the context of four models:

1. Outcomes: object-based; outcome-based and impact assessment
2. Process evaluation or program monitoring
EVALUATION 231

3. Naturalistic investigation
4. Expert

While there are disagreements about this schema, it is a fine way to start. Recognize that
there are hundreds of books on each of these methods and some scholars will be upset with any
classificatory schema that lumps their favorite method with others. More important, these
methods are often combined in practice, improving our understanding of the program or policy
being evaluated.

Object-Based Evaluations

Object-based evaluations center on the question: Has the program or policy achieved its
goals? This question focuses the evaluation on the stated intentions of the program or policy-
their formal goals. Thus, the evaluator might assess the number of clients served by a soup
kitchen, the number of clients who have fond jobs after completing a job training program, the
improvement in interoffice communication following a seminar on office interactions, the
number of babies inoculated via a medical outreach effort, the number of communities helped
with new traffic plans. Object-based evaluation is not limited to merely counting. One could, if
so specified in the program's goals, measure the quality of the service or product. For example,
the evaluator could measure:

1. The nutritious content of the soup kitchen's soup and/or soup quality ratings by the
clients
2. The quality of inoculations via blood tests or subsequent infections, or
3. The change in quality of discussions and interactions following a human relations
seminar.
With object-based evaluation, the researcher measures how well the program achieves its
goals. It turns out, however, that goals are often not stated, not stated clearly, and not stated in
ways that are measurable. Sometimes the goals may be clear but they are so outlandish or
outdated that they make no sense.
Consider these goals from a variety of programs:
1. Bring God to the poor of Camden
2. Make the children of Cleveland happy
3. Show that our company cares about the five-county region
4. Improve the quality of life for the elderly of Cherry Hill
5. Make the United States proud again
6. Find a "Big Brother" for each of the boys in our neighborhood
7. Improve the quality of children's nutrition
8. Reduce taxes for honest Chicago businessmen
9. End dependency on welfare and make people work again.
Measuring some of these goals would challenge the most sympathetic and skilled evaluator.
Some are so vague that measurement would be meaningless, futile, or silly. But let us take a
look at some of the goals where we have a chance of measuring something of meaning-
perhaps to the program, the participants, or the funders. Keep in mind that the evaluator's first
role is often to help the client define goals and to define those goals in ways that can be
measured.
232 ROSS KOPPEL

1. Bring God to the poor of Camden. We are not theologians but we could measure
changes in the locals' religious beliefs via surveys; and we could monitor church attendance in
poor areas of Camden. Of course we would not know if any changes (assuming we had
baseline data) were due to the particular program being evaluated or to larger social trends, or
to a local crime wave, or to especially bad weather, or to other "acts of God."
2. Make the children of Cleveland happy. We could interview teachers, school coun-
selors, a representative sample of children or parents. We could count smiles of kids at play.
We could see if there is a reduction in prescriptions for pediatric antidepressants. Measuring a
change in children's happiness is complex and we probably will not know what caused it even
if we were happy with our measures.
3. Show that our company cares about the five-county region. Here there really are two
issues to evaluate: (1) to assess if the company is doing anything that reflects its care for the
five-county region and (2) to determine if people in the five-county region have noticed the
company's caring acts. The company might claim that employing people from the area is a
caring act. Certainly it is beneficial. The company might also point to a recent and generous
donation to the local zoo or to its charitable work with the United Way. People in the area, in
surveys and in focus groups, may express deep appreciation for the company's employment,
good works, and generosity. Alternately, residents may never have heard of the company or
think it an exploitative polluter of land, water, and air. Some may be both thankful for the

Example-of evaluating a nutrition education effort-also offers an illustration of

the need for sociological sensitivity and imagination. Remember the food pyramid?
Do you think it reflects objective science from nutritionists and public health ex-
perts? The complaints about the pyramid are many and fascinating, varying from
measurement concerns to claims of racism and agism. On the level of measure-
ment, there's how one defines a "serving." The USDA defines a serving as a much
smaller unit than most people realized. A bagel, for instance, is not one bread/cereal
serving, but three. A USDA "serving" of pasta is Y2 cup; but most people eat three or
four times that amount. The same applies for typical servings of meat and even
vegetables. Then there's the question of what is understood by the admonition to
eat fats and sweets "sparingly."
Even more interesting is the perspective that the food pyramid is inherently racist.
Only a small proportion (less than 5%) of Caucasians are lactose intolerant. (can't
digest milk products or milk). But the proportion of Asians, Latinos, Native Ameri-
cans Americans and African Americans who are lactose intolerant is much greater-
as much as five times higher. Thus the food pyramid's suggestion to eat two-to-
three daily servings of milk, yogurt and cheese is seen by some as racist.
Last, the pyramid is criticized for focusing on average adults, and it is not neces-
sarily appropriate for children and the elderly.
Post script on serving size: The suggested size comparison of a serving of meat
used to be "about the size of a pack of cigarettes." Clearly, that was not the analogy
one wants for a health education effort. They switched the analogy to a pack of
cards. I await the anti-gambling forces to press to another analogy. Let's save some
time and avoid "about the size of the average revolver handle" as our next metric.
FIGURE 12.2. The "racist" measurement error-prone food pyramid.
EVALUATION 233

employment and the charity but unhappy over the environmental policies. All of this informa-
tion would address the company's evaluation question (even if some of it were unappealing).
4. Improve the quality of life for the elderly of Cherry Hill. We hope the agency or
program seeking to improve the lot of the local elderly has some specific goals, such as dis-
tributing large-print editions of the newspaper, making curb cuts to allow wheelchairs to
negotiate sidewalks, or helping people get to the doctor. If they only have vague goals, like
"improving the quality of life," it is unclear how they would go about implementing them.
This is the same issue we just noted-helping the agency or program with goal specification
and clarification.
5. Find a "Big Brother" for each of the boys in our neighborhood. Let us assume, for
this example, the neighborhood has clear boundaries and we know all the boys in the neighbor-
hood. It is very easy to determine how well the program has done at finding a Big Brother for
the neighborhood's boys. (But we would undoubtedly urge that another question be addressed:
Did the Big Brothers make a difference in the lives ofthese boys, e.g., compared with the boys
without Big Brothers, did the boys with Big Brothers do better at school?)
6. Improve the quality ofchildren s nutrition. There is, in fact, a discipline of nutrition
education that routinely evaluates nutrition outreach projects like this. We have been involved
in research of this type. Evaluators of these programs watch kids at school lunchrooms and
daycare centers, give exhaustive food consumption surveys, monitor what is sold or distrib-
uted, and monitor what is thrown away. Again, here, clarification of goals is essential. Do we
mean eating "five a day" of vegetables and fruits? Do we mean eating less refined carbohy-
drates or fats? Perhaps we are concerned about the balance of the diet? Are we concerned with
vitamin and mineral consumption? All would be used to assess the programs' achievements.
7. End dependency on welfare and make people work again. We briefly discussed this
earlier but the topic offers many lessons. Let us say that the new policies help former welfare
recipients to get jobs and leave welfare. Sounds great: win-win. There have been thousands of
these successful cases. However it may be that many of these former welfare recipients take
jobs that do not offer benefits, have obliged some to quite promising education and training
programs, and offer no opportunities for learning or advancement. Are we still convinced the
program is a success? It might be a useful though difficult step toward self-sufficiency.
Another difficulty is that many people have left welfare, but officials do not know what these
people are now doing. They may be creating wonderful new companies that will employ
hundreds of workers, they may be going into crime or drugs, they may be studying economics,
social work, or marksmanship. We only know they are no longer collecting welfare from our
state. Is this still a success?

The message of these examples should be clear: Meaningful object-based evaluation

requires that the program's goals be well articulated and measurable (including a chance to
understand causation-who is responsible for achieving the goals?). This does not mean,
however, that you just throw up your hands when you are faced with fuzzy or unstated goals.
On the contrary, it means, as we suggested earlier, that you have another job: to help the
agency or program figure out what they are trying to do. This task often is remarkably helpful,
forcing the agency or program to think about its actions, resources, clients, strengths and
clients' greatest needs.
It is astonishing to learn how many programs do not have clear goals. How could a
program, agency, or policy not have clear goals? How could the goals go unstated? What
would prevent one from measuring those goals? Reasons for these seemingly odd gaps are
234 ROSS KOPPEL

many. Sometimes programs and interventions are cobbled together in compromise and haste,
with insufficient attention to goals and outcomes. In several cases, the goals are confused or
contradictory. Sometimes programs are offshoots of other projects or agencies, left as orphans
of good intention but poor direction. Some programs exist to funnel money to a legislator's
district, such as a project or agency that few expect to be very helpful except as a conduit of
money to the district. Sometimes agencies want to help people or communities but have not
thought carefully or strategically about what they actually can do, should do, or are doing.
We have evaluated multimillion dollar programs that were created to convince politicians
and government regulators that a company was a good corporate citizen. It is true that the
company's money has helped the nearby communities in real ways. But the true goal was to
improve the political standing of the company. (Remember that we were evaluating what was
accomplished for the local communities, not the motivation of the funders.) The multimillion
dollar effort had not defined its goals in relation to the good work that it actually did. Our first
job was to help the company figure out what it wanted to accomplish. Then we could see if
it achieved those goals.
A different type of confusing goal emerged in a drug treatment program we evaluated.
The program gave the following statement as proof of its successful results: "all of the
'clients' met with Reverend Bob." We politely asked if they had any other measures of suc-
cess, such as "clean" urine samples from program graduates, retum-to-work data, criminal or
arrest data. They were not pleased with our suggestion that a meeting with the Reverend Bob
would be insufficient to set the "clients" on the road to recovery. Needless to say, while it is
possible that Reverend Bob's influence may have been profoundly effective, few outside
funders would be impressed with the program's suggested measure of efficacy.
Sometimes a goal is clearly stated and very measurable but of questionable worth. We
evaluated a housing assistance program that listed its own sustained existence as its primary
goal. While the stated goal was delightfully honest, one expects an agency of this type to
proffer goals such as "help the people of this area buy low-cost homes" or "work with local
people and area banks to help first-time, low-income home buyers." The agency felt its work
was so important, however, that its first responsibility was to ensure its own survival.
We shall return to the task of evaluating programs' goals in our discussion of outcome-
based evaluations and impact assessments.

Outcome-Based Evaluation and Impact Assessment

The previous discussion focused on object-based evaluations-where the evaluation

starts from the stated goals of the project or agency. Outcome-based evaluations and impact
assessments are similar to the object-based evaluations we have just reviewed but with a not-
able difference: with outcomes-based evaluations or impact assessments the evaluator-not
the program administrator-determines the measures to reflect what the program has accom-
plished. The evaluator might start with the program's stated goals, but then add other outcomes
or "impacts." Some examples:
• The program's stated goals are to improve reading and math scores at a local school. In
conducting an evaluation, however, the evaluator realizes it is also important to
measure school attendance, scores in other subjects (perhaps subjects dependent on
reading and math skills), and overall student satisfaction with school.
• The agency seeks to educate residents about energy costs and usage. The evaluator
adds measures of actual energy usage and of the types of appliances the residents buy.
EVALUATION 235

Joel Telles, Ph.D., is Vice President, Information Services and Research, at the
Delaware Valley Healthcare Council of the Hospital and Healthsystem Association
of Pennsylvania. The Healthcare Council is a trade association of hospitals and
other healthcare providers in the Philadelphia area. Dr. Telles, who has his doctor-
ate in sociology from Columbia University, has been on the faculty of UCLA and the
University of Virginia, and lectures in the Temple· University Health Administration
Department.
Dr. Telles's work covers a range of activities, including: assembling and reporting
large scale databases on healthcare, data analysis to support advocacy initiatives,
pure research studies, coordinating data collection and reporting to improve quality
of care, project management, direct advocacy and coalition building, data and
statistical consultation to members, and internal information systems management.
The validity of his studies and data analyses are subject to careful evaluation
different from the peer review of academic research. Results must be able to sur-
vive scrutiny by opponents in a political discussion. Lawsuits (unsuccessful)
brought by groups unhappy with results lead to the need to be sure that the design,
conduct and report of the study is not merely intellectually, but legally, defensible.
The data and research are used for strategic planning decisions by members who
stand to lose or gain large sums of money and affect the healthcare access and
quality of many persons. Studies are taken by Council staff to meetings with legis-
lators, regional administrators, state and federal administrators, and the like. For
some studies, even information about who participated-without any results-can
affect major decisions.
While it is important that reporting is accurate and data not be reported selectively,
the implications of the results for the membership must be kept in mind. When
possible, the data and analysis reported in a paper are separated from the charac-
terization of the results in advocacy activities. All data and analyses must be
reported bearing in mind that others routinely take the data and report it out of con-
text. The changed information is often attributed to the Healthcare Council, since
that provides legitimacy to the data. Dr. Telles often receives calls about results he
can barely recognize from what he reported. A final difference in the way studies are
used is that they often are the basis for subsequent research and change the
behavior and processes of those collecting new information. A form Telles created
to collect information on non-payment by managed care organizations was adopted
by hospitals as the official data log. A survey of the ways in which hospitals do and
do not provide easy access to healthcare for Latinos was used by hospitals as a self
assessment tool for improving access. A survey of services available for caring for
stroke patients currently underway is expected to bring to the attention of the
hospitals the guidlines for good stroke care.
FIGURE 12.3. Portraits and stories from real evaluators.

• The organization says that former drug users who meet with Reverend Bob will be
better and wiser people, thus leading to less drug use. The evaluator decides that the
evaluation should also measure subsequent drug use via arrest records, ER records,
interviews with the former drug users, and job records. 3 Sometimes, as we have seen,
the evaluator might find the stated goals neither sensible nor measurable.
3Note that an outcome-based evaluation or impact assessment may be indistinguishable from an object-based
evaluation because the list of stated goals includes the results the evaluator wishes to assess.
236 ROSS KOPPEL

In almost any evaluation, the evaluator is seeking to determine if the intervention is

making a difference, if that difference is useful, if the cost is reasonable, and if the people being
helped are the ones who need the help? These questions are more formally and fully enumer-
ated by Rossi et al. (1999), from which the following list is very loosely adapted:
• Do the goals or outcome measures make any sense?
• Can you understand the stated goals?
• Do the goals or outcomes serve the needs of the target population?
• Do the goals meet professional standards?
• Are the goals in line with customary practice and/or norms for other programs?
• Do the goals conform to legal requirements?
• Do the goals or outcomes conform to ethical or moral standards? How do they address
issues of social justice and equity?
• How do the goals or outcomes compare with historical data or past performance?
• Were these goals set by administrators, by stakeholders, or by some combination of
these groups?
• Were there other stakeholders who should have been involved in goal settings?
• Have experts been involved or consulted in setting these goals?
• Does anyone have, or can we ascertain, preintervention baseline levels for the target
population?
• Can the outcome or impact measures be causally related to the program's work?
• What would the conditions be in the absence of this program (counterfactual)?

An Example

In outcomes-based evaluations or impact assessments the evaluator seeks to understand

the relationship between the project's efforts and what has happened to the target population
and others who might be affected. Thinking about the list above, what would you evaluate if
you were evaluating a program that was trying to reduce highway deaths associated with
speeding?
Clearly this is a useful goal with wide moral acceptance, seemingly few legal obstacles or
professional conflicts. While drivers are obviously the target population, most people would
benefit from fewer highway deaths. If the public outreach effort were directed to as many of
the states as wanted it, you would limit concerns of inequity. You would have historic data
(traffic fatalities per miles driven before the new outreach effort) and you would have similar
data from the period after the campaign had been in effect long enough to have some impact.
Because you have a consistent numerator and denominator (traffic fatalities per miles driven),
you would not have as many worries about changes in driving patterns.
Let us look at that list of evaluation concerns again and consider more of the issues.
Who set the goals and which stakeholders, if any, were involved? It turns out that drivers
in the western United States argue that speed limits appropriate for eastern states are foolish in
western states, where there are often straight roads, less traffic, and longer distances. Any law
that slows down drivers, they say, actually increases accidents.
Who is the target population? As noted, drivers are clearly the target population. But
targeting drivers may not be the most effective way of influencing them. It might be more
effective to target children, who are impressionable, often in confined spaces where they are
forced to listen to people in authority (e.g., school), and are delighted to speak to parents with
great moral force. Also, because young children have the most number of years to lose in a
fatal car accident, their voices may carry unexpected weight.
EVALUATION 237

Before
After

\--
Anti speeding
campaign

FIGURE 12.4. Traffic fatalities before and after antispeeding campaign.

Can the outcome or impact measures be causally related to the program's work? What
would the conditions be in the absence of this program? Figure 12.4 appears to support the
efficacy of the antispeeding campaign. The numbers seldom look better than this: steady
before the campaign, and clearly going down after the campaign.
But was the reduction in speeding actually caused by the political efforts? It is entirely
possible that the campaign reflected a public outcry about traffic fatalities. In other words, the
antispeeding campaign was the political response to a popular movement, and not a cause of
the reduction in foolish driving. Schematically, this relationship would be represented in
Figure 12.5, where we see the concern about fatalities "created" both the movement toward
safer driving and the antispeeding campaign. Causation is unclear. How important was the
antispeeding campaign in reducing the traffic fatalities? Perhaps both change in driving and
the campaign were "caused" by responses to fatality increases.
Ideally, an evaluator has comparison groups (control groups) that were not exposed to the
intervention (in this case the antispeeding campaign). Of course, in societywide programs,
finding a pure control group may be impossible. But this antispeeding effort provides us with
states that did not participate in the effort. There will be some leakage, or overlap, from states
where newspaper advertisements and TV programs reach some of he citizens in nonparticipat-
ing states, but compromises and next-best solutions are often required in evaluation research.
Figure 12.6 would represent the "control" group's driving behavior (the states without the
antispeeding campaign) in relation to the "experimental" or "treatment" group (the states
with the antispeeding campaign). It would provide additional support: a comparison group that
was not exposed to the campaign and that does not show a decrease.
Thus, we have the classic research design where we can measure average traffic speeds,
traffic accidents, and traffic fatalities before and after the campaign in the treatment states

Growing
/ro__ Popular movement
w,~~
response
to traffic '" fatalities
fatality
increase Political movement to/
limit speeding
FIGURE 12.5. Traffic fatalities before and after antispeeding campaign.
238 ROSS KOPPEL

Campaign Start

States with anti-s

campaign

States without
anti-speeding cam

Driving-related fatalities
FIGURE U.6. Traffic fatalities before and after antispeeding campaign.

(those participating in the campaign) and compare those with the control group states (those
not participating in the campaign). If the campaign is effective, we should see a reduction in
average traffic speeds, traffic accidents, and traffic fatalities in the states where there was an
antispeeding campaign that is greater than in the other states.
Summary so far: This example is on a broader scale (societywide) than many evaluations
but illustrates many of the issues involved in outcome evaluations or impact assessments. In
any evaluation that focuses on the program's results, the evaluator addresses eight basic ques-
tions that serve as a useful summary of this subsection:
1. Is the intervention (could also be called policy, program, agency, organization)
directed at the appropriate population?
2. Is the intervention reaching the target population?
3. Is it being administered or implemented in the ways designed and intended?
4. What aspects of the implementation are defeating the success of the effort?
5. Does it work?
6. For whom does it work?
7. How much does it cost?
8. What are its costs relative to its effectiveness?
Only one or two of these questions (No.3 and maybe No.4) address the process by which the
program or project achieves its results. But examination of the project's internal actions and
decisions-the process-is an area that deserves separate analysis. It is to "process evalua-
tion" that we now tum.

Process Evaluation and Project Monitoring

Evaluation researchers can investigate factors other than outcomes or impacts of pro-
grams, agencies, or organizations. We often examine the processes-the ongoing actions,
events, decisions, and rules within the programs, agencies, or organizations. This is called
process evaluation or project monitoring. Examples of this type of evaluation research are:
EVALUATION 239

• Eamining how clients are treated when they come for job training programs (e.g., how
long it takes to complete paperwork; how many visits are required to determine skill
needs and set up training or courses; friendliness of staff to clients; how convenient are
the job referrals for graduates).
Note that this is not an evaluation of how many graduates found jobs or of which
type of clients found jobs.
• A nutrition education campaign distributes posters and recipes that promote healthy
eating. A process evaluation might consider the locations of the posters and recipe
distribution points: Were they where the target population lives or travels or shops?
Were the posters and recipes attractive, culturally sensitive, and tasty?
An outcome or impact evaluation would want to know if the area residents bought
healthier foods and if the posters and recipes influenced people to buy and eat healthier
foods.
• A school system is operating a reading improvement program for third graders. As part
of the process evaluation or program monitoring effort, the evaluator sits in (observes)
the reading improvement classes, interviews the students about their levels of interest
and enjoyment, logs (keeps a systematic record of) attendance, talks with the teachers
about their plans and aspirations, and interviews the program's administrators and
designers.
An outcome or impact assessment would focus on improvement in reading scores
among those students who were in the program versus the students not in the program.
• An evaluator of a teen-focused antidrug hotline listens to calls, monitors staff training,
and reviews phone logs. He or she considers the interactions between staff and callers,
how staff are prepared for their work, how many rings before the line is answered, and
the quality of recommendations and referrals.
An outcome or impact assessment would probably examine the number of local teens
arrested, surveys of teen drug use, school reports, police reports, and emergency room
records of drug overdoses.

Les Baxter is a senior staff member in the Planning and Evaluation Department of
the Pew Charitable Trusts, a large philanthropy based in Philadelphia. The Trusts
make extensive use of strategic planning and evaluation activities to strengthen the
development of grant programs and inform the decision-making of program staff,
senior management and the board. Dr. Baxter and his colleagues are responsible
for supporting programmamtic strategic planning and designing and managing
assessments of grantmaking for all of the Trusts' program areas. On the planning
side, he provides guidance to program staff as they develop grantmaking goals and
strategies, track progress toward those goals, and report annually on progress to
both the Trusts' management and the board. In evaluation, Dr. Baxter assesses the
evaluation needs of major grantmaking areas, designs and develops integrated
evaluation approaches to assess the progress and performance of complex multi-
year grant portfolios, and then designs and manages all of the evaluation activities
required to implement those evaluation approaches. The evaluations use a variety
of methods, some of which are at the leading edge of evaluation practice. His recent
projects inlcude assessments of the Trusts' grantmaking in climate change, marine
protection, and sustainable forestry.
FIGURE 12.7. Portraits and stories from real evaluators.
240 ROSS KOPPEL

As must be evident from this discussion, process evaluation or project monitoring focuses
on what is happening within the organization, agency, or program. This is not to say, however,
that process evaluations ignore the outcomes of the efforts. On the contrary, it is through our
understanding of, and improvement of, the workings of the programs and interventions that we
can best help them achieve their desired goals. One cannot just "will" better service, more
clients served, fewer poor, more literate children. The staff, rules, and actions of the programs
are the "agents" of the desired changes. Evaluating and monitoring the programs' processes
can help determine why the project is succeeding or failing to succeed. Thus, analyses of
programs' processes are frequently the most effective way of helping programs accomplish
their goals.
Note that process evaluations frequently include structured interviews with administra-
tors and clients. This can be an opportunity to learn more about the program's design, changes,
and constraints. It is also an opportunity to provide feedback to the program if that is part of the
evaluation plan (see discussion of summative versus formative evaluations, below).
Not one or the other. Evaluations often combine research on outcome and on process.
Usually, combining both foci is the most effective way of understanding a program and its
results. There is no conflict between the two forms of evaluation; they are complementary.

Naturalistic Investigation

To the uninitiated, naturalistic investigation is thought to be just hanging around and

watching what goes on. Needless to say, this is a misinterpretation. Naturalistic investigation
covers a range of techniques of which seemingly casual observation is one. But this method, if
properly conducted, requires exquisite attention to detail, an excellent understanding of the
program's history and theoretic underpinnings, and a lot of time. It is closer to ethnography
than other forms of evaluation research, where the evaluator often seeks to view the program
from the perspective of the client or target audience. The skills for this orientation involve the
ability to closely interview participants without the clumsiness usually associated with formal
interview protocols. Moreover, because the evaluator discusses his or her observations with
the participants, mutual learning is enhanced.
In or own evaluation experiences we observed:
• A nurse fail to check for drug reactions in a semicomatose elderly woman, by saying
"You're not allergic to penicillin, are you dear? Take this."
• A social service agency require clients to reapply for the same job training programs
seven times in seven days (for no reason we could understand).
• A computer training system for nurses that told them to ignore the built-in software
safeguards unless the supervisor was watching.
• A multimillion dollar welfare-to-work evaluation effort where the case workers con-
fused the control and treatment groups, thus rendering evaluation meaningless. The
case workers were not sure who was to be subjected to some newly proposed restric-
tions and who was allowed to continue with the old regulations. Because of the con-
fusion, the state was unable to determine the impact of the new restrictions on clients'
behaviors.
In all of these situations, the observations and informal discussions provided insights that
would not have been possible from formal interviews or analyses of outcome data.
EVALUATION 241

A few more points about naturalistic investigation:

1. Some students are occasionally drawn to this method because it seldom involves
complicated math or statistics. This is a fool's solution. It is often much easier to collect and
present statistics than to make penetrating observations and insightful analysis. With the
numbers, you have got a recognized method and somewhat predictable measurement con-
cerns. With ethnography, you are alone with the quality of your observations, understanding,
and thinking.
2. The amount of time in preparation, and then observation and interviews, can be very
demanding.
3. Without an easily explained methodology or formal statistics, the acceptance of
naturalistic investigation-based evaluations is dependent on the faith and trust in the evaluator.
One does not have the usual guarantees from reanalysis of questionnaires or data, log books, or
test scores. The method lacks the classic protection of replication.
4. Naturalistic investigation methods have received support from postmodern and
feminist scholars who have renewed our basic questions of epistemology and have enhanced
our appreciation of multiple research methods.
5. We would add that one evaluation method does not exclude the other. Evaluations are
usually best and most useful when they combine differing methods, e.g., process evaluation,
outcome evaluation, and naturalistic investigations.

Expert
In our preview to this chapter we talked about such experts as movie critics, restaurant
reviewers, and automobile test drivers. Just as we use experts in everyday life, we can use
experts in evaluation of programs. Such experts should be very familiar with the type of
program being evaluated, perhaps having administered similar programs in their careers.
Many complex organizations rely on experts to conduct evaluations. Colleges are evaluated by
teams of professors and deans from other schools. They review curricula, hiring practices,
faculty publications, student opinions, graduation rates, postgraduation placements, adminis-
trators' plans and visions. They may sit in on classes and just walk around. Although this
method is called "expert" evaluation, it obviously integrates many of the approaches dis-
cussed above.
Hospitals are also evaluated by peer reviewers in a process similar to college reviews.
Hospital reviewers walk around but also collect data on infection rates, unexpected illnesses
and deaths, number of operations, experience of the clinical teams and so forth. Again, what is
called an expert evaluation is really a combination of methods filtered ultimately through the
decisions of experts.
Sometimes "expert" evaluations involved competing experts, almost like a courtroom
setting. In these cases, often associated with regulatory proceedings, each side has its own
experts. An electric company, for example, may have its experts testify about their research on
the need for another power plant, while a citizens' group or the regulatory agency's staff may
testify on the ability of the region to rely on conservation. Both groups may use economists,
survey researchers, demographers, and engineers.
Expert evaluations can be efficient because the evaluators start out with a full understand-
ing of the issues, types of organizations, and constraints. As we have seen, however, they often
incorporate many of the evaluation research approaches.
242 ROSS KOPPEL

Summative versus Formative. Years ago, evaluation texts spent considerable energy
distinguishing between the tenns, summative andformative. Summative refers to an evaluation
that is intended to give a judgment about the program-to sum up its outcomes or results; a
summation of project accomplishments. Formative refers to an evaluation that provides
infonnation back to the program or policy leaders to help improve, or fonn, the intervention.
We realize now that the dichotomy between summative and fonnative is usually unnecessary.4
Increasingly, evaluators seek to incorporate both functions: studying, collecting infonnation,
and providing feedback to the project or organization.

More than Yes or No. Evaluation research is dreadfully underused if it only gives a
thumbs up or thumbs down judgment on project outcome. Evaluation research can help guide
programs and policies with subtle and nuanced insights based on analysis of the findings.
Rather than "yes" or "no," evaluators can say, for example, that an intervention is most
effective for those with more than an eleventh grade education, for women, for those who
completed at least one training course but less than three training courses, for those commu-
nities that already have traffic lights, or complex patterns of variables. Evaluators, as we have
repeatedly indicated, are also not limited to one methodological approach, but can combine
insights and findings from several fonns of inquiry.

RESEARCH DESIGNS AND METHODS

In the course of our discussion we have already reviewed several of the research methods
and research designs used by evaluators. you will not be surprised to learn that most of the
research tools of social science are used in evaluations. Evaluations can employ mail or phone
surveys, long face-to-face interviews, observations, logs of transactions, analysis of existing
data, and so on. While evaluation researchers often face constraints not encountered by those
who can control all aspects of the research context, we have tried to develop new strategies to
address, at least partially, these additional constraints.
Below, we provide a short overview of the most common designs. Students who are to
conduct evaluations or who wish more infonnation should examine texts devoted to research
methods and/or to books on evaluation research. See, for example, Babbie (1998), Rossi et at.
(1999), Schutt (1999), or Weiss (1998).

Random Assignment to Control and Treatment Groups

The gold standard of research design is the randomized assignment of participants into a
control group and a treatment group. This allows researchers to make powerful comparisons
linked to the "treatment" (or intervention or program)-where we know that most other
factors should be the same. Often, evaluators can use this design in large and small projects.
Consider these examples:
• Clients coming to a job training center are randomly assigned to one or the other program.
• People in 25 randomly chosen states receive public health advertisements but the
people in the remaining 25 states do not.
• The city institutes new parking regulations for all odd-numbered streets.
4()ften, legal or financial requirements demand that these functions be separated.
EVALUATION 243

Joan I. Biddle earned her Ph.D. in Sociology at Boston University. She has recently
retired from the United States Army Reserve, and holds the rank of Lieutenant
Colonel. In addition to her interests in military topics, Dr. Biddle is an adjunct at the
New School University where she teaches sociology courses on-line. She also
writes about social interaction in cyberspace, distance learning, and family/women.
LTC Biddle, Ph.D., is a long-time adjunct at the U.S. Army Command and General
Staff College, School of Corresponding Studies, at Fort Leavenworth, Kansas. Dr.
Biddle relates this vignette about evaluation in the Army:
Re-enlistment of first·term soldiers, and "lifers," is very important to the survival of
the Army. Each unit in the Army has specific numerical goals for the re-enlistment of
its soldiers. Meeting these quotas is the ultimate responsibility of the Commander.
A few years ago, Dr. Biddle had an opportunity to do a short study about re-
enlistment in one of the Brigades of a large, branch school training post. The
Brigade Commander was convinced that there was a "problem" meeting re-
enlistment quotes. He had been advised about this problem by the Brigade Com-
mand Sergeant Major. At the time, Dr. Biddle was a Major on tour at the post, and
the "re-enlistment problem" had been an issue that no one else had time to tackle.
The Brigade Executive Officer noted with some interest that Dr. Biddle was a
sociologist.
The "problem" presented to Dr. Biddle was from the perspective of the Commander
and included his guidance for what he wanted to know. The result was a study
comprised mostly of interviews with everyone connected with re-enlistment. Addi-
tionally, as we shall see, critically, Dr. Biddle examined: re-enlistment statistics; the
projected goals/quotas for re-enlistment in each level of the Brigade; and the Bri-
gade's next higher level for statistics, the Post level, of which the Brigade statistics
were a portion.
Her findings differed from what the Brigade Commander had expected: a "problem"
meeting re-enlistment quotas. In her written report and discussions she explained
that in some units there was sometimes a discrepancy in meeting the quarterly
quotas, yet, the annual quotas for the units were always met because losses in one
quarter was mostly offset by gains in another quarter, bringing the total numbers
around to meet, or even exceed, the annual goal. Her numerical analysis revealed
that when all of the numbers for the Company, Batallion, and Brigade levels were
examined in aggregate form, there really was no "problem" meeting the re-
enlistment goals for the Brigade. There was then, a perception that a problem
existed, based upon faulty conclusions reached from an examination of data that
had been extracted out of their total context, rather than from an analysis of the
data as part of a larger data set.
FIGURE 12.8. Portraits and stories from real evaluators.

You can probably see the difficulty in this arrangement. Many people find it hard to purposely
and arbitrarily "deny" help to half of those in need or half of those who could benefit just
because some eggheaded evaluator says it will provide information on which to make better
decisions. Those who believe their public health effort is beneficial, those who think their
training program can bring people out of poverty, and those who want all of the city to have
better traffic patterns may not want to cooperate with the research design. In addition, program
personnel who should randomly assign clients can easily defeat the evaluation research design
244 ROSS KOPPEL

for what are viewed as the most noble of reasons. More, the undermining of the design can be
subtle, where the mixing (the "contamination") of the "control" and "treatment" groups is
not known. For example, a caseworker wants to help those who have had the most problems or
a counselor wants to help those who show the most promise for improvement. These are
research nightmares. But there are several defenses:
1. Fully explain the design and intention of the research plan to all staff. Explain that we
do not know if the new intervention is really effective, and for whom it may be more or
less effective, or if it works at all. Only by comparing the new intervention with the old
intervention in a structured setting can we determine its value.
2. If this evaluation shows the new intervention is really more effective than the old, the
findings from this analysis will help us spread the word and help us receive more
funding.
3. We are not denying services to the "control" group; we are just giving them the older,
established service or product which may work much better than the new product or
service. (This is an important ethical point that is often lost.)
4. The evaluation researchers can help structure the program's operations so that assign-
ment into control or treatment groups is automatic, e.g., a computer program assigns
the cases, or you can created "systematic assignment" where every other person is
sent to the control group or treatment group. (Note: this latter method is not true
randomization but is called near randomization, and will often suffice.)
5. In many cases, the assignment to one or the other group can be made where neither the
staff nor the client knows which group they are in. This is called double blind and is
standard methodology in medical and pharmacological research.

Alternative Approaches

With these obstacles to gaining cooperation, evaluators can only occasionally rely on
research designs as rigorous as random assignment to control versus treatment groups.
Usually, evaluations must make due with alternative approaches. Consider these common
research designs:
1. Constructing control groups by "matching" samples. The evaluator finds "similar"
people in the group that received the "treatment" and in the group that did not (the control).
Then the evaluator compares the outcomes of the two groups. Of course, the evaluator cannot
be certain that he or she has matched on the correct variables or that his or her measurement
of those variables was accurate.
2. Using statistical controls to "match" groups. Here the researcher "statistically
adjusts" for each of the nontreatment factors that may explain outcome differences. For
example, if more people in the control group are older, and if older people do not do as well on
the outcome measure, then the researcher "statistically adjusts" the numbers to account for the
differences between the two groups.
3. Using "historical" controls. The program or agency may have years of experience
and records of service before trying the new "treatment" or intervention. The researcher uses
the previous data on people served and on outcomes as a basis to compare with the new
method. Researchers, obviously, must try to ascertain that the previous groups (historical
groups) did not strongly differ on other factors and that the environment is similar. The
EVALUATION 245

research could combine these historical controls with statistical adjustments and "matching"
to make the comparison more meaningful.
4. Time series or interrupted time series. In the earlier example on reducing traffic
fatalities via an antispeeding campaign, we illustrate a time series design. That is, automobile
drivers in each state generated data on miles driven, and on fatalities. Then, we "interrupted"
the series via our antispeeding campaign in half of the states. By examining the outcome data,
we can see the change in the time series and assess the effect of the intervention.
5. Pre-post design. For most of life we do not have a control group. If we go on a diet,
we seldom have twin siblings who promise to not change their eating patterns. Yet, somehow,
we seem to determine the effect of the diet on our bodies. Much evaluation research is similar
to the non-control group design, or what is also called the pre-post design. We have the "pre,"
or pretest measure (we weigh ourselves before the diet), and we have the "post," or posttest
measure (we weigh ourselves after the diet). The problem with social reality and social
programs is that they are much messier to understand than just one person on a diet. Programs
and interventions, as we have argued, are inevitably embedded in complex history, culture,
and shifting environments. Did the target population change between the pre- and posttests?
Did other factors or policies affect the clients? Did they just grow older, wiser, or bored? did
the pretest sensitize them to the researchers' concerns and thus bias their responses? These are
some of the questions that cannot be answered via the single pre-post design and that haunt
researchers. 5 However, just as we can think about several issues in our own diets (e.g., did we
eat the same but exercise more; did we eat more salads and less cake?) we can examine factors
that we think may have influenced the results. We could, for example, look at the demographic
information on the target population for people measured at the pretest stage and the posttest
stage. Were they the same? Who dropped out? Can this help explain the findings?
Many years ago we evaluated an adult reading course. The results were extraordinary.
Students, on average, raised their reading grade levels three years in nine weeks. These adult
students went from an average reading level of third graders to an average of sixth grade
reading levels. When we examined the intermediate tests and the characteristics of the
dropouts, however, we realized that everyone with problems in the course quite before the
posttest. The course did a fine job, but some of that positive result was due to the fact that the
slower or less interested students were not included in the final scores. Fortunately, we were
able to discern both the excellent work of the adult education program and the effects of the
dropouts-a double finding that could be addressed in future efforts (e.g., give special help or
encouragement for those who are not doing well).
Natural experiments. Evaluators can use naturally occurring events to examine reactions
to changes. A college may change the requirements to demand three years of literature courses
for all students; and evaluators could see if this change results in improved writing. A
community could get a new road. Evaluators could examine how this affects sales by local
stores or access to movies and drugs. About 25 years ago there was a large electric power
blackout in New York City. Nine months later the maternity wards were especially busy.
Everyone thought the cause in the birth rate spike was due the lack of lights: people were left in
the dark with only each other. Interviews with women in the maternity wards revealed a
different cause for the increased procreation: no TV. Late night TV, it appeared, serves many
functions not anticipated by demographers or, probably, Planned Parenthood.

5See the classic work on these and other threats to validity in Campbell and Stanley's 1996 book, Experimental and
Quasi-Experimental Designs for Research.
246 ROSS KOPPEL

Natural experiments also occur in policy and program settings. A state may only have
enough training dollars to provide services to half the population. Two similar cities may take
different approaches toward informing their citizens about water conservation. One state
raises the drinking age from 18 to 21 and the contiguous state leaves it at 18. In cases like these,
the evaluator "takes advantage" of the events he or she did not arrange to examine the effects
of the changes and differences.
In any evaluation, it is essential that the evaluator create a clear research protocol-a
detailed guide to data collection and research procedures. This protocol can be changed as the
evaluation proceeds, but it should be available to all interested parties for review and as a
written record of plans and actions.

Just an Overview

In this one chapter, we cannot cover all research designs or the dangers to validity and
misinterpretation. We wanted, instead, to suggest the extraordinary range of possibilities in
designing research and in building on the thoughtfulness and creativity of previous scholars.
Research design is like an ever-growing puzzle that challenges the evaluator in the most
exciting ways. How can the research be structured to allow the least bias and/or most
opportunity to measure whatever bias might be present? What are the sources of "contamina-
tion" that may confuse my findings? What prevents me from generalizing from the findings of
this evaluation to similar interventions?
When evaluators are involved in the intervention from the start, they can often suggest
ways of structuring the program or agency to facilitate the evaluation, provide better research
designs, and allow collection of more useful data. sometimes, even when the evaluator is
involved from the start, issues of cost, politics, time, ethics, law, or departmental conflict will
limit the best evaluation designs. But even knowing these limitations can help the evaluator
better understand the intervention. An appreciation of the dynamics of the program and its
constraints will help the evaluator explain the evaluation purpose and gain the cooperation of
participants.
Programs of course do not exist for the convenience of the evaluator. The best laid plans
can and probably will go astray, sometimes because of lack of cooperation and sometimes
because of forces outside the program or policy. No social policy or intervention occurs in
isolation. History, economics, previous efforts, agency connections, and politics all affect
social programs and policies. Evaluation of any social policy or intervention is likewise
embedded in this rich context. And it is the context of evaluations to which we now turn.

EVALUATIONS IN CONTEXT

We have suggested that evaluations can be tools of improvement, insight, redirection,

refunding, and also of destruction. While most reasons for evaluation are laudatory, one is
wise to question the motivation of any request for evaluation. Few projects or policies are
evaluated to increase the sum of human knowledge; fewer because program administrators
sincerely believe an independent assessment would help them understand and improve their
program. Usually, an evaluation is conducted because legislation, regulators, or a funder
demand it.
Let us consider what happens when an evaluation is required.
EVALUATION 247

While working for the Internal Revevue Service, Bob Dotzler completed his Ph.D. in
sociology at George Washington University specializing in the area of work and
organization. At the IRS he worked in various areas including human resource
development, performance analysis, work systems design, re-engineering, and
Total Quality Management. Evaluation was the skill area that cut across all his work.
The strong methodological training he received opened up a wide range of oppor-
tunities for participating in key agency evaluation projects. For example, he was
asked to provide methodological support to the IRS Commissioner's Study Group
on Women and Minorities where he worked on developing and analyzing a large
survey sent to 15,000 managers designed to identify internal agency barriers to the
advancement of women and minorities. At one point he was assigned responsibility
for developing agency guidelines for evaluating all agency training programs.
Throughout his career at the IRS, Dotzler found his evaluation skills to be constantly
in demand. Few of the agency analysts with tax backgrounds possessed profes-
sionallevel skills in questionnaire design, measurement, item construction, or data
analysis. Similarly, few brought a theoretical perspective to the analysis of organiza-
tional problems and organizational change. As a consequence, Dr. Dotzler found
himself working on a wide range of evaluation-related projects, e.g., a bi·annual all-
employee survey focused on measuring employee morale and job satisfaction, re-
engineering procedures, and performance appraisal systems. Bob Dotzler believes
the rigor of his sociological training helped advance his professional career in
government as well as adding to the quality of agency surveys, procedures, and
processes. He is particularly proud of bringing methodological integrity to internal
agency research which can and is often challenged by other organizational in-
terests.
FIGURE 12.9. Portraits and stories from real evaluators.

Selecting an Evaluator

If the funder or sponsoring business or government agency selects the evaluator, the issue
is generally moot for the program or policy being evaluated. They get whomever is assigned.
As we have suggested, however, knowledge of what evaluation research should be will help
program leaders understand the needs and aims of an evaluation effort. On the odd chance the
data collection or research effort is inappropriate or incomplete, program personnel can
discuss this with the sponsor or funder.
More probably, program personnel are involved in selecting the evaluator. Here, obvi-
ously, one starts with a search for a combination of experience and expertise. But the real work
is in finding an evaluator with whom the program leaders reach a mutual understanding of, and
ability to address, these questions:
1. What is the program seeking to accomplish with this evaluation?
There may well be multiple aims, e.g., justify the program's existence, show its
good works, show that it is better than it used to be, impress a local politician.
2. What resources are available for evaluation?
3. If there are needs for immediate feedback from the evaluation, how will this be
accomplished?
4. How can disruption of operations be minimized; how much disruption can be tol-
erated?
248 ROSS KOPPEL

5. What biases will be introduced by the evaluation process?

6. How will ethical concerns be addressed? This includes:
a. Treatment of confidential information
b. Full presentations to relevant ethical review boards/internal review boards
c. Sensitive and respectful interactions with clients, staff, and other stakeholders
d. Long-term care of data collected as part of the evaluation
e. Care about how information is presented in discussions and in the evaluation report
7. What will be done with the evaluation findings? That is, what is the political and social
context of the project within which the evaluation will be a part?

Internal versus External Evaluator

Many funders and government agencies demand outside evaluators (an evaluator not
from the agency or program). Often, an outside evaluator is the only way of collecting
meaningful information when a powerful director would intimidate, or restrict data access
from, an employee of the organization. Outside evaluation reports are generally more re-
spected than reports prepared "in-house." On the other hand, internal evaluators are often very
familiar with the agency's operations, know how to efficiently and effectively get the data,
have a better idea of "where the bodies are buried," and have a contextual knowledge that
requires years of experience.
Evaluation research is both a learning and a teaching experience. The evaluator learns
about the program and teaches the program staff about the logic of the evaluation in addition to
explaining the specific findings. The program staff help the evaluator better understand her or
his own findings by putting them in a richer perspective than she or he would otherwise have.
The oft-pictured image of the evaluator as inspector general is almost always wrong. Few
evaluations involve just marching in, looking around, examining some data, and marching out
while dropping hints about the report to headquarters. The more accurate metaphor is one of a
relationship. Both benefit from increased cooperation and understanding. Selecting an evalua-
tor should be a considered and thoughtful process.

The Audiences for Evaluation Reports

1. Funders or authorizing sponsors. The first audience is usually the folks who paid for
the evaluation: the sponsoring government agency, business, or funder. The funders or
authorizing agencies can sometimes end the program, replace it or its leaders, reduce or
restructure its functions, or increase its resources. They will probably read the evaluation
report.
2. Program leaders. The next audience-and the one we tend to think of as most
essential-is the leaders of the program being evaluated. These are the people who can most
immediately implement the evaluation's insights and recommendations. They can directly
influence the rules, allocations, and policies.
The next three audiences are not hierarchically ranked.
3. Clients or those directly affected by the program or policy. The clients-those receiv-
ing the training, those being helped by the service for shut-ins, those learning how to handle
their capital gains, those city commissioners receiving millions of dollars in block grants, and
those treated at the homeless shelters-all have good reason to know about the evaluation
findings of programs serving them. As one can guess from this list, however, only some of the
groups are likely to have access to the evaluation reports.
EVALUATION 249

4. Staff of the agencies, programs, or interventions. While leaders of agencies and

programs set the rules and hire the staff, it is the staff of these organizations that implement the
programs. It is often the staff who are being evaluated. The evaluation report can be a useful
tool for improvement and change. It can also be used to foment managerial change. Evaluation
reports are seldom distributed to all staff members.
5. Other stakeholders. There are others whose lives can be seriously affected by evalua-
tion reports and their recommendations. Is the homeless shelter to be placed on your block?
Will the job training program help your business find good workers? How will the new park
design affect your daily walk or your real estate? How will new TV ratings affect your kids?
Will money you thought would go to your program go to another program instead? Does the
agency's board of directors want to reevaluate its executive director? Evaluation reports are
often consequential in ways that even evaluators do not realize.
6. Everyone else. Earlier, we talked about evaluation research as a way of reducing or
eliminating programs and policies that some political groups disliked. That use still exists. In-
creased use and acceptance of evaluation research gives evaluation reports more prominent
roles in political and economic dialogue. Evaluation reports can be the basis for allocations of
billions of dollars and determine the actions of hundreds of thousands of people. The use of
evaluation reports on needle exchanges, welfare reform, early childhood education, and school
choice are just four examples of evaluation as a fulcrum ofpolitical, social, and economic debate.
This last issue of evaluation's impact leads us to our final discussion: What happens with
evaluation reports and recommendations?
Ifevaluation research is launched near troublesome social, historical, and political shoals,
then evaluation findings are adrift in stormy waters far more ominous and unpredictable.
Evaluation reports are written by people who are presumed to be knowledgeable about the
programs being evaluated and about evaluation methods. But once a report is released, it may
turn up in the hands of those without such knowledge or skills. Its interpretation of findings
may be entirely distorted, the context of the research completely twisted. Let us look at what
may happen to evaluation reports.
• The recommendations are carefully reviewed and relevant steps are taken. The project
is improved in both its processes and its goals.
• Funders gain a better understanding of the goals and work. Funds are reallocated,
perhaps with new emphases toward better policies and use of resources.
• Clients and community groups use the report to press for changes that make the agency
more responsive to their needs.
• The report is filled with complex mathematical and research terms. Few read it. Some
experts who can understand it indicate that the report suggests changes. Absent a broad
consensus on what it says, however, few changes are made.
• Conflicting groups within a program or agency both use the report as "proof" that the
other side is even more incompetent than they realized. Both groups become more
entrenched in their positions.
• Despite a sensitive and well-researched evaluation, including a clear and seemingly
convincing report, the program's leaders and the local community are convinced that
the report is nonsense because it conflicts with their beliefs. The report is used to
support a leaky air conditioner in the director's office.
• Political or social leaders in another region use the report as "proof" that a particular
policy or program is dangerous and should be ended. The fact that the methodology and
findings are largely ignored is of little consequence.
250 ROSS KOPPEL

• The report is held up as proof of the wisdom of a well-supported and well-liked pro-
gram. Careful reading of the report, however, reveals the program's effect is non-
existent.
• Most of the above-at the same time.
The first lesson from this list is that evaluation reports must be written with great care and
clarity. The second lesson is that even if the report is well done, the evaluator (and the program
or policy that was evaluated) should be prepared to explain the research and the recommenda-
tions. The third lesson is that of political and social wisdom: Documents will be used and
abused as others wish. The uses of the information may be the flotsam and jetsam of others'
arguments, often long ago tossed from the logic of careful methodology or context.

Why Do It?

Evaluaton research is like Churchill's comment about democracy: It is the worst imagin-
able system except for all the others. Evaluation research is the best way we have of
systematically understanding and improving our efforts at helping people. Only by careful
investigation, observation, and data collection can we ascertain if we are intentionally improv-
ing or worsening our society and the help we give to our most vulnerable members. Everyone
has biases and prejudices. Good research design enables us to assess programs, agencies, and
interventions in ways that eliminate or at least make manifest our biases and the measurement
biases we introduce. People may differ about even good evaluation research findings, but those
findings provide a rational basis for discussion, action, and improvement. We simply do not
have a better way of understanding the complexities of social reality.

ACKNOWLEDGMENTS. The author thanks Meg Koppel, Eugene Sapadin, and Joel Telles for
their thoughtful comments and suggestions. Any errors and omissions, however, are entirely
the responsibility of the author.

REFERENCES
Babbie, E. (1998). The practice of social research (8th ed.). Belmont, CA: Wadsworth.
Campbell, D., & Stanley, J. C. (1966). Experimental and quasi-experimental designs for research. Chicago: Rand
McNally.
Rossi, P. H., Freeman, H. E., & Lipsey, M. W. (1999). Evaluation: A systematic approach (6th ed.). Thousand Oaks,
CA: Sage.
Schutt. R. K. (1999). Investigating the social world: The process and practice of research (2nd ed.). Thousand Oaks,
CA: Pine Forge Press.
Weiss, C. H. (1998). Evaluation (2nd ed.). Englewood Cliffs, NJ: Prentice-Hall.
 CHAPTER 13

Social Policy
MILDRED A. MORTON

INTRODUCTION

To be involved in social policy is to participate in the transformation of the status quo. Social
policies aim to create change. They represent priorities, statements of goals, and the proce-
dures to be used in achieving those goals. This chapter explores the policy process and
describes how clinical sociologists contribute to both the development and implementation of
social policies.
Social policies develop through a dynamic political process that unfolds over time as
people interact in both formal and informal settings. Sometimes research reports bring a
problem to public attention, but often media reporting, crises, or unplanned events are also
involved. As the problem is discussed, recommendations or proposals emerge and attempts are
made to mobilize support. Action mayor may not follow as policymakers and others assess
priorities, alternatives, and political feasibility.
At the broadest level, national governments make policy. State and local governments,
public and private organizations, and other institutions make policies also. At all levels, many
individuals and groups are involved, including politicians, members of interest groups, re-
searchers, staff of implementing organizations, and beneficiaries. The process is complex and
varies from one context to another. Many issues or conditions merit attention but only a few
achieve public recognition and are actively pursued by institutional and political leaders. Over
time, through numerous actions and interactions, large numbers of interested participants
clarify agendas, gather and assess information, create partnerships, encourage collaboration
and consensus building, and define policy objectives.
Defining a policy is only the beginning. To take effect, a policy must become more than a
statement that mandates change. It must have the resources to bring about change and the
personnel to design, manage, and implement programs that carry out policy objectives. For
example, if the policy is to move people from welfare to work, programs are the specific plans
of action developed to achieve that objective.
Many different types of programs can contribute to policy objectives and many individ-
uals and groups participate in policy implementation. The design and implementation of
programs is a dynamic and political process. Included are activities such as further clarifica-

MILDRED A. MORTON • Falls Church, Virginia 22044.

Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

251
252 MILDRED A. MORTON

tion of agendas, research to anticipate or assess the consequences of new policies, planning to
create operational guidelines for action, and advocacy activities among various participating
groups.
Opportunities exist for clinical sociologists to participate actively in the development and
implementation of social policies as staff of the various participating organizations and as
consultants. Expert knowledge and experience with the subject matter (e.g., welfare, educa-
tion, healthcare, or employment) open the door to work opportunities. This chapter covers
only a few of the numerous topics of interest to clinical sociologists. It offers no predictable
formats for initiating and implementing change. Rather, it presents relevant literature, case
studies, and the author's personal experience to provide insights into how social policy evolves
and how sociological skills can be applied to policy development and implementation.

REVIEW OF THE LITERATURE

The processes through which policy decisions are made reflect the political structure of
the society, community, or organization making the decision. In totalitarian societies, central
authorities exercise considerable control over policy decisions and their outcomes. In pluralis-
tic, democratic societies, policies evolve from a process of collaboration and conflict. Opinion
leaders with different points of view seek to mobilize support among interest groups, politi-
cians, and the public. Through dialogue and debate, media events, meetings, and voting, many
individuals and groups struggle for common ground or at least majority consensus. As Etzioni
(1969:752) observed: "Pluralist societies tend toward muddling through because no central
authority-not even the presidency-can impose a set of centrally-made decisions."
Lindblom and Cohen (1979) noted that social scientists believe they should be influential
in problem solving, but they, like others, only contribute to the policymaking process. To
contribute (and be potentially influential), clinical sociologists need to position themselves to
participate in the policy process and act in ways that ensure their knowledge and perspectives
are heard. To contribute means being part of a team that works within the policy process.
Clinical sociologists can contribute to policy development and implementation in multiple
ways, for example by documenting the current situation through research, by working with
others to ensure that findings are communicated to others, and by fostering the development of
an environment in which changes are possible. Clinical sociologists may also design and
implement programs that carry out policy changes. All of these contributions or interventions
are potentially valuable. None is likely to control what happens. As Deborah Stone (1988)
pointed out, policymaking may not be a rational process. It may be more like a game in which
many participants make moves and no single move determines what others will do.
The following section presents a useful model of policy formation and examines several
specific ways for clinical sociologists to participate in policy development and implemen-
tation.

The Social Policy Process

A model developed by Kingdon (1984) provides a framework for understanding the

policy process and exploring how clinical sociologists can contribute to the development and
implementation of policy. The model, based on the making of federal policy in the United
States, recognizes that policymaking requires collective decision making and that information
SOCIAL POLICY 253

influences policy change in several ways. It conceptualizes policy as evolving from three
process streams simplified as problems, proposals and politics.
The problem stream involves the definition of problems through dialogue and debate,
evaluation of statistical indicators, assessment of existing program results, and responses to
crises or disasters. For example, violence in U.S. schools has been an ongoing problem, but
after several high profile incidents in which students were killed or injured, it became a more
prominent problem. Existing programs that had already demonstrated some measure of
success were profiled in the media. Elected officials and their staff members, interest groups,
parents, journalists and others engaged in dialogues and debates about the reasons for the
problem and how policies could respond.
The proposal stream involves proposed solutions and options for policy change, usually
generated by researchers, policy analysts, and other experts. Searching for solutions may
include research to clarify specific issues, program planning to outline actions that could ad-
dress the problem, and strategies for collaboration, consensus building, and managing conflict.
Many different recommendations for policy change emerge from researchers, interest groups,
practitioners in existing programs, and others. For example, proposals to address violence in
the schools include restrictions on portrayals of violence in the media, the installation of metal
detectors and security cameras in schools, and many other proposals.
The politics stream recognizes the role of political developments in creating the initiative
for policy change. Political developments include a change in the political party in power, a
new leader, or the concerted actions of interest groups. Policy advocates mobilize support for
change and assess political costs and benefits. Through bargaining and persuasion, issues
deemed to be politically feasible move forward to become priorities for action or move back-
ward to be forgotten. On the issue of violence, for example, the National Rifle Association has
a history of lobbying to influence legislation affecting gun owners.
In Kingdon's policy process model, three separate streams flow along according to their
own criteria, but they overlap to some extent as people and institutions share common
concerns. Each stream involves the interactions of many individuals and groups in various
institutions. Each stream contributes to the process, but when all three come together, a
window of opportunity opens and a problem becomes more likely to achieve policy promi-
nence that results in action. The key to achieving policy change is to work with others across
streams to create the conditions for policy change and implementation.

Intervening in the Policy Process: Roles for Clinical Sociologists

For clinical sociologists, the policy process model is useful because it offers insights into
where and how to work on social policies. As researchers, staff members, and consultants,
clinical sociologists can apply their skills within the problem, proposal, or politics streams as
policy is being developed and implemented. The range of private, public, and political
organizations that address social policy issues is broad. The challenge is to elaborate the
contributions clinical sociologists can make and promote these roles on resumes, in inter-
views, and in work situations.
Kingdon's three streams of the policy process have some commonality with Christen-
son's three models of community development outlined by Flora et al. (1992:299-321). Each
model suggests specific roles for change agents. In the self-help model (problem stream),
people work collectively to identify and solve problems and change agents are facilitators and
educators. The focus is on process, rather than outcome, and on achieving consensus in
254 Mll..DRED A. MORTON

arriving at group decisions. In the technical assistance model (proposal stream), people apply
science or research to problem solving and change agents are advisers or consultants. The
emphasis is on the task to be accomplished and on specific actions needed to achieve goals. In
the conflict model (politics stream), power and political interests are brought to bear to address
problems and change agents are organizers and advocates. Both task and process orientations
are involved as change agents and groups attempt to reconcile diverging approaches and
mobilize support for specific actions.
Since communities are not static and may change through the years, change agents are
called on to play different roles at different points in time. In the three policy streams too,
clinical sociologists play different roles. As circumstances change, they may be more effective
(or less effective) in encouraging policy development and implementation. This paper focuses
on three roles or skill areas that are relevant to the policy process: research, communications,
and facilitation. Although the three areas are closely related, each represents a separate
constellation of skills.
Research and analytical skills are a core part of the package of skills clinical sociologists
offer to organizations addressing policy areas. Included are skills in using a whole range of
quantitative and qualitative research methods, the ability to select methods appropriate to
policy or implementation needs, and the ability to analyze and interpret how findings relate to
particular policy contexts.
Research can document the existence of a problem and provide evidence that convinces
opinion leaders and others of the need for change. To be policy-relevant, research must address
issues over which policymakers have some control. Lindblom (1990:272) noted that policy
analysis may include research to disclose missing facts, syntheses to analyze data in particular
ways, or critiques of existing analyses. Research provides data, ideas, and ways to conceptual-
ize that help define options for action.
When research is commissioned, clinical sociologists must be able to work in a timely
fashion, using methods that generate answers within the time frame allowed and within
budget. Elaborate survey research may be possible, or limits of time and resources may dictate
the use of focus groups or interviews with key informants.
Viewing the research itself as only part of the researcher's role is helpful. Researchers can
help link findings with actual policy development. Fortmann (1984) recommended that re-
search tasks be broadened to include involvement in policy drafting and implementation. In
her experience, collaboration and communication between researchers and clients helped
answer questions and improve understanding of recommendations emerging from the re-
search. Furthermore, Fortmann recommended that those who will be participating in the
policy process (stakeholders) be identified and involved in the research from an early stage.
The early participation of stakeholders helps coordinate research with program and policy
planning and creates a "demand" for the research findings.
Communication skills include an ability to simplify both research and policy information
and interact effectively with others. Evers et at. (1998:73-92) identify four communicating
skills: interpersonal, listening, oral, and written communication. Communicating research
findings means synthesizing the essence of the research, interpreting what is important, and
devising ways to present relevant findings without technical jargon. Communicating policy
information involves explaining policy positions clearly and promoting an understanding of
policy positions and their importance. Presentations may be in the form of oral briefings,
speeches, posters, Websites, media messages, reports, or informal communications. The chal-
lenge is to provide accurate information in a way that proves interesting to the audience, in an
SOCIAL POLICY 255

appropriate and timely manner. Communication involves listening too-receiving feedback

from others, responding effectively, and collaborating to strengthen the policy process.
More than 20 years ago, in a major study of the federal investment in social research, the
National Academy of Sciences (1978) recognized that the dissemination of research is ne-
glected. Researchers may intend to communicate their findings, but often fail to carry through.
Communication activities are time-consuming and require skills in synthesizing, simplifying,
and reaching out to various audiences. The audiences must be clearly identified; if they have
been involved in the research, they may be more interested in outcomes. Kingdon's model
suggests that policymakers will be most interested in the research findings when they relate to
a current policy issue.
Levine (1995) noted that "getting the message out and engendering a sense of the
credibility of the messenger are both important." She outlined a communication strategy for
researchers who want to bring their research to the attention of Congress. The strategy
included identifying key members of Congress who are or may be interested in the subject and
making contacts with relevant interest groups. She emphasized the importance of providing a
one-page summary that presents highlights of the research and outlines its relevance to
legislative debates. Another way to get the attention of policymakers is through the media by
writing op ed pieces or working with reporters.
Simply mailing reports to policymakers is unlikely to generate much response. Data are
more valuable when they are organized to communicate directly to their needs. The transfor-
mation of information for policymakers is like translation from one language to another
(Konan, 1981). It captures the essence of the subject accurately and interprets it for a different
audience. Policymakers want to get to the point quickly. They have little patience for the
typical academic format that presents background, theory, methods, and analysis before
getting to the conclusions and findings. Policymakers want to read the findings first, followed
by a clear discussion of what they mean.
In work related to the policy process, communications may be with policymakers directly
or with interest groups. Identifying and working with interest groups or other potential users of
research information takes time and effort, but involving them early can cultivate an audience
even before the findings are in. Early planning can even encourage the collection of informa-
tion needed for effective communication, for example, photographs that help tell the story.
Communication activities range across a continuum from relatively objective presenta-
tions to those that advocate specific points of view and seek to mobilize a constituency for
change. Clinical sociologists may take a lead role or support the activities of other policy
advocates. Kingdon (1984:188) described a role for policy entrepreneurs as "advocates who
are willing to invest their resources-time, energy, reputation, money-to promote a proposal
in return for anticipated future gain." Policy entrepreneurs may be career civil servants,
lobbyists, academics, Members of Congress, or clinical sociologists who promote a particular
position, speak from authority, maintain political connections, and are persistent. Their
activities may include various types of presentations to inform relevant audiences, numerous
communications with other groups to build support and consensus, and the ongoing monitor-
ing of political developments. Sundquist (1978) described a similar role for research brokers
who bring findings, analyses, and ideas to the policy development process. Hassanein (1998)
recommended a broader activism that includes communicating with interest groups, sharing
knowledge in policy forums, and identifying strategies for change.
Facilitation skills help stimulate learning, encourage collaboration, and promote problem
solving. Facilitation involves working in groups to create a climate for clarifying goals,
256 MILDRED A. MORTON

exchanging information, assessing options, reaching some measure of consensus, and taking
related action. Facilitators are managers of process. McCaffrey (1988) identified active listen-
ing as an important facilitation skill-listening very carefully to ensure that messages are
understood. Active listening includes paraphrasing what someone has said to clarify the
meaning, summarizing a group discussion to identify main points, and asking questions in a
way that encourages participants to elaborate. For example, questions that begin with how,
what, or why contribute to an opening up of discussion and dialogue on various points of view.
Questions that can be answered by "yes" or "no" are less effective in encouraging discussion.
Facilitation may include planning and assisting at workshops or conferences where large
groups share research and program experience with a view to assessing what has been
achieved and making decisions for the future. With large groups, facilitation involves creating
an appropriate structure for exchange and working in teams to summarize deliberations and
build consensus (or clarify conflicts). Facilitators are managers who smooth the way toward
decision making.
Porter (1995:29-33) outlined ways to build advocacy coalitions by facilitating links
between policy analysis and policy advocacy. The coalition may include communities, stake-
holders, media, nongovernmental organizations, and policy leaders. Facilitating their coming
together to develop strategies and policy options may help push an issue forward on political
agendas or provide policy options that can be advocated when a window of opportunity opens.
All three roles-research, communication, and facilitation-are valuable in the policy
process because they support decision makers in policy development and implementation.
They may be part of an organizational position or they may be assigned to clinical sociologists
on a consulting basis because of the concentrated effort required during a short period of time.
Although clinical sociologists may choose to specialize in one role or another, competency in
all three roles is an asset. Often policymakers and managers work at a feverish pace with little
time for reflection, planning, and reading (Mintzberg, 1990). Clinical sociologists can expedite
work on policy development by conducting research that policymakers want and need,
synthesizing and communicating findings that can be shared among interested groups, and
facilitating dialogue to help build consensus.
Policy implementation offers opportunities for clinical sociologists too. Support to
management may be critical to ensure the availability of resources and the participation of key
groups. For example, the Federal Emergency Management Agency (FEMA) has a mandate
from Congress to help u.S. communities mitigate damage before disaster strikes. FEMA's
Project Impact is a national effort to promote disaster reduction measures (Witt, 1999). It
encourages communities to create partnerships between private and public sectors, evaluate
risks, develop a list of priority actions, and mobilize public and financial support to implement
mitigation activities. Thus, implementation, too, involves research, communication, and facil-
itation.
The three roles-research, communication, facilitation-allow clinical sociologists to
participate in the policy process, contributing their knowledge and skill to the formation of
new policies, the implementation of those policies, and the resolution of social problems.

HOW TO DO IT: CASE STUDIES

This section illustrates cases in which sociologists or clinical sociologists contributed to

the policy process. The first case describes a policy process that occurred over a period of
several years. It summarizes how an applied research program along with effective communi-
SOCIAL POLICY 257

cation and facilitation contributed to policy change within a university. Other cases illustrate
situations in which clinical sociologists supported part of the policy process through specific
consulting assignments.

From Research to Policy: Changes in a University Curriculum

Evers, Rush et al. (1998) described an applied research program that began in 1984 and
eventually contributed to policy changes (modifications of the curriculum) in one college of
the University of Guelph in Canada. The research began with a broad mandate, initiated
outside the individual university. The Corporate Higher Education Forum (C-HEF), an organi-
zation similar to the Business-Higher Education Forum in the United States, commissioned the
first phase of the study to assess the match between university graduates and the needs of
corporate employers. C-HEF knew that corporate globalization and restructuring were chang-
ing the world of work. They believed graduates of universities and colleges needed to change
too in order to work successfully within changing organizations. The research was designed to
explore what changes were needed to "make the match" between education and work.
Initially, the research focused on technical skills, but a series of open-ended interviews
with managers and graduates of a major high-technology manufacturer led to a change of
emphasis. The interviews showed that both managers and graduates were more concerned
with generic skills, such as written communication and the ability to work effectively in teams.
The technical skills required for their work were of less concern.
A follow-up survey of managers and graduates in 27 corporations obtained ratings on the
adequacy of 13 skills. Both graduates and their managers gave graduates high scores on
quantitative and mathematical skills, technical skills, the ability to work independently, and
problem-solving skills. They gave lower scores for skills in oral and written communication,
leadership, creativity and innovation, and administration. The quantitative data confirmed the
open-ended interviewing. University graduates needed more emphasis on generic skill devel-
opment.
A second phase of the research, funded by the Social Sciences and Humanities Research
Council of Canada, the Secretary of State of Canada, and other organizations, began in 1987. In
three consecutive years, more extensive surveys captured self-assessments on 18 skill areas for
1610 students and graduates of five universities. The design permitted comparisons across
cohorts in order to trace skill development.
At regular intervals, researchers presented results to C-HEF and other Canadian and U.S.
groups and obtained feedback that helped translate the findings into workable actions. The
feedback enabled the researchers themselves to improve their ability to present research
findings to an audience of policymakers. The C-HEF task force of five corporate CEOs and
four university presidents had little interest in the details of literature review or research
design. They assumed the researchers were experts in these areas. They constantly encouraged
the researchers to simplify their presentations and interpret data in ways that facilitated
assessment and action.
The regular interaction between researchers and policymakers demonstrated the iterative
nature of policy development. It helped policymakers understand what research findings
showed about the nature of the problem. In fact, it helped them change their perceptions of
the problem and accept that the problem was not technical skills, but generic skills such as
communication and teamwork. Further, it pushed researchers to develop a conceptual frame-
work that was useful in policy development.
258 MILDRED A. MORTON

The surveys documented 18 skill areas-too many to be easily remembered and applied.
Difficulties with efforts to communicate the 18 skill areas led researchers to search for a way to
group them. The result was four categories or four bases of competence: managing self,
communicating, managing people and tasks, and mobilizing innovation and change. Evers et
al. (1998:5) described the four bases of competence as follows.
• Managing self Constantly developing practices and internalizing routines for maxi-
mizing one's ability to deal with the uncertainty of an ever-changing environment
• Communicating. Interacting effectively with a variety of individuals and groups to
facilitate the gathering, integrating, and conveying of information in many forms (e.g.,
verbal, written)
• Managing people and tasks. Accomplishing the tasks at hand by planning, organizing,
coordinating, and controlling both resources and people.
• Mobilizing innovation and change. Conceptualizing, as well as setting in motion, ways
of initiating and managing change that involve significant departures from the current
mode.
These four competencies became a framework for understanding and discussing the research
findings. In common, easy-to-remember language, they represented the skills college gradu-
ates needed to complement their technical abilities.
As the research program evolved between 1984 and 1995, two independent activities were
under way on the campus of the University of Guelph. Auger (1998) documented the activities
in a case study. Employers of recent graduates of the agricultural college initiated one activity
in the early 1990s when they began complaining that graduating students were technically
competent, but lacked communication skills, problem-solving skills, and the ability to work in
teams to resolve conflict or develop consensus. The Dean organized a series of meetings with
employers and other stakeholders, developed a new strategic plan for the college, and initiated
planning for a new curriculum. The plan was dubbed Vision 95.
Meanwhile, the university's office of career services questioned its programs and em-
barked on a project to identify ways to prepare students for employment. Their project was
called Lifelong Learning and the World of Work (LL-WOW). Over a period of several months,
they developed a plan based in large part on the competencies identified in Evers's research.
They envisioned it operating outside the formal academic credit system with volunteer
assistance from alumni, potential employers in industry, and other nonuniversity resources.
Eventually, the efforts of the Dean and the office of career services came together. In
1995, a symposium with employers generated the idea of linking Vision 95 and LL-WOW to
create a new curriculum that incorporated world of work skills into regularly scheduled
courses and activities over the 4 years of their degree program. The new curriculum was
implemented immediately in modules that included all of the skills identified by Evers in the
four bases of competence and several other skills identified by career services personnel.
Faculty members who participated on the committee that made the decision agreed to
incorporate skills development modules into the eight existing mandatory core courses offered
over the eight semesters of study required to earn a degree.
Since implementation began immediately, all participants engaged in learning by doing.
Career services staff assumed responsibility for the modules and worked in close collaboration
with faculty to select formats that fit within each mandatory course. They wrote a manual,
identified reading materials, and arranged experiential learning activities such as work place-
ment assignments and job shadowing in business, industrial, and community organizations.
Within each module, students prepared sections of a portfolio that was to be discussed
eventually with a faculty advisor and employer for an assessment of job readiness.
SOCIAL POLICY 259

At a second symposium in 1996, faculty, staff from career services, employers, and other
stakeholders gathered to review progress. Forty enthusiastic employers volunteered to contrib-
ute to the new curriculum as facilitators of module sessions and as resource people. A third
symposium in 1997 confirmed that the partnership between professional staff and faculty was
working well and highlighted feedback from students on their experience with the new
curriculum.
As implementation occurred, additional meetings and symposia were held to design
activities, share experience, and make changes, where needed. Ongoing efforts illustrate the
extent to which the new curriculum is a work in progress. Research (evaluation), communica-
tion, and facilitation remain part of the process. One concern is the skepticism of first-year
students who view graduation as a distant event and have difficulty accepting the importance
of the new curriculum. To address this concern, an easily accessible office has been set up to
provide information. Enthusiastic students have been identified as "early adopters" and asked
to be peer helpers.
In Kingdon's framework, the policy process involves three streams-problem, proposal,
and politics. This case study illustrates the tendency for groups to specialize in one stream or
another. Although there is some overlap among activities, the applied research program seems
to represent the problem stream; the career services activities represent the proposal stream;
the university decision-making process represents politics. All three were essential to the
process of change and their common interests made change-and implementation-possible.
Research clarified and enlightened conventional wisdom, convincing policymakers of the
need to give increased attention to generic skills. Researchers used multiple methods. Initial
open-ended interviewing produced information that led to changes in the focus of the research
itself. Survey research was essential to elaborate the skills needed by graduates.
Communication and feedback led to the grouping of 18 skill areas into a conceptual
framework with four bases of competence that could be applied. Communication among
groups helped define the problem, propose solutions, and develop political consensus. Career
services worked on specific proposals. The Dean's office put the planning structure in place to
facilitate change and supported symposia where the participants could share information,
explore options, and develop consensus. Interaction among researchers, employers, student
counselors, and academic administrators led to compromises and agreements on what needed
to be done. Policy evolved incrementally. Implementing the new curriculum was a continua-
tion of the process as professors, students, career counselors, and employers created the new
learning experiences.
All participants continue to be involved. In 1999, Evers worked with Andre Auger,
Director of the Counseling and Student Resource Center, to conduct an evaluation of the first
cohort of students to complete the new 4-year curriculum.
Other spinoffs are under way. Evers is writing a manual to help students understand the
workplace and prepare for work. A course he has offered to graduating sociology and
anthropology majors, entitled Transition from School to Work, has been approved for Bache-
lor of Arts students. Numerous publications have reported the Evers's research to broader
audiences.
In this case, sociologists were involved primarily in conducting applied research and
communicating and interpreting results to others in the university and corporate communities.
They simplified and synthesized research findings and presented them to numerous audiences
in a policy-relevant way. They interacted with decision makers and other staff over time as
options were being assessed. The policy process was time-consuming, requiring many of the
skills the new curriculum now offers students: skills in communicating, planning, coordinat-
ing, initiating, and managing change.
260 MILDRED A. MORTON

As this case illustrates, participating in a policy process may be a long-term commitment.

Problems are defined and redefined. Proposals offered by various groups are outlined and
revised as groups consider what actions are appropriate, cost-effective, and politically fea-
sible. Working within an existing political structure provides forums for sharing, developing
consensus, and reaching decisions. Resources for applied research, sharing of information, and
consensus building activities remain important as implementation proceeds. The process is
dynamic and ongoing, providing many opportunities for sociologists to research, learn, share,
and influence.
In other settings, clinical sociologists may focus on facilitating the communication of
research results or the planning of symposia that promote decision making, without participat-
ing in the research itself. Managers and staff within an organization may take on this role, or
consultants may come in to support decision making.
My professional experience as a clinical sociologist and consultant suggests that work in
support of the policy process is available, challenging, and rewarding. Several examples of
consulting assignments illustrate ways clinical sociologists can support the policy process.
Each case includes discussion of some of the specific skills and techniques that have proved
valuable to me (Morton, 1998).

Research and Communication: Gathering and Sharing Data to Support

the Policy Process

After working to achieve policy reform in the maize-marketing system of Zimbabwe,

the U.S. Agency for International Development (USAID) wanted to explain its achievements
to senior management and share the experience with others who were undertaking similar
efforts. An economist familiar with the reform process wrote a paper presenting the results of
several studies that had been commissioned as reforms were made. The studies documented
changes that were beneficial to large numbers of people, such as the creation of many new jobs
and reductions in the cost of maize, a key staple. The change process was complex and difficult
to understand. My task was to gather qualitative data that put human faces on the statistical
evidence and then write a brief paper (approximately 1200 words) to explain the essence of
this complex development effort.
After reviewing numerous research reports, I traveled to Zimbabwe and visited rural
areas where entrepreneurs had opened small mills. With assistance from USAID staff who
were familiar with the reform effort, I interviewed entrepreneurs, government officials, and
consumers and took photos to help tell the story. My research was qualitative. I looked for
personal stories to illustrate what the quantitative research had already shown.
The existing surveys provided the statistics. They documented that policy reform had
resulted in the abandonment of centralized maize milling and marketing. In rural areas, small
entrepreneurs had established more than 10,000 small mills that provided employment for
more than 20,000 people and enabled rural populations to grind maize locally. As a result, the
price of a staple food had decreased 20%, a significant change for poor people who spent about
75% of their income on food.
This case illustrates how both research and communication supported the policy process.
The interviews I conducted made these statistics come alive. I was able to tell the story of real
people, with quotes and photographs that helped readers understand what was happening to
those who had been affected by the reforms. My paper was published in a USAID publication,
excerpted for a Congressional presentation, shared with staff in other missions, and adopted
SOCIAL POLICY 261

in at least one undergraduate economics course to help students understand how policy reform
works. The paper supported the policy process by helping others understand the essence of a
complex change effort and advocate its continuation and replication.

Communication: Clarifying the Policy Implications of Research

As a pilot program in nutrition education was ending, two nutrition experts conducted an
evaluation of the program. Their report, 147 pages in length, with many complex charts and
detailed footnotes, was excellent, but it was not user friendly to the managers who had to
decide what to do next. My assignment was to write a report entitled Policy Implications ofan
Evaluation.
Over a 2-week period, I studied the research report and communicated frequently with
the authors, asking specific questions to enhance my understanding of their work and its
importance. I struggled to select the information that was crucial for decision making and to
communicate it in language that managers would find easy to understand. I decided to
emphasize the policy recommendations, putting the two major recommendations into the
introductory section of the report. A description of the interventions and a discussion of five
major findings followed. I presented findings as headings so a busy manager could review
them quickly and locate or skip the detail easily. I selected a few charts and graphs to help tell
the story, minimized the use of technical terms, and prepared a glossary to facilitate under-
standing.
I allocated more than 5 of the 15 pages in the report to recommendations emerging from
program experience. To facilitate assessment, I highlighted each recommendation and fol-
lowed with discussion that outlined relevant data or program experience in support of the
recommendation. A brief conclusion summarized the essence of the report. My report was a
key document in a workshop where managers decided how ongoing nutrition education
programs would be structured.
In this case, efforts to communicate research findings to potential users were initiated
only after the research was completed. Communication activities can be strengthened by
informing decision makers about key aspects of the intervention as it proceeds and collecting
qualitative data to supplement survey findings. Quotes, anecdotes, and photos can add consid-
erable interest to a presentation of statistics. (Imagine the power of before and after photo-
graphs to illustrate what change looks like.) Keeping in touch with a few key people can
provide guidance for future communication efforts. By recording their concerns, researchers
can obtain insights on what to communicate, how, when, and where. In other words, dissem-
ination can be better handled as a forethought than as an afterthought.
Writing for those who may use and apply research findings is not a substitute for scientific
reporting. It is a necessary additional form of communication that clinical sociologists can
offer. The integrity of the research report must be maintained; it contains all the detail. The
policy document analyzes the research from a policy perspective and presents specific recom-
mendations, each of which can be evaluated on its merits.
Repackaging research for policymakers is an analytical task. The effort required to
synthesize research and present it concisely and clearly seems enormous, but busy managers
appreciate this effort because it facilitates decision making and encourages action. As an
independent consultant, I have had many assignments that involved translating technical
material into a style, form, and length that someone without advanced training in sociology
could read and understand. In each case, as in the creation of the policy document described
262 MILDRED A. MORTON

above, the researchers' report included lots of detail, complex charts, and technical language. I
struggled daily to decide what to leave out of my synthesis. I had to understand the detail of
the research, assess what was most relevant to policy perspectives, and then communicate the
essence economically and effectively. The translation of research from technical language to
everyday language is often neglected, but it is crucial to ensuring that research findings have a
chance to be understood and applied.

Communication: Explaining the Bows and Whys of Policy Change

Several years ago I was invited to review a policy document that had been prepared by
numerous high-level professionals in the Pan American Health Organization (PAHO), a
regional office of the World Health Organization. The policy responded to a United Nations
resolution and was designed to improve the health of all citizens, especially women. The
document included a detailed program of action for member governments, statistics to support
the rationale for policy change, an agreed-upon timetable, and recommendations for action.
Many recommendations were to be implemented by member governments in Latin America.
Through relevant committees, they had been involved in the development of the policy
document. The problem was that nothing was happening. A year after approval of the policy,
few Ministries of Health had taken any action toward the policy's objectives.
Initially, PAHO staff asked me to synthesize and clarify the 80-page policy document. In
discussing the challenges they faced, we decided that the policy document was too complex to
stir up enthusiasm for the new policy. Instead, we decided to create a brochure in easy-to-
understand language to clearly explain the new policy and the rationale behind it. We wanted
to create something that looked different from the many documents busy staff are asked to
read. And we wanted to provide key information that would facilitate decision making within
Ministries of Health. Using the original policy document and other data, we designed a 16-
page brochure (or booklet) to provide staff with the information and arguments they needed to
promote the new policy within their organizations.
The assignment was challenging. We tried to think about the policy from the point of
view of potential implementers, anticipating their questions or reservations, and providing
answers that would encourage action. We emphasized key points by turning them into
carefully worded headings. We debated the usefulness of various types of supporting data and
provided examples of actions governments could take to promote and implement the policy's
objectives. We labored over both Spanish and English versions to make sure they communi-
cated effectively and we added photos and an attractive design to increase interest in the
brochure. Our goal was to provide government officials with the information they needed to
understand the policy, assess options within their organization, develop programs, and take
action.
The brochure was distributed to Ministries of Health throughout Latin America and the
Caribbean and used in several planning workshops. No systematic evaluation was made of its
impact, but its popularity was encouraging. The initial supply quickly disappeared and a
second printing was soon depleted. Within a few months, the World Health Organization
adapted it for worldwide use. It seems likely the brochure helped at least a few governments
understand the policy and take action in support of it.
As this case illustrates, the adoption of a policy is no assurance that it will be imple-
mented. Implementation requires the cooperation and collaboration of numerous individuals
and often several organizations. Implementation involves long-term planning, staff time,
SOCIAL POLICY 263

actions that make policies operational, and adequate funding. We could not control the out-
come in any particular policy context, but we could contribute clear, concise information in
an attractive format to facilitate understanding of the policy and make it easier for others to act
persuasively in support of action.

Facilitation: Planning for Information Exchange and Action

A client planned a workshop and invited numerous researchers to share their findings and
develop policy recommendations. The goal was to assess achievements and identify new
directions for action. My role as facilitator included work before, during, and after the
workshop.
Before the workshop, I assisted in planning an agenda that provided a framework for
exchanging and assessing information. Planning included attention to content, logistics, and
protocol. We involved participants in the planning, seeking input on themes and key issues to
be addressed by the content of the workshop. We invited them to create sessions on selected
themes and to serve as moderators and reporters, as well as presenters, during workshop
sessions. We made concerted efforts to ensure that all had an opportunity to offer suggestions
and participate actively in workshop planning. We organized the logistics to facilitate partici-
pation and ensure comfortable surroundings. We invited policymakers to participate. Invita-
tions required more than putting the workshop on their schedules. We met with them or mem-
bers of their staff individually to stimulate interest in the topics being discussed. We invited
them to speak and offered to assist in speech preparation.
During the workshop, we implemented the planned agenda, improvising and revising as
needed to address unexpected events such as no-shows, requests for impromptu sessions, and
changes in timetables. The agenda provided a framework for decision making, but a comfort-
able environment was important also. Workshop staff were organized to assist participants in
many ways and to receive complaints and take action quickly to remedy difficulties. As lead
facilitator, I worked with organizers to establish norms of punctuality, speaker time limits,
opportunities for discussion and debate, and regular breaks for informal discussion and having
fun. We were able to create an environment that was conducive to learning, assessing, and
making decisions.
My main role was to facilitate the process of developing a synthesis of the proceedings.
The agenda for the 4-day workshop included numerous plenaries where research findings were
presented. After each plenary, participants adjourned to small-group discussions. The small
groups were given specific assignments, worked out in advance, to encourage them to clarify
major findings and identify recommendations for action. Reporters in each group synthesized
the discussion and forwarded it to me. I managed the synthesis process, reviewing materials
received from all reporters and creating a draft that a committee of experts reviewed at regular
intervals.
The result of this effort was a IO-page synthesis of substance and recommendations that
was presented in plenary at the closing session of the workshop and distributed to participants,
politicians, and press. The synthesis reinforced the participants' experience, contributed to
high-quality press reports, and provided politicians and everyone else with clear guidance on
the next steps recommended. When workshop participants returned to their organizations, they
had a copy of the synthesis and the support of collective decision making to enable them to
share information with colleagues and promote relevant follow-up action within their organi-
zations.
264 MILDRED A. MORTON

Mter the workshop, our involvement with participants continued. We analyzed their
responses to an evaluation distributed on the final day of the workshop and shared the results
with them. We supported participants in following up on actions requested and made sure
policymakers had copies of the synthesis and personal briefings. We sent thank-you notes to
key participants.
We conducted an internal review of our own efforts to identify what worked and what
could have been done better. This process review, along with process reviews from previous
workshops, proved to be valuable in subsequent workshop planning, helping us avoid the
mistakes of the past and providing timesaving suggestions. In fact, the decision to do a
synthesis during the workshop arose from process reviews of previous workshops. The client
decided that a synthesis available at the end of the workshop was more valuable than a lengthy
report of proceedings produced weeks or months after the workshop. Thus, the emphasis was
on synthesizing during the workshop and moving forward with recommendations while the
momentum was strong.
This case illustrates the substantial effort required to facilitate and manage a participatory
workshop where decisions are made. The workshop itself was viewed as part of an ongoing
process. The decision making that took place at the workshop pushed the policymaking
process forward. Networks expanded, policymakers argued forcefully for certain policies, and
participants supported and argued various points of view. Activities before, during, and after
the workshop enabled participants to make informed decisions and recommendations and
helped ensure that policymakers would hear and understand those views.

STRENGTHS AND WEAKNESSES

Social policy evolves over time with many influences from many sources. In the long run,
nobody controls the process, but many individuals and groups participate in policy develop-
ment and implementation. Clinical sociologists have (or can cultivate) relevant skills in
research, communication, and facilitation. Participation is possible for those who are patient,
persistent, and willing to learn. Sound technical knowledge may be an asset. For example,
knowledge of infectious diseases may help those who are developing relevant health policies,
especially when they are facilitating communication among team members with diverse
specialties. Flexibility, creativity, and sensitivity to political nuances are valuable strengths.
Outputs cannot be controlled and successes are difficult to measure, but inputs can include
sociological perspectives if clinical sociologists enter the fray. The text box offers some
guidance for students and others who wish to get involved in social policy.
Participating in policy requires networking with people and institutions in all three of the
policy streams (problem, proposal, and politics). It requires an ability to articulate what
clinical sociologists do to many others whose expertise is in other disciplines. It opens research
findings to possibilities of misrepresentation or criticism. Sometimes it means being the only
sociologist on a multidisciplinary team. Often, it means moving from research into research
brokering or advocacy.
Working on social policy can be exciting, with unexpected political events or new
personalities changing the opportunities for action overnight. For reasons beyond anyone's
control, research findings may come under attack or communication strategies may backfire.
An ability to keep cool under stress is an asset.
Gaining and keeping the trust of clients is critical. Knowing the organization and its
culture is a strength that makes teamwork and communication easier (especially when clients
SOCIAL POLICY 265

Getting Involved in Social Policy

Social policy work is available in many organizations, including government agen-
cies, nongovernmental organizations, and private companies. Although job descriptions
may omit the word policy, opportunities are available for those who are energetic, knowl-
edgeable, and willing to make connections. The guidance offered by Bolles (2000) in
What Color is Your Parachute? is a place to start. He recommends that job seekers and
job changers begin by deciding what they want to do and where they want to do it.
Social policies cover a broad range of topics, including welfare, education, health-
care, and environmental issues. After deciding which topics are of interest, you can create
opportunities by doing the following:
Learn. Read, take courses, conduct or follow research, keep track of relevant legislation,
and find out about organizations that work in the area.
Network. Conduct exploratory interviews with staff in relevant organizations, participate
in conferences, volunteer in nongovernmental or community organizations, and
exchange ideas to connect with others whose interests are similar to your own.
Join a Team. Get involved through internships, volunteer activities, or paid employment.
Work with others to create conditions for change and keep learning.
Stay Committed. Over time, involvement in a social policy area provides many oppor-
tunities to learn and become an expert in both the subject matter and the history of
action (or inaction). The knowledge and skills acquired are what make a valuable
adviser, planner, or advocate in the social policy process.

use numerous acronyms or insiders' jargon). Broad training that incorporates other disciplines
may be important to facilitate working cooperatively with others on policy issues-and even
to get a foot in the door. Often, the roles for clinical sociologists are support roles or team roles.
Advice is welcome; power plays are not. Ultimately, policymakers may take credit for ideas or
achievements even when many others participated, but, hopefully, they remember who
contributed and ask them to continue contributing to policy development and implementation.
Further documentation of policy change and implementation efforts would provide
valuable insights into the roles clinical sociologists play.

CONCLUSION

Contributing to social policy processes involves much more than excellence in research.
Communication and facilitation skills have a legitimate place, along with research, in the
package of skills sociologists offer decision makers. Presenting sociological information
clearly, concisely, and without jargon is a difficult task, but too important to be left to others.
Clinical sociologists can cultivate these skills, build their use into the applied research process,
and apply them in a wide range of work settings to promote policy formation and implemen-
tation.
The ability to do solid, quantitative research is a core skill in sociology. Research can seek
answers to a multitude of questions, but resources are always finite and policymakers may be
unwilling to wait for extensive data gathering and analyses. Clinical sociologists can find
insights in existing literature and do ministudies rapidly through key informants or focus
groups to incorporate sociological perspectives into the policy process. Effective communica-
266 MILDRED A. MORTON

tion links among researchers, decision makers, and those affected by the policy issues can
increase the relevance of research to potential users and enhance the opportunities for action.
Since policy processes are dynamic and ongoing, many opportunities exist for sociolo-
gists to apply a range of skills as employees within organizations or as independent consultants
working with a number of organizations. Sociologists can market their skills as researchers,
communicators, and facilitators-gathering relevant data, making research findings user-
friendly, and creating an environment for learning and decision making. Articulating and
demonstrating these skills will help employers understand how sociologists can add value to
research and contribute to social policy processes.

REFERENCES
Auger, A. (1998). Teaching world of work skills within a degree program. In F. T. Evers, J. C. Rush, & I. Berdrow
(Eds.), The bases of competence (pp. 179-206). San Francisco: Jossey-Bass.
Bolles, R. N. (2000). What color is your parachute? Berkeley, CA: Ten Speed Press.
Etzioni, A. (1969). Toward a theory of guided societal change. Social Science Quarterly, 50(3), 749-754.
Evers, F. T., Rush, J. C., & Berdrow, I. (Eds.). (1998). The bases of competence. San Francisco: Jossey-Bass.
Flora, B., Flora, 1. L., Spears, J. D., & Swanson, L. E. (1992). Rural communities. Boulder, CO: Westview Press.
Fortmann, L. (1984). Turning field research into government policy. The Rural Sociologist, 4(4),287-290.
Hassanein, N. (1998). Beyond armchair activism in rural sociology. The Rural Sociologist, 18(4), 28-29.
Kingdon, J. W. (1984). Agendas. alternatives and public policies. Boston: Little, Brown.
Konan, M. A. (1981). Translation: A neglected stage in the research process. The Rural Sociologist, 1(1), 11-18.
Levine, F. J. (1995, September/October). Connecting sociology to public policy. Footnotes. Washington, DC:
American Sociological Association.
Lindblom, C. E. (1990). Inquiry and change. New Haven: Yale University Press.
Lindblom, C. E., & Cohen, D. K. (1979). Usable knowledge. New Haven: Yale University Press.
McCaffrey, J. A. (1988). Facilitation skills for trainers and group facilitation. Alexandria, VA: Training Resources
Group.
Mintzberg, H. (1998), March-April). The manager's job: Folklore and fact. Harvard Business Review.
Morton, M. A. (1998). From research to policy: Roles for sociologists. Clinical Sociology Review, 16, 93-96.
National Academy of Sciences. (1978). The federal investment in knowledge of social problems. Washington, DC.
Porter, R. W. (1995). Knowledge utilization and the process of policy formation. Washington, DC: Academy for
Educational Development.
Stone, D. (1988). Policy paradox and political reason. Glenview, IL: Scott Foresman.
Sundquist, J. A. (1978). Research brokerage: The weak link. In Knowledge and policy: The uncertain connection.
Washington, DC: National Academy of Sciences.
Witt, J. L. (1999, April 19). Director's speech to National Association of Development Organizations. Washington,
DC: Federal Emergency Management Agency. http://www.fema.govnibrary/wittspch18.htm.
 CHAPTER 14

Preventive Programming
JOHN G. BRUHN

INTRODUCTION

The superiority of prevention as an alternative strategy in maintaining life and health is a

widely held belief-an ounce of prevention is a pound of cure (Blaney, 1987). It is believed
that prevention is humane because it averts pain, suffering, and disability. However, most
preventive measures involve some risk. Eliminating or reducing a behavior or practice may
create new problems. Often the risk cannot be understood until an intervention has been
applied to a large population for a considerable time. While prevention has great potential it
is not riskless.
Prevention is also not without economic cost. Most preventive programs do not save
money; consider intensive care units for newborns, high blood pressure screening, mandatory
air bags in cars, and vaccinating the elderly against pneumococcal pneumonia. Yet, as a
society, we spend only about 5% of our healthcare budget for disease prevention and health
promotion (Hiatt, 1987).
Prevention cannot be assumed to be a better choice than cure or dealing with the effects of
a chronic problem in every case (Russell, 1986). But, of the ten leading causes of death in the
United States today, seven could be substantially reduced if people were willing to change
aspects of their lifestyle (Imperato & Mitchell, 1985). Most risks are chosen rather than im-
posed (Bruhn, 1988). People do have the moral right to take personal risks, but what is of
concern here is the effects of risk behavior on others (Amartya, 1986). Such an example is
violence and abuse.
Violence is pervasive in the world, but particularly in the United States. Homicide in
schools, gang violence, intimate partner violence, sexual assaults toward women, and an in-
crease in suicide among young people and the elderly, are rapidly changing the quality of life
for all Americans. On an average day in the United States, 70 people die from homicide, 87
commit suicide, as many as 3000 people attempt suicide, and a minimum of 18,000 people
survive interpersonal assaults (U.S. Department of Health and Human Services, 1998). A drive
to reduce suicides, the eighth leading cause of death in the United States, was launched in 1999

JOHN G. BRUHN· College of Health and Social Services, New Mexico State University, Las Cruces, New Mexico
88003.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

267
268 JOHN G. BRUHN

by the U.S. Surgeon General who declared it a serious public health threat. About 30,000
people took their lives in 1997, a year that saw 19,000 homicides (Wall Street Journal, 1999).
There is a strong conviction that most violence can be prevented. Strategies for reduc-
ing violence should begin early in life, before violent beliefs and behavioral patterns can be
adopted. Poverty, discrimination, and lack of education and employment opportunities are
risk factors for violence which must be addressed on a societal level. There are thought to be
many potentially effective intervention strategies such as parent training, mentoring, home
visitation, and social-cognitive curricula for violence prevention that need ongoing evaluation
(U.S. Department of Health and Human Services, 1998). Violence and abuse are not only
sociological problems, they are problems of public health and societal well-being. As such
they require multifaceted strategies, and strong collaboration across disciplines and levels of
intervention. We should not be misled to believe that the scope of violence and abuse we are
seeing is a phase or somehow driven by transient aberrant factors in our society. Violence and
abuse are not new problems in the world or in the United States, but they have become
endemic and threaten our values.
As Miller (1995) has suggested, sociologists need to think strategically about society and
health. Clinical sociologists and sociological practitioners are essential in providing leadership
in such efforts at all levels of intervention: individual, group, organizational, community, and
societal.
The purposes of the present chapter are to (I) better understand prevention as a concept
and intervention strategy in clinical sociology, (2) examine how preventive interventions have
been used at different levels of human complexity and analyze what works and what does not,
and (3) outline and discuss how to do prevention programming.

HEALTH AS A SOCIAL SCIENCE: THE CONCEPT OF PREVENTION

Prevention is based on a broad understanding of health that goes beyond the absence of
disease or illness; it encompasses the notion of social responsibility of health. Anderson et al.
(1988) list several components of a broad model of prevention that include:
• Concern for the whole person, and her interaction as an individual, a member of a
group, community, and member of society; the individual's ability to experience
independence, fulfillment, and to function in social roles.
• Concern for the social distribution of health, that is, cumulative individual lifestyles
which help to create a healthy society.
• Concern for the cultural and personal meaning of health. For some people health is not
the highest value; people choose and embrace risks differently.
• Concern with how perceptions and emotions are related to health; people will act on
their perceptions, real or unreal; people will have strong feelings about things and
behaviors they feel that they need and value.
• Concern about health actions in the context of everyday life; demands of living may
structure and thus inhibit or facilitate the practice of certain behaviors.
• ,-oncern that health is a total resource, as Wilkinson (1996) points out; health is a social
product and some forms of social organization are healthier than others; prevention is
finding ways of strengthening the healthy aspects of society.
• Concern that self-reliance is an expression of human dignity; prevention emphasizes
self-care.
PREVENTIVE PROGRAMMING 269

• Concern that there is more than one form of caring, curing, healing, and preventing;
prevention intervention needs to be culturally sensitive; it can be modified to what
works in a particular setting or for a specific group.
In medicine, prevention is thought of at three levels, each of which has distinct interven-
tion strategies. Primary prevention aims to prevent disease or illness before its occurrence.
Secondary prevention is concerned with the detection of signs of disease or illness prior to its
manifestation. Tertiary prevention focuses on limiting the damage and restoring normal
functioning once disease or illness has occurred (Hirschman, 1982). A clinical sociologist
might conceptualize these three levels differently than medical professionals. Prevention
might be seen as intervening into known or suspected social pathways or processes to change
unhealthy or undesirable conditions and/or behavior. Prevention involves intervention with
healthy people as well as those who are acutely or chronically sick or disabled.
For example, health education programs might be instituted to get individuals to modify
their lifestyles and thus reduce their risk for coronary heart disease. This would be an effort in
primary prevention. Encouraging individuals who were experiencing chest pain and shortness
of breath to change certain behaviors would be an example of secondary prevention. Recruit-
ing individuals who had suffered a heart attack into a supervised exercise program would be an
example of tertiary prevention. The aims or purposes of preventive interventions are different
at each progressive level of disease. But, as Renaud (1994) points out, the ability to modify
potentially pathogenic behaviors and to stick with the necessary regimen is directly related to
one's wealth, power, and education-the degree of control one has over one's future. The
higher up the socioeconomic ladder, the more control one feels capable of exerting over life,
the easier it is to change unhealthy habits. The will to change is largely predetermined by one's
social environment.
Furthermore, as Renaud continues, it has been well documented that a simple educational
program will not change behavior significantly, as concluded by one of the most important
randomized control trials of health education (MR FIT) in history (Syme, 1990). The moti-
vated and well-supervised members of the experimental group did modify their lifestyles, but
so did members of the control group, and the two groups did not statistically differ from each
other. The "social environment" effect of being involved in the experiment may have
produced the behavior change of both groups, but there was no evidence for an independent
influence from the educational program. Renaud stresses that evidence would show that if
the whole population were to begin to lead a healthier lifestyle (e.g., reduced use of tobacco,
alcohol, low-fat diet, regular exercise, stress management) life expectancy would increase, but
the health gradient between the socioeconomic classes would remain; the resources of all
kinds at one's disposal enhance the individual's health and longevity, indeed, the quality
of life.
Prevention should not merely be selecting and implementing a strategy to reduce a
specific disease or illness. Certain types of heart disease, for example, may be clinically
homogeneous, but the behavior and lifestyles of those with the disease may differ greatly
according to their social environments. Hence, a single preventive strategy used to intervene to
change an outcome may not be effective even though all of the people participating in the
prevention have the same disease.
It is not yet possible in sociology to identify with precision the main social pathways or
processes for the current social problems of our society. There are research results, observa-
tional data, statistical and demographic data, and "hunches," to support rather powerful social
factors that have been shown to influence physical health, specifically, morbidity and mortal-
270 JOHN G. BRUHN

ity. Wilkinson (1996) notes that there is an enormous range of pathways or links yet to be
identified, several of which are already known to be potent connectors between disease and
illness and the social environment, such as income, social cohesion, unemployment, autonomy
(perceived and real), and work environment. Efforts such as the United Nation's Human
Development Index (of national social deficits) can help identify links, pathways, and pro-
cesses to help set priorities and identify emerging social and health problems (Osberg, 1990).
The concept of prevention is most useful to the clinical sociologist after there is some
evidence of distress or unhealthiness (secondary prevention). This is because the techniques
and knowledge of sociology and other social and behavioral sciences are not yet refined
enough to be predictive of the majority of human behavior (primary prevention). Clinical
sociologists and their colleagues are able to contribute substantially at the tertiary level of
prevention in order to refine interventions to assist people to return to normality. This is less
pressing than work at the secondary level.

PREVENTIVE PROGRAMMING

Failed Self-Regulation

Many of the problems that the clinical sociologist will be approached with by clients deal
with failures in self-regulation. Self-regulation failure is a major pathology in our society at the
present time. Some of these problems reflect difficulties in social structures while others rest
with individuals who are unable to control themselves (Baumeister et aI., 1994). People have
difficulties controlling their money, their weight, their emotions, their drinking, their craving
for drugs, their smoking, their sexual impulses, their gambling, and especially their aggres-
sion, anger, and hostility. Impulsive crimes have risen steadily. Statistics on rape, muggings,
murder, robbery, assault, and human abuse show alarming increases. Our prisons are over-
flowing and early signs of problems with self-control are evident in our schools at all levels. A
recent report, however, indicates that between 1991 and 1997 fighting and weapon carrying
among U.S. adolescents were on the decline (Brener et al., 1999).
Many of the excesses in self-control are preventable, but to make significant inroads in
prevention will take coordinated and sustained efforts on the part of all of the helping profes-
sions, all levels of government, and the will to do so by society. The sociological practitioner
is an important link in treatment and prevention at all levels of complexity ranging from the
individual level to the societal level in helping to plan and implement interventions.
As Baumeister et aI. (1994) point out, there are many theories and speculations as to
the causes of the failure of self-regulation ranging from low self-esteem, to poor parenting, to
rapid changes in values and culture. Our purpose here is not to explore the etiologies of self-
regulation failure, but to examine how clinical sociologists and others can intervene to prevent
self-regulation failure, in particular to analyze what prevention approaches and strategies work
and do not work and, if known, why they work or do not work.
The author has chosen to focus on violence and human abuse as a category of failed self-
regulation for the discussion of successful and unsuccessful interventions.

Youth Violence

Violence has enormous individual and public health consequences. The most serious
manifestations of violent behavior are homicide and suicide. Persons at greatest risk of vio-
PREVENTIVE PROGRAMMING 271

lence victimization include young males, ethnic minorities (including non-Hispanic black,
Hispanic, and native American), persons with a history of delinquent or criminal behavior or
of violence victimization, and persons living in poor urban communities (U.S. Department of
Health and Human Services, 1998). nearly half of all homicide victims in 1991 were males
aged 15-34. Young blacks are at especially high risk for violent injury. Homicide is the leading
cause of death of black men and women aged 15-24. Risk factors for violence perpetration are
similar to those for victimization, including youth, male sex, minority race, poverty and
urbanization, and exposure to and victimization by violence (U.S. Department of Health and
Human Services, 1998). Fishbein (1992) points out that there are few studies of female
aggression; they typically extrapolate from studies of male aggression and neglect the dy-
namic intersection between biology and environment. She notes that pre- or postnatal biolog-
ical experiences, combined with a disadvantaged environment, predispose certain women to
antisocial behavior. Once these conditions are confirmed, strategies for prevention and treat-
ment can be more appropriately targeted to females.
There are many causes of youth violence. These causes involve interactions between the
individual, family, community, and society. While community programs aimed at poverty,
unemployment, and poor schools appear to be among the most effective in combating youth
violence, several risk factors may be amenable to interventions by individual practitioners
such as eliminating the availability of weapons and drug use in school and other such settings,
and requiring attendance in problem-solving skills classes. Certainly these efforts control the
environments in which abuses are permitted, but they cannot by themselves eliminate negative
behaviors. Problem-solving skills classes cannot change the attitudes of everyone; they do
offer an alternative and a resource for youth.
There are no published studies regarding whether there is a reduced risk of assault or
homicide when people voluntarily relinquish the firearms they own or carry (U.S. Department
of Health and Human Services, 1998). While guns may predispose to violence, it may be that
those predisposed to violence are more likely to obtain a gun. A study of inner-city junior high
school students reported significant associations between gun carrying and having been
arrested, knowing more victims of violence, starting fights, and being willing to justify
shooting someone, suggesting that gun carrying may be a component of aggressive delin-
quency, rather than purely defensive behavior (Webster et at., 1993).
Legislative approaches to reducing gun availability and use have yielded mixed effects
on violent injury. Increasing the punishment for crimes committed with firearms is another
legislative prevention strategy. Studies of mandatory sentencing for illegally carrying, con-
cealing, or using a firearm have reported small, but not statistically significant, decreases in
firearm violence (Fife & Abrams, 1989; Loftin et aI., 1993; O'Carroll et aI., 1991).
In 1992, almost half of all murder victims were related to or acquainted with their
assailants, and at least one-third of all murders resulted from arguments, brawls, or other
interpersonal conflict (Federal Bureau of Investigation, 1993). In large cross-sectional surveys
of middle and high school students, violent or aggressive attitudes and behaviors have been
associated with an increased risk of being involved in physical fights (Centers for Disease
Control and Prevention, 1993; Cotten et aI., 1994). Violent juvenile offenders have been
reported to be more inclined to hold beliefs supporting aggression and to have less extensive
skills in social problem-solving compared with control adolescents (Slaby & Guerra, 1983).
These data have led some experts to suggest that changing violent or aggressive attitudes and
improving conflict resolution skills might reduce the risk of violent injuries (Forum on Youth
Violence, 1991). There have been no evaluations of conflict resolution skills training in the
clinical setting, so the effectiveness of such interventions for reducing violent injuries remains
unproven.
272 JOHN G. BRUHN

Studies in the United States and elsewhere show that about half (22-60% range) of
homicide victims have positive blood alcohol levels at the time of death, and that there is also
substantial alcohol involvement among perpetrators (Abel & Zeidenberg, 1985; Batten et aI.,
1991). Similar to gun owners versus nonowners, alcohol drinkers are less likely to differ from
nondrinkers and a causal relationship between alcohol and violence is not established. Never-
theless, these data suggest that there may be a benefit of reducing alcohol intake in preventing
violence injury.
Legislative interventions aimed at reducing alcohol intake in young persons by raising
the legal drinking age have not reduced homicide rates (Hingson et aI., 1985; Jones et aI., 1992)
and appear to have had little effect on alcohol consumption in the targeted population.
Many victims of violence have evidence of other drugs besides alcohol on toxicologic
testing including cocaine, barbiturates, and heroin. Adolescent, young adult, and ethnic minor-
ity homicide victims are more likely to have positive drug screens at autopsy. Several large
surveys of high school students have reported associations between illicit drug use and
involvement in violence (U.S. Department of Health and Human Services, 1998).
Potential victims or perpetrators of violence can be counseled to prevent future injuries or
deaths. Clients can be advised about risk factors, and persons identified as at risk might be
counseled to learn nonviolent approaches to conflict resolution. The efficacy of these interven-
tions is largely unstudied. There is limited evidence regarding the effectiveness of community
and school-based interventions for preventing violence (National Center for Injury Prevention
and Control, 1993). There is some evidence that school-based programs in inner-city schools
have produced enhanced knowledge and improved attitudes related to aggressive behavior, but
injury outcomes were not evaluated. A school-based program in Central Harlem was associ-
ated with a significant decline in assaults in the targeted community without a corresponding
decrease in the control community (Davidson et aI., 1994).
Violent injuries and death exact a high toll on youth, yet there is little evidence of
effective interventions to prevent violent acts. On the other hand, Renfrew (1997) describes a
promising behavioral approach for the preventive intervention of predelinquent youth, known
as the Achievement Place and/or Teaching-Family Program at the University of Kansas. The
original Achievement Place was a community-based home in Lawrence, Kansas, and the
Teaching-Family program was developed from experiences at Boys Town in Omaha, Ne-
braska (Phillips, 1968; Phillips et ai., 1974).
The basic clientele of the Teaching-Family homes are adolescent boys or girls whom the
courts have considered delinquent, predelinquent, or neglected. "Parents" are extensively
trained in the application of behavioral techniques to help control inappropriate behaviors,
such as aggression, and how to teach appropriate social interaction skills. Residency in a home
is voluntary when appropriate behavior allows for such. Clients are able to learn new behavior
patterns in a natural environment. They attend schools, live in their old neighborhoods, and
continue to interact with their "parents" and friends. The number of criminal offenses
committed by residents of the Teaching-Family program have been shown to be less than those
of residents in traditional youth homes, but a follow-up 1 year after treatment did not differ
from traditional homes. This model appears to be a good one, but it, along with others, are not
the "answers" we continually strive to discover.
Kazdin (1985) suggests family therapy and parental management training as two other
approaches where parents and other family members are involved in efforts to improve
communication and increase positive interaction, and the children are taught more appropriate
behaviors. Feindler and Ecton (1986) have developed a more cognitive behavioral approach in
which adolescents are taught to recognize situations and thoughts that lead to aggression. They
PREVENTIVE PROGRAMMING 273

are taught social skills for facilitating nonaggressive interactions as well. Like the Teaching-
Family program, these techniques produce good results while being applied. Long-term
effectiveness has yet to be demonstrated. Renfrew (1997) points out that there needs to be an
integrated, multifaceted approach to preventing youth violence. Renfrew (1997) and Lewis
(1981) encourage a biopsychosocial approach. Single-faceted approaches, no matter the disci-
pline, are doomed to fail. Goldstein (1991) states that an approach that integrates work with
individuals, gangs, and the community has the best chance of success. Sanders (1994) took a
situational approach to learning what makes juvenile gang violence occur the way it does. He
feels that by examining the violent situation and expanding outward to the gang, we can learn
about gang violence and the phenomenon of gangs. Sanders states that by examining social
situations of violence we not only can see the patterns of violence, but also examine the
meaning of the actions in situations of violence. This is a meaningful way to gain insights into
prevention interventions for the clinical sociologist.

Family Violence

The repetitive nature of family violence suggests that early detection may be important in
preventing future abuse-related problems. Counseling may help the victim terminate personal
relationships with violent individuals. The practitioner may help identify individuals who are
at increased risk of committing abuse in the future. Such persons can be referred for counsel-
ing, family therapy, or to learn stress management and nonviolent alternatives for conflict
resolution. The practitioner should report suspected causes of abuse and neglect to appropriate
protective service agencies.
Intervention studies in child abuse have concentrated on primary prevention (Canadian
Task Force on the Periodic Health Examination, 1994). Two clinical trials have shown that
home visits to high-risk families decrease the rate of child abuse and the need for medical visits
early in life (Hardy & Streett, 1989; Olds et aI., 1986). Interventions may need to be ongoing as
one of these trials found no effect on the rate of abuse later in life (Olds et aI., 1986). Studies
evaluating the effectiveness of treatments for abused children are limited, and their results
have been mixed (Dubowitz, 1990). Recurrent abuse despite interventions may occur in up to
60% of cases (Jones, 1987). The effectiveness of treating sexual abusers of children remains
controversial, although one outpatient program reduced recidivism by one-half (Marshall &
Barbaree, 1988). The effectiveness of early intervention for domestic violence is also mixed.
The options available to women are often limited because of financial dependence on an
abusive partner, fear of retribution, alcohol or drug problems and the like. As a result, many
abused women decline offers of help. In cases of severe abuse the woman may suffer from
"learned helplessness" (Walker, 1981).
Sengstock (1987) reports on the work of a committee that used social research and
knowledge of sociological principles in the development of services for battered wives in a
major metropolitan area. Three major intervention strategies were explored in the committee
setting: provision of information about social structure and its consequences to enable mem-
bers to develop more effective plans; use of sociological principles and data to make people
aware of aspects of the situation of which they had not been aware; and involvement of group
members and others in the planning process to maximize the likelihood of an investment in the
outcome. Sengstock points out that a major drawback of the committee approach is the
possibility that some members may subvert the group's activities for their own ends. In a
controlled study of battered women leaving a shelter, those who received services of an
274 JOHN G. BRUHN

advocate for 4 to 6 hours per week reported better overall quality of life, but no significant
difference in levels of physical abuse, compared with controls (Sullivan et ai., 1994). Whether
the treatment of abusive men is effective in reducing domestic violence remains undetermined.
Effective approaches to couples who engage in mutual, less severe violence, such as pushing
and slapping, have not been developed.
Effective interventions for elder abuse may also be limited because the abuser is often the
primary caregiver to the victim (Lachs & Pillemer, 1995). If the only alternative is nursing
home placement, the victim may be reluctant to give up her independence in order to escape
abuse. Among abused elders an advocate program decreased social isolation and improved
services, but a reduction in subsequent abuse was not shown (Filinson, 1993).
Interventions for physical and sexual abuse vary greatly in effectiveness. Although crisis
interventions such as shelters and arrests help to protect victims, there are few adequately
controlled studies to determine the effect of counseling or referral on the long-term outcome of
family violence. Screening for abuse is problematic with young children, may be unreliable if
the abuser is present, and can be complicated by denial in all age groups. Despite these
limitations, benefits can be substantial when the cycle of abuse is broken. Hogue and Liddle
(1999) stress the need to develop interventions that cross multiple systems rather than become
focused on intrafamilial interventions. Preventive interventions with youth, for example,
should involve peer groups, a variety of adults who can act as sources of guidance and advo-
cacy for youth, and parental and family friends. Building strong, positive social networks for
high-risk and adolescent populations in addition to the immediate family, and incorporating
treatment-like skills and strategies into prevention, offer promising alternatives.

LEVELS OF PREVENTIVE PROGRAMMING

Preventive Interventions in Communities

Patrick and Wickizer (1995) discuss community efforts to modify the social and physical
environment such as prevention programs that activate communities or change community
power structures. Some prevention programs seek to change community-level characteristics
such as social cohesion or sense of community. Others aim to change individuals' behaviors
and attitudes through dissemination of information without modifying community structures
or processes.
The Healthy Cities Project is a series of global and national networks initially developed
by the World Health Organization in response to Global Strategy for Health for All by the
Year 2000 (Ashton & Seymour, 1988; Ashton et ai., 1986; U.S. Department of Health and
Human Services, 1990). The movement spread in North America leading to the Healthy
Communities Project in several cities in the United States and Canada. The Healthy Cities
movement is based on the premise that a city is a place where people can be empowered to
formulate a definition of health for themselves and decide how best to achieve it. Hancock and
Duh! (1986) describe this project as family therapy for cities. The project encourages participa-
tion, the building of social networks, decentralizing decision-making, and building coping
skills and self-esteem among the population. Through empowerment the challenges of reduc-
ing inequalities, promoting prevention, and enhancing ability are achieved in healthy environ-
ments that promote self-care and mutual aid. The extent of empowerment determines the
degree of healthiness of the community. While no evidence has been published on the effects
of this prevention effort on health outcomes, the movement has inspired enthusiasm and
mobilized energy (Patrick & Wickizer, 1995).
PREVENTIVE PROGRAMMING 275

Community-level prevention programs are based on the assumption that it is more

effective to build on, and modify where appropriate, existing community norms about what is
healthy behavior and develop positive role models to support these norms. The community
approach targets whole communities or parts thereof for intervention. It gives emphasis to the
role of social and environmental factors as key determinants of health as opposed to identify-
ing people at risk. A commonly used implementation strategy in interventions at the commu-
nity level is to mobilize community leaders and obtain their buy-in and, in tum, help to gather
other respected leaders who can build citizen support for the proposed interventions.
Several large community prevention efforts have used community organization strategies
to design and implement interventions. The Minnesota Heart Health Program (Mittelmark et
aI., 1986) used community analysis in communities participating in cardiovascular risk-
reduction interventions to identify organizations and citizen groups that could help plan and
support interventions. The A Su Salud prevention program in Texas (Amezcua et aI., 1990)
relied on grass-roots community organization methods to stimulate citizen participation.
Numerous programs related to smoking cessation, cancer, and heart disease have used com-
munity organization principles and techniques (Patrick & Wickizer, 1995).
The effectiveness of these interventions is unclear because evaluation focuses on pro-
gram impact, and often behavior change, rather than the implementation process (Pechacek
et ai., 1994). Therefore, some time needs to elapse before follow-up efforts are initiated. Often
the cost of follow-up and the transiency of people make long-term evaluation efforts impos-
sible. Mobilizing community leaders to allocate community resources to prevention and to
enhance public awareness of health issues are major benefits to community interventions
(Wickizer et aI., 1993).
Figure 14.1 shows a decision tree to assist in organizing a framework for community-
based interventions. Well-conceptualized and implemented intervention studies are needed at
the community level. It is essential that community buy-in and participation be obtained if an
intervention is to have a chance of succeeding. Often we have an "all or none" expectation of
an intervention. Every intervention has some direct and indirect "good" and "bad" effects.
Each community is unique so we learn by doing, but having the community and its leaders
beside the change agent gives the intervention an even chance of succeeding. There are no
universal blueprints to ensure success. Clinical sociologists need to be innovative in planning
and executing interventions. Careful observation, field notes, and invitations for input from
others are all ways to keep on top of what seems to be working well and what needs fine tuning.
The Task Force on Community Preventive Services is developing a Guide to Community
Preventive Services. Based on available evidence the Guide will summarize the effectiveness
and cost-effectiveness of population-based interventions for prevention and control, and
provide recommendations for people who plan, fund, and implement population-based ser-
vices and policies (Pappaioanou & Evans, 1998). The primary target audience and purpose of
the Guide is to facilitate preventive interventions at the community level. This will be a help-
ful resource to clinical sociologists.

Preventive Interventions in Organizations

It has been noted that the organizational change literature is devoid of an all-embracing,
widely accepted theory of organizational change and there are no agreed-on guidelines for
action by change agents (Dunphy, 1996). Kets de Vries and Balazs (1999) claim there are
resemblances between personal and organizational change that can be learned by listening
with a third ear. Being aware of the prerequisites of change at both personal and organizational
276 JOHN G. BRUHN

Intervenor's
1. Expertise 2. 3.
~

~
Prevention Community
Intervention
Problem
or Issue Plan ~ Participation
in Plan
f---+ Commmunity
and
Citizens Values, 4.... 5....
Expectations
No
Buy-in Buy-in r-

...
6. Y ----- 7. 8.
I Possible I Evaluate Intervention
Intervention
Initiated
~ +I Modifications 1---+ Process
and Outcome ~ Goals
I in Intervention I of Intervention
Achieved
-----
9. +
Follow-up
Plan

+
~
H I
10. Addition of
Yes Other
Should Interventions
Intervention

H
be. Continued? ~I
No
Termination of I
Intervention
I
FIGURE 14.1. A decision tree for community-based interventions.

levels can provide insight into how interventions can succeed or fail as well as understanding
resistance to general change and to specific planned interventions.
Kets de Vries and Balazs (1999) discuss parallels from what is known about the way
individuals change and how organizations change. The first parallel is, as with individuals, that
organizations change sequentially, and that process requires the impetus of stress. In other
words, people in the organization have to become prepared for change, planned or unplanned.
Stress helps get change started. Usually there is resistance to change, especially if it is seen as
not in one's self-interest. A second parallel between individual and organization change is that
resistances have to be confronted and overcome. Involving the participants in the change
process to alleviate the feeling of victimization is essential. Not everyone may choose to be
involved and may become a silent, nonparticipative resistor, but the invitation should be made
to all members of the organization to be players. A third parallel is that there must be some
hope that things will improve. If people in the organization are participants, they can help
ensure that changes are doable and beneficial. If people see that organizational members can
be active in implementing changes, they will usually join in. A fourth parallel is that there
needs to be continuous opportunities for input and feedback as change proceeds. Periodic
small and large group meetings can provide forums for the interchange of facts and ideas. A
PREVENTIVE PROGRAMMING 277

fifth parallel is that individuals in the organization will not all react to organizational change in
the same way. There must be options for individuals to deal with their feelings and emotions-
indeed to grieve for what was. As members are helped to redefine themselves and their role in
the transformed organization, they will begin to evaluate the trade-offs of change more
objectively (Kets de Vries & Balazs, 1999). No organizational transformation is pain free, but
too often there are more victims of change than there need to be. Clinical sociologists can play
a key role, especially as consultants planning mergers and other organizational refrarning and
restructuring, e.g., downsizing.
An organization's history in coping with change can give the practitioner-consultant
insights into how the organization might respond to preventive interventions. Like individuals,
organizations are not planners; most are reactive and deal with issues on a "present need"
basis. Nonetheless, organizations have optimal opportunities for intervention (Bruhn, 1997a).
There is a cyclical relationship between the forces of resistance and acceptance in organiza-
tions. The organization is a dynamic organism, like the people who work there. There are times
of readiness to accept change that can be referred to as "windows of optimal intervention."
These time periods are similar to what Lewin (1958) refers to as "unfreezing" in attempting
change at the individual level. It is natural for organizations to resist change and to oscillate
between resistance and cooperation while members are weighing the costs of change to them
individually. The skill of the intervenor can help to stabilize the period of disequilibrium with
the support of organizational leaders. The more the total organization can be involved in the
process of change, the greater is the likelihood of the acceptance of change. Rosen (1991) notes
several ways to lead employees through the stages of change:
• Overcoming denial by honoring the past and informing employees regularly
• Moving through resistance by sharing a vision and not making promises you cannot
keep
• Exploring change by using symbols, e.g., newsletters, slogans, buttons
• Arriving at commitment
To create a resilient organization that not only survives change, but creates positive
change, organizations need continuous programs in education, retraining, seeking alternatives
to crisis management, and flexibility in meeting changing work-force needs.

Preventive Programming in Multicultural Settings in Communities

and Organizations

Pasick et al. (1996) discuss the interactions among culture, behavior, and prevention and
present a framework for cultural tailoring in the development of interventions for cultural and
ethnic groups. They distinguish between targeting of interventions for specific subgroups of
the population to ensure exposure of the target group to the intervention, and cultural tailoring,
which is the development of interventions and strategies that reflect specific characteristics of
the targeted group. Pasick and colleagues note that cultural tailoring provides a way to focus
on specific cultural factors.
Huff and Kline (1999) developed a cultural assessment framework (CAF) to assist
practitioners in understanding similarities and differences between mainstream culture and a
specific cultural or ethnic group. The CAF has five primary assessment levels. The framework
involves asking questions at each stage of the assessment process. The CAF can be applied to
individuals, groups, or communities. The five major levels of assessment are:
278 JOHN G. BRUHN

1. Cultural or ethnic group-specific demographic characteristics

2. Cultural or e,thnic group-specific epidemiological and environmental influences
3. General and specific cultural or ethnic group characteristics
4. General and specific healthcare beliefs and practices
5. Western healthcare organization and service delivery variables.
The CAF is further divided into a number of subcategories to provide a more in-depth review.
Kline and Huff (1999) also offer tips for practitioners to consider in planning, implementing,
and evaluating programs for multicultural target groups. Mensah (1993) distinguishes between
the concepts of transcultural, cross-cultural, and multicultural. Transcultural refers to the
beliefs, values, lifestyle, and practices of cultural groups so that helpers can provide better
care. Cross-cultural is based on the assumption that the practitioner and client are of different
cultural backgrounds. Sensitivity to cross-cultural differences and similarities is thought to
yield better interventions. Multicultural is the inclusion of ethnic groups in the process, what-
ever it is. Legge (1993) illustrates these concepts as she examines the relationship between
substance misuse and prevention programming in four ethnic groups in Canada (Chinese,
Indo-Canadian, Latin American, and Vietnamese). Through interviews with key informants
and selected consumers she ascertained perceived alcohol and substance abuse problems and
the need for preventive programming. Traditionally most alcohol and drug programs have
been developed for English-speaking Canadians; they are geared to the middle class, and are
based on Western values and concepts of child development and socialization, parenting
practices, and family structures. Therefore, it is not surprising that very few members of ethnic
communities participate in educational prevention programs. It is also well known in Canada
and the United States that social services treating alcohol or drug problems and related mental
health problems are underutilized by ethnic groups (Legge, 1993).
Legge found that the ethnic groups have different perceptions of their problems and that a
broad program aimed at all four communities will be ineffective. Legge stresses the need for a
needs assessment of each group's problems. Specifically she recommends five categories of
information proven to be useful in preventive programming: (1) data about cultural aspects of
use; (2) each communities' estimate of the substance abuse problem, reasons for abuse, results
from abuse; (3) potential target groups; (4) estimated need for programs; and (5) components
of prevention programs. Prevention initiatives require collaborative working relations in the
community, a high degree of cooperation among immigrant-serving agencies, leaders, and
social service workers. As Legge points out, prevention is an invitation to change, not an
edict-an invitation to change will be accepted and acted on only if it makes "cultural sense"
and is seen and supported by community members.

Preventive Programming for Society

Preventive programming at the societal level usually involves initiatives by the Surgeon
General, the Secretary of Health and Human Services, the President, and Congress, although
programs can also be started by national organizations and voluntary groups. There are several
topics that have national attention concerning their preventability: AIDS, cigarette smoking,
and automobile fatalities. Two of these behaviors, AIDS and cigarette smoking, involve
stopping doing something, the third, auto fatalities, involves doing something (using seat belts
and child seats) to prevent disability and death. Ultimately, while programs can be initiated at
the national level, the target is individual behavior change. National preventive programs in
PREVENTIVE PROGRAMMING 279

these three areas are not new and one of the major things we have learned is that we cannot
assume that a single intervention will be effective for all smokers, persons with HIV and
AIDS, or drivers of automobiles. What is important to consider is how to reach more people
before they get HIV or AIDS, smoke, or become risk-taking seasoned drivers and how we can
be more effective in tailoring preventive interventions to these groups (Glasgow & Orleans,
1997). Most effective interventions involve more than one modality, such as self-help mate-
rials and face-to-face advice/counseling.

Smoking Cessation

With respect to cigarette smoking the public health approach is to develop interventions
that target entire communities and states. Given logistical and cost constraints these ap-
proaches have used social marketing and mass media to influence attitude and behavior
change. In addition, there have been attempts to maximize community participation through
community boards and task forces. The key to success is the involvement of both influential
community members and stakeholders and community volunteers in the implementation of
cigarette cessation programs. Bracht (1990) points out that the degree, mix, and timing of
involvement by these various constituents is more art than science.
Another characteristic of communitywide approaches is that they involve multiple com-
munication channels. They utilize some or all of the following: worksite efforts, media and
public education, community organizations, self-help materials, and health professionals. The
best known large-scale efforts to modify risk factors in addition to smoking have been clinical
trials funded by the National Heart, Lung, and Blood Institute. The trials addressed multiple
risk factors in the same program but were unsuccessful in decreasing the prevalence of smok-
ing (Luepker et aI., 1994). In other projects where smoking cessation was the only risk factor
addressed (COMMIT Research Group, 1995), there has been more success, as in California
where a 25¢ increase per pack in the state cigarette tax was accompanied by aggressive media
ads and nonsmoking policies (pierce et aI., 1993).
Other strategies that seem to help in smoking cessation are tailoring intervention through
a stepped care process, personalizing the intervention to the individual using telephone
counseling or computer messages. Similar benefits have been shown when programs ha'ie
been tailored to specific demographic characteristics and medical status, e.g., pregnancy
(Glasgow & Orleans, 1997).

Seat Belt Use

Reducing death on the road by instituting federal minimum safety standard has been
effective. Robertson (1996) indicates that vehicle-related deaths have decreased from 5.5 per
hundred million vehicle miles in 1966 when the Motor Vehicle Safety Act was enacted to 1.8
in 1992. Factors in addition to the Act which helped reduce death rates are improved vehicle
crash worthiness, increased seat belt use, and reduced alcohol use. The effects of governmental
safety standardized laws requiring seat belt use are disputed. Some argue that protected drivers
drive more riskily, offsetting the effects of the regulations. Actual observations of seat belt use
and driving behavior before and after a belt use law, in comparison with observations in a
jurisdiction with no law, revealed no changes in risky behaviors such as speeding, following
too closely, and running stop signs, which suggested riskier behavior when drivers increase
seat belt use (Robertson, 1996).
Wide differences in the state's laws, enforcement, and other activities concerning safety
280 JOHN G. BRUHN

belts have contributed to belt use rates in 1994 ranging from a low of 32% to a high of 84%.
Four states reported rates of over 80% belt use, while six states reported rates of less than 50%
use. Those states that have been most successful in increasing belt use generally have primary
enforcement laws, visible and aggressive enforcement, and active public information and
education programs. Through concentrated enforcement efforts, many of the states were able
to substantially increase the use of safety belts. For example, North Carolina reported an
increase in belt use from 65% to 80% in 1993 as a result of an active program of operating
safety belt checkpoints throughout the state (U.S. General Accounting Office, 1996).
Safety belt laws and programs in Canada have been very effective in achieving a high rate
of seat belt use. As of mid-1994, Canada reported that its seat belt use was about 90% in
passenger cars and 88% in all vehicles. Factors contributing to this compliance were (1) laws in
all jurisdictions, (2) required primary enforcement, (3) fines higher than in the United States,
(4) demerit points against drivers' licenses, and (5) compliance as a top national priority.

HIVI AIDS Education

Since 1981 more than a quarter of a million Americans have been diagnosed with AIDS
and over one million Americans are estimated to have been infected with HIV (DiClemente &
Peterson, 1994). There is no preventive vaccine or medical cure for this disease. Consequently,
efforts to change high-risk behaviors remain the only available means to prevent HIV
infection. Since HIV is primarily transmitted through sexual behavior and sharing drug
injection equipment, it can be prevented through appropriate behavioral changes. The risk
behaviors occur in the context of people's interpersonal relationships.
While sexual abstinence is the most obvious method of preventing sexual transmission of
HIV, a substantial population of adults and adolescents fail to adopt this strategy. For most
people who are not celibate the consistent use of condoms would be the most effective way to
reduce exposure to HIY. A number of factors influence the decision to use condoms including
age, gender, and cultural attitudes toward sexuality. In addition to sexual transmission, HIV is
largely transmitted through sharing contaminated needles. Efforts to promote needle cleaning
or to avoid needle sharing have encountered great obstacles. These include concerns that
needle exchange might increase or condone drug use, the criminality of purchasing needles,
limited availability of services, and social factors related to needle sharing.
Early HIV prevention efforts were primarily information-based. Despite increased public
awareness, there has not been a corresponding change in HIV high-risk behaviors. While there
have been remarkable changes in the epidemiology of AIDS among urban white gay men,
other populations such as young or minority homosexually active men, heterosexual women,
and ethnic minorities in poor urban areas have shown an increased prevalence of the disease.
Coates and Greenblatt (1990) suggest several principles for community-based interven-
tions. In order to implement these principles it is necessary that the change agent be (1)
pragmatic-use all avenues and types of helpers indigenous to a community; (2) simpatico-
the interventions and methods of implementation must be consistent with the dominant values
of the community; (3) persistent-interventions need to occur and reoccur frequently over
time to maximize the diffusion process and shape new community norms; and (4) inclusive-
special care must be taken to include representatives of community interest groups and
coalitions, in addition to leaders, in planning and delivering interventions. Catania et al. (1989)
state that evidence from San Francisco's gay community clearly indicates that substantial
strides have been taken to reduce HIV transmission. Two key elements that may have helped
are eroticizing safe sex and utilizing extensive help seeking. It is difficult to make definite
PREVENTIVE PROGRAMMING 281

statements about what is an effective intervention in HIV/AIDS as there are no appropriate

comparison communities. Small cities may differ from large cities in ways that influence both
HIV risk and the development of intervention programs (Kelly, 1994).
Barnes et al. (1997) discuss prevention of HIV and AIDS along the U.S.-Mexico border.
HIV prevention programs that target Hispanics must address the diverse cultural, economic,
and educational backgrounds of the population. It has been discovered that Hispanics emigrat-
ing from Mexico to a large metropolitan border community in the United States had fewer
financial resources, and were less able to receive support to obtain HIV prevention programs
and health services than were U.S. native-born Hispanics. Among Hispanic populations,
family planning clinics are an ideal setting for AIDS education, since structured counseling
sessions are provided as part of routine healthcare.
Many researchers and practitioners who have worked with Hispanic populations in the
U.S.-Mexico border region report that developing culturally and linguistically appropriate
prevention programs is critical. Amaro (1988) recommends that an effective education pro-
gram for preventing HIV/AIDS should focus on general reproduction and AIDS education
issues through a trained community health educator who is of the same gender and cultural and
linguistic background as the individual who is the target of the prevention effort. Community-
based efforts involving tenant groups, neighborhood organizations, unions, churches, parent
groups, and indigenous leaders are critical. Alternative communication media such as soap
operas, Spanish radio and television, street theater, bilingual telephone hot lines, and written
materials are all important.
Powerful sexual taboos about homosexuality and the barriers to communication about
sex between men and women complicate HIV prevention efforts. Educational attainments are
low among Hispanics and this is important to keep in mind when developing materials for
dissemination to target groups. Parents playa key role in AIDS education for teenagers. In the
Hispanic culture, discussions about sexuality have been regarded as a private subject that
should be restricted to the family. AIDS education in the schools is still controversial. Another
powerful influence is the Catholic Church. The most prevalent forms of transmission of HIV
are viewed as immoral by the Church. Prevention methods like abstinence from sexual
relations and intravenous drug use can be promoted without offending people's religious
values.
Trad (1994) has suggested a technique called previewing whereby a group envisions
significant events in the future. Members role-play situations from their own point of view.
After the enactment, discussion follows resulting in a type of values clarification. Previewing
furnishes the opportunity to explore options, practice skills, and understand peers' opinions.
By enacting real-life situations youth have the opportunity to articulate possible repercussions
from their behavior and to experiment and receive reinforcement or sanctions for behavior in
a protected environment. Besides positive peer pressure, enactments can help youth gain
benefits from guided techniques that enable them to confront personal challenges (Seltzer
et at., 1989).
Other models for AIDS prevention for Hispanic youth are cognitive-skill interventions.
This model incorporates five components: ethnic pride, HIV facts, problem solving, coping,
and communication, which occur in a nurturing environment that strengthens self-image and
maintains a sense of cultural heritage. Barnes et at. (1997) critique other models of HIV/AIDS
prevention in Hispanic populations. Hispanics account for 9% of the U.S. population, but
represent 17% of all reported AIDS cases. Although the rate of increase is slowing among the
general population in the United States, among Hispanics and blacks it is not.
HIV/AIDs represents a major challenge to an intervenor's armamentarium of skills,
282 JOHN G. BRUHN

techniques, and methodologies and calls for enormous creativity, innovation, and patience.
Orsi (1995) has suggested roles for sociologists in interventions for substance abuse and AIDS.
Behaviors that people find satisfying are hard to give up no matter what the trade-off.
Ultimately the individual is his or her own best interventionist; each person knows his or her
own limits of change.

Preventive Intervention among Marginalized Groups-The Homeless

Marin (1987) says that "homelessness" is the sum total of our dreams, policies, inten-
tions, errors, omissions, cruelties, kindnesses, all of it recorded, in the flesh, in the life of the
streets. Nationwide the homeless population has a median age of 33 years. Typical homeless
persons are no longer indigents, drinkers, lazy, or indigenous, they are victims of dependency
on alcohol and drugs, mental patients who reside on the streets, and women, youth, and
families who are economic victims. Families are the fastest growing segment. In Chicago, for
example, families represent 37% of the homeless population. A large percentage are women
who have left home because of domestic violence. Most homeless women and children are
unemployed. Estimates are that there are about 2 million homeless youth nationwide. The
health problems of homeless people are significant. Tuberculosis, mental disorders, and respi-
ratory diseases were common 40 years ago, but today a host of chronic diseases and illnesses
related to drug abuse and AIDS predominate (Liebow, 1993).
Even when preventive services are available, circumstances often limit their effective-
ness. Cancer mortality rates are significantly higher among the homeless, but screening is
limited because of the lack of continuous care and follow-up. The poor health of the homeless
reflects a much larger problem of access and delivery of health services. Perhaps the key
question here under the rubric of preventive interventions for the homeless is, how far does
responsibility of preventive interventions extend? If they are to embrace all citizens, society
and the health professions will have to embrace a larger concept where everyone counts
(Woods, 1994).

PREVENTIVE PROGRAMMING

What Works and Does Not Work

Table 14.1 summarizes key factors that help influence success or failure in prevention
programs. There is no blueprint for success; each prevention intervention is a unique effort
because the characteristics and readiness of the recipients are different, the situations are
different, and expectations of outcomes differ.
We are creatures of habit. Preventive programming involves intervening to modify or
change our habits. People feel comfortable with their habits and will resist efforts to change
what they like and what feels good. Prevention means some type of change in behavior and
this usually also means choices and trade-offs. People may make changes, but after a time
revert to former habits if the change does not meet their needs. One of the unknowns in
preventive programming is what works and does not work over a sustained period of years.
People move and many resist being ongoing participants in an effort; furthermore, follow-up is
time-consuming and costly. So we know more about what works and does not work in the
short run.
PREVENTIVE PROGRAMMING 283

TABLE 14.1. What Works and Does Not Work in Effective Preventive Programming
What works What does not work

Involving the recipients of the intervention in its planning
and implementation
Sensitivity to cultural, ethnic, and demographic factors of
the recipients
Using a variety of techniques or approaches to change
one's behavior
Obtaining leadership and recipient "buy-in"
Viewing and planning intervention as a process involving
steps or stages
Being willing to accept degrees of change without 100%
of expected outcome
Repeated interventions over time for reinforcement
Need to provide group support and networks for recipients
A positive approach
A thorough needs assessment
Use of volunteers or "train the trainers" campaigns
Encouragement from leaders and healthcare providers
Use of incentives and rewards
Single focused efforts
A general effort without regard to demographic
and cultural differences
Lack of reinforcement and social support
Limited availability of intervention
Limited information about the intervention
Significant cost, discomfort, or embarrassment
Lack of incentives, rewards, feedback
Limited involvement of recipients in planning and
implementation
Fear, stigmatization
Limited communication and interaction
Education or knowledge approaches alone
Group approaches alone
Addressing multiple risk factors in one
intervention program

The reader might look at the factors listed in Table 14.1 and say that these are just good
common sense. They are, but we forget. Common sense is a helpful asset in preventive
programming. We simply lack the rigorous evaluation of preventive programming to give
unconditional statements about outcomes.

THE ART AND SCIENCE OF DOING PREVENTIVE PROGRAMMING

Planning and implementing prevention programs are as much art as they are science.
Prevention basically means that something bad must be kept from happening; that we must
confront the risk of something bad happening. Neddleman and Leviton (1998) state that risk
confrontation is a problem-solving process. Not all risks can be minimized or eliminated, but
most can be managed. In order to manage risk we need to assess and communicate about it
over time. Risk management and prevention are ongoing processes. We tend to focus more
readily on risks we can see, but not all risks are observable or measurable or continuous. But all
risk is in some way tied to the way people act or behavior, which, in tum, is related to what they
enjoy or value. Managing risk involves change, and especially changes in values. Not
everything we value is healthy, although we usually make strong cases to defend what we do
value irrespective of its degree of healthiness. We often say, "I'll take my chances," or "We
all need to die of something."
People's judgments about different risks are not always based on facts, but on deep
beliefs about fairness and equity (Graham & Wiener, 1995). We need to protect people's sense
of control over their behavior and their environment and provide them with the opportunity to
determine the risk levels they wish to tolerate. Individuals, families, organizations, commu-
nities and societies all engage in risk trade-off analyses-the magnitude, the range of issues,
and options for regulation-to make things better from everyone's standpoint (Graham &
Wiener, 1995). This involves the science of prevention.
284 JOHN G. BRUHN

We refer to the art of prevention because prevention is, or should be, people-centered.
Raeburn and Rootman (1998) point out that development (personal and community) and
empowerment are key to getting promotion programs to work. Prevention is driven by a
viewpoint that starts with the subjective experience of excesses, limitations, or inadequacies of
individuals, rather than from the objective views of social scientists. The art of preventive
programming involves creating a positive synergy and unity that will reduce risk and embrace
the quality of life for everyone-at least the options are there; the choice remains an individual
responsibility.

PREVENTION INVOLVES FAILURE

Before we discuss precise steps in preventive programming we should note that, while it
is generally thought to be good to "prevent" what is or might be deleterious to one's health or
well-being, not all agree. When prevention programs are offered, not everyone participates or
even supports them. To some people prevention is telling them what they should do; it intrudes
on their privacy and freedom of choice. While interventionists might like to get everyone on
board, this is idealistic, and occasionally prevention efforts have failed because of overzealous
interventionists or too highly structured programs. A classic example in the literature is a
6-month educational program to alter popular attitudes toward the mentally ill carried out in a
small Canadian prairie town (Cumming & Cumming, 1955). The community "closed ranks"
on the educators!interventionists because they had established ways of relating to and dealing
with the mentally ill and resisted attempts by outsiders to change these ways. As the educators!
interventionists persisted, anxiety in the community turned to hostility and the outsiders were
ejected. These researchers were forthright in analyzing the project's failures. There are
probably more failures than we hear or read about. There are risks to the interventionist,
namely, that a program will not be successful, and to the participants, they may not get their
expectations met. Thus, it is important that any effort in preventive programming be a
partnership with up-front agreed-on benefits and consequences for all parties. Prevention after
all is an investment in the quality of life, and everyone defines that differently. Hence,
expectations about outcomes will differ. It is perhaps more meaningful to think of prevention
efforts along a continuum of success and failure where all programs share some of both
outcomes.

THE STEPS IN PREVENTIVE PROGRAMMING

Where does one start in preventive programming? Figure 14.2 outlines the steps:
1. Preparation. The first step is preparation. Whether the client is an individual or an
organization or a community, it is important to explore the process by which they were led to
you, the problem they want to prevent or remedy, and their expectations regarding the outcome
of an intervention. All clients have preconceived notions of what might happen, how they
might be involved, and what will change as a result of the intervention. Whether these ideas are
real or fantasy they need to be explored fully. It is possible that you might not be able to help
because of resources, time, or expectations. You might have to refer the client elsewhere. Or,
you may have to engage in a dialogue to modify expectations. Is this client reasonable and the
intervention doable? What is the client's history of past interventions with other helpers or
1. • I
Exploring the problem, risks,
and expectations. Is the
client reasonable and the
intervention doable? Preparation

2. I Planning is a partnership I
I
between client and intervenor;
programs should meet unique
client needs. Planning

3.1 i
Structure and content of the
program. Documentation and
accountability is made explicit.
I
Implementation

4.1 . I
A procedure for carrying out
program effectiveness, impact,
and cost-benefit analyses
needs to be established. I Evaluation

5.• Contact client sometime after

intervention to assess program
impact; clients should commit
to this in Steps 1 and 2. 1Follow-up

6.. Self-reflection by intervenor on

what went well and what didn't.
Use in self-improvement.
Self-evaluation

FIGURE 14.2. Steps in prevention programming.

IV
00
VI
286 JOHN G. BRUHN

programs? In other words, the first step in preventive programming is preparation, on the part
of both the client and the intervenor.
2. Planning. The second step is planning. Prevention programs are tailored to clients
based on what was learned in Step 1. Prevention programs might be packageable, but rarely
can they be applied from individual to individual or group to group without some modifica-
tions. Clients should be active parties in planning. If they are not, their commitment to change
is not finn and they can back out at any time something does not please them. Similarly, the
intervenor will not be fully engaged in helping a client she or he knows is not fully committed.
Planning takes time and to some it is boring and arduous. Shortcuts in Steps I and 2 usually are
the reasons why clients become no-shows, resist, or drop out of programs.
Planning also involves helping the client mobilize a strong supportive network to help
sustain changes produced by the program. Change is not just a burden for the client, behavior
is reinforced and encouraged by others in the client's network.
3. Implementation. The third step is implementation. On the basis of infonnation about
the client's characteristics, expectations, resources, and so on, what is the appropriate structure
and content of the program? Its length? What will the client be expected to do? What personnel
will be involved? What kind of documentation will be kept to facilitate outcome analysis?
4. Evaluation. In this fourth step both process and outcome evaluation should be carried
out. As Schalock (1995) points out, it is important to analyze a program's effectiveness,
impact, and cost-benefit. It is critical that there be a blend of qualitative and quantitative data.
Programs can have an impact but be too expensive. On the other hand, programs can be
ineffective because of poor planning and insufficient resources or poor implementation.
Evaluation is often an afterthought and as a result prevention interventionists find it hard to
explain both their successes and failures.
5. Follow-up. This fifth step is extremely important. The responsibility of the intervenor
does not end when the implementation phase is complete. The effects of an intervention are
often assumed to be pennanent unless there is follow-up. Follow-up is difficult because clients
often feel an end to their commitment when the program is finished. A commitment to
providing follow-up infonnation should be discussed with the client in Steps I and 2. Indeed, it
is often some months after an intervention that its real impact becomes apparent. Follow-up
takes time and resources and some interventionists are therefore reluctant or not financially
able to do follow-ups.
6. Self-evaluation. The final step involves the interventionist conducting an evaluation of
him- or herself. What went well, what did not? What were "hunches" the interventionist has
about how the program failed or succeeded? No person or program is perfect so lessons can be
learned. We need to make an effort to reflect on them and improve our work. The professional
is only an instrument in treatment and prevention. Individuals, organizations, and commu-
nities are responsible for their own self-management.
Professionals often regard programs as successful when clients "comply." yet a client
can comply and not continue to apply what she or he has learned after the program has ended.
Noncompliance does not mean that a client has failed. This is why honest dialogue must occur
consistently between the client and intervenor at all stages. When prevention intervention fails
or succeeds, both the client and intervenor share the responsibility (Bruhn, 1997b).

SUMMARY

Prevention involves engaging in activities that may enhance the health and well-being of
all levels of human complexity from the individual to the group, organization, institution,
PREVENTIVE PROGRAMMING 287

and society. The rules underlying the participation in these activities often involve weighing
and trading off risks, a reranking of values (what is important), and a commitment to self-
regulation.
Some prevention efforts succeed and others fail. It is the premise of this author that we
can ensure more long-term successes by involving clinical sociologists and sociological
practitioners because of their appreciation and understanding of societal structure and the
dynamics of complex social institutions and organizations. Sociological practitioners do not
have all the answers, but they do have perspective, insight, and sensitivities across boundaries.
This chapter examined the reasons why prevention programs succeed and fail and provided a
decision tree and step-by-step process to assist in preventive programming. There is no
blueprint for prevention planning, but there are well-known steps that, when heeded, enhance
success.
It is the author's belief that individually and collectively we must assume greater
responsibility for our own health and behavior. We live in a world where people seem to have
lost sight of the way to enhance their individual and collective well-being and longevity and
instead purposefully pursue acts that destroy individuals and cultures. Preventive intervention
is a positive, proactive activity that, when well-planned, modeled, and reinforced, can benefit
all people.

REFERENCES

Abel, E. L., & Zeidenberg, P. (1985). Age, alcohol, and violent death: A post mortem study. Journal of Studies of
Alcohol, 46, 228-231.
Amaro, H. (1988). Considerations for prevention of HIV infection among Hispanic women. Psychology of Women
Quanerly, 12, 429-443.
Amartya, S. (1986). The right to take personal risks. In D. MacLean (Ed.), Values at risk (pp. 155-169). Totowa, NJ:
Rowman & Allanheld.
Amezcua, c., McAlister, A., Ramirez, A., & Espinoza, R. (1990). A Su Salud: Health promotion in a Mexican-
American border community. In N. Bracht (Ed.), Health promotion at the community level (pp. 257-276).
Thousand Oaks, CA: Sage.
Anderson, R., Davies, J. K., Kickbusch, I., McQueen, D. Y., & Turner, 1. (Eds.). (1988). Health behavior research and
health promotion. London: Oxford University Press.
Ashton, J., & Seymour, H. (1988). The new public health. Philadelphia: Open University Press.
Ashton, J., Grey, P., & Barnard, K. (1986). Healthy cities-WHO's new public health initiative. Health Promotion, 1,
319-323.
Barnes, M. D., Buckingham, R. w., & Wesley, A. M. (1997). Hispanics, HIY, and AIDS along the U.S.-Mexico
border. In J. G. Bruhn & J. E. Brandon (Ed.), Border health: Challenges for the United States and Mexico (pp.
87-116). New York: Garland.
Batten, P. J., Hicks, L. 1., & Penn, D. W. (1991). A 28-year (1963-1990) study of homicide in Marion County, Oregon.
American Journal of Forensic Medicine Pathology, 12, 227-234.
Baumeister, R. E, Heatherton, T. E, & Tice, D. M. (1994). Losing control: How and why people fail at self-regulation.
New York: Academic Press.
Blaney, R. (1987). Why prevent disease? In S. Doxiadis (Ed.), Ethical dilemmas in health promotion (pp. 47-56).
New York: Wiley.
Bracht, N. (Ed.). (1990). Health promotion at the community level. Thousand Oaks, CA: Sage.
Brener, N. D., Simon, T. R., Krug, E. G., & Lowry, R. (1999). Recent trends in violence-related behaviors among high
school students in the United States. Journal of the American Medical Association, 2828, 440-446.
Bruhn, J. G. (1988). Creating risk-sensitive persons: The roles of choice and chance in staying healthy. Southern
Medical Journal, 81(5), 624-629.
Bruhn, J. G. (1997a). The organization as a person: Analogues for intervention. Clinical Sociology Review, 15, 51-70.
Bruhn, J. G. (1997b). Relevance of health behavior research to training and practice in the health professions. In D. S.
Gochman (Ed.), Handbook ofhealth behavior research IV: Relevance for professionals and issues for the future
(pp. 7-23). New York: Plenum Press.
288 JOHN G. BRUHN

Canadian Task Force on the Periodic Health Examination. (1994). Canadian guide to clinical preventive health care
(pp. 320-332). Ottawa: Canada Communication Group.
Catania, J. A., Coates, T. J., Kegeles, S. M., Ekstrand, M., Guydish, J. R., & Bye, L. L. (1989). Implications of the
AIDS risk-reduction model for the gay community: The importance of perceived sexual enjoyment and help-
seeking behaviors. In V. M. Mays, G. W. Abbee, & S. F. Schneider (Eds.), Primary prevention ofAIDS (pp. 242-
261). Thousand Oaks, CA: Sage.
Centers for Disease Control and Prevention. (1993). Violence-related attitudes and behaviors of high school
students-New York City, 1992. MMWR, 42, 773-777.
Coates, T. J., & Greenblatt, R. M. (1990). Behavioral change using interventions at the community level. In K. K.
Holmes, P. Mardh, P. F. Sparling, & P. J. Weisner (Eds.), Sexually transmitted diseases (2nd ed., pp. 1075-1080).
New York: McGraw-Hili.
COMMIT Research Group. (1995). Community intervention trial for smoking cessation (COMMIT). 1. Cohort results
from a four-year community intervention. American Journal of Public Health, 85, 183-192.
Cotten, N. U., Resnick, J., Browne, D. C., Martin, S. L., McCarraher, D. R., & Woods, J. (1994). Aggression and
fighting behavior among African-American adolescents: Individual and family factors. American Journal of
Public Health, 84, 618-622.
Cumming, J., & Cumming, E. (1955). Mental health education in a Canadian community. In B. D. Paul (Ed.), Health,
culture, and community: Case studies of public reactions to health programs (pp. 43-69). New York: Russell
Sage Foundation.
Davidson, L. L., Durkin, M. S., Kuhn, L., O'Connor, P., Barlow, B., & Heagarty, M. C. (1994). The impact of the Safe
KidslHealthy Neighborhoods injury prevention program in Harlem, 1988 through 1991. American Journal of
Public Health, 84, 580-586.
DiClemente, R. J., & Peterson, J. L. (1994). Changing HIV/AIDS risk behaviors: The role of behavioral interventions.
In R. J. DiClemente & J. L. Peterson (Eds.), Preventing AIDS: Theories and methods ofbehavioral interventions
(pp. 1-4). New York: Plenum Press.
Dubowitz, H. (1990). Costs and effectiveness of interventions in child maltreatment. Child Abuse Neglect, 14,
177-186.
Dunphy, D. (1996). Introduction: Organizational change in corporate settings. Human Relations, 49(5), 541-552.
Federal Bureau of Investigation. (1993). Uniform crime reports of the United States, 1992. Washington, DC: U.S.
Government Printing Office (Publication No. 342-498/94321).
Feindler, E. L., & Ecton, R. B. (1986). Adolescent anger control: Cognitive-behavioral techniques. New York:
Pergamon Press.
Fife, D., & Abrams, W. R. (1989). Firearms' decreased role in New Jersey homicides after a mandatory sentencing
law. Journal of Trauma, 29, 1548-1551.
Filinson, R. (1993). An evaluation of a program of volunteer advocates for elder abuse victims. Journal ofElder Abuse
and Neglect, 5, 77-93.
Fishbein, D. H. (\992). The psychobiology of female aggression. Criminal Justice and Behavior, 19(2), 99-126.
Forum on youth violence in minority communities: Setting the agenda for prevention. (1991). Summary of the
Proceedings, December 10-12, 1990, Atlanta, GA. Public Health Reports, 106, 225-279.
Glasgow, R. E., & Orleans, C. T. (1997). Adherence to smoking cessation regimes. In D. S. Gochman (Ed.), Handbook
of health behavior research: Vol. JJ. Provider determinants (pp. 353-377). New York: Plenum Press.
Goldstein, A. P. (1991). Delinquent gangs: A psychological perspective. Champaign, IL: Research Press.
Graham, J. D., & Wiener, J. B. (1995). Risk versus risk: Tradeoffs in protecting health and the environment.
Cambridge, MA: Harvard University Press.
Hancock, T., & Duhl, L. J. (1986). Healthy cities: Promoting health in the urban context. A background working paper
for the Health Cities Symposium Portugal, 1986. Copenhagen: WHO.
Hardy, J. B., & Streett, R. (1989). Family support and parenting education in the home: An effective extension of
clinic-based preventive health car services for poor children. Journal of Pediatrics, 115, 927-931.
Hiatt, H. H. (1987). America's health in the balance. New York: Harper & Row.
Hingson, R., Merrigan, D., & Heeren, T. (1985). Effects of Massachusetts raising its legal drinking age from 18 to 20
on deaths from teenage homicide, suicide, and nontraffic accidents. Pediatric Clinics of North America, 32,
221-232.
Hirschman, R. S. (1982). Social psychology and prevention. In G. S. Sanders & J. Suls (Eds.), Social psychology of
health and illness (pp. 183-226). Hillsdale, NJ: Erlbaum.
Hogue, A., & Liddle, H. A. (1999). Family-based preventive intervention: An approach to preventing substance use
and antisocial behavior. American Journal of Orthopsychiatry, 69(3), 278-293.
Huff, R. M., & Kline, M. V. (1999). Promoting health in multicultural populations: A handbook for practitioners.
Thousand Oaks, CA: Sage.
PREVENTIVE PROGRAMMING 289

Imperato, P. J., & Mitchell, G. (1985). AcceptabLe risks. New York: Viking.
Jones, D. P. H. (1987). The untreatable family. Child Abuse NegLect, 11, 409-420.
Jones, N. E., Pieper, C. F., & Robertson, L. S. (1992). The effect of legal drinking age on fatal injuries of adolescents
and young adults. American JournaL of PubLic HeaLth, 82, 112-115.
Kazdin, A. E. (1985). Treatment of antisocial behavior in children and adolescents. Homewood, IL: Dorsey Press.
Kelly, J. A. (1994). mv prevention among gay and bisexual men in small cities. In R. J. DiClemente & J. L. Peterson
(Eds.), Preventing AIDS (pp. 297-317). New York: Plenum Press.
Kets de Vries, M. F. R., & Balazs, K. (1999). Transforming the mind-set of the organization: A clinical perspective.
Administration & Society, 30(6), 640-675.
Kline, M. V., & Huff, R. M. (1999). Tips for practitioners. In R. M. Huff & M. V. Kline (Eds.), Promoting heaLth in
multicultural populations: A handbook for practitioners (pp. 103-111). Thousand Oaks, CA: Sage.
Lachs, M. S., & Pillemer, K. (1995). Abuse and neglect of elderly persons. New EngLand Journal of Medicine, 332,
437-443.
Legge, C. (1993). Ethnicity and substance misuse: Problems, needs and prevention program implications. In R. Masi,
L. Mensah, & K. A. McLeod (Eds.), Health and cultures: Exploring the reLationships, programs, services and
care (Vol. 2, pp. 229-247). Oakville, Ontario, Canada: Mozaic Press.
Lewin, K. (1958). Group decision and social change. In E. E. Maccoby, T. M. Newcomb, & E. L. Hartley (Eds.),
Readings in sociaL psychology (3rd ed., pp. 197-211). New York: Holt.
Lewis, D. O. (1981). Vulnerabilities to delinquency. New York: SP Medical and Scientific Books.
Liebow, E. (1993). Tell them who I am: The lives of homeless women. New York: Penguin.
Loftin, c., McDowall, D., & Wiersema, B. (1993). Evaluating effects of changes in gun laws. American Journal of
Preventive Medicine, 9(Suppl. 1), 39-43.
Luepker, R. U., Murray, D. M., Jacobs, D. R., Jr., Mittelmark, M. B., Bracht, N., Carlow, R., Crow, R., Elmer, P.,
Finnegan, J., Folson, A. R., Grimm, R., Hannan, P. J., Jeffrey, R., Lando, H., McGovern, P., Mullis, R., Perry, C.,
Pechacek, T., Pinie, P., Sprafka, J. M., Weisbod, R., & Blackburn, H. (1994). Community education for
cardiovascular disease prevention: Risk factor changes in the Minnesota Heart Health Program. American
Journal of Public Health, 84, 1383-1393.
Marin, P. (1987). Helping and hating the homeless: The struggle at the margins of America. Harpers, p. 41.
Marshall, W. L., & Barbaree, H. E. (1988). An outpatient treatment program for child molesters. AnnaLs of the New
York Academy of Science, 528, 205-214.
Mensah, L. (1993). Transcultural, crosscultural and multicultural health perspectives in focus. In R. Masi, L. Mensah,
& K. A. McLeod (Eds.), Health and cuLtures, expLoring the reLationships (Vol. 1, pp. 33-41). Oakville, Ontario,
Canada; Mosaic Press.
Miller, S. M. (1995). Thinking strategically about society and health. In B. C. Amick ill, S. Levine, A. R. Tarlov, & D.
C. Walsh (Eds.), Society and health (pp. 342-358). London: Oxford University Press.
Mittlemark, M. B., Luepker, R. V., Jacobs, D. R., Bracht, N. F., Carlaw, R. w., Crow, R. S., Finnegan, 1., Grimm, R. H.,
Jeffery, R. w., Kline, F. G., Mullis, R. M., Murray, D. M., Pechacek, T. F., Perry, C. L., Pirie, P. L., & Blackburn,
H. (1986). Community-wide prevention of cardiovascular disease: Education strategies of the Minnesota Heart
Health Program. Preventive Medicine, 5, 1-17.
National Center for Injury Prevention and Control. (1993). The prevention of youth violence: A framework for
community action. Atlanta, GA: Centers for Disease Control and Prevention.
Needleman, C. E., & Leviton, L. C. (1998). Confronting risk: A value-laden activity. In L. C. Leviton, C. E. Needle-
man, & M. A. Shapiro (Eds.), Confronting public heaLth risks: A decision-maker's guide (pp. 1-20). Thousand
Oaks, CA: Sage.
O'Carroll, P. w., Loftin, C., Waller, J. B., McDowall, D., Bukoff, A., Scott, R. 0., Mercy, J. A., & Wiersema, B.
(1991). Preventing homicide: An evaluation of the efficacy of a Detroit gun ordinance. American JournaL of
Public Health, 81, 576-581.
Olds, D. L., Henderson, C. R., Chamberlin, R., & Tatelbaum, R. (1986). Preventing child abuse and neglect: A
randomized trial of nurse home visitation. Pediatrics, 78, 65-78.
Orsi, M. (1995). The role of the sociologist in multidisciplinary interventions for substance abusers and persons with
AIDS. InternationaL SocioLogical Association-Research Committee on Clinical SocioLogy, No. 46 (ISA-RCCS).
Osberg, L. (1990). Sustainable sociaL deveLopment. Unpublished document, Dalhousie University, Halifax, Nova
Scotia.
Pappaioanou, M., & Evans, C., Jr. (1998). Development of the Guide to Community Preventive Services: A U.S.
Public Health Service Initiative. JournaL of PubLic HeaLth Management Practice, 4(2), 48-54.
Pasick, R. J., D'Onofrio, C. N., & Otero-Sabogal, R. (1996). Similarities and differences across cultures: Questions
to inform a third generation for health promotion research. HeaLth Education Quarterly, 23(Suppl.), S142-
S161.
290 JOHN G. BRUHN

Patrick, D. L., & Wickizer, T. M. (1995). Community and health. In B. C. Amick III, S. Levine, A R Tarlov, & D. C.
Walsh (Eds.), Society and health (pp. 46-92). London: Oxford University Press.
Pechacek, T., Pirie, P., Sprafka, J. M., Weisbrod, R., & Blackburn, H. (1994). Community education for cardiovascular
disease prevention: Risk factor changes in the Minnesota heart health program. American Journal of Public
Health, 84, 1383-1393.
Phillips, E. L. (1968). Achievement Place: Token reinforcement procedures in a homestyle rehabilitation setting for
predelinquent boys. Journal of Applied Behavior Analysis, 1, 213-223.
Phillips, E. L., Phillips, E. A., Fixsen, D. L., & Wolf, M. M. (1974). The teaching-family handbook. Lawrence:
University of Kansas Printing Service.
Pierce, J., Farkas, A., Evans, N., Berry, c., Chio, w., Rosbrook, B., Johnson, M., & BaI, D. G. (1993). Tobacco use in
California: Afocus on preventing uptake in adolescents. Sacramento: California Department of health Services.
Raeburn, J., & Rootrnan, I. (1998). People-centered health promotion. New York: Wiley.
Renaud, M. (1994). The future: Hygeia versus panakeia? In R G. Evans, M. L. Barer, & T. R. Marmor (Eds.), Why are
some people healthy and others not? The determinants of health of populations (pp. 317-334). Berlin: de
Gruyter.
Renfrew, 1. W. (1997). Aggression and its causes: A biopsychosocial approach. London: Oxford University Press.
Robertson, L. S. (1996). Reducing death on the road: The effects of minimum safety standards, publicized crash tests,
seat belts, and alcohol, American Journal of Public Health, 86, 31-34.
Rosen, R H., with L. Berger (1991). The healthy company. New York: Putnam.
Russell, L. B. (1986). Is prevention better than cure? Washington, DC: The Brookings Institute.
Sanders, W. B. (1994). Gangbangs and drive-bys: Grounded culture and juvenile gang violence. New York: Aldine
DeGruyter.
Schalock, R L. (1995). Outcome-based evaluation. New York: Plenum Press.
Seltzer, V. I. Rabin, 1., & Benjamin, F. (1989). Teenagers' awareness of the acquired immunodeficiency syndrome and
the impact on their sexual behavior. Journal of Obstetrics Gynecology, 74, 55-59.
Sengstock, M. C. (1987). Sociological strategies for developing community resources; Services for abused wives as an
example. Clinical Sociology Review, 5, 132-144.
Slaby, R G., & Guerra, N. G. (1988). Cognitive mediators of aggression in adolescent offenders. 1. Assessment.
Developmental Psychology, 24, 580-588.
Sullivan, C. M., Campbell, R, Angelique, H., Eby, K. K., & Davidson, W. S. (1994). An advocacy intervention
program for women with abusive partners: Six-month follow up. American Journal of Community Psychology,
22, 101-122.
Syme, S. L. (1990). Health promotion: Old approaches, new choices, future imperatives. Paper presented at "The
New Public Health: 1990," Los Angeles.
Trad, P. V. (1994). A developmental model for risk avoidance in adolescents confronting AIDS. AIDS Education and
Prevention, 6(4), 322-338.
U.S. Department of Health and Human Services. (1990). Healthy people 2000: National promotion and disease
prevention objectives. Washington, DC: U.S. Government Printing Office.
U.S. Department of Health and Human Services, Office of Public Health and Science. (1998). Healthy people 2010
objectives: Draft for public comment (September 15). Washington, DC: U.S. Government Printing Office.
U.S. General Accounting Office. (1996). Report to the Subcommittee on Transportation and Related Agencies,
Committee on Appropriations, House of Representatives. Motor vehicle safety, comprehensive state programs
offer best opportunity for increasing use of safety belts. GAO/RCED-92-24, Washington, DC.
Walker, L. E. (1981). A feminist perspective on domestic violence. In R B. Stuart (Ed.), Violent behavior: Social
learning approaches to prediction, management and treatment (pp. 102-115). New York: BrunnerlMazel.
Wall Street Journal. (1999, July 29) AI.
Webster, D. w., Gainer, P. S., & Champion, H. R (1993). Weapon-carrying among inner-city junior high school
students: Defensive behavior vs. aggressive delinquency. American Journal of Public Health, 83, 1604-1608.
Wickizer, T. M., Vonkorff, M., Cheadle, A, Maeser, J., Wagner, E. H., Pearson, D., Beery, w., & Psaty, B. M. (1993).
Activating communities for health promotion: A process evaluation method. American Journal ofPublic Health,
83, 561-567.
Wilkinson, R R. (1996). Unhealthy societies: The afflictions of inequality. London: Routledge.
Woods, K. (1994). Homelessness: A risk factor for poor health. In A Dula & S. Goering (Eds.), "Itjust ain 'tfair:" The
ethics of health care for African Americans (pp. 105-120). New York: Praeger.
 PART IV

APPROACHES TO
CONTEMPORARY
SOCIAL PROBLEMS

Clinical sociologists assert that sociological theories and methods should be used. Through
use, theories and methods can be refined and ideas for new theories and methods emerge.
There is no bigger challenge or test of theories and methods than through their application in
preventing and solving contemporary social problems. Human abuse, crime, terrorism, pov-
erty, health care inequities, racism, and environmental pollution are a few examples. We have
selected a few of these problems as examples of how sociology has been and can be applied to
alleviate them. Chapters 15, 16 ,17 and 18 provide discussions on healthcare equity; racism and
diversity; poverty, social welfare and social policy; and domestic violence.
Applying sociology requires sociologists to assume new roles in addition to the tradi-
tional ones of observer, teacher, researcher, and philosopher. Sociologists putting sociology to
work have learned new roles such as broker, mediator, change agent, expert witness, therapist,
and planner. Many of these roles will be discussed and illustrated in this section of the book. It
is our hope that the reader will be challenged to think of many more ways sociology can be
applied to deal with current social problems.

291
 CHAPTER 15

Healthcare Equity
BONNIE L. LEWIS AND F. DALE PARENT

INTRODUCTION

Purpose

The purpose of this chapter is to provide a discussion that will be useful to clinical
sociologists on the concept of equity as it pertains to health and healthcare in the United States.
We begin by defining what we mean by healthcare equity. We then describe how the lack of
equity has emerged out of the dominant political economy. The severity of inequities is
described in terms of two broad types of indicators: health status, and access to and utilization
of healthcare services. In understanding this issue, it is also important to look at both how the
problem is currently viewed and what methods have been used to address the problem. We
close with the dilemmas that face clinical sociologists and strategies for addressing the
problem of healthcare inequities in the United States.

Definition of Terms

As with many social concepts, developing a definition of healthcare equity is not

straightforward. Pereira (1993) suggests four requirements for an acceptable definition of
healthcare equity. The definition should be easily comprehensible, so that it can be used for
policy setting by persons in many disciplines; it should be easily operationalized so that no
misunderstandings occur; it should be subject to empirical verification with accessible data
sources; and lastly, it should be intuitive and widely acceptable.
Even with these guidelines, value underpinnings, both ethical and political, affect con-
ceptual and operational delineation, and the subsequent setting of goals for the achievement of
healthcare equity. Pereira (1993) describes numerous classical and contemporary theories used
among health economists for attempting to define healthcare equity.! These primarily revolve

IThese include egality, entitlement, the decent minimum, utilitarianism, Rawlsian maximin, envy-free allocations,
equity as choice, maximization of health, and capabilities approaches.

BONNIE L. LEWIS and F. DALE PARENT • Department of Sociology and Criminal Justice, Southeastern Loui-
siana University, Hammond, Louisiana 70402.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

293
294 BONNIE L. LEWIS AND F. DALE PARENT

around issues of how to make allocation decisions in an environment of scarce resources. They
also attempt to deal with such issues as ensuring freedom of choice and requiring that need is a
criterion for receipt of healthcare. These issues are ultimately important, but may blur the
primary focus of what equity is in a pure sense. As Gilson (1998:1894) points out: :Despite
some debate, those who promote equity as a health policy objective generally agree that
inequity is generated by differences in health status that are unnecessary, avoidable and
unfair-because [they result] from circumstances beyond individuals' control"
The definition we have developed, based on current discourse in the literature, is this:
Healthcare equity is the just distribution of access to and utilization of healthcare-related
services, resulting in equity in healthcare outcomes and health status among members of a
population. Just distribution means without variation due to income status, race, gender,
ethnicity, or other social or economic characteristics. Healthcare and healthcare-related ser-
vices include such goods and services as hospital, dental, and mental health services; pharma-
ceuticals; durable goods, such as wheelchairs, prosthetic devices, and eyeglasses; diagnostic
tests; long-term care; and health education, prevention, and promotion programs. The term
medical care, occasionally used interchangeably with healthcare, is less inclusive, generally
referring to curative medicine.
Access to healthcare is frequently, but inaccurately, seen as equivalent to equity. Equi-
table access is referred to as procedural equity, or the just distribution of procedures used to
obtain healthcare services and the actual use of services. This is contrasted to what is called
substantive equity, the just distribution of health outcomes and health status. Procedural access
(equitable access and use of comparable healthcare services) does not always result in
comparable health status of recipients, or substantive equity. This is due in part to factors
related to justice. Research has shown that services to disadvantaged persons are not always
equivalent to those with greater resources. Also, discriminatory practices in care delivery at
times lead to avoidance of care, even when a person in need of health services possesses the
resources necessary to obtain care. It must be noted, however, that the receipt and quality of
healthcare services is only one factor that affects health status (Aday et ai., 1998). Others are
environment, lifestyle, and human endowment (Folland et al., 1997). However, it still can be
said that while some of the health differences may be attributed to hereditary factors within
groups of people, most are a product of social factors (Funkhooser & Moser, 1990). The
importance of these factors will be expanded on later in the chapter.

Definition of the Problem

"The American health care system has been called a 'paradox of excess and deprivation'
because it is characterized by both very high cost and inaccessibility to health care of good
equality for a substantial segment of the population" (Lassey et ai., 1997:27). Despite the
expressed concern over inequities, and years of debate, discussion, and legislation, little has
been done to solve this problem.
The healthcare debate in recent years has been driven by concern for the costs of
healthcare, with concerns for equity hinging around cost. As is now commonly known, the
United States spends substantially more on healthcare than any other industrialized nation. In
1980, national health expenditures accounted for 8.9% of the gross domestic product (GOP).
This rose to an all time high of 13.7% in 1993. In the past few years, spending has remained
close to this level, declining slightly in 1997 to 13.5%. The 1997 figure represents total
expenditures of $1.1 trillion, and averages nearly $4000 for each American. Predictions are
HEALTHCARE EQUITY 295

that by the year 2008 the percentage of the GDP accounted for by national health expenditures
could reach 16.2% (Smith et at., 1999).
With all the money we spend on healthcare, one would think that we would have a model
system that provides high quality care for all Americans. However, we remain the only
Western nation without a comprehensive healthcare system sponsored by the government, and
we rely on a heavily market-based system in which healthcare can be expensive with insurance
coverage, and prohibitively expensive without coverage. And unfortunately many people-
among both the employed and the unemployed-do not have insurance. The number of
uninsured Americans hit a record high at 43 million, or 16% of the population in 1997
(Anderson & Poullier, 1999).
Even though an enormous amount of money is spent, and some of the most advanced
medical technology and best trained healthcare professionals in the world are found here, an
examination of international health statistics reveals that the United States compares poorly
with other countries. For example, 20 industrialized nations have a lower infant mortality rate
than the United States. Ranking 21st, our infant mortality rate is more than twice that of
Sweden. In terms of life expectancy we rank 17th among these nations (Miringoff & Mirin-
goff, 1999).
Paramount to this chapter's focus on equity, there are great discrepancies in the health
status and access to healthcare among Americans. What is most glaring is that poor health and
lack of access to high-quality, affordable, reasonably available healthcare is concentrated
among low-income Americans and other selected subgroups. But how has this happened?
Why do we find in a country that is so rich and powerful the existence of great disparities in
healthcare and health status?

Emergence of the Problem Out of Social Arrangements

The U.S. healthcare system did not develop and does not exist in a vacuum. It is a part of
the larger society and is shaped by both its structure and cultural values. The health inequities
that exist are a microcosm of the inequity that exists in every other institution in the United
States. There is greater income and wealth inequality here than in any other Western society.
This is generally attributed to our strong commitment historically to the principles of laissez-
faire economics and individualism. The pervasiveness of these two ideals provides the
structure and the cultural justification for the unequal distribution of resources in general and
healthcare in specific. This way of thinking maintains that the market is generally seen as the
best mechanism for the distribution of goods and services, including medical care, in a fair,
just, and efficient manner. The cultural norms rising from these ideals have led to an ideology
that individuals should be responsible for their own well-being and not rely on government to
solve their problems. This notion is much less fervently held in Europe where "national and
community responsibility are of great importance" (Lassey et aI., 1997:6). Pereira (1993)
reports substantial consensus among Western European countries around concerns for equi-
table distribution of healthcare. This is contrasted to the United States where equity takes a
second place to efficiency and maximization of consumer choice.
As a result, most Western societies have settled the debate over whether healthcare is a
right or privilege, but the United States still struggles over the issue. Most developed nations
consider high-quality healthcare to be a right and then work to fulfill that right for all their
citizens. In other countries there are philosophical debates and political battles among various
interest groups, resulting in different policies and programs, but as mentioned, on most major
296 BONNIE L. LEWIS AND F. DALE PARENT

indicators of health status, the results are better than have been achieved in the United States. It
is true that all Western nations are currently dealing with the problems of providing equitable
healthcare and controlling costs, but the level of commitment to equity is far greater than here
in the United States. The fact that as a nation we still grapple with the "right versus privilege"
issue in such a basic way says a lot about why we have the current equity problem. The
inequity that exists in the U.S. healthcare system today is a product of a political economy that
established the goals ofthe system and policies to meet these goals (Freund & McGuire, 1999).
It is clear that those who have the most influence over our political and economic systems-
the wealthy and big business-benefit most from our existing healthcare system.
The medical care system is a major part of the larger system of economics production and consump-
tion; it is structured to allow various interest groups to make significant profits and to control
considerable resources in medical production.... The powerful economic interests involved in medical
businesses-insurance companies, hospital corporations, pharmaceutical companies, medical technol-
ogy corporations, and so on-often supersede the interests of both sick people and health care workers.
(Freund & McGuire, 1999:279).

More than any other Western nation, healthcare in the United States is a business, and not
a service, a privilege and not a right. Most policies reflect this overall reality and over-
whelmingly protect the interests of what has become known as the medical-industrial com-
plex (Rellman, 1980). The ultimate goal of the system is profit-not equity in healthcare for
all. Writing in reference to the failure of Congress to pass any type of comprehensive
healthcare reform in the early 1990s, Vicente Navarro (1995) succinctly captures the essence of
the political framework that underlies the problem:
The staggering power of the capitalist class and the enormous weakness of the working class explains
why health care reform failed again. The United States, the only major capitalist country without
government-guaranteed universal healthcare coverage, is also the only nation without a social-
democratic or labor party that serves as the political instrument of the working class and other popular
classes. These two facts are related. In most advanced countries, the establishment of universal
entitlement programs has been based on the political alliances of the working class with the middle
classes, through the election of social-democratic governments or through their pressure on non-social-
democratic government. (p. 585).

Within the structure of our political economy and system of norms, there are, of course,
exceptions to the market-driven approach to healthcare. We have two major government
programs, Medicaid and Medicare (although these two programs are really designed to profit
the private sector). And there are caring people and organizations whose goals are to promote
high-quality healthcare that is equitably distributed among all citizens. But health indicators
show that these have had limited success in achieving equity. The two major comprehensive
government healthcare programs that have been developed in the United States are limited to
the elderly (Medicare) and the poor (Medicaid), and are of increasingly questionable quality.
Ironically, it was the creation of these two government programs in the 1960s that is said to
have helped fuel a large proportion of the inflation in medical care costs. This happened as a
result of the efforts of both for-profit and nonprofit entities that attempted to maximize
government payments for services rendered under these programs. Recent cost containment
measures used by the government to control the cost of Medicare and Medicaid have resulted
in a reduction of services for recipients and a shifting of costs to nonrecipients, and all the
while keeping profits high for the medical care industry.
There have been success stories for decades among such organizations as Families USA,
Physicians for National Health Insurance, labor unions, consumer groups, and a multitude of
state and local organizations that have been waging the battle for equitable healthcare.
HEALTHCARE EQUITY 297

However, any attempt to circumvent the power and profit of the medical care industry is
routinely met with stiff and well-funded resistance. A recent example is the insurance
industry's massive 1993 assault on President Clinton's universal healthcare plan. The proposed
Clinton plan itself fell short of any existing program in Europe, and kept the private insurance
industry in the mix. However, because the plan did not give insurance companies the ability to
exploit the public to the extent desired, they spent millions of dollars on advertising and were
able to stop any meaningful reform.
It is certain that our political and economic systems will not change in any fundamental
way in the near future. At the same time, significant reductions in inequity in healthcare appear
unlikely, based on the recent failed attempts to pass any type of federal legislation that would
bring more equitable healthcare in the near future. But change is possible. The difficulty of the
task and the societal factors involved make it imperative that clinical sociologists understand
the complexity of the structural barriers to change and are actively involved in reducing
inequity. The specific roles of clinical sociologists will be examined later in the chapter.
We now focus more directly on what has transpired historically in the area of healthcare
in the United States and highlight critical events relative to healthcare equity. It is understood
that the specific evolutionary path of the system is constantly affected by the overall political
economy as described above. It should also be noted that while we refer to the healthcare
system, many scholars are amused at the use of the term system to depict the organizational
fragmentation that characterizes healthcare delivery in the United States. Weitz (1996:328)
simply says, "the United States does not have a health care system. Rather, it has an
agglomeration of public and private health care providers functioning autonomously in myriad
and often competing ways." This lack of coordination in itself is a formula for inequity in
health care delivery as many healthcare providers are able to establish practices and facilities
that benefit them without necessarily taking community needs into account.
The following selective history of healthcare in the United States provides a necessary
backdrop to the understanding of healthcare equity and strategies for change. We will illustrate
the interaction of the four basic components: providers of care, insurers, employers, and
consumers. Providers of care is jargon for what originally included physicians and hospitals,
but has grown over the years to include all forms of healthcare facilities. Insurers of healthcare
include the major nonprofit insurer, Blue Cross and Blue Shield; commercial, for-profit
insurers; health maintenance organizations and other managed care organizations (the latest
hybrid of providers with built-in insurance systems); and federal insurance programs (Weitz,
1996). Employers are usually seen as the largest purchasers of healthcare through their
employee benefit plans, second only to government through its provision of health insurance
coverage for certain subgroups. Consumers are the fourth basic element. These four compo-
nents have been organized throughout the years to have varying amounts of influence on
healthcare activities.

History of Healthcare in the United States

Up to the early 1900s, the practice of medicine by physicians was very limited. Most
healthcare was provided within families or by other lay people. The medical care system was
very simple-physicians had direct relationships with their patients, providing care when they
were sick or in need of services. "Physicians collected their own bills, set and usually adjusted
their charges to their estimates of patients' ability to pay" (Sultz & Young, 1999:34). At that
time the doctor-patient relationship was considered sacred. This view was supported by the
298 BONNIE L. LEWIS AND F. DALE PARENT

American Medical Association (AMA), which had been in existence since 1847 to protect
physician interests. But even at that time there were efforts by insurance companies, em-
ployers, and other organizations to compromise that basic relationship. In terms of equity,
however, it still was the case that medical care was bought and sold through the market, and
those persons who did not have the resources to pay had less access to care (Brown, 1984). The
best they could rely on was the goodwill of physicians and hospitals.
By the early 1900s there were public health departments in many large cities. Business
leaders and members of the middle and upper class had begun to realize that good public health
was necessary for attracting business interests. The public health departments primarily
engaged in public health education, environmental concerns, food and water inspections,
vaccinations, screenings for disease, and a few maternal and child services. Whenever health
departments attempted to provide medical care to those unable to afford care, physicians rose
up in opposition (Duffy, 1993).
Discussion of universal health insurance began around 1915. The American Association
for Labor Legislation campaigned for some form of public health insurance between 1915 and
1918. By 1919 these efforts had ended, in part because of World War I and in part because the
AMA took an opposing position, fearing that there would be a threat to physician income and
autonomy (Young, 1984). This would be a common theme throughout the century.
It was also around that time that the U.S. government first publicly stated that it had a
responsibility to reduce healthcare inequity because of the need to serve as a "counterweight
to other powerful forces" as well as to serve as a "provider of last resort" (Kronenfeld, 1993).
It was between 1927 and 1933 that the Committee on the Cost of Medical Care, using
funds from private foundations, conducted 26 studies on the organization and financing of
medical care (Brown, 1984). They determined that low- and moderate-income people and
persons in certain geographic locales were using comparatively less hospital and physician
services (Kronenfeld, 1993). The committee also made recommendations that group practice
and voluntary health insurance be established, concluding that this would solve healthcare
problems in the United States. While this committee was chaired by a physician, and had 45 to
50 distinguished persons from medicine, healthcare, and the social sciences on the committee,
its recommendations were weakly endorsed, and a minority report of physicians condemned
the recommendations on the grounds that they would cause medical care to deteriorate due to
competition of physicians, and that the relationship of the patient and physician would suffer
(Sultz & Young, 1999). The recommendations were opposed by the AMA and never imple-
mented (Geiger, 1984).
The Great Depression led to a substantial reduction in the use of medical services and
healthcare inequities became much worse.
many working-class and middle-class persons who could afford ordinary medical expenses-
physicians' fees, prescription drugs, simple laboratory tests-were either totally impoverished by
extraordinary expenses related to hospitalization or were forced to forego such care when it was really
needed. These financial and medical problems increased the personal and social burdens of illness and
were borne individually by those afflicted unless relieved by charity, a partial solution that always
carried with it a humiliating means test. (Brown, 1984:51).

Because in large numbers Americans were now forced to reduce their use of healthcare
services, hospitals and physicians suffered drastic losses in their income. They were forced to
explore financing alternatives in order to avoid bankruptcy. Baylor University is credited with
the initiation, in 1929, of the first hospital insurance plan, which eventually was approved by
the American Hospital Association. The first premiums cost 50 cents per month, and Baylor
was able to enroll 1250 public school teachers in exchange for a guaranteed 21 days' stay in the
HEALTHCARE EQUITY 299

hospital (Sultz & Young, 1999). And while labor unions would have preferred a national health
insurance program, they helped Blue Cross grow by bargaining for employee insurance for
workers (Freund & McGuire, 1999). While Blue Cross was not a true public health insurance,
it was designed in such a way that risk was shared by many people by basing the price of
premiums on anticipated average costs of care for all persons in the community being served.
Because young and healthy people with low healthcare costs were included in the averages, it
provided a way to keep the costs down (Weitz, 1996).
Like hospitals, physicians also suffered financially from the Depression and became
more receptive to insurance plans that could increase their income without reducing their
autonomy (Sultz & Young, 1999). Blue Shield was started after Blue Cross to cover physician
expenses. Mter plans popped up across the country, the AMA decided to form the National
Association of Blue Shield Plans (Weitz, 1996). Just like Blue Cross, Blue Shield used a
community rating system to share costs of the insurance premiums. In another self-serving
maneuver on the part of hospitals and physicians, they began limited support for government
sponsored programs, encouraging a system whereby the government would reimburse or
subsidize the costs of care for those unable to afford it (Sultz & Young, 1999).
Ironically, the creation of the Blue Cross and Blue Shield insurance plans had an
unfortunate tum of events for U.S. medical history with regard to equity and health. As Brown
describes, "problems of inequities in access, impoverishment due to large medical expenses,
and unstable hospital and physician revenues called forth two distinctly different strategies,
one focused on public health insurance and the other on private insurance" (1984:51). The
United States selected the private insurance alternative, to eventually be supplemented, as the
AMA, AHA (American Hospital Association), and insurers favored, by public insurance for
those unable to afford private insurance. Almost immediately, commercial insurance com-
panies saw an opportunity for big profits. They began to skim low-risk individuals from the
community ratings pool and offer less costly premiums to people with lower risk of illness and
disease. This more and more left Blue Cross and Blue Shield with the higher risk individuals
and eventually resulted in their abandoning, many years later, the community rating system.
In 1935 the Social Security Act was passed. Young (1984) identifies this as an important
juncture in federal policy: differentiating between what was seen as the deserving and the
undeserving poor. The deserving poor, that is, deserving of federal assistance, were those who
fit defined categories of being "truly unable to work." This included the blind, disabled, aged,
dependent widows and children, and those who were, while able-bodied, truly unable to find
work. Assistance for the "undeserving poor," those who did not fit the defined categories, was
paid for by local or state government and private agencies. What emerged was two levels of
assistance: one level for the deserving poor, who received their assistance through what was
seen as social insurance earned by workers as a result of their own contributions, and the other
level for those who relied on "unearned" publicly funded assistance (Young, 1984).
At this time there were also definable efforts to provide major healthcare coverage for the
elderly. Again, the AMA saw a threat to the income of its constituency and waged successful
opposition (Kronenfeld, 1993). In terms of equity, however, the Social Security Act marked a
turning point in that now it allowed for state aid for public health and welfare, maternal and
child health, and disability services for children (Sultz & Young, 1999), thus increasing
healthcare availability to selected groups.
During the 1930s and 1940s, there was the emergence and development of early forms of
health maintenance organizations. HMOs were initially designed as single organizations that
offered healthcare to members for a fixed fee. As an alternative to a fee-based system in which
physicians were paid for each office visit, these innovative organizations paid physicians a
300 BONNIE L. LEWIS AND F. DALE PARENT

salary for treating a fixed number of patients. Also, for the first time in the United States,
physician incentives were built into the system to provide effective treatment and preventive
services (Weitz, 1996). Eventually, however, the incentive system would be found to threaten
the quality of care provided by HMOs.
There was again hope for passage of a universal healthcare bill beginning in 1945.
President Harry Truman led the effort, but the bill was defeated in 1950. The AMA again led
the campaign against it (Lassey et aI., 1997).
As a measuring stick for equity, one can look at the progress made up to this time as a
result of the insurance now available to individuals. In 1940, less than 10% of Americans had
hospital insurance. In five years, it was up to 24%, and by 1950 it was 51% (Young, 1984).
Although insurance coverage increased fivefold between 1940 and 1950, the costs to con-
sumers were still considerable.
In 1950. private health insurance paid for only 37 percent of total hospital costs and 12 percent of
physician services.... private insurance was available mainly to the middle and the upper-working
classes, that is, those covered by union- or employer-sponsored plans and those affluent enough to buy
individual insurance policies. It was becoming apparent that private health insurance would not meet
the needs of the poorly paid, nonunionized working population or their families, or those who were
very poor and unable to work-single-parent households with very young children, the blind and
disabled, and the aged. (Brown, 1984, p. 53)

Not long after World War II, the Hospital Survey and Construction Act of 1946 was
passed. This Act, referred to as the Hill-Burton Act, legislated federal funds for nonfederal
hospital construction in exchange for requiring that hospitals provide free indigent care. It also
encouraged physicians to move to rural areas, addressing some geographic barriers to access.
Hill-Burton resulted in having a major effect on improving healthcare for rural Americans
(Gesler et ai., 1992; Kronenfeld, 1993).
Finally, in 1960, public and political support had grown sufficiently to allow passage of a
limited program of healthcare for the elderly poor (Starr, 1982). The Kerr-Mills Act operated
by offering states grants to expand their services. It was not mandatory, however (Brown,
1984).
In 1964, President Lyndon B. Johnson initiated the War on Poverty. In 1965 an amend-
ment to the Public Health Service Act added the goal of reducing the leading causes of death
(heart disease, cancer, and strokes). Although regional medical programs were created, and
educational and clinical resources increased, there was little effect on the targeted causes of
death (Sultz & Young, 1999). Also occurring in 1965 was the signing into law of the Social
Security Amendments, with three important healthcare programs: Medicare, Medicaid, and
the Maternal and Child Health Program. These provided for funds to pay healthcare providers
for increased care to Americans. A fourth component, the Comprehensive Health Services
program, had even greater significance in the story of seeking equity in healthcare for all
Americans. It established funds for community health centers (CHCs), the goal of which was
to provide healthcare to the poor under a new model-for the United States-that required the
poor to be involved in decision making. Speaking even more grandly, the initial goal for CHCs
was "affect those powerful determinants of health status that lie in the economic and social
order. Health care services ... should be deliberately used as a point of entry for such broader
social change" (Geiger, 1984:13). The model was borrowed from other countries, many of
which had to deal with extreme poverty.
The 1960s and 1970s were a time when much attention was being paid to poverty and civil
rights, and publicity focused on healthcare inequities of the poor, the elderly, and minorities.
Although there were major problems for CHCs, most notable being inadequate funding, they
HEALTHCARE EQUITY 301

were found to have a positive impact on equity. By the early 1980s, there were about 800
clinics which served many individuals, impacted infant mortality, and reduced hospitalization
for their target population (Geiger, 1984).2
The 1960s and 1970s also represented a short time in U.S. history when healthcare was
beginning to be seen as a right, not a privilege. Unions were active in promoting health
benefits, and there was rapid growth in the healthcare labor force. There was investment by the
government in hospital construction and renovations. It also should be noted that Medicare
and Medicaid linked federal dollars with a fee-based healthcare system, thus firmly establish-
ing the market model for healthcare, both the private and public insurance (except Medicaid)
being employer-based systems. Hospitals at that time remained predominantly nonprofit
(Young, 1984).
The early 1970s were also a time of renewed interest in compulsory health insurance.
Nationally, costs were high, as were concerns for access. It was believed that legislation would
finally be passed for insurance coverage for all Americans, with employers being required to
provide insurance for the employed and the government providing a mechanism for the
unemployed. The Watergate crisis, however, attracted most of the public's attention, prevent-
ing passage of any health legislation (Kronenfeld, 1993).
The Health Maintenance Organization (HMO) Act of 1973 provided for funds to be
allocated for demonstration projects. It was hoped that they could provide higher quality
healthcare and curb costs by providing less expensive healthcare, using salaried physicians
and preventive techniques, such as required yearly examinations, along with regular curative
health services.
In 1974 the National Health Planning and Resource Development Act created the Health
Systems Agency (Sultz & Young, 1999) to attempt to promote the involvement of consumers
and providers in health planning by mandating their presence on governing boards and
committees, so that duplication of services could be avoided. The boards were not representa-
tive of all interest groups, however, and failed in its mission because too often the board
members acted in their own interests (Sultz & Young, 1999).
During the Carter era (1976-1980) there was again a strong interest in universal coverage.
However, controlling inflation began to dominate Carter's efforts, and universal coverage
again never occurred (Kronenfeld, 1993).
The 1980s were characterized by continued, and even greater, concerns about rising costs
than during the 1970s. It became widely known that U.S. healthcare expenditures were
extremely high relative to those of other countries. This concern coincided with the term of
President Ronald Reagan, who was elected in 1980. He simultaneously argued for increasing
competitionamong healthcare providers along with leading a major front against government
programs (Kronenfeld, 1993).
On the other hand, it was during Reagan's first term that the President's Commission for
the Study of Ethical Problems was formed. It stated that everyone in the United States had a
societal right to equitable access to healthcare because of the role of healthcare in the
maintenance of a high quality of life. At the same time, however, individuals were expected to
share in the responsibility for their care. A definition was formulated for what equity was, that
everyone should have "access to a standard level of care without incurring excessive burdens"
(Kronenfeld, 1993:137). The Commission's expectation was that solutions to the problem
would flow from joint government and private efforts.

2By 1999, there would be more than 900 clinics, operating at 2500 sites throughout the country (National Association
of Community Health Centers, Inc., no date).
302 BONNIE L. LEWIS AND F. DALE PARENT

The Health People initiative was an important activity that began in 1979 with a clear
population-based strategy for addressing problems in healthcare. This approach recognizes
that the good health of a nation is a result of more than just medical care. Part of this initiative
established the Office of Health Promotion and Disease Prevention. In 1980, the first Healthy
People 1990 objectives came out, to be updated twice, once for the year 2000 and currently for
2010. While a weakness in the Healthy People initiative is that clear strategies have not
accompanied the objectives, there have been some positive results (Aday et ai., 1998).
The 1990s have been noteworthy for an ever-increasing wave of "market oriented
changes, competition, and privately organized managed care organizations" (Sultz & Young,
1999:3). By the time of the election of President Clinton in 1992, healthcare was back on the
national political agenda. In 1993, President Clinton named Hillary Rodham Clinton to chair a
task force to examine healthcare issues. The staff then developed a plan based on six principles
(security, savings, simplicity, choice, quality, and responsibility) so that all Americans would
be guaranteed healthcare. (Blendon et at., 1999). The plan was never implemented (Navarro,
1995).
Little significant federal legislation has passed since then. The Healthcare Access,
Portability, and Renewability Act of 1996 was important for providing for continued coverage
after job loss and limiting exclusions due to preexisting conditions, health status, medical
conditions, or loss of eligibility for group coverage. Also, special enrollment periods were
provided for people with changes in family composition or employment (Sultz & Young,
1999). In 1998, the Children's Health Insurance Program expanded coverage to children not
eligible for Medicaid and in families that could not afford private insurance (Mooney et at.,
2000).
Since then, instead of federal activity, various types of reform have been attempted, with
some success, at the state level. In general, the foci of these plans, to varying degrees, are on
increasing public coverage of persons without insurance, altering benefit structures (although
in some cases, these have led to reduced, rather than increased, benefits), increasing mandated
or voluntary private coverage, containing costs through budgeting and spending restrictions,
using managed care options, and improving quality through a variety of mechanisms (Aday et
at., 1998).

SCOPE OF THE PROBLEM

In this section we selectively describe major research findings related to health and
healthcare inequities.

Social Indicators

The primary indicators used to study healthcare equity can be organized under the
broader concepts of health status, access to care, utilization of services, and barriers to care.
Health status includes such factors as life expectancy, mortality rates, occurrence of
disease and illness, and self-reported descriptions of health. Healthcare access includes such
indicators as whether individuals have a usual source of care, whether a physician or other
provider was seen when needed, or the extent of delays encountered in obtaining needed
healthcare. While not a direct measure of health, studying the barriers to healthcare is also
important in understanding how to eliminate inequities. Frequently studied barriers include
HEALTHCARE EQUITY 303

such factors as cost, availability of insurance, transportation or childcare availability, and

characteristics of provider services, such as physician/clinic hours and waiting time. Because
healthcare in the United States is primarily an insurance and employer-based system, the study
of the extent to which people are employed or have insurance is important. Finally, because
there are many non-healthcare factors that affect health status, broader structural characteris-
tics, such as environmental problems, access to high quality education, the socioeconomic
status of the broader community, and the income inequality among members of a society, are
also important.
Healthcare equity is the just distribution of health and healthcare among members of a
population. Inequities will therefore be examined along income lines, race and ethnicity,
gender, education, and age.

How Many Affected

Health Status

The gap in life expectancy for Mrican-Americans and whites in the United States has
been closing in recent years, but highly significant disparities remain. In 1996, the life
expectancy for blacks was 70.3 and for whites it was 76.1. In 1997, white females had the
highest life expectancy at birth (79.9), followed by black females (74.7), white males (74.3),
and then black males (67.2) (Hoyert et ai., 1999). Lower life expectancy among blacks is
reflected in the fact that blacks have a higher infant mortality rate and a higher prevalence of
many life threatening ailments and injuries as compared with whites.
Infant mortality is frequently a primary indicator of a nation's health status. The infant
mortality rate (the number of infant deaths under the age of 1 year per 1000 live births) has
dropped steadily in the past few decades and in 1997 was 7.2, a record low for the United
States. However, we still do not rank well among industrial nations in the world. In addition,
the variation among the racial and ethnic groups in the United States is a cause for great
concern. The 1997 infant mortality rate for blacks, at 14.2, is more than twice that of whites, at
6.0 (Hoyert et at., 1999). The overall death rate among Hispanic infants is 7.6, with the rate
among Puerto Ricans substantially higher, at 8.9 (National Center for Health Statistics, 1998).
The death rate from heart disease is nearly one and a half times higher for black males
than for white males. Black females die from heart disease at a rate is more than one and a half
times higher than their white counterparts. Mortality from stroke is 80% higher among the
black population than the white population. Deaths due to cancer also remain significantly
higher for blacks than for whites (National Center for Health Statistics, 1998). Partial explana-
tion for the disparity in cancer rates is "that Blacks (and Latinos) are more likely to be
diagnosed with cancer in its later stages, making survival less likely. This, of course, is not
because of race per se but because of the greater likelihood of Blacks and Latinos to be poor
and without adequate medical insurance" (Eitzen & Baca Zinn, 1997:432). Racial differences
in deaths from AIDS are most dramatic. While between 1995 and 1996 there was a decrease of
6% in reported AIDS cases among all persons, the rate for non-Hispanic black females 13
years and over increased by 6%. HIV infection causes deaths among black males at a rate
quadruple that of white males. The rate for black females in 10 times that for white females
(National Center for Health Statistics, 1998).
While the discrepancies in health status among racial and ethnic groups are revealing, a
significant portion of the variation can probably be attributed to social class. "How people
304 BONNIE L. LEWIS AND F. DALE PARENT

live, get sick, and die depends not only on their race and gender, but primarily on the class to
which they belong" (Navarro, 1991:2). Members of the lower classes have less access to high-
quality healthcare, and are more likely to live in areas that are polluted; they have inadequate
housing, labor under poor working conditions, and have poorer diets, compared with those
with greater financial resources. A brief look at recent poverty statistics illustrates why this
situation is such a problem for many ethnic minorities. In 1996 the overall poverty rate in the
United States was 13.7%. For whites the rate was 11.2 followed by Asian or Pacific Islanders
(14.5%), blacks (28.4%) and Hispanics (29.4%) (National Center for Health Statistics, 1998).
The United States has more wealth, more income inequality, and more poverty than
almost any other Western nation. The gap between the rich and the poor has been growing for
the last two decades (Atkinson et at., 1995; Hacker, 1997).
This country also has some of the highest poverty rates among industrial nations. There is
a clear correlation between health status and social class position. Those with fewer resources
suffer the poorest health while those with the most wealth, power, and prestige experience the
best health in society. "Among persons 25-64 years of age, death rates for chronic diseases,
communicable diseases and injuries are all inversely related to education for men and
women.... Adults with low incomes are far more likely than those with higher incomes to
report fair to poor health status" (National Center for Health Statistics, 1998:6).
Overall, since the 1960s there has been a widening of the differences in mortality rates
between upper and lower social classes (Kennedy et at., 1996). The negative impact of poverty
on mortality rates is now a well documented fact (Hahn et at., 1996). There is also a clear
relationship between life expectancy and family income, with individuals from higher income
families experiencing a greater life expectancy than those at lower income levels (National
Center for Health Statistics, 1998).
Recent evidence also demonstrates that the distribution of income within society may
have an impact on the health of individuals independent of the direct effect of an individual's
social status on his or her health. It appears that the more overall income inequality there is in a
community, the lower the health status of individuals within that community.
The effects of inequality on health may be mediated by under-investment in social goods, such as
public education and health care; disruption of social cohesion and the erosion of social capital; and the
hannful psychosocial effects of invidious social comparisons" (Kawachi & Kennedy, 1999:215).

Poor families are significantly more likely to give birth to babies who are premature, of
low birth weight, with stunted growth, iron deficiencies, auditory or visual impairments, or
suffering from pneumonia or other serious physical or mental disabilities (Sherman, 1997).
Low-birth-weight infants are most commonly found among the least educated mothers (Na-
tional Center for Health Statistics, 1998).

Access to and Utilization of Healthcare

Using data from the 1996 Medical Expenditure Panel Study, the Agency for Health Care
Policy and Research (1997:9) found that
Nearly 13 million of the roughly no million families in the United States-11.6 percent of all
families-said they experienced difficulty or delays in obtaining medical care or did not get the care
they needed during 1996.... The most common barrier, experienced by 7.6 million families or about 60
percent of all those reporting difficulty with access, was not being able to afford the care they needed.

Of those who did not receive the care needed, 19.5% said it was due to insurance problems
such as not having the insurance benefits for the type of care needed or using physicians who
would not accept insurance as payment for care. Other reasons cited were unavailability of
HEALTHCARE EQUITY 305

transportation or childcare. This study also looked at the access problems of persons who were
uninsured. Of these, 27% were found to be at substantially higher risk of encountering barriers
to care (Agency for Healthcare Policy and Research, 1997).
African-Americans also reported greater difficulty than whites in obtaining healthcare
services. Financial difficulty and lack of insurance were the primary reasons given by African-
American respondents. In addition to lacking full access to healthcare, African-Americans are
also much more likely than whites to encounter barriers to education. This is important
because better education typically leads to higher quality jobs and therefore improves access to
health insurance (Blendon et at., 1995). The education link becomes even more critical when
one looks at, as Ross and Wu did (1996), the trends in the link between health and education.
They found that when looking at self-reported health, physical functioning, and physical well-
being, the differences between those with higher and lower educations become greater as
individuals age. This finding was not explained by income. The advantage of higher income
also was found to increase with age (Ross & Wu, 1996).
Besides difficulty in obtaining timely medical care, another indicator frequently used to
measure access is whether individuals have a usual source of healthcare. In this case,
according to Zuvekas and Weinick (1999), 46 million of the noninstitutionalized civilian
population fit this definition, or almost 18% of all Americans. They also found that this had not
changed substantially over a 20-year time span. However, there were significant changes for
certain subgroups. Among Hispanics they found the greatest increase in the percentage of
persons without a usual source of care. This increased from a base in 1977 of 19.7% to 28.0% in
1987, and on to 29.6% in 1996. Other research (Agency for Healthcare Policy and Research,
1997) validates the problems for Hispanics, finding, as compared with whites and blacks, that
Hispanic families experienced the greatest barriers to care, the predominant reason being cost.
Zuvekas and Weinick (1999) also reported disparities by age and insurance status. The
likelihood of young adults, aged 18-24, to not have a usual source of care increased from a
base of 21. %, to 29.6% 10 years later, and finally, to a current rate of34% as of 1996. Among
the uninsured, the percentage of persons without a usual source of care increased from 25.5%
in 1977, to 34.2% in 1987, ending in 1996 with 38.%.
Mueller et at. (1998) conducted a more complex analysis, measuring access as the
probability of having had a physician visit in the previous year. They looked at variation based
on ethnicity and geographic location (rural or urban) and controlled for both health status (self-
reported as excellent, very good, good, fair, or poor) and health condition (acute or chronic).
They also controlled for income, family size, age, and education in their analysis. They found
that the greatest predictor of whether people visited a physician in the previous year was
whether or not they had any form of insurance. People who did not have insurance of any kind
were 60% less likely to have visited a physician. They also found that rural Latinos and rural
Asians were least likely to have had a physician visit. Those most likely to see a physician, on
the other hand, were white persons living in urban areas. Rural Latinos had a 70% greater
likelihood of not seeing a physician, and rural Asians/other were 60% more likely to not see a
physician. Lastly, Mueller et at. (1998) found regional variation: People in the Northeast were
most likely to see a physician; people in the South were least likely.

Social Cost

The above indicators of inequity in healthcare and health status represent great social cost
to Americans. When people delay care, it is clearly documented that they are sick longer, miss
more work, and lose valuable household income. Persons of marginal health status must face
306 BONNIE L. LEWIS AND F. DALE PARENT

compromises in their quality of life, affecting those around them as well. Inequities in a society
hurt those better off as well.
A strong case can be made that a more equal distribution of health care and health resources contributes
to greater overall health status of the population. Several countries have demonstrated that a healthy
population appears to be more productive (notably Sweden, the Netherlands, and Japan). There is also
strong evidence that the highest per capita costs are associated with: lower income individuals who do
not have access to good public health services or primary healthcare and contract acute problems that
might have been prevented; and, the older population who contract chronic diseases that demand
constant and expensive care, much of which also could have been minimized or avoided with adequate
public health and primary care at younger ages. (Lassey et al., 1997:352).

CURRENT PERSPECTIVES ON THE PROBLEM

OF HEALTHCARE EQUITY

How the Problem Is Presently Understood

In general, the problem of healthcare equity is viewed almost exclusively-among

laypersons and professionals alike-as an access to medical care problem. And, to a large
degree, the concern is not with equity at all, but rather with providing a minimum standard of
care for those at the bottom of the social class structure. A multitiered system of medical care is
firmly entrenched in the United States and seems to be accepted as a solution by the majority of
policymakers. A minimum level of services are to be made available to members of the lowest
tier. In addition, the medical model, and its emphasis on curative procedures rather than
preventive healthcare, provides the primary avenue to an appropriate level of healthcare.
Broader social, economic, and environmental factors that can affect healthcare are given much
less attention. In fact, policy debates rarely go beyond the discussion of "the pro's and con's of
competing proposals for extending public or private health insurance coverage" (Aday,
1993:724). Even within this limited conception of equity, cost containment is seen as the
overriding problem, with issues of equity a distant second concern.
However, earlier we stated that the specific problem of health and healthcare inequity,
and more broadly, general inequity in the United States, results primarily from the strength and
dominance of both laissez-faire economics and our cultural emphasis on individualism.
Expanding on this idea, a greater depth of understanding of the issue of health and individual-
ism is offered by Aday et al. (1998). They maintain that a distributive justice paradigm, with its
emphasis on personal well-being and the maintenance of individual rights and freedom, has
served as the core to our current system. The dominance of this paradigm has caused difficulty
in allowing for alternate solutions for healthcare problems to emerge. The idea of distributive
justice is summed up by the egoistic question that underlies demands on the healthcare system:
"What can I justly claim?"
This reliance on distributive justice has benefited segments of the population. Those with
access to resources have been able to maximize their health and healthcare benefits. Today in
the design of any healthcare system or subsystem, there is an emphasis on maintaining
consumer choice and stressing the personal responsibility persons must assume for their
health. However, this emphasis has led to excessive costs (many tests, unnecessary care), and
more importantly, a lack of concern for the equitable distribution of good health. What has
been neglected is a different view of the equity issue, one that emphasizes the broader social
issues that affect health-such as reducing poverty, maintaining a clean environment, elim-
inating the effects of racism, and making the workplace safe-one that recognizes the
importance of public health and preventive care. Aday et al. (1998) refer to this alternate view
as the social justice paradigm-in which the question asked is: "Whats goodfor us?"
HEALTHCARE EQUITY 307

Shortell et at. (1996) offer an important view from a healthcare management perspective
on how the problems in the healthcare system in general, and indirectly that of equity, can be
viewed. They suggest we must move to a new model in which integrated healthcare delivery
systems address broader issues of community health and well-being. For this to happen, they
suggest that we need to eliminate the fragmentation that currently exists, we need to develop a
sense of the critical importance of community involvement, we must provide the skills needed
for operating community-based healthcare management systems, and we must establish local
and national health policies that support this new orientation.
Further, they discuss how the motivations for involvement by the community must be
made clear. To do this, an image of a system must be created that addresses the interests of all
those involved and also requires everyone's involvement for its achievement. They believe
this involvement can lead to full collaboration and learning only if solid leadership is
developed, win/win situations are promoted, and individuals, groups, and organizations are
honest and open about each other's shortcomings. It must be understood, however, that
community involvement must not be taken for granted, requiring daily renewal in an endless
process of tending to issues that arise (Shortell et at., 1996). As a final, but paramount, point,
the importance of community involvement is a major component of the Aday et at. (1998)
solutions to inequity. They talk about what they have labeled the deliberative justice para-
digm, for which the question to be address is: "Who decides and how?"

What Has Been Tried to Deal with Equity, What Works, What Does
Not Work

In essence, the attempts historically to reduce inequity in health and healthcare in the
United States have consisted of occasional governmental statements accepting responsibility
for the problem and the establishment of government programs, of which none have ap-
proached universal coverage. Many of the programs still in place are large and expensive and
have impacted sizable segments of the population (e.g., Medicare, Medicaid, Community
Health Centers, and programs and legislative acts passed to increase providers and facilities).
What has not been tried is some type of a comprehensive, government sponsored, universal
healthcare program. The United States has had a long history of tinkering with the provision of
healthcare, but has yet to overhaul the system in such a way that would begin to make an
equitable distribution of health and healthcare possible. There is a need for a national health-
care system that is integrated into a larger comprehensive system of social welfare and that
addresses the myriad of factors-poverty, environmental problems, racism, sexism-that
affect health and well-being. Despite rhetoric from the conservative right, evidence reveals
that well-funded government programs aimed at reducing inequity in general and healthcare in
specific usually work. This is true for programs both in our own country and in other
industrialized nations. What does not work in promoting equity is a minimally regulated
profit-oriented system.

WHAT ARE THE SOCIOLOGICAL DILEMMAS AND PRACTICE

ISSUES RELATED TO HEALTHCARE EQUITy?3

It is our conclusion that the only meaningful solution to the healthcare equity problem in
the United States is a radical change in our current healthcare system to some type of

3A portion of this section draws directly form Lewis and Parent (1993).
308 BONNIE L. LEWIS AND F. DALE PARENT

government-sponsored universal system. Ideally this would be part of a larger comprehensive

social welfare system designed to reduce inequities throughout society and provide a high-
quality standard ofliving for all Americans. The latter goal, unfortunately, is wildly naive. The
last two decades have witnessed a retrenchment of government involvement and a movement
toward even greater reliance on the market to provide social services. This same trend is taking
place in most European countries, although those governments remain much more committed
to the provision of social benefits to their citizens than is found in this country (Blau, 1999).
Although this type of extensive social change may be beyond reach at this time, it is our belief
that even within the current privatization trajectory, the promotion of a national healthcare
system is still possible. The dilemma, of course, for clinical sociologists is that the goal of
national healthcare runs counter to the interests of the most powerful segments of society. But
recent American history tells us that this type of radical change is possible. The civil rights and
the women's movement are two clear examples of major social change in this century. The
United States appeared to be on the verge of establishing a national healthcare program in the
early 1990s, or at least the topic was given legitimate debate. However, opponents dug in their
heels and ended most discussion. It is our role, as clinical sociologists, to rekindle this flame.
Healthcare appears to be one area in which the strong cultural bias toward individualism and
limited government involvement can be penetrated. Although there is much debate about the
meaning of national polls taken on the issue, since the 1940s a national healthcare system has
appeared to be much more palatable to U.S. citizens than many other types of massive
government-sponsored social programs. It should be noted, however, that support for national
healthcare has waned significantly in the past few years (Blendon et aI., 1999). But support had
lasted well into the 1990s, when the public was otherwise supporting the reduction of social
programs. This gives some hope that the issue can be revived. Also, a slight downturn in the
economy, which is inevitable (Blau, 1999), will most certainly refocus the public's attention to
healthcare reform.
What can clinical sociologists do to contribute to the realization of a fair and just health
system in the United States? First, we must remind ourselves that as clinical sociologists our
goal is to initiate social change and not to simply act as detached evaluators of the problem.
Second, we must convey to others that, as sociologists, we are capable of making the most
comprehensive analysis of society, one that includes the healthcare system, its relationship
with other institutions and individuals, and the forces that make social change possible.
Compared with many of our counterparts in the social and natural sciences (i.e., economists,
psychologists, political scientists, physicians), we do not command instant credibility. Instead,
often it is something we must earn. Third, and this helps with establishing credibility, it is our
task to collect accurate and valid information that clearly illuminates all relevant aspects of a
problem and establishes the ground work for needed change. It is also important that we are
able to articulate workable solutions. Finally, we must work to disseminate our knowledge so
that it ultimately influences the policymakers who have the power to make the needed changes.

Level of Intervention

When we tum to Straus's (1984) scheme of sociological intervention, it is apparent that

these types of efforts are most directly concentrated at the "organizational level" ofparticipa-
tion. The organizational level contains such entities as communities and governments. This is
the second highest level at which sociologists can intervene, the "world level" being the
highest. The organizational level is preceded by the group and personal levels. Since each level
HEALTHCARE EQUITY 309

of social structure is an emergent product of the preceding structures, intervention at the

organizational level can be very complex (Straus, 1984). Therefore, even a simple intervention
model is difficult to develop. However, there are some basic intervention strategies we can
suggest.
The only place we have seen movement toward establishing universal healthcare in the
United States is at the state level. While maintaining the private insurance system for those
who choose it, Florida, Hawaii, Minnesota, Oregon, and Tennessee are closest to universal
coverage in their attempts to establish programs that would allow coverage of all citizens in
single public programs (Aday et ai., 1998). Even now, it can still be hoped that the United
States remains in the infancy of a movement that began in a similar fashion for Canadians and
that led to their national healthcare system. The Canadian movement began at the provincial
(state) level. The activity at the state level provides an excellent opportunity for sociologists to
contribute to policy formation without needing to have direct impact at the national level.
In developing any strategy for promoting such change, sociologists must promote the
benefits of such a system for all citizens. There must be a deliberate effort to define the
"benefiting group" so that it incorporates as many people as possible. Much ofthe discussion
concerning healthcare reform during the last two decades emphasized the problems of the poor
and uninsured. While their problems are acute and must be addressed, a program directed
toward all citizens has the most potential of being accepted and supported by a broad spectrum
of the population and therefore beneficial to the poor and uninsured.

Intervention Strategies

Intervention strategies by sociologists to influence government healthcare policy can be

used to shape public opinion and motivate citizen action to demand change, or to influence
government officials through personal contact. In either case, one important first step is to
provide high-quality, locally based data. In this way both the public and government officials
are made aware of the current state of the healthcare system and local citizens' attitudes.
The local media provide an excellent avenue to inform citizens and promote citizen
action. However, sociologists must be aggressive in their pursuit of media coverage. Typically,
newspeople do not seek out sociologists as they do other experts to address issues. Sociologists
quite often must "knock on doors" and make targeted phone calls to get their information
reported in the press. It is a good idea to establish a good working relationship with individual
reporters, as they are often the key to whether a story is printed or receives air time. Again,
though delivering high-quality research and information is imperative. Newspeople have
become much more sophisticated in their ability to assess the quality of social science research
and editors will want evidence of sound research procedures. Sociologists rarely consider
releasing their findings to the press. They most often think in terms of preparing results of their
research and analysis for publication in professional journals. While this is important, in order
to have a direct impact on public opinion, we must go through their sources of information.
Good media coverage not only stimulates interest in healthcare issues, but also adds to the
credibility of the researchers. This becomes an asset in and of itself. Political scientists have
had influence in policy affairs for years because of their willingness to address the public.
Another way to intervene in shaping public opinion and stimulating citizen action is by
working with existing community organizations (Rubin & Rubin, 1986). The universal con-
cern for improved healthcare should make almost any organization a potential partner in an
effort to change the system. Local groups frequently want speakers who are knowledgeable on
310 BONNIE L. LEWIS AND F. DALE PARENT

subjects to speak at their meetings. Brief, carefully constructed talks could be prepared and
presented to many local groups explaining the problems of our current system and offering
thoughtful solutions, stressing the benefits of reform for all. By working with a cross section of
organizations, any stigma associated with one group or another is avoided. Probably one of the
most fruitful ways of promoting reform is working with organizations already mobilized to
address the healthcare issue. Involvement in such groups can be beneficial in two ways. First,
the sociologist can contribute his or her expertise to the group. Second, active participation in
such an organization can be a source of valuable information. While this information often
contains bias, as sociologists we are well trained to evaluate its validity.
Finally, when sociologists have direct communication with public officials, they work
with people who will actually make the critical decisions concerning healthcare reform.
Accurate information about the problems and sound solutions are of course crucial. But
because many decisions include political considerations, sociologists wishing to engage in
such a cooperative effort with government officials should make it clear early on that this issue
does not need to be infused with the typical social group divisions, making it easier for them to
comfortably support what may seem to be extreme policy changes.

REFERENCES

Aday, L. (1993). Equity, accessibility. and ethical issues: Is the U.S. health care reform debate asking the right
questions American Behavioral Scientist, 36(6), 724-740.
Aday, L., Begley, C. E., Lairson, D. R., & Slater, C. H. (1998). Evaluating the healthcare system: Effectiveness,
efficiency, and equity. Chicago: Health Administration Press.
Agency for Health Care Policy and Research. (1997). Access to care. Research Activities, 210(November), 9.
Anderson, G. E, & Poullier, J.-P. (1999. Health spending, access, and outcomes: Trends in industrialized countries.
Health Affairs, 18(3), 178-192.
Atkinson, A. 8., Rainwater, L., & Smeeding, T. M. (1995). Income distribution in OEeD countries. Evidence from the
Luxembourg Income Study. Paris: Organization for Economic Co-operation and Development.
Blau, J. (1999). Illusions ofprosperity: America's working families in an age ofeconomic insecurity. London: Oxford
University Press.
B1endon, R. J. (1993). Introduction (pp. 1-14). In A new deal for American health care by R. M. Soriano New York:
Faulkner & Gray.
Blendon, R. 1., Scheck, A. C., Donelan, K., Hill, C. A., Smith, M., Beatrice, D., & Altman, D. (1995). How white and
African Americans view their health and social problems; different experiences, different expectations. Journal
of the American Medical Association, 273, 341-346.
Blendon, R. J., Benson, J. M., Brodie, M., Altman, D. E., James, M., & Hugick, L. (1999). Voters and health care in the
1998 election. Journal of the American Medial Association, 282, 189.
Brown, E. R. (1984). Medicare and Medicaid: Band-aids for the old and poor. In V. W. Sidel & R. Sidel (Eds.),
Reforming medicine: Lessons of the last quarter century (pp. 50-78). New York: Pantheon Books.
Duffy, J. (1993). From humors to medical science: A history of American medicine. Urbana: University of Illinois
Press.
Eitzen, S., & Zinn, M. 8. (1997). Social problems (7th ed.). Boston: Allyn & Bacon.
Folland, S., Goodman, A. C., & Stano, M. (1997). The economics of health and health care (2nd ed.). Englewood
Cliffs, NJ: Prentice-Hall.
Freund, P., & McGuire, M. (1999). Health illness and the social body (3rd ed.). Englewood Cliffs, NJ: Prentice-Hall.
Funkhooser, S. W., & Moser, D. K. (1990). Is health care racist? Advances in Nursing Science, 12(2), 47-55.
Geiger, H. (1984). Community health centers: Health care as an instrument of social change. In V. W. Sidel & R. Sidel
(Eds.), Reforming medicine: Lessons of the last quarter century (pp. 11-32). New York: Pantheon Books.
Gesler, W. M., Hartwell, S., Ricketts, T. c., & Rosenberg, M. W. (1992). Introduction. In W. M. Gesler & T. C. Ricketts
(Eds.), Health in rural North America: The geography of health care services and delivery (pp. 1-24). New
Brunswick: Rutgers University Press.
Gilson, L. (1998). In defence and pursuit of equity. Social Science and Medicine, 47(12), 1891-1896.
HEALTHCARE EQUITY 311

Hacker, A. (1997). Money: Who has how much and why. New York: Scribner's.
Hahn, R. A., Eaker, E. D., Barker, N. D., Teutsch, S. M., Sosniak, W. A., & Krieger, N. (1996). Poverty and health in
the United States. International Journal of Health Services, 26, 673-690.
Hoyert, D. L., Kochanek, K. D., & Murphy, S. L. (1999). National vital statistics reports. Deaths: Final data for 1997,
Vol. 47, No. 19. Washington, DC: National Center for Health Statistics.
Kawachi, I., & Kennedy, B. P. (1999). Income inequality and health: Pathways and mechanisms. Health Services
Research, 34(1, Pt. 2), 215-227.
Kennedy, B. P., Kawachi, I., & Prothrow-Stith, D. (1996). Income distribution and mortality: Cross-sectional
ecological study of the Robin Hood Index in the United States. British Medical Journal, 312, 1004-1007.
Kronenfeld, J. J. (1993). Controversial issues in health care policy. Thousand Oaks, CA: Sage.
Lassey, M. L., Lassey, W. R., & Jinks, M. J. (1997). Health care systems around the world: Characteristics, issues,
reforms. Englewood Cliffs, NJ: Prentice-Hall.
Lewis, B. L., & Parent, F. D. (1993). Government sponsored health care: A cluster profile of supporters and
nonsupporters. Clinical Sociology Review, 11, 142-158.
Miringoff, M., & Miringoff, M.-L. (1999). The social health of the nation. London: Oxford University Press.
Mooney, L. A., Knox, D., & Schacht, C. (2000). Understanding social problems (2nd ed.). Belmont, CA: Wadsworth.
Mueller, K. J., PatH, K., & Boilesen, E. (1998). The role of uninsurance and race in healthcare utilization by rural
minorities. Health Services Research, 33(3), 597-610.
National Association of Community Health Centers, Inc. 1330 New Hampshire Avenue, NW Suite 122, Washington,
DC 20036. (n.d.). www.nachc.com.Printed 8/16/99.
National Center for Health Statistics. (1998). Health, United States, 1998 with socioeconomic status and health
chartbook. Hyattsville, MD.
Navarro, V. (1991). Class and race: Life and death situations. Monthly Review, 43 (September), 1-13.
Navarro, V. (1995). Why Congress did not enact health care reform. Journal ofHealth Politics, Policy and Law, 20(2),
455-462.
Pereira, J. (1993). What does equity in health mean? Journal of Social Policy, 22(1), 19-48.
Rellman, A. S. (1980). The new medical-industrial complex. New England Journal of Medicine, 303, 963-970.
Ross, C. E., & Wu, C.-L. (1996). Education, age, and the cumulative advantage in health. The Journal ofHealth and
Social Behavior, 37(1), 104-120.
Rubin, H. J., & Rubin, I. (1986). Community organizing and development. Columbus, OH: Merrill.
Sherman, A. (1997). Poverty matters: The cost of child poverty in America. Washington: Children's Defense Fund.
Shortell, S. M., Gillies, R. R., Anderson, D. A., Erickson, K. M., & Mitchell, J. B. (1996). Remaking health care in
America: Building organized delivery systems. San Francisco: Jossey-Bass.
Smith, S., Heffler, S., Freeland, M., & the National Health Expenditures Projection Team. (1999). The next decade of
health spending: A new outlook. Health Affairs, 18(4), 86-95.
Starr, P. (1982). The social transformation of American medicine. New York: Basic Books.
Straus, R. A. (1984). Changing the definition of the situation: Toward a theory of sociological intervention. Clinical
Sociology Review, 2, 51-63.
Sultz, H. A., & Young, K. M. (1999). Health care USA: Understanding its organization and delivery. Gaithersburg,
MD: Aspen Publishers.
Weitz, R. (1996). The sociology of health, illness, and health care: A critical approach. Belmont, CA: Wadsworth.
Young, Q. (1984). The urban hospital: Inequity, high tech, and low performance. In V. W. Sidel & R. Sidel (Eds.),
Reforming medicine: Lessons of the last quarter century (pp. 33-49). New York: Pantheon Books.
Zuvekas, S. H., & Weinick, R. M. (1999). Changes in access to care, 1977-1996: The role of health insurance. Health
Services Research, 34(1), 271-280.
 CHAPTER 16

Domestic Violence
BARBARA SIMS

The Department of Public Safety is having a hard

time giving away federal money. Almost $300,000 of a
grant to combat crimes against women was not
awarded last year.
Kennebec Journal, Augusta, ME, June 5, 1998

The $300,000 in grant money mentioned in this opening quote from a local paper refers to
funds available to communities for addressing the issue of domestic violence. The article goes
on to say that "the unclaimed funds are part of $989,000 the Department of Public Safety
(Maine) received through a federal program known as STOP Violence Against Women," with
STOP being an acronym for Services, Training, Officers, and Prosecutors. A director of the
community Family Violence Project is quoted as saying, "It is important that the money be
used to get all the service providers in a community working together." Evidently, in several
Maine communities, the availability of funds for domestic violence intervention programming
under STOP grants was not well known. For that reason, a campaign by the Department of
Public Safety was launched through which those communities could be made aware of such
funds. I
The problem of domestic violence in the United States is widespread, and a variety of
approaches to the problem have been implemented over the last three decades. The overall
goal of this chapter is to discuss the issue of domestic violence within a social problem
framework. It is within such a framework that discussions of the social consequences of
domestic violence, and intervention programs that have been used to reduce those conse-
quences, can progress. The chapter begins with (1) an overview of the problem of domestic
violence in the United States, (2) a discussion of current perspectives on domestic violence,
and (3) a discussion of the individual and social consequences of domestic violence. The focus
then changes to a discussion of several different approaches to the problem of domestic
violence, beginning with the legislative approach and the Violence Against Women Act of
1994. Other intervention programs are then discussed, including one in which the author is
ISTOP grants utilize federal monies that have funneled through various state agencies. In the State of Maine, it appears
that the Department of Public Safety serves in that capacity.

BARBARA SIMS· School of Public Affairs, Penn State Harrisburg, Middletown, Pennsylvania 17057.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

313
314 BARBARA SIMS

involved both as a concerned citizen and as a social scientist. The chapter concludes with a
look at the future of domestic violence intervention programs and the role that clinical
sociologists might play in that future.

SCOPE OF THE PROBLEM

The facts are undisputed. Violence against women is widespread in the United States.
Battering, defined by Campbell and Humphreys (1993) as repeated physical and/or sexual
assault by an intimate partner within a context of coercive control, is the subject of this chapter,
and will be discussed within the context of intervention programs designed to address this
particular social problem. It should be noted at the outset that the terms domestic violence and
battering will be used interchangeably throughout the chapter. Consider the definition of
domestic violence listed in the Arlington County Victims of Violence, Volunteer Training
Manual: a systematic infliction of physical, emotional, and economic terror resulting in the
erosion of a woman's self-esteem and her ability to lead a productive life. These two
definitions are not dissimilar, and both are equally distributed in the literature on the subject. 2
In a 1995-1996 national telephone survey, sponsored by the Nil and the Centers for
Disease Control and Prevention, respondents reported (1) physical assaults experienced as
children by adult caretakers, (2) physical assaults experienced as adults by any type of
perpetrator, and (3) forcible rape or stalking experienced at any time in their life by any type of
perpetrator. Eighteen percent of female victims reported being raped, 52% reported being the
victim of physical assault, and 55% reported being the victim of both a rape and a physical
assault. Significant differences were found for race/ethnicity, with Black/African-American
women reporting a higher incidence in all categories than their white counterparts (Tjaden &
Thoennes, 1998).
Other studies on domestic violence reveal that 4.4 million adult women in the United
States are abused every year by a spouse or partner (Plichta, 1996), that domestic violence is
the most frequent reason for females seeking emergency room treatment (Campbell &
Humphreys, 1993), and that 3-14% of married and/or cohabiting women are assaulted by their
partners each year (Hanson et ai., 1997). One study concluded that domestic violence results in
psychological and physical health problems for as many as 6 million women annually in the
United States (Henderson, 1992).

CURRENT PERSPECTIVES

The causes of domestic violence, particularly in the relationships between men and
women, include a number of factors. According to Berger and Luckmann (1966), wife abuse is
most often attributed to expectations of males and females, manifested along gendered lines.
According to this perspective, social constructs reinforce the notion that males are expected to
maintain control over the lives of women. As a result, many males exercise control over
women, both physically and psychologically (Berger & Luckmann 1966).
Several studies have found a link between alcohol use by husbands and battering (Brown
et ai., 1999; Coleman et ai., 1980; Hotaling & Sugarman, 1986; Fitch & Papantonio, 1983). A

2Although other forms of abuse (child abuse, elder abuse, same-sex partner abuse, for example) are often subsumed
under the definition of domestic violence, this chapter focuses on domestic violence as it relates to male-female
spousal or partner abuse.
DOMESTIC VIOLENCE 315

1999 study by Brown and his colleagues suggested that dual substance abuse, alcohol and
drugs, plays a major role in battering. It appeared that alcohol use greatly increased incidents
of physical violence, while drug use greatly increased episodes of emotional or psychological
abuse (Brown et aI., 1999).
Yet another explanation for domestic violence comes from the literature on resource
deprivation. Miles-Doan (1998) found a higher rate of violence between intimates in neighbor-
hoods with higher poverty levels and greater economic inequality, due in part to weak social
disorganization and an inability to socialize youth against violence. The author argued that one
effect of concentrated poverty is increased interaction between members of street-based peer
groups, a social context in which young men learn violence as an acceptable solution to
disagreements. As these young men mature, and as work disappears from their neighborhoods,
unemployment is the likely outcome for many of them. There is a long-established history
of the relationship between unemployment and battering. It could be that in neighborhoods
suffering from resource deprivation, violent behavior in the home is a continuation of learned
violence from youth (Miles-Doan, 1998).
As Martin (1976) pointed out, the physical abuse of women at the hands of their husbands
has been recorded for hundreds of years and has often been viewed as acceptable behavior.
In 1874, the courts ruled that a man had a right to beat his wife as long as no permanent damage
was done and as long as he did not use a stick that was bigger than his thumb, thus the "rule of
thumb" was born (see State v. Oliver, for example). The family unit presented private matters,
areas that were, in the view of most judges, best left alone by the courts, and court interven-
tions in this social unit were rare.
According to a report from the National Institute of Justice (NU) and the Centers for
Disease Control and Prevention (Tjaden & Thoennes, 1998), violence against women became
viewed as a major social problem in the 1970s, in part because of the women's movement.
Kanuha (1996:37) suggests that domestic violence was relegated to the status of a social
problem through a complex set of activities, called typification, in which "claims makers"
engage. For Kanuha (1996), claims makers, over time, have made public claims about
battering and defined the term in relation to the behavioral, psychological, and other charac-
teristics that describe a battered woman.
In the struggle for the right to vote, for example, Elizabeth Cady Stanton and Susan B.
Anthony attempted to make the public aware of the widespread problem of battering (Pleck,
1989). Dobash and Dobash (1979) tell of a group of women in a small English town who, in
1971, marched to protest rising food costs and the reduction of free milk for children. Their
efforts proved successful, but not for the initial problem the group set out to address. Instead,
the solidarity of the group proved instrumental in subsequent group meetings in which the
subject of battering began to be discussed. At these meetings, women grew less inhibited about
talking about their personal experiences of enduring physical assaults and psychological abuse
at the hands of their intimate partners (Dobash & Dobash, 1979).
The example of the group solidarity from this very small community in Britain was soon
copied on the American continent (United States and Canada) and by many European coun-
tries as well (Belknap, 1996). As a result, shelters were created in which women and their
children could seek refuge from the tumultuous storms brewing on the home front.
According to Tierney (1982:208), "The movement has made substantial headway in three
areas, besides emergency shelter: legislation, government policy and programs, and research
and public information." In a 20-year period, between 1975 and 1995, over 1200 shelters were
established, protection from abuse legislation was reformed in every state in the United States,
and education programs were expanded and offered to a host of professionals and lay people
(Schechter, 1996).
316 BARBARA SIMS

SOCIAL COSTS: INDIVIDUAL AND SOCIAL CONSEQUENCES

In 1998, Ascione identified four major dimensions of domestic violence: physical abuse,
psychological abuse, sexual abuse, and abuse to personal property. Follingstad et aI. (1990)
found that physically abused women reported a high frequency of three types of emotional
abuse: restriction, batterer jealousy, and ridicule. Physical injury is, of course, the most
obvious result of battering, and the evidence points to the conclusion that domestic violence
i&.a major cause of both injury and noninjury visits to the emergency room by women (as noted
previously) (Goldberg & Tornlanovich, 1984), but in a study of victims of domestic violence,
Ti.% reported that the psychological abuse was worse than the physical abuse (Follingstad et
aI., 1990).
With regard to physical injuries to victims of battering, chronic pain has been found to be
the most frequent reason for seeking medical assistance and is a common symptom of battered
women who never seek medical assistance (McCauley et aI., 1995). It has been suggested that
chronic pain is related to old injuries that were never treated, bad headaches being one example
(Gelles & Straus, 1990). In addition, loss of hearing or vision and problems remaining focused
or concentrating have been found to be related to samples of victims of domestic violence
(Eby et al., 1995) as have digestive problems and/or chronic irritable bowel syndrome (Berg-
man & Brismar, 1991).
In many instances, women suffer not only physical assault, but sexual assault as well.
Forced sexual activity has led to such problems as HIV/AIDS, vaginal tearing, bladder infec-
tions, sexual dysfunction, pelvic pain, and unintended pregnancies (Bergman & Brismar,
1991). These problems are widespread as evidenced by studies reporting that 40 to 45% of all
battered women are forced into sex by their male partners (Campbell, 1989).
When it comes to women's mental health consequences, the number one problem is
depression. Victims of domestic violence consistently were found to have more symptoms
associated with battering than members of a nonbattered comparison group (Jaffe et aI., 1986;
McCauley et aI., 1995; Ratner, 1993). In fact, one study showed that frequency and severity of
current physical abuse and stress were better predictors of depression symptoms than were
prior history of mental illness or demographic, cultural, or childhood characteristics (Camp-
bell et al., 1997).
As costly to the individual and community as domestic violence is (one young woman,
imprisoned for killing her abuser, remarked that she had more freedom in prison than when she
was living with her husband), there is another cost of domestic violence to be considered. A
Senate Judiciary Committee concluded in 1991 that gender-based crimes, and fear of gender-
based crimes, have an impact on the nation's economy at several levels. First, violence against
women affects business in a major way. The U.S. Justice Department reports that in the 60,000
incidents of on-the-job violence each year, the victims knew their attackers intimately. Further,
homicide is the most frequent cause of fatal injuries suffered by women at work (Family
Violence Prevention Fund, Special Report, 1998). Women who are the victims of battering
show up more often, and significantly, in records of absenteeism, and the increased costs of
medical and insurance expenditures related to battering are passed along to companies where
these women are employed (Family Violence Prevention Fund, Special Report, 1998). The
results of a national family violence survey found that, in the workplace, women who are
victims of domestic violence cost employers $3 to 5 billion annually due to excessive
absenteeism and another $100 million annually in medical costs (Family Violence Prevention
Plan, Special Report 1998). In light of the economic drain on U.S. businesses, Cain (1999:26)
concluded that:
DOMESTIC VIOLENCE 317

With women representing such a large part of the American workforce and of American consumers and
producers, the effect violence against women has on the national economy cannot be ignored.

The U.S. Congress agreed. In 1994, the Congress passed, and President Clinton signed
into law, Title IV of the Violent Crime Control and Law Enforcement Act, better known as the
Violence Against Women Act (VAWA), reflecting a firm commitment toward improving the
criminal justice system's response to domestic violence (VAWA is discussed in greater detail
below). The most controversial aspect ofVAWA is the civil rights remedy (42 U.S.C., Section
13981) for victims who can prove that crimes committed against them were gender-motivated.
The inclusion of the civil rights remedy in VAWA survived in the Congress because the
proponents of such a remedy applied the Interstate Commerce Clause of the U.S. Constitution,
arguing that domestic violence has a tremendous impact on the nation's economy. This major
victory for domestic violence victims, however, was short lived. In its 2000 term, the U.S.
Supreme Court ruled (U.S. v. Morrison) that Congress had exceeded its powers under both the
Commerce Clause and the Fourteenth Amendment. Victims, as a result of this recent ruling,
no longer have such a civil remedy at their disposal.

THE VIOLENCE AGAINST WOMEN ACT:

A LEGISLATIVE APPROACH

As is the case with rape victims, victims of domestic violence are often faced with the
disbelief that the battering occurred, and, in addition, are sometimes blamed for somehow
causing or provoking the abuse. Through the 1970s and into the 1980s, however, grass-roots
efforts to aid victims of domestic violence kept pushing the issue to the forefront of legislative
agendas, both on a state and on a federal level (Burt, 1996). By 1992, many states had enacted
state codes dealing with domestic violence, which included such measures as: (1) listing
domestic violence in the state's criminal code, (2) mandating arrests of offenders if any
physical signs of abuse are present, (3) increasing the penalties associated with domestic
violence, and (4) providing civil protection orders for victims of domestic violence.
At the federal level, and aided by support from the National Organization for Women's
Legal Defense Fund, victim advocates documented the problems associated with trying to
intervene in victims' lives at the community level, and the immensity of the unmet needs of
these victims (Burt, 1998). Receiving strong support from a bipartisan Congress, work began
on the drafting of legislation dealing with the issue of domestic violence in the United States.
The Violence Against Women Act of 1994 (VAWA) was passed as part of the 1994
Violent Crime Control and Law Enforcement Act. VAWA is seen as a firm commitment toward
improving the criminal justice system's approach to violence when "any woman is threatened
or assaulted by someone with whom she has or has had an intimate relationship, with whom
she was previously acquainted, or who is a stranger" (National Institute of Justice, 1997:1).
Recognizing the importance of interagency involvement in clearing the hurdles many domes-
tic violence victims face, the VAWA included four subtitles within the Act: (1) the Safe Streets
Act, (2) Safe Homes for Women, (3) Civil Rights for Women (discussed in the preceding
section), and (4) Protections for Battered Immigrant Women and Children. Recognizing also
the need to educate law enforcement, prosecutors, judges, and other criminal justice personnel,
the VAWA included authorization for prevention, education, and training and on improving
communications within the justice system (Burt, 1996).
One part of the VAWA provides grants to assist states and local government to develop
318 BARBARA SIMS

and strengthen effective law enforcement and prosecution strategies to combat violent crimes
against women and to develop and strengthen victim services in cases involving violent crimes
against women. Known as STOP (Services, Training, Officers, Prosecutors) grants, these
assistance programs funnel funds to communities interested in combating domestic violence
using a community-based approach.

DOMESTIC VIOLENCE INTERVENTION: THE DULUTH MODEL

One of the best known and often cited domestic violence programs in the country is found
in Duluth, Minnesota. Since early 1980, the Domestic Abuse Intervention Project (DAIP) has
worked hard to negotiate agreements with key agencies to coordinate interventions through
a series of written policies and protocols, thus limiting individual or agency discretion
(Shepard & Pence, 1999). The agencies involved include police, probation, prosecutor, court
administrator's office, and victims' advocates. According to Shepard and Pence (1999:41), the
overall goals of DAIP are to "promote safety for the victims of domestic violence and
accountability among offenders." At the heart of the Duluth model is the fact that changes and
reforms have taken place across two decades in response to cracks in the system through which
the victims of domestic violence were falling. These problem areas were identified through
interaction between agency representatives, interaction that often included discussions about
actual cases. Shepard and Pence (1999:29) argue that it was the discussion of these actual cases
that "created the chink in each agency's theoretical suits of armor."
The Duluth model grew out of the Women's Coalition, founded in Duluth in 1979, and
whose purpose was to serve as an advocate for individual victims of domestic violence. In con-
trast, DAIP was established, with a small grant of $30,000 and three staff members, to monitor
and coordinate agency responses to domestic violence. Getting started involved making con-
tacts with agencies, informal meetings to identify which approaches might be met with resis-
tance from practitioners and why, a low-key, nonconfrontational approach to policy develop-
ment, and an agreement to raise all monies needed for training (Shepard & Pence, 1999).
After two decades of working toward greater coordination among the agencies involved
in intervention, the DAIP staff offer several suggestions for implementing a successful domes-
tic violence intervention program:
• Mandatory arrest of perpetrators of domestic violence.
• Neutralize the offender's ability to control the process by getting the victim to have the
charges dropped: the solution is a no-drop policy by the prosecutor;
• Examine the texts and manuals of practitioners to better understand rules, regulations,
protocols, policies.
• Change the ideology of the agencies involved so that all see the important role they play
in protecting the victim.
• Be willing to recognize that policymaking is a process, and that changes will have to be
made.
• Anticipate resistance: exercise patience.
• Do not overwhelm practitioners with unnecessary reporting forms or forms that are
difficult to follow.
• Listen to victims advocates because they can tell you where the approach is failing victims.
• Develop a good tracking system to allow for the collection of data at all steps in the
process.
DOMESTIC VIOLENCE 319

In addition to these suggestions on how to produce a well-coordinated approach to

domestic violence in the community, the staff of the Duluth model stress the importance of
ensuring that essential services are available for women and their children. These would
include emergency housing, legal advocacy, group counseling, and emergency financial re-
sources. According to Shepard and Pence (1999) it is important that in the process of
institutionalizing battered women's programs, the interests of the victims not get lost along the
way. The needs of the victim should always take priority over the needs of the system and what
might work best for it.

STOP GRANTS: A COMMUNITY RESPONSE

IN DAUPHIN COUNTY, PENNSYLVANIA

At the end of the first year following the enactment of the VAWA (1995), $23.5 million
was distributed to states through formula grants, $250,000 to states for assistance in develop-
ing their STOP programs, $250,000 was used to support federal management of STOP grants,
and $1 million was devoted to evaluations of these programs. As of fiscal year 1997, $33
million had been appropriated by Congress to the U.S. Department of Justice, Office of Justice
Programs for grants to encourage arrest policies by local law enforcement agencies, and for
fiscal year 1998, Congress appropriated $59 million to encourage states to treat domestic
violence as a serious violation of crirninallaw (National Institute of Justice, 1997).
At the heart of STOP programs is a recognition that legal reform alone is not enough, that
changes in attitudes and public opinion are critical, and that coordination within the commu-
nity is essential. Research has shown that domestic violence statutes, for example, will have a
greater effect if attitudes about domestic violence of police, prosecutors, judges, and juries
change (Marsh et aI., 1982). A protection from abuse order in the civil court has very little
meaning if the criminal justice community fails to enforce it (Harrell et aI., 1993). In regard to
the victim, experience has taught community advocates that victims of domestic violence must
be seen to differ from other victims of violent crime in one important way: the ongoing threat
to individual safety persists across time. It is important, then, that the system redefine its
mission to include protection from future harm, and not just accountability in the form of
arresting a perpetrator (Burt, 1996).
In 1998, and through the county's District Attorney's office, Dauphin County was
awarded a grant from the Pennsylvania Commission on Crime and Delinquency (the agency
through which federal funds are funneled) under the STOP Violence Against Women Formula
Grant Program. Prior to submitting a request for funds, the County created a strong partnership
among law enforcement, prosecution/corrections, and victim services, the sole purpose of
which was to establish an organization through which to plan and implement a STOP Violence
Against Women program. As a result, the partnership decided on the development of Domestic
Violence and Sexual Assault Rapid Response Teams (RRTs) whose overall objective would be
to protect victims, children, and other family members from violence, while holding offenders
accountable for their behavior.
The critical components of the RRT agencies (law enforcement, prosecution/corrections,
and victim services) are shown in Table 16.1, along with stated goals and planned activities
under the STOP grant. What is particularly striking about the information in Table 16.1 is the
manner in which program goals and related planned activities for each of these agencies
overlap. What comes through is a recognition that all parties are committed to the arrest,
prosecution, and conviction of perpetrators of domestic violence and sexual assault.
320 BARBARA SIMS

TABLE 16.1. Rapid Response Team Agencies: Critical Components, Goals, and Planned
Activities

Agency Critical component Program goals Planned activities

Law Through the Protect victims, children, and Develop procedures with victim
enforcement development of other family members from services and prosecution for
RRTs for domestic violence and its the responsibilities of the RRT
domestic effects Initiate implementation of the
violence and Response professionally and RRT
sexual assault effectively to all cases of Work with a coordinating team
cases, an increase domestic violence and sexual from law enforcement,
in the number of assault prosecution, and victim
arrests and Increase effectiveness in services to provide training for
convictions for gathering and preserving key personnel/staff
these crimes evidence in domestic violence Identify software/technical needs
should occur cases to enable the district to facilitate communication
attorney's office to prosecute among the program group
victimless cases
Improve communications
between law enforcement,
prosecutors, and victim
services
Provide the training law
enforcement officers need in
order to respond with greater
professionalism and
effectiveness
Prosecution! Develop and Protect victims, children, and Hire an asssitant district attorney
Corrections implement a other family members from who will be responsible for
Domestic domestic violence and its immediate response to all
Violence/Sexual effects domestic violence complaints
Assault Unit Respond professionally and Secure telecommunications and
using a vertical effectively to all cases of other equipment that will assist
prosecution domestic violence and sexual in evidence gathering and
model to pursue assault tracking cases
prosecution of Hold batterers accountable for Develop and implement protocols
domestic their behavior for evidence gathering and
violence under Prosecute domestic violence tracking cases to increase the
the Dauphin cases successfully, with or rate of incarceration when
County District without the cooperation of the victims, out of fear or
Attorney's Office victim intimidation, refuse to
"no-drop" cooperate
prosecution Collaborate with victim services
policy to protect victims from further
abuse, particularly those
victims who hesitate to testify
Work with victim services and
law enforcement to make sure
victims are notified of major
actions and proceedings in
their cases
Develop and implement a
training curriculum for
Dauphin County law
enforcement on training
policies and procedures related
to the prosecution of domestic
violence and sexual assault
DOMESTIC VIOLENCE 321

TABLE 16.L (Continued)

Agency Critical component Program goals Planned activities

Victim Develop the RRT Create a faster contact with
services unit which will victims of domestic violence
be comprised of and sexual assault
victim crisis Increase and develop a more
counselors, law positive working relationship
enforcement with law enforcement officials
officers, and an and the district attorney's staff
assistant district Work with law enforcement and
attorney prosecution on changes to the
system of response in order to
empower victims of domestic
violence and sexual assault
Increase the legal advocacy that
enables domestic violence
survivors to exercise their full
legal rights for protection
Develop protocols and
procedures with law
enforcement and prosecution
for the RRTs
Hire and train additional staff as
needed so that a trained
counselor is on hand 24 hours
a day
Design strategies to protect
women from being put at risk
of further abuse, particularly
those women who decline to
testify, due to the "no-drop"
policy of the Dauphin County
District Attorney's Office
Execute a contract with Legal
Services to assure effective
legal assistance to victims
Assist in planning and carrying
out necessary training sessions
related to RRTs

What also is clear from Table 16.1 is that all parties are committed to serving victims in
such as a way to get them the immediate help they so often need, and in a manner that does not
put them at greater risk from their abusers. With the adoption of the "no-drop" policy of the
Dauphin County District Attorney's office, all cases of aggravated domestic violence and sexual
assault will be prosecuted to the fullest extent, even if the victim, for personal safety reasons or
otherwise, refuses to cooperate. This policy could put victims at risk for further retaliation, and
the agencies appear to recognize this fact, and are taking steps to reduce that risk.
The RRTs that are mentioned quite often in Table 16.1 are the key to Dauphin County's
approach to domestic violence and sexual assault under the STOP grant. Shortly after the grant
was awarded, and through the District Attorney's office, police officers and crisis intervention
counselors from the Dauphin County YWCA participated in training workshops designed to
educate them on a new approach to domestic violence and sexual assault cases. Under this new
approach, all aggravated domestic assault cases (signs of physical abuse), and all sexual
assault cases, would require an on-the-scene team of police officers and counselors, the
purpose of which would be twofold: (1) to gather evidence in such a way as to better facilitate a
conviction in court, and (2) to make sure that victims receive immediate assistance for
themselves and/or their children or other family members. This approach is quite different
from how these cases had been handled before RRTs. In most cases, even in light of new state
legislation requiring an arrest if signs of physical abuse are present, police officers were
hesitant to make an arrest if the victim seemed unwilling to cooperate. Too, there were no on-
the-scene counselors to make the victim aware of services available to her.
A few months into the grant period, I was asked to meet with members of the coordinat-
ing team for the RRTs to discuss the evaluation component of the grant. It was clear that these
professionals, all experts in their individual fields, were at a loss as to how to go about
evaluating their program. It was also clear that the funding agency, the Pennsylvania Commis-
sion on Crime and Delinquency, required that an evaluation take place.
322 BARBARA SIMS

As Rebach (1991:81) suggested, one critical component of a relationship between the

client and the professional (researcher/evaluator) is communication, and that "forming a
positive relationship with the client is as much as art as it is a science." Further, the relation-
ship that needs to be formed is one of a helping nature more than a social nature. In other
words, I knew when I first met this group of highly trained and educated people that they were
looking to me for suggestions, not for how to do their jobs, but to assist them in developing a
plan through which their work could be evaluated.
There was a trust that had to be developed between the client and myself, and I began that
process at the first meeting. I did so through the process described by Rebach (1991:83):

Clients enter the encounter searching for structure and assume the existence of an objective reality that
can be shared. They will attempt to train you to perceive them in ways that are familiar to them or the
ways they prefer to be seen and treated. And they will assess the likelihood of awards from interaction.
The relationship you get is the one you ask for, both overtly and unconsciously, as the client perceives
your communication behaviors and assigns meaning to them.

Before the first meeting, I acquired copies of Dauphin County's grant proposal and
became familiar with the RRTs they were proposing to establish. From the grant proposal, I
had some idea of the agencies that would be represented at the first meeting (law enforcement,
prosecutors and/or their staff, and people from the YWCA). Through a close examination of
the information outlined in Table 16.1, I knew what each agency would be bringing to the table.
The law enforcement community and prosecutors would need a mechanism through which
offenders could be tracked across time in order to ascertain whether the RRTs had made a
difference with regard to number of arrests and convictions. Victim services people (people
from the YWCA) would need a way to track victims to determine if the RRTs had affected
their lives for the better, and if so, how, and if not, why not.
In the four years since the first meeting between members of the RRT coordinating team
and myself, I have worked closely with the program group to ensure a successful evaluation
process. This process began with a meeting with a data manager with the local police agency
and a review of the software that would be used to gather information about arrests and
dispositions of domestic violence and sexual assault cases. A data file has been constructed,
and we have been able to show a slight increase in the mean (average) number of arrests per
month, for both aggravated domestic violence and sexual assault. This finding is preliminary
in nature, but is promising. What is important, however, is the fact that a data file has been
constructed through which offenders who were arrested in the first year of RRT programming
can be tracked over time to determine the disposition of the case.
Presently, I am working with the staff of the YWCA on a survey instrument through
which to measure the extent to which victims participated in programs available to them, and
their level of satisfaction with those programs. In addition, yet a third component of the overall
response to domestic violence is gearing up for an evaluation: batterer intervention programs.
This particular type of programming is aimed at improving the lives of domestic violence
victims through weeks of group counseling for their batterers. Several programs are in
operation in Dauphin County and I am working closely with program directors to design an
appropriate evaluation tool for those programs.
At monthly meetings of the Dauphin County Domestic Violence Task Force, discussions
about how to best proceed to ensure the safety of domestic violence victims extend well
beyond the allotted hour slotted for the meeting. The Duluth model, discussed above, has been
presented to the Task Force, and representatives from various agencies are moving toward a
similar approach in Dauphin County.
DOMESTIC VIOLENCE 323

OTHER PROMISING APPROACHES

TO THE PROBLEM OF DOMESTIC VIOLENCE

On an infonnal level, research also suggests that victims of domestic violence receive
support from friends and relatives (Hanmer, 1995; Kelly, 1996; Mooney, 1994). Mooney
(1994) found that friends and relatives were most frequently told about domestic violence (46
and 31%, respectively) (followed by doctors, police, lawyers, social services, and women's
shelters). Thirty-eight percent of victims in a British survey of battered women reported that
they had contacted family and friends, with 31% reporting that they had contacted their
mothers (McGibbon et al., 1989). A 1995 study by Hanmer of Asian victims of domestic
violence revealed the extent to which family members would assist victims of domestic
violence, but only if they could be assured that they would not be found out. In the research, the
loyalty to these supporters by battered women was so great that the respondents would not
reveal the names of those supporters even to the researcher (Hanmer, 1995).
The problem, according to Kelly (1996), is that it is difficult to measure the extent to
which infonnal networks have actually assisted victims of domestic violence, unless, of
course, these victims have appeared in official records somewhere. Still, there is a consensus
among most victim advocates that the infonnal network is crucial for women and their
children, and that work needs to be done to fonn a nexus between both infonnal and fonnal
networks in the community.
Batterer intervention programs, briefly discussed above, are programs designed to get
offenders to realize that they practice controlling behaviors in the home, and that they can learn
alternatives to such behaviors. In most programs, close contact is maintained with the victim to
ascertain the offender's level of violence and to provide referrals and support to battered
women (Mederos, 1999). Battering programs, using group counseling as the primary method
of programming, have shown some promising results, but only under certain circumstances.
The research shows a significant difference in reoffending between those batterers who were
court-ordered to treatment and those who volunteered for treatment, and between those who
were in treatment for 26 versus 52 weeks. Offenders who were court-ordered for treatment,
and those who were in treatment for a longer period of time, were significantly less likely to
reoffend than were those who volunteered for treatment and those who were in treatment for a
short period of time (Mederos 1999).
As alluded to above, until the 1960s or so criminal justice agencies supported the idea that
a man was free to do as he chose in the privacy of his own home. For police officers, the
domestic violence incident was a nuisance at worst, and a potentially dangerous situation for
them (Butzer et ai., 1996). Over time, police came to realize the seriousness of domestic
violence, and through the umelenting efforts of the claims activists defined above, domestic
violence came to be defined as a crime. As such, a very different approach had to be adopted by
police agencies around the country. In Portland, Oregon, a Domestic Violence Reduction Unit
was developed under the city's new commitment to community policing (Butzer et al., 1996).
Under this model, the police provide supportive, professional service to the victims of
domestic violence, work in partnership with the broader community and service agencies, and
decision making is encouraged at the street level. Through the Portland program, offenders
have been deterred, victims empowered, and the reporting of domestic violence has been
enhanced (Butzer et ai., 1996).
In the same vein, a study by Davis and Taylor (1997) found that households that receive
educational infonnation about domestic violence by police officers called to the scene of a
domestic violence incident, and those households that are visited at least once after the initial
324 BARBARA SIMS

contact by a police officer and a social worker, are at least more likely to contact the police
when a repeat offense occurs. These studies show that a proactive approach by the police,
similar to the Dauphin County RRT described earlier, can make a positive difference in the
lives of domestic violence victims and their children.
Another promising approach to the problem of domestic violence includes training
emergency room personnel to recognize injuries and other health problems associated with
domestic violence, while at the same time changing the attitude that personnel sometimes have
toward victims of domestic violence. Burke et ai. (1998) incorporated concepts from a
psychological model of empowerment to facilitate interactive planning and implementation of
solutions. Solutions included taking steps that lead to physicians and medical staff's acknowl-
edging the abuse and offering support services and options to the patient. The authors were
able to conclude that the program produced attitude changes among the staff, and that patients
were more readily made aware of support services, thus empowering the victims themselves
(Burke et ai., 1998).

THE FUTURE OF DOMESTIC VIOLENCE INTERVENTION:

A CONTINUING ROLE FOR THE CLINICAL SOCIOLOGIST

According to Rebach and Bruhn (1991:3), "sociology must go beyond the theoretical to
provide knowledge applicable to real human problems." As was seen in a review of the
literature on domestic violence, this phenomenon became defined as a social problem in the
United States around the middle of the twentieth century. This does not mean, however, that
the problem did not exist prior to that time. It is clear that only through social action did society
as a whole begin to call for intervention policies and programs at the formal level. The works
reviewed here point to a conclusion that there has been sufficient research conducted by the
academic community to support a continuation of such programs. This means that there is
much work to be done by clinical sociologists, both to provide the field with further knowledge
about approaches to the problem of domestic violence that appear to work best, and to
contribute to the community, in a hands-on manner, certain skills typically attributed to a
sociological approach.
A major role that the clinical sociologist could play is in the area of coordinating the
community's response to domestic violence. As seen in the Duluth model, and in the Dauphin
County approach to domestic violence, coordination and cooperation is critical to the process.
Although victim advocates could, and often do, take the lead in such undertakings, this may
not be the best solution. This is because victims advocates, although a necessary component of
any domestic violence intervention program at the community level, may find themselves at
odds with other agencies when it comes to the development of protocols and practices that can
be fitted within the already-existing framework of those agencies. Victims advocates are
known for being unyielding when it comes to protecting the rights of victims. That is, after all,
their role. It could be, then, that a clinical sociologist could serve as an organizational
consultant, complete with the necessary skills to assist all parties in reaching a compromise
that meets the goals of the individual parts, while also, meeting the overall goal of protecting
victims and holding offenders accountable.
Clinical sociologists could also provide the community with an objective evaluation of
domestic violence programs. The above discussion of the Dauphin County approach to
domestic violence and my role as an evaluator of that program is one such example. As noted
by Bank (1991), evaluation can feed valuable information back into the program. Too, more
DOMESTIC VIOLENCE 325

and more funding sources are requmng evaluations, both process and outcome, of the
programs that they fund. It often is the case that local agencies and practitioners have no clue
about the evaluation process, which creates the need for someone with expertise in that
particular area. It is also often the case, and it certainly is true in my situation with the Dauphin
County Domestic Violence Task Force, that what begins as a role as an objective observer, i.e.,
academic as evaluator, can quickly evolve into other roles such as promoting community
organization and compromise among the various parties concerned.
From their "humanistic base," a term taken from Rebach and Bruhn (1991:14), clinical
sociologists, and other social scientists for that matter, can, and have, involved themselves in
improving the lives of domestic violence victims, although at a more macrolevel. Changing
the social system that for decades was silent about violence in the home has been a major
undertaking. Although much has been done to improve the lives of such victims, the fact
remains that domestic violence continues to be a major problem in this country.

REFERENCES
Ascione, F. R. (1998). Battered women's reports of their partner's and their children's cruelty to animals. Journal of
Emotional Abuse, 1(1), 119-133.
Bank, A. (1991). Program evaluation and clinical sociology. In H. M. Rebach & J. G. Bruhn (Eds.). In Handbook of
clinical sociology (pp. 65-80). New York: Plenum Press.
Belknap, J. (1996). The invisible woman: Gender, crime, and justice. Belmont, CA: Wadsworth.
Berger, P. L., & Luckmann, T. (1966). The social construction of reality. Garden City, NY: Anchor.
Bergman, B., & Brismar, B. (1991). A five-year follow-up study of 117 battered women. American Journal of Public
Health, 81(11), 1476-1488.
Brown, T. G., Werk, A., Caplan, T., & Seraganian, P. (1999). Violent substance abusers in domestic violence treatment.
Violence and Victims, 14(2), 179-190.
Burke, L. K., Busch, N. B., & Faucette, M. R. (1998). Educating medical personnel to recognize domestic violence:
Enhancing knowledge and changing attitudes through action research. The Community Psychologist, 31(4), 28-31.
Burt, M. (1996). The Violence Against Women Act of 1994: Evaluation of the STOP block grants to combat violence
against women. Washington, DC: The Urban Institute.
Butzer, D., Bronfman, L. M., & Stipak, B. (1996). The role of the police in combating domestic violence in the United
States: A case study of the Domestic Violence Reduction Unit, Portland Police Bureau. Policing in Central and
Eastern Europe. http://www.ncjrs.org/unojust/poliicinglrole16I.htm.
Cain, M. A. (1999). The Civil Rights Provision of the Violence Against Women Act: Its legacy and future. University
of Tulsa Law Journal, Winter, 367.
Campbell, J. C. (1989). Women's response to sexual abuse in intimate relationships. Womens Healthcare Inter-
national, 8, 335-347.
Campbell, J. c., & Humphreys, J. (1993). Nursing care of survivors offamily violence. St. Louis, MO: Mosby.
Campbell, J. c., Kub, J., Belknap, R. A., & Tamplin, T. (1997). Prediction of depression in battered women. Violence
Against Women, 3, 276-293.
Coleman, K., Weinman, M. C., & His, B. P. (1980). Factors affecting conjugal violence. American Journal of
Psychology, 105(2), 197-202.
Davis, R. c., & Taylor, B. G. (1997). A proactive approach to family violence: The results of a randomized
experiment. Criminology, 35(2), 307-333.
Dobash, R. E., & Dobash, R. (1979). Violence against wives. New York: Free Press.
Eby, K., Campbell, J. c., Sullivan, C., & Davidson, W. (1995). Health effects of experiences of sexual violence for
women with abuse partners. Womens Health Care International, 16, 563-576.
Harrell, A., Smith, B., & Newmark, L. (1983). Court processing and the effects of restraining orders for domestic
violence victims. Washington, DC: Urban Institute.
Family Violence Prevention Fund, Special Report. (1998). The impact of family violence on the workplace. From
website http://www.igc.apc.orglfundlthe_facts/factsht.html.
Fitch, F. 1., & Papantonio, A. (1983). Men who batter: Some pertinent characteristics. Journal of Health and Social
Behavior, 23, 260-271.
326 BARBARA SIMS

Follingstad, D. R., Rutledge, L. L., Berg, B. J., Hause, E. S., & Polek, D. S. (1990). The role of emotional abuse in
physically abusive relationships. Journal of Family Violence, 5(2), 107-120.
Gelles, R. J., & Straus, M. A. (1990). The medical and psychological costs of family violence. In M. A Straus & R. J.
Gelles (Eds.), Physical violence in Americanfamilies: Riskfactors and adaptations to violence (pp. 425-429).
New Brunswick, NJ: Transaction Publishing.
Goldberg, W. G., & Tomlanovich, M. C. (1984). Domestic violence victims in the emergency room. Journal of the
American Medical Association, 251, 3259-3264.
Hanmer, J. (1995). Women's coping strategies. Keynote address, ROKS Conference, Stockholm.
Hanson, R. K., Cadsky, 0., Harris, A., & Lalonde, C. (1997). Correlates of battering among 997 men: Family history,
adjustment, and attitudinal differences. Violence and Victims, 12(3), 191-208.
Henderson, A. D. (1992). Critical care nurses' need to know about abused women. Critical Care Nurse, 12, 27-30.
Hotaling, G. T., & Sugarman, D. B. (1986). An analysis of risk markers in husband to wife violence: The current state
of knowledge. Violence and Victims, I, 101-124.
Jaffe, P., Wolfe, D. A., Wilson, S., & Zak, I. (1986). Emotional and physical health problems of battered women.
Canadian Journal of Psychiatry, 31, 625-629.
Kanuha, V. (1996). Domestic violence, racism, and the battered women's movement in the United States. In L.
Edleson & Z. C. Eisikovits (Eds.), Future interventions with battered women and their families (pp. 34-50).
Thousand Oaks, CA: Sage.
Kelly, L. (1996). Tensions and possibilities: Enhancing informal responses to domestic violence. In 1. L. Edleson &
Z. C. Eisikovits (Eds.), Future interventions with battered women and their children (pp. 67-86). Thousand
Oaks, CA: Sage.
Marsh, J. c., Giest, A., & Caplain, N. (1982). Rape and the limits of law reform. Boston: Auburn House.
Martin, D. (1976). Battered wives. San Francisco: Glide.
McCauley, 1., Kern, D. E., Kolodner, K., Dill, L., Schroeder, A E, DeChant, H., Ryden, J., Bass, E., & Derogatis, L.
(1995). The battering syndrome: Prevalence and clinical characteristics of domestic violence in primary care
internal medicine practices. Annals of Internal Medicine, 123, 737-746.
McGibbon, A., Cooper, L., & Kelly, L. (1989). What support?: An exploratory study of council policy and practice,
and local support services in the area of domestic violence Within Hammersmith and Fulham. London:
Hammersmith and Fulham Council, Community and Police Committee.
Mederos, E (1999). Batterer intervention programs: The past, and future prospects. In M. E Shepard & E. L. Pence
(Eds.), Coordinating community responses to domestic violence (pp. 127-150). Thousand Oaks, CA: Sage.
Miles-Doan, R. (1998). Violence between spouses and intimates: Does neighborhood context matter? Social Forces,
77(2), 623-645.
Mooney, J. (1994). The hidden figure: Domestic violence in North London. London: Islington Police and Crime
Prevention Unit.
National Institute of Justice. (1997). Solicitation for the evaluation of arrest policies program under the Violence
Against Women Act. Washington, DC: U.S. Department of Justice.
Newmark, L., Harrell, A, & Adams, B. (1995). Evaluation ofpolice training conducted under the Family Violence
Prevention and Services Act. Project report submitted to the National Institute of Justice. Washington, DC: The
Urban Institute.
Pleck, E. (1989). Criminal approaches to family violence, 1640-1980. In L. Ohlin & M. Tonry (Eds.), Family violence
(pp. 19-58). Chicago: University of Chicago Press.
Plichta, S. B. (1996). Violence and abuse: Implications for women's health. In M. M. Falik & K. S. Collins (Eds.),
Womens health: The Commonwealth survey (pp. 237-272). Baltimore: Johns Hopkins University Press.
Ratner, P. A. (1993). The incidence of wife abuse and mental health status in abused wives in Edmonton, Alberta.
Canadian Journal of Public Health, 84(4), 246-259.
Rebach, H. (1991). Communication and relationships with clients. In H. M. Rebach & 1. G. Bruhn (Eds.), Handbook of
clinical sociology (pp. 81-97). New York: Plenum Press.
Rebach, H., & Bruhn, J. (1991). Clinical sociology: Defining the field. In H. M. Rebach & J. G. Bruhn (Eds.),
Handbook of clinical sociology (pp. 3-15). New York: Plenum Press.
Schechter, S. (1996). The battered women's movement in the United States. In J. Edleson & Z. C. Eisikovits (Eds.),
Future interventions with battered women and their families (pp. 53-66). Thousand Oaks, CA: Sage.
Shepard, M. E, & Pence, E. L. (1999). Coordinating community responses to domestic violence. Thousand Oaks, CA:
Sage.
State v. Oliver 70 N.C. 60 (1874).
Tierney, K. J. (1982). The battered women movement and the creation of the wife beating problem. Social Problems,
29, 207-220.
Tjaden, P, & Thoennes, N. (1998). Prevalence, incidence, and consequences of violence against women: Findings
from the National Violence Against Women Survey. Washington, DC: U.S. Department of Justice.
 CHAPTER 17

Racism and Diversity

in U.S. Society
Issues for Clinical Sociologists

DARLENE L. PINA

INTRODUCTION

The purpose of this chapter is to present an overview of racism and inequality as social
problems in contemporary U.S. society. Recent trends in ethnic relations within the occupa-
tional, educational, socioeconomic, and health arenas will be examined with a focus on the
dynamics of power and privilege among whites and people of color. Although power relations
also generate inequalities for women, gays and lesbians, and people with disabilities, the
primary concern of this chapter will be on diversity by race and ethnicity.
The chapter begins with definitions of individual and institutional racism, power, privi-
lege, discrimination, and ethnocentrism in U.S. society. Recent trends describing the extent
and forms of racial inequality in various institutions will then be examined. Research on
legislation, diversity training, integration, and multiculturalism as attempts to solve racial
inequalities will be compared. The chapter will conclude with an examination of how clinical
sociologists can address the problems of racism and inequality in their work with individuals,
groups, organizations, communities, and the wider society.

DEFINITION AND SCOPE OF THE PROBLEM

Racism and Inequality

Racism involves beliefs that abilities such as intelligence are predetermined by one's
racial group membership and that people of particular racial groups are inferior (Lawson &
Pillai, 1999). Racism exists when individuals of a dominant racial or ethnic group consciously

DARLENE L. PINA • Department of Sociology, California State University at San Marcos, San Marcos, California
92096.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

327
328 DARLENE L. PINA

or unconsciously hold prejudice and/or discriminate against people from a different racial or
ethnic background. Prejudice is a negative attitude toward an entire category of people, and
discrimination involves behavior that excludes members of a group from certain rights,
opportunities, or privileges (Schaefer, 1998). Individuals' racist beliefs and actions may
combine to create a pattern of institutionalized racism, where ostensibly neutral and objective
standards, policies, and procedures are used to perpetuate a dominant group's power and
control (Marger, 1991).
In U.S. society, people from white, Northern European ethnic backgrounds have histori-
cally held dominant positions in creating our social institutions and having access to material
and cultural forms of power (Steinberg, 1989; Takaki, 1994). White dominance over people of
color has therefore become overtly or covertly embedded in the operations of our social insti-
tutions. Institutional racism may range from indifference and lack of empathy for the different
experiences of people of color, women, and gays and lesbians to blatant hostility, harassment,
and exclusion of those who are considered different. In either case, the consequences of
individual and institutional racism for those in various subordinate groups (e.g., women,
people of color, gays and lesbians, people with disabilities) are inequalities in treatment,
power, and access to resources.
There is much evidence that individual and institutional racism continue to persist in
contemporary U.S. society (Bell, 1992; Bennett, 1995; Cose, 1993; Feagin, 1991; Feagin &
Sikes, 1994; Hacker, 1992; Hughes & Thomas, 1998; Lawson & Pillai, 1999; Thomas et al.,
1994; West, 1993). Whites and people of color, however, often have very different perceptions
of whether or not race-based inequality and discrimination have decreased over the years
(Farley & Allen, 1987; Pinkney, 1993; Yates & Pillai, 1992). One way to explain these compet-
ing views is the argument that blatant acts of racism have been replaced by a more subtle
ideology of cultural inferiority (Cose, 1993; Essed, 1991; Hacker, 1992; Sigelman & Welch,
1991). This more subtle racism may take many forms, including ethnocentrism, assimilation
agendas, and white privilege. I will first define these three processes of racism and then present
trends documenting the comparative status of whites and people of color within educational,
occupational, political, and health arenas of our society.

Ethnocentrism, Assimilation, and White Privilege

Ethnocentrism is the tendency to assume that one's culture and way of life are superior
to all others (Schaefer, 1998). In U.S. society, ethnocentrism typically involves the use of
dominant group values and assumptions (usually white, Northern European middle class) to
judge the beliefs and actions of people from subordinate groups. The notion that Eurocentric
values are cultural universals undermines the reality that people from other cultures have
different ways of defining such concepts as family, time, health and illness, intimacy and
conflict, and communication. It is important to note that a cultural clash of values between
whites and people of color is not simply a misunderstanding among equals, but actually
represents a power imbalance. Because our social institutions (the courts, schools, businesses,
government, and so on) were originally created by those from Northern European back-
grounds, they contain Eurocentic value systems that in tum inform the rules and practices of
these organizations. Those who interact within these institutions are required to do so on terms
that may clash with their own cultural sensibilities and value systems. The danger here is that
certain members of our society may feel compelled (or be required) to suppress parts of
themselves in order to fit in, at the risk of being labeled different and therefore inferior.
RACISM AND DIVERSITY 329

A related form of racism involves overt or covert pressures to assimilate people of color to
conform to the practices of the dominant group. In other words, acceptance into U.S. society is
conditional on those in the minority groups becoming more like those in the majority group
(Jiobu, 1988; Niemonen, 1993). The purpose of this historical assimilation process has been to
produce a homogeneous U.S. national identity. However, this "melting pot" model has been
critiqued extensively, since the costs to the power and integrity of those receiving assimilation
pressures are quite high. Many scholars have argued that the dominance of the assimilation
model in social practice has negatively affected families of color (Bash, 1979; Steinberg, 1989;
Williams et aI., 1995). Historically, programs of assimilation have led to the breaking apart of
families not meeting the "minimum specifications" of participation in U.S. society. Much
scholarship has documented how cultural and institutional programs of "Americanization" or
"Anglo Conformity" (such as boarding schools for American Indian children) led to the
removal of children, the exacerbation of family tensions, and the personal scarring of people
within European immigrant, American Indian, and black families (DuBois, 1961; Early, 1993;
Feldstein & Costello, 1974; Takaki, 1994; Tatum, 1987; Trennert, 1988). These authors de-
scribe in detail the contradictions and strains created by assimilation pressures.
The critics of assimilation programs also argue that proponents of the assimilation model
are limited by a privileged view of the world that blinds them to the realities of life of the less
privileged (Scott, 1990; Williams & Sjoberg, 1993). This experience of privilege is all the more
problematic because it typically is not recognized by those who hold it. Scholars of race in
the United States explain that there is privilege attached to whiteness (mostly those who are of
Anglo-Saxon and Protestant background) (Frankenberg, 1990; Lipsitz, 1995, 1998; McIntosh,
1990; Roediger, 1994). Not only have historical legal and property rights favored whites, but
there is also psychological comfort associated with being white. Specifically, one's whiteness
typically does not have to be thought about because, as the historical "standard" or "measur-
ing stick," whites have not had to experience assimilation pressure or a feeling of being
different. The invisibility of whiteness as a racial category contributes to the privilege of iden-
tifying as the "normal," "standard" person.
One of the consequences of white privilege is that social and structural barriers that
prevent people of color from assimilating are ignored. With this blindness often comes the
assimilation goal of duplicating the lifestyle of the privileged, which in effect tramples the
dignity of the nonprivileged group. Other consequences include defining people of color as
deviant and/or in need of correction. The invisibility of privilege is associated with observa-
tion and scrutiny of the so-called "others." Privileged observers can then label those who do
not fit in or "make it" as rebels deciding to be different or as people with inherent weaknesses.
It is important to note that these processes of ethnocentrism, assimilation agendas, and
white privilege may be practiced by those who do not hold blatant hostilities or disregard
toward people of color. Those who do not think of themselves as racist can indeed perpetuate
racist beliefs and actions. This insidious nature of racism can then lead to systematic bias
against people of color that may translate into inequality in economic and personal well-being.
The next section of this chapter will provide a description of the comparative status of whites
and people of color within various social institutions.

Economic Disparities

Much of the research on the economic status of people of color compared with whites
finds that the economic gaps that existed before the civil rights movement of the 1960s have
330 DARLENE L. PINA

persisted into the 1980s and 1990s (Bound & Freeman, 1992; Jaynes & Williams, 1989;
Lawson & Pillai, 1999; Swinton, 1990). The majority of this literature focuses on comparisons
between the income, employment status, and occupational mobility of blacks and whites.
Statistics on the income disparities between white and black families show mostly
inequalities, with a few encouraging findings. Specifically, between 1970 and 1990 the median
income for white families increased from $34,419 to $36,915, an increase of7.4%. In contrast,
the income of black families changed only from $21,151 to $21,423 (U.S. Bureau of the
Census, 1996). On the positive side, the proportion of black households with incomes over
$50,000 increased by 46% between 1978 and 1987. However, blacks in the mid-1990s were
three times as likely to live in poverty, with one-third of all blacks and 46% of black children
falling below the poverty line (U.S. Bureau of the Census, 1996).
Comparisons of annual earned income between white and black men find a persistent
gap favoring whites over the last 30 years (Bound & Freeman, 1992; Jaynes & Williams, 1989;
Smith, 1997; Thomas, 1993). Explanations for this income gap are typically based on human
capital or structural models, with human capital representing characteristics of a worker, such
as education and work experience, and structure representing factors exogenous to the worker,
such as discrimination and segregation. The human capital model suggests that black men earn
less than white men because they have less human capital, and therefore supply less valuable
labor. However, researchers have found higher income levels for white men even when human
capital factors are controlled (Lyson, 1985; Parcel & Mueller, 1989; Smith, 1997). Further-
more, this income gap is largest among black and white men with the highest level of educa-
tion and occupational status (Thomas, 1993), and black men receive a lower income return
than whites when occupying the highest levels of job authority (Smith, 1997).
Research on racial gaps in retirement income indicates that among those who began
receiving Social Security Old Age Benefits in 1980-1981, the total annual retirement income
for Mrican-Americans was 54% of the white income (Ozawa & Kim, 1989). Estimates for
future retirement cohorts suggest that the racial gap will increase (Hogan & Perrucci, 1998;
J. P. Smith, 1995).
For the last few decades the unemployment rate for blacks has been about twice that of
whites, and has even been four times the rate of whites in some cities (U.S. Bureau of the
Census, 1996). There are even discrepancies between the unemployment rates of college-
educated whites and blacks, with 4.5% of blacks who completed college unemployed com-
pared with 2.2% of whites (U.S. Bureau of the Census, 1996). Another concern is the
underemployment rate for blacks, which estimates that perhaps as much as one-third of black
workers have no jobs, work parttime, or make wages below the poverty line (U.S. Department
of Labor Statistics, 1991). Scholars typically attribute these high black unemployment and
underemployment rates to the movement of capital and jobs to the suburbs, away from the
inner cities where most blacks live (Eggers & Massey, 1992; Lawson & Pillai, 1999; Wilson,
1987, 1996).
This suburbanization of employment, combined with the decline of manufacturing jobs
in particular and the growth of low-wage service jobs, is related to the poverty levels of blacks
and Hispanics, but does not affect the poverty levels of whites (Eggers & Massey, 1991;
Massey et aI., 1994). A growing concentration of urban poverty has been particularly high in
cities in the Northeast (in the 1970s) and the Midwest (in the 1980s) and has affected people of
color, particularly blacks, disproportionately (Abramson et aI., 1995; Jargowsky, 1997; Ka-
sarda, 1993; Krivo et aI., 1998; Massey & Eggers, 1990). These increasing concentrations of
poverty in urban areas have important consequences for people of color. Specifically, these
residents are isolated from important resources, such as high-quality schools and jobs (Galster
RACISM AND DIVERSITY 331

& Killen, 1995; Mincy, 1994; Wilson, 1987), and are less likely to organize collectively to
improve their communities (Bursik, 1988; Sampson & Groves, 1989; Wilson, 1996).
There is much research evidence that people of color do not have equal access to the same
neighborhoods or to the same types of housing as whites (Alba & Logan, 1991, 1993; Bianchi
et aI., 1982; Jackman & Jackman, 1980; Krivo, 1986; Logan & Alba, 1993; Massey & Denton,
1993; Rosenbaum, 1994; Villemez, 1980). As discussed above, residential segregation has an
important impact on economic opportunity and life quality. Because residential location
affects the quality of life chances, differential access to high-quality housing and neighbor-
hoods and to home-ownership may help to perpetuate racial inequality (Massey & Denton,
1993; Oliver & Shapiro, 1995; Parcel, 1982; Rosenbaum, 1996; Squires, 1994).
Increasing numbers of people of color have been moving to historically white suburbs
since the 1970s (Frey, 1994; Frey & Fielding, 1995), but blacks are less likely than Latinos and
Asians to reside in the suburbs, controlling for socioeconomic status (Massey & Denton,
1987). The suburbs where blacks move also tend to have lower income levels, higher
unemployment, lower tax bases, and more of the problems that inner-city neighborhoods have
(Alba & Logan, 1993; Logan & Alba, 1993; Schneider & Phelan, 1995).

Educational Attainment

Dramatic differences in educational attainment continue to exist between people of color

and whites. For example, approximately 73% of blacks complete high school compared with
82% of whites (U.S. Bureau of the Census, 1996). The high school drop out rate is especially
high among black males. Blacks are also less likely to attend college than whites, with 9.6% of
blacks compared with 15.8% of whites completing four years of college (U.S. Bureau of the
Census, 1996). The United States actually has more black men serving prison terms than
attending college classes (Bloom, 1997; Farley & Allen, 1987; Hacker, 1992; Kozol, 1991;
Massey & Denton, 1993; Staples, 1982).
The situation of Latinos is also problematic. By 1991, only 61% of Latinos 20-21 years
old had completed high school compared with 90% of whites (U.S. Department of Education,
1992). Research has found that Latinos have fewer of the family background characteristics
that lead to higher educational attainment (Fernandez et aI., 1989; Sandefur, 1998). Specifi-
cally, low parental education level, living in mother-only families, living in stepparent
families, and having many siblings are each associated with lower educational attainment.
Additional predictors of lower educational attainment include foreign birth, non-English
language background, and short duration of U.S. residence (Bean & Tienda, 1987; Fligstein &
Fernandez, 1985; Rong & Grant, 1992; Rumberger, 1983; Velez, 1989). However, U.S.-born
Mexicans with foreign-born parents are more likely to graduate from high school than both
whites and U.S. born Mexicans with U.S.-born parents (Wojtkiewicz & Donato, 1995).
Because previous research has found a strong relationship between family background
characteristics and educational attainment, recent comparisons of the high school dropout and
college enrollment rates among people of color and whites have controlled for family back-
ground. Specifically, Hauser and Phang (1993) found that when family background was
controlled, whites were the most likely to drop out of high school during the 1973-1989
period, with Latinos less likely and blacks least likely. Other studies controlling for family
background found that blacks were more likely than whites to enroll in four-year colleges and
to obtain bachelor's degrees (Alexander et at., 1982, 1987; Thomas et aI., 1979). Sandefur
(1998) has also found that the lower high school graduation and college attendance rates of
332 DARLENE L. PINA

American Indians, blacks, and Latinos are in part due to differences in family background
(family structure, number of siblings, and parental education).
Tracking within the schools is another process found to hinder the educational attainment
of people of color. Tracking is a system of classroom organization that assigns students to
particular classes and programs within a school. Schools that categorize students on the basis
of standardized tests, grades, or related criteria tend to have racially and ethnically segregated
classrooms (Epstein, 1985). In defining curriculum content, tracking defines student status and
worth, and also narrows opportunities for contact among diverse students (Braddock et aI.,
1995). There is evidence that black, Latino, and American Indian children are overrepresented
in low-track, low-ability classes and programs and underrepresented in high-track college
preparatory programs and classes for the gifted and talented (Braddock, 1989; Haller, 1985;
Oakes, 1982, 1985, 1992). Also, students in low-income families are greatly overrepresented in
the low tracks (Alexander et aI., 1978; Heyns, 1974).

Health and Personal Wen-being

Thomas and Hughes (1986) found that African-Americans' sentiments about society and
their place in it were considerably less positive than those of whites in 1972 and this effect
remained into the 1980s and 1990s (Hughes & Thomas, 1998), after significant social improve-
ments in civil rights had taken place. Specifically, Mrican Americans were less satisfied, less
happy, more mistrustful, more anomic, had less happy marriages, and rated their physical
health worse than whites. These effects were found for all socioeconomic status groups. How-
ever, other scholars have found more optimistic trends, specifically that African-Americans
are not more likely than whites to have psychiatric disorders (Kessler et ai., 1989; Robbins &
Regier, 1991; Somervell et ai., 1989; Williams et ai., 1992).
The inconsistencies in these two sets of findings may indicate that self-reports of quality
of life are distinct from psychiatric diagnoses (Hughes & Thomas, 1998). In other words, one
can be free of psychological disorders and still perceive life as having low quality. An
important yet unanswered question is whether racial discrimination is the social mechanism
leading to lower quality of life for African Americans. Some research has found support for
this relationship (Williams et aI., 1997), whereas another study found that happiness among
African-Americans was unaffected by the belief that racial discrimination occurs in the United
States (Davis, 1984). More research is needed to specify any possible linkage between rac-
ism and the quality of life of African-Americans.

ATTEMPTS TO END RACISM AND INEQUALITY

Social responses to the inequalities discussed above have become widespread over the
last 40 years. Both academic scholarship and public policy have proliferated in the areas of
legislation, diversity training, integration, and multiculturalism. The results and promise of
each of these attempts to end racism and inequality will be discussed in turn.

Legislation

The Equal Employment Opportunity Commission (EEOC), created by Title vn of the

Civil Rights Act of 1964, is responsible for eliminating "discrimination based on race, color,
RACISM AND DIVERSITY 333

religion, sex, national origin, disability, or age in hiring, promoting, firing, setting wages,
testing, training apprenticeships, and all other conditions of employment" (U.S. Bureau of the
Census, 1994:556). In 1968 President Johnson created Executive Order 11373, which set goals
and timetables for federal contractors to establish affirmative action programs to increase the
representation of available and qualified women, minorities, and other historically mar-
ginalized groups in education and in the workplace (Public Agenda Foundation, 1990:23).
There is currently much debate not only about the effectiveness of EEO and affirmative action
laws for reducing racism and inequality, but also about whether these laws are still necessary.
The debate challenging the necessity of these laws revolves around the notion that white
males are discriminated against because these programs are believed to substitute group-based
criteria (e.g., gender, race) for merit-based criteria (e.g., education, experience) (Loden &
Rosener, 1991). Assumptions then follow that women and people of color working in com-
panies with active affirmative action programs are less qualified employees. The argument is
further made that because past inequalities have already been remedied, government policies
to eliminate discrimination are no longer needed (Kluege1, 1985; Pech, 1995). Many lawsuits
filed during the 1980s and 1990s successfully challenged the application of affirmative action
laws (Foner & Garranty, 1991; Lindsley, 1998b).
The other side of the debate questions the assumption that discrimination against people
of color has been eliminated. Trends of decreasing racial inequality in employment show some
progress, but they do not reflect a steady improvement (Carlson, 1992). Specifically, Carlson
found that the most significant declines in racial occupational inequalities occurred between
1960 and 1980, the two decades in which EEO laws were most actively reinforced (Smith &
Welch, 1984). However, the trends showed a significant decline during the 1980s when the
Reagan administration decreased funding for EEOC enforcement of antidiscrimination poli-
cies. It appears, then, that equal employment opportunities were most effective when there was
stronger federal government economic support and reinforcement for the policies.
Furthermore, the research described earlier in this chapter provides strong evidence of
continued racial inequalities in income as well as occupational attainment and advancement.
Additionally, government figures show that white males at every level of education continue
to earn higher salaries than men of color (U.S. Bureau of the Census, 1994). White males also
occupy 91.7% of top management and 88.1% of director positions in organizations (Galen,
1994). Finally, the 1990 unemployment rate for white males was 6%, whereas black males
experienced a 12.9% rate of unemployment (U.S. Bureau of the Census, 1994).
In sum, it appears that continued government action is needed to dismantle ongoing
barriers to racial equality. However, the controversies over the fairness and appropriateness of
affirmative action and equal employment policies suggest that additional types of social
interventions are necessary to eradicate prejudice and discrimination in U.S. society.

Diversity Training

Diversity training has become a widely used method of enhancing relationships among
diverse groups within business (Chemers et aI., 1995; Chesler, 1994; Friedman & Friedman,
1993; Lindsley, 1998a,b; Sashkin & Burke, 1987; Thomas, 1991, Wendell et aI., 1989), educa-
tion (Zeichner, 1995), and social service organizations (Ferguson, 1996; Gutierrez & Nagda,
1996; Hasenfeld, 1996; Hyde, 1998; Murdock & Michael, 1996). Much of the diversity
consulting work done in these organizations combines the psychological orientation of in-
creasing the cross-cultural sensitivity of individuals with the structural approach of promoting
collaborative relationships and dismantling power hierarchies that perpetuate discrimination.
334 DARLENE L. PINA

The various approaches to diversity training in organizations can be categorized into two
models (Hyde, 1998). The first is more mainstream and comes from organizational develop-
ment theory. The assumptions include diversity training as a way to improve productivity,
diversity as all-inclusive (race, gender, nationality, age, disability, sexual orientation, educa-
tion, religion, marital/parental status), and diversity as both a goal and process to be managed
(the manager takes the lead in promoting this pluralistic vision) (Friedman & Friedman, 1993).
A second model agrees with the all-inclusiveness point, but promotes diversity training in the
name of social justice, not productivity. Power and privilege are viewed as normative in
organizations and need to be directly challenged. The responsibility for change comes from all
members of the organization in a democratic fashion. Structural inequalities and institutional
racism are addressed with the goal of fundamentally restructuring the organization so that
white, male culture is not dominant.
The most individualistic models of diversity training work exclusively on enhancing
individuals' levels of cultural competency or sensitivity, which is defined in individual-level
terms as a skill or personal resource that facilitates positive cross-cultural relations. Cultural
competency typically involves having knowledge of diverse groups, skills in cross-cultural
interaction, and awareness of one's own cultural identity and perspectives on diversity and
difference.Trainers help employees or students to build these competencies by working with
hypothetical vignettes, paper and pencil questionnaires, and role play scenarios. Consultants
may also hold informational workshops on how to work with certain populations.
Those at the cutting edge of research on race and ethnic relations have suggested that
structural issues related to the delivery of diversity programs need to be considered. Specifi-
cally, Hawley et al. (1995) have made six suggestions about the context and process of
diversity training and five recommendations on content that should be included within these
interventions. Other research supporting these findings is also cited.
Program delivery
1. Diversity training must address not only individuals, but also the institutional struc-
tures and practices within an organization (Cox, 1993; Johnson, 1992; Lindsley,
1998b; McEnrue, 1993).
2. Strategies to end racism must have the support and participation of those with
authority and power in the particular organization (McEnrue, 1993; Rynes & Rosen,
1995; Wentling & Palma-Rivas, 1998). The impact of diversity training programs will
be undermined if the leaders do not participate. Leaders should also support and
reward those who pursue equality and sanction those who engage in discrimination.
3. The organization's commitment to equality and positive relations among diverse
groups must be shared with the new members.
4. Strategies to promote equality and multicultural development should be part of a con-
tinuing set of learning activities that are valued and incorporated throughout the
organization (Delatte & Baytos, 1993; Hyde, 1998; Rynes & Rosen, 1994; Wentling &
Palma-Rivas, 1998). This involves high commitment to ending racism as well as spe-
cific expertise to integrate these experiences into the day-to-day operations of the
organization. Separating diversity from other training marginalizes it and minimizes
its effectiveness.
5. Those who implement multicultural development activities must be higWy trained
(Hyde, 1998; Wentling & Palma-Rivas, 1998).
6. Strategies should recognize that lessons related to prejudice and its consequences for
any particular racial or ethnic group may not transfer to other races or groups.
RACISM AND DIVERSITY 335

Curriculum
l. Similarities and differences across and within racial and ethnic groups, including
differences related to social class, gender, and language, should be examined within
diversity programs. This will help prevent the use of stereotyping and the understating
of common human characteristics.
2. Ending the racism of individuals involves not only enhancing knowledge and aware-
ness, but also attention to behaviors and skills is necessary.
3. Diversity training should focus on awareness, knowledge, and treatment of all racial
and ethnic groups involved, not just people of color (Lindsley, 1998b; Mobley &
Payne, 1992; Solomon, 1991). The entire diversity of a group provides an opportunity
for learning and for comparison that can help avoid oversimplification and stereotyp-
ing. It is important to recognize that whites have varying cultures and identities.
4. Diversity training curriculum must recognize and value the bicultural and multi-
cultural identities of individuals and groups. There are unique challenges for those
who live in two or more cultures. The contrasting pressures for persons of color either
to abandon their racial and ethnic identities or to choose a single cultural identity are
disrespectful.
5. The curriculum should also expose the inaccuracies of myths that sustain stereotypes
and prejudices. Although solely correcting misconceptions is not necessarily enough
to change behavior.
Several scholars have also emphasized the importance of conducting a needs assessment
through a variety of research methods to specify the learning needs of individuals as well as
organizational dynamics before any program is delivered (Hawley et aI., 1995; Hyde, 1998;
Kirkland & Regan, 1997; Lindsley, 1998; Piiia, 1998). Some diversity consultants have been
criticized for not using assessment, not truly understanding the organization, and providing
canned programs instead of tailoring their activities to the needs and goals of the specific site
(Hyde, 1999). Evaluation of diversity training is also essential (Morrison, 1992; Wentling &
Palma-Rivas, 1998). Rynes and Rosen's (1995) research on diversity training programs found
that the most successful ones had long-term follow-up evaluations of the training.
There is little research evaluating the effectiveness of diversity training programs, but
current findings will be highlighted. First, some scholars have speculated that short diversity
programs may result in more negative outcomes than no training at all (Morrison, 1992).
Because diversity training initially attempts to bring socially undesirable opinions or long-
held resentments out into the open, it often produces feelings of anger and defensiveness that
can be very destructive. Second, programs that use a more broad definition of diversity
(inclusion of white males) are perceived to be more successful by human resource managers
(Rynes & Rosen, 1995). Finally, the most successful diversity programs are associated with
mandatory attendance for managers and perceived top management support for diversity
(Rynes & Rosen, 1995).

Integration and Contact

There is a large literature on how increased contact among diverse groups may help
individuals to confront racism and prejudice in their everyday lives. Much of this research
began as a testing of Gordon Allport's (1954) well-known contact theory of improving
relationships among people from different racial and ethnic backgrounds (Amir, 1969; Cook,
336 DARLENE L. PINA

1985; Schofield, 1995; Slavin, 1995; Stephan & Stephan, 1996). Allport's contact theory
specifies that the following three conditions must exist in order for contact between diverse
groups to create positive relationships: (1) each group must be considered to be of equal status,
(2) there must be an emphasis on cooperative rather than competitive activities, and (3) there
must be explicit support from relevant authority figures for positive relations. The principles of
contact theory have been extensively tested within educational settings, with the recognition
that desegregation, by itself, has not been enough to improve relations and promote equality
between students of different racial and ethnic backgrounds.
It has been fairly well established that desegregated schools do not necessarily achieve
true racial integration (Gerard & Miller, 1975; Schofield, 1991; Stephan, 1978), and traditional
instruction methods permit little contact between students that can promote positive race
relations (Slavin, 1995). The exceptions to these general trends are found in extracurricular
school activities, particularly sports, and in classrooms using cooperative learning techniques.
Specifically, the increasingly important agents of socialization found in extracurricular school
activities and community-based nonschool settings have played key roles in fostering positive
relations among children from various racial and ethnic groups (Braddock et aI., 1995). For
example, Hallinan and Teixeira (1987) and Patchen (1982) have found evidence that participa-
tion in extracurricular activities in desegregated schools is associated with positive race
relations. In addition, students who participate in sports teams in desegregated high schools are
much more likely to have friends outside of their own race group and to have positive racial
attitudes than those who do not participate in such sports teams (Slavin & Madden, 1979).
Studies of cooperative learning activities involving small student groups that are diverse
in race and ethnicity, sex, and level of achievement have found promising effects on positive
race relations (Slavin, 1990, 1995). Cooperative learning groups receive awards, recognition,
and evaluation based on the degree to which they can increase the academic performance of
each member. Student competition for grades and teacher approval is not part of this model, as
cooperation between students is emphasized both by the classroom rewards and tasks and by
the teacher. Cooperative learning methods satisfy the conditions outlined by Allport (1954) for
positive effects of desegregation on race relations: cooperation and equal status roles across
racial lines combined with meaningful contact that allows students to learn about one another
as individuals, not as categories.
However, there are barriers that prevent the type of meaningful contact outlined in the
above research. Specifically, people tend to insulate themselves from information that chal-
lenges their existing beliefs and tend to be more favorable toward individual members of a
category than they are toward the entire category (Rothbart, 1996). It is also difficult to create
the type of contact needed to reduce prejudice in the real world because of longstanding
intergroup hostilities and durable stereotypes (Rothbart, 1996; Snyder & Meine, 1994). Fi-
nally, people often do not generalize from the individual to the group (Rothbart, 1996).
However, even with these barriers, positive relations among diverse people can occur under
the following conditions: equal status relationships, cooperation and interdependence, sup-
portive climates, opportunities for personal relationships, opportunities for self-revealing
interactions, and egalitarian norms (for a review see Marsiglia & Hecht, 1998).

Multiculturalism

Multiculturalism is a recent social movement encouraging Americans to maintain and

value their ethnicity that has arisen in opposition to traditional goals of assimilation toward a
common "American" culture (the so-called "melting pot"). Multiculturalism emphasizes an
RACISM AND DIVERSITY 337

appreciation of our individual differences based on such categories as race, ethnicity, gender,
sexual orientation, and class. As an extension of the cultural pluralism perspective, it posits
U.S. society as a "salad bowl" of unblended ingredients. Each racial and ethnic group should
preserve their distinctive ethnic identity while remaining loyal to the nation as a whole
(Gordon, 1964; Williams et aI., 1995). Democratic and equal cooperation among diverse
groups of people is described as the goal of a culturally pluralistic society. In sum, multi-
culturalism is concerned with social equality and cultural recognition of diverse groups in our
society (Wieviorka, 1998).
The practice of multiculturalism can be found within various social institutions, but it has
been particularly prominent in the schools (Banks, 1995; Gay, 1992). The major goal of multi-
cultural education is to reform schools, colleges, and universities so that students from diverse
racial, ethnic, and social class groups will experience educational equality. The implementa-
tion of multicultural education involves changes not only within traditional curriculum, but
also within teaching materials, teaching and learning styles, attitudes and behaviors of teachers
and administrators, and the goals and norms of schools (Banks, 1992; Bennett, 1990; Sleeter &
Grant, 1988).
One well-known scholar in this area has argued that multicultural education should
involve the following five dimensions (Banks, 1993):
1. Content integration. Teachers use examples and data from a variety of cultures and
groups to illustrate key concepts and theories in their subjects and disciplines.
2. Knowledge construction. Teachers help students to understand how knowledge is
created and how it is influenced by the racial, ethnic, and social class positions of
individuals and groups.
3. Prejudice reduction. Teachers deliver interventions to help students develop more
positive racial attitudes.
4. Equity pedogagy. Teachers use techniques and methods that facilitate the academic
achievement of students from diverse racial, ethnic, and social class groups.
5. Empowering school culture and social structure. The culture and organization of the
school is restructured so that students from diverse racial, ethnic, and social class
groups will experience educational equality and cultural empowerment. For example,
grouping practices, labeling practices, the social climate of the school, and the expec-
tations that school staff have for student achievement are all examined.
Within each of these five areas there are various perspectives on what types of changes
should be made. Considering only the area of curriculum change, for example, there are four
approaches to reform (Banks, 1995). The contributions approach involves adding ethnic
heroes and holidays to the curriculum using the same criteria employed to select mainstream
heroes. This method is criticized for encouraging the view of racial and ethnic groups as an
appendage to the main story of U.S. history and for focusing on the material aspects of the
cultures without exploration of the cultural meanings of objects and artifacts. The additive
approach involves adding ethnic content, concepts, themes, and perspectives to the existing
curriculum. This method is problematic because it usually results in the teaching of ethnic
content from the perspective of mainstream writers, artists, scholars, and historians. For
example, children are encouraged to study Indians within the Thanksgiving curriculum from
the point of view of the Pilgrims (Banks, 1995). The transformation approach is quite different
from the contributions and additive approaches because students view events, concepts,
themes, issues, and problems from several ethnic perspectives and points of view. For
example, students learn how the experiences of "thanksgiving" were different for the Native
Americans and the British colonists. This transformation approach is taken further with the
338 DARLENE L. PINA

personal, social, and civic action approach, where students are required to make decisions and
to take actions related to the concept or issue they have studied.
Although there has been much experimentation with multicultural education in schools,
there is a lack of empirical evidence that diversity initiatives achieve their goals (Gibson, 1984;
Grant & Millar, 1992; Sleeter & Grant, 1987). One explanation for these findings is that there is
often a gap between the conceptualization of multiculturalism and its practice (Hoffman,
1997). Studies by May (1994) and Merelman (1993), for example, have found the need for
better specification of how intended goals will lead to certain outcomes. A second explanation
of the gap between goals and results is the role of insider/outsider perspectives on ethnicity and
identity in framing multicultural education programs (Davidson, 1994; Hanna, 1994; Heath &
McLaughlin, 1993; Hoffman, 1997; Masemann, 1983; Nieto, 1994). These studies demonstrate
the ways that diversity programs and policies often use notions of ethnic culture and identity
that are not shared by those they are supposed to support. These programs are criticized for
categorizing, trivializing, and even misrepresenting the difference they attempt to teach about
(Hoffman, 1997). A final explanation of this problem is that multicultural programs often use
static and reified notions of culture that mask the political and socioeconomic conditions that
continue to support inequalities and injustice (Handler, 1991; Musgrove, 1982; Perry, 1992;
Turner, 1993; Wax, 1993). This perspective is further elaborated on below.
Hoffman (1997) has developed strategies for teaching about diversity that may eradicate
these three types of problems. Specifically, she argued that the best teaching about cultural
difference comes from in-depth study where students are given a wide range of materials and
information about a culture and allowed to come to their own conclusions. Mere infusion of
multicultural content across the curriculum may not produce this kind of learning because it
does not result in any sustained encounter with cultural difference that can lead to the defamil-
iarization of the learner's taken-for-granted cultural frames of reference. This traditional
anthropological approach to the study of cultures involves making the familiar strange and the
strange familiar, so that we will not project our own presuppositions as common sense onto
others (Segal & Handler, 1995). Hoffman points out that this process results in affirming
diversity, which is distinct from teaching about diversity, but needs to happen first. It is
important that multicultural educators do not presume that we all know what is meant when we
"affirm diversity."
In Hoffman's view, affirming diversity means to see difference as offering real cultural
alternatives that can be learned at a deep level and can provide real possibilities for expanding
one's cultural ways of being and even one's cultural identity. This is in contrast to what
Hoffman calls the "radical other" approach to diversity where each culture is construed as
incommensurably different from every other and it is impossible to really understand the
experience of someone from a different background. According to the "radical other" view,
a person can celebrate his or her own identity and the identity of others only when a well-
defined and conscious racial or ethnic identification is achieved. The problems, according to
Hoffman, are that cultural identities become privileged commodities that are owned like
property and invested with notions of individual rights and privilege. Learners therefore are
supposed to keep their identities at all costs and other cultures are viewed from a distance. So
the question about multicultural education then becomes "to what extent do our programs
reinforce the given categories of identity difference and allocate individuals to each, or
instead, deconstruct these categories and paint cultural difference as a source of personal
encounter, learning, and growth that transcends labels?" (Hoffman, 1997). The very concept of
diversity, then, may contain a view of cultures as inherently in conflict and identities as
intrinsically fixed.
RACISM AND DIVERSITY 339

PRACTICE ISSUES FOR CLINICAL SOCIOLOGISTS

Clinical sociologists interested in diversity work can bring their expertise as agents of
change to individuals, groups, organizations, communities, and wider social institutions. The
insights from research on integration, diversity training, and multicultural education discussed
above combined with more macro-sociological change approaches can inform the work of
clinical sociologists. This section of the chapter will discuss clinical sociology efforts to
combat racism in the areas of organizational intervention, community organizing, and partici-
patory action research.

Organizations

Assessment

Sociological theory can aid in the identification of racism and diversity problems in
various social organizations, including those within business, education, health, and social
services. Theories of power and inequality, a core part of sociological analysis, specify how
stratification and segregation processes become entrenched within both overt and covert
organizational practices and policies. This author's research of a nonprofit human service
agency provides an example of the application of sociological theory to diversity assessment
(Pifia, 1998; Pilla & Canty-Swapp, 1999).
Specifically, my study of a human service agency utilized systems and constructivist
theoretical perspectives that encouraged insight beyond individual traits and behaviors to the
organizational factors maintaining institutional racism. The systems perspective encouraged a
holistic view of the agency as containing interdependent relationships among its various parts
and as an open system in interaction with its environment (Chess & Norlin, 1988; Watzlawick
et ai., 1967). This study of the agency specifically examined how the nature of the interactions
and relationships among various parts of the agency affected service delivery to Latino
immigrant clients. Assessment of the way the organization adapted to environmental exigen-
cies furthered understanding of agency policies and practices affecting these clients.
I also used constructivist theory, which highlights the importance of individual and group
definitions of the situation. The emphasis is on context and meaning. Behaviors and experi-
ences are given meaning within various contexts, and therefore actions cannot be understood
in isolation from larger social narratives or discourses (Efran et ai., 1988; Watzlawick, 1984).
The analysis centered on how the agency members framed their identities, goals, values,
relationships with colleagues, and the agency hierarchy, and how these framings affected
delivery of services to the Latino immigrant clients. How various groups in the organization
(i.e., clients, service providers, managers) perceived one another and defined themselves in
relation to the other groups was of specific interest. Understanding the content of these
perceptions as well as any disagreements within and between groups provided further insight
into the types of multicultural relations occurring at the agency.
Assessment for racism and diversity problems within organizations should involve
measurement of both individual and structural components of institutional racism. Data on
members' levels of multicultural knowledge, awareness, and skills can be gathered using
instruments developed in the business organization, social work, and psychology literatures
(Chemers et ai., 1995; Gardenschwartz & Rowe, 1995; Pope-Davis & Coleman, 1997;
Thomas, 1991). Information about structural processes and organizational culture can be
340 DARLENE L. PINA

gathered by using systems and constructivist theories (as well as many other sociological
theories) to guide surveys, focus group interviews, and ethnographic data collection and
analysis. Measures of diversity in an organization can also be obtained from staff and
management hiring, promotion, and retention statistics.
The findings of my study showed structural processes hindering effective service delivery
for Latino clients. Staff-client, staff-staff, and agency-community relationship dynamics
revealed several conflicts over how service delivery and clinical relationships were defined at
this human service organization. Typically, the Spanish-speaking Latino service providers
perceived themselves as having different perspectives and goals for clients than their man-
agers, and they felt constrained to conform to external expectations. Among each other,
service providers in English-speaking programs grappled with how best to serve their diverse
clients, but they did not feel pressure from their managers. The dilemma for the Latino
providers was role conflict; they felt confident in what they wanted to do with Latino
immigrant clients, but were not allowed to. The dilemma for the white providers was role
ambiguity; they were less sure about how to proceed with Latino immigrant clients and they
wanted to talk about it, but their managers did not provide such opportunities.
Further analysis of this same agency revealed that these service providers' goals of
achieving multiculturalism were also being subverted by legacies of assimilation pressures in
their work. While the agency staff wanted to accept and value their diverse clients, at times
they consciously and unconsciously perpetuated assimilation agendas. It was common for
providers, both whites and people of color, to associate the identity "American" with white
skin. Moreover, this process was described differently for providers and managers with
different life experiences and roles. Latino immigrant service providers, for example, often
viewed assimilation pressures as harmful not only to their clients, but also to their own
identities as Latinos. Many white managers, on the other hand, defended their practice of
assimilating clients as in the clients' best interest.
White privilege was also revealed in the conversations of agency staff, as they described
clients of various ethnic groups in terms of how they were "different" or how their cultures
interfered with successful daily living. They also felt it was a noble goal to help these clients
adapt to systems that did not accept their values and practices. Racial injustice as an aspect of
these clients' experiences was not challenged, or even examined. By ignoring the problem of
racism, these particular providers were implicitly promoting it.
Becoming agents of assimilation seemed to be the path of least resistance for the agency
staff. The providers' often conceptualized their work as helping clients to "fit in" to U.S.
institutions. Managers overtly stated this goal. White service providers unselfconsciously
supported it. And even the Latino service providers who broke agency rules to support their
clients' cultural background acknowledged also assimilating them. The privilege of whiteness
as the "norm" or "standard" way of being was indeed maintained by the agency's practice
of changing clients of color.
However, even within these institutional pressures to conform, some providers were
interested in learning about and supporting cultural differences. Those who spoke of making
adjustments within themselves, instead of encouraging clients of color to change, highlighted
the possibility of this agency valuing and promoting difference among clients and providers.
The notion of helping clients to maintain their "ethnic integrity" was also introduced as an
important yet difficult to achieve goal. Many Latino service providers subverted assimilation
of their immigrant clients by secretly breaking agency rules that did not match their cultural
sensibilities. Some white service providers supplanted assimilation ideas with processes of
self-reflection and adjustment-making in their own expectations and behaviors.
RACISM AND DIVERSITY 341

The process of changing these types of organizational processes requires working with
the roles and perspectives of the individual members, as well as with the larger system of
relationships, hierarchies, information networks, and policies. The relationship the clinical
sociologist develops with an organization's members has a major influence on the success of
these interventions. Key considerations in this relationship, as well as various structural-level
interventions informed by research with organizations are presented in this section.

Interventions

Enhancement of multicultural relations within organizations must involve interventions

at the organizational level (McMahon & Meares, 1992; Schlesinger & Devore, 1995). Re-
search has found human service agency staff to be critical of diversity consultants' over-
whelming psychological orientation that ignores structural processes and group power dy-
namics (Hyde, 1999). Interventions should be made in collateral and hierarchical interactions
and relationships, formal and informal policies and practices, and written and visual represen-
tations of the agency culture.
Ideally, both the goals and methods of these structural interventions will be guided by
sociological theory. My previous research found that systems and constructivist theories could
be used to guide assessment of diversity problems and to shape organizational solutions (Piiia
1998). The goals of intervention were to (1) change the patterns of relationships between
English and Spanish-speaking programs at the agency to enhance communication and contact
between them, (2) reassess the agency's policies on professional roles and clinical relation-
ships between staff and clients so that Latino staff and clients were not forced to behave in
culturally inappropriate ways, (3) institutionalize more formal and informal opportunities for
staff to discuss strategies of culturally sensitive practice, (4) vertically integrate Latino
providers throughout the agency hierarchy, and (5) restructure the agency's relationships with
external organizations so that funding sources and referral agencies are aware of the specific
needs of their Latino immigrant clients. These changes were needed to ensure that the needs of
this agency's Latino immigrant clients would not be at the margins of their service delivery.
My other research on the same human service agency emphasized intervention informed
by discourse analysis (Piiia & Canty-Swapp, 1999). Agency policies and procedures needed to
be examined for residuals of assimilation agendas (as discussed above). Clinical sociologists
can help an organization to answer the following questions: (1) Are providers encouraged to
follow ethical guidelines written from the perspective of only one cultural group? (2) Do
agency procedures for such activities as client involvement with paperwork, transfer of clients
between providers, and provider-clients interaction outside the agency site feel more comfort-
able for one type of cultural group than for another? (3) Does the agency allow and encourage
(through bilingual forms, flyers, brochures, and signage) clients to speak languages other than
English? (4) Are the ideas and perspectives of providers of color incorporated into agency
decision-making processes? Answers to these types of questions should demonstrate the
degree to which an agency is promoting or hindering the development of multicultural
practice.
Other structural interventions promoting multicultural development involve making
improvements in outreach, retention, and power hierarchies (Hyde, 1998). Outreach is directed
toward both human service agency staff and clients. The clinical sociologist can assist the
agency in becoming more visible to and viable for various target groups of underrepresented
clients. Assessment of how well the agency is doing in this area can be done by interviewing
clients, staff, and community members and is essential before the work begins. An important
342 DARLENE L. PINA

theme in outreach is to enhance underserved clients' access to the agency. This process
involves examination of whether agency materials, hours of operation, marketing, childcare
availability, and location are accommodating to the target groups of clients.
Outreach also involves bringing in underrepresented groups as staff members. There is
much research evidence that cultural compatibility, the matching of service providers and
clients of the same cultural group, enhances service utilization of minority clients (O'Sullivan
& Lasso, 1992; Pifia, 1998; Sue et aI., 1991). These researchers suggest that culturally compat-
ible counselors may be better able to avoid stereotypes, develop rapport, assess clients
accurately, and create appropriate treatment plans. If this is true, then hiring staff from cultural
groups reflecting target clients is an important part of multicultural development. Methods of
recruitment of these employees have been well-documented in organizational and social work
research (Fernandez, 1991; Morrison & Von Glinow, 1990; Stephenson, 1994; Woody, 1992),
but the greater challenge is found in the integration, retention, and promotion of underrepre-
sented groups within organizations.
The key issue is that various underrepresented groups have different ways of doing things
from the historically dominant group (white males). The culturally competent organization
must find ways of accommodating all these various groups. Diversity means difference, and
support for those who do not match the existing organizational culture must be created. The
clinical sociologist must help an organization to recognize what the organizational culture is,
how it may clash with the perspectives of various groups, and how it can be redesigned to be
more inclusive and respectful to all. This process typically involves rewriting the organiza-
tion's mission statement to be more inclusive and developing community programs that
engage the organization in a collaborative role with its neighborhood (Ferguson, 1996; Ing1e-
hart & Becerra, 1995).
As a partner in mobilizing organizations to make improvements, it is important for the
clinical sociologist to generate interventions in such a.way that all organization members take
ownership of the change process. Implementing a thorough assessment before any specific talk
of problem-solving or change begins can foster a nondirective, collaborative relationship with
all organization members. This type of assessment involves taking a neutral and curious
standpoint to finding out what is happening at the organization. The goal of individual and
group interviews is not only to gather infonnation, but also to mobilize all the organization's
members as key players in generating and implementing solutions.
How can an organization's members be empowered as key players in defining and
making changes at their organization? The use of focus group interviews in assessment can be
quite useful for this goal. Ideally, focus group interviews would be conducted with separate
groups of staff and managers who are similar in their experience and work at the organization.
These similarities enhance trust and disclosure in the conversations (Basch, 1987; Hughes &
DuMont, 1993; Morgan & Krueger, 1993). The goal is for focus group participants to feel safe
to disclose all opinions and experiences, and they should be assured that what they say will not
go outside the group (particularly to those who have any power over them). Within these
interviews, it is important for the sociologist to hear and validate the ideas and concerns of
organization members so that they become the definers of what needs to change. Conveying
respect for their expertise and wisdom should enhance their trust of the clinical sociologist
and their motivation to take ownership of the change process.
The goal is for all the organization's members to see a need and to have the motivation to
change. The clinical sociologist can then use the assessment findings to develop the types of
structural interventions discussed above. Of course, it is quite optimistic to expect all members
to want change, especially in the sensitive area of diversity work. The clinical sociologist
RACISM AND DIVERSITY 343

should therefore use the assessment period to take note of points of resistance (both within
individuals and the organizational system). For example, some individuals may have a difficult
time understanding how institutional racism promotes inequality. Some may have little
capacity for being reflective, changing themselves, and developing empathy. Some individuals
and organization subsystems may have access to power and resources that they do not want to
share. Change cannot be forced in these situations, as directives typically lead to further
resistance in the form of defensiveness and backlash.
So how does the clinical sociologist effectively manage these forms of resistance so that
positive change can occur? Although typically more narrow than sociological intervention,
recent research on diversity training efforts has emphasized two skills consultants should
possess to be effective: (1) the ability to identify and respond to different levels of skill,
knowledge, awareness, and commitment among agency members (Fong & Gibbs, 1995; Hyde,
1999; Loden, 1996) and (2) the ability to work with discomfort and resistance from agency
individuals and groups (Hyde, 1999). The consultants interviewed in Hyde's research noted
that anxiety is an inevitable part of diversity work. Individuals may resist change due to fear of
losing status or control, fear of the unknown, forced participation, lack of incentive or rewards
to change, a presumed correct viewpoint, or preexisting group distrust (Chemers & Murphy,
1995; Loden, 1996; Mobley & Payne, 1992). Consultants therefore defined their job as helping
agency members to anticipate, understand, interpret, and challenge any resistant or confronta-
tional behaviors. The mechanics of effectively working with discomfort and resistance involve
developing ground rules for discussion and establishing norms of confidentiality, respect,
inclusion, and noncensorship of opinions (Fong & Gibbs, 1995; Hyde, 1999; Schein, 1992).·
Negotiation of how to divide the responsibility for developing solutions and making
changes is another key consideration in the relationship developed with clients. In general, the
clinical sociology perspective favors an emphasis on the organization members' responsibility
for change (Bruhn & Rebach, 1996). The clinical sociologist is a facilitator, and should not be
putting more energy into making the actual changes than those who work at the organization.
These members have the real stake in whether or not diversity is valued in the organization's
principles and practices.
The sociologist's responsibility is to draft the collaboratively developed solutions into a
document of recommendations. Because the sociologist spends so much time in assessment
and solution-generating processes with the organization's members, these recommendations
do not come as a surprise, but rather they validate members' experiences. It is important for the
sociologist to present these recommendations directly to various subsystems of the organiza-
tion, and not just to the upper-level management. Because a relationship with all levels has
already been formed during the assessment process, direct communication from the sociolo-
gist conveys the message that it is essential for all organization members and subgroups to be
involved in developing solutions and implementing change. In practice this means that the
sociologist is presenting the recommendations at various staff meetings throughout the orga-
nization.
In sum, the clinical sociologist conducts an assessment, builds collaborative relationships
with organization individuals and subgroups, shares assessment findings with a balance of
support and confrontation, and makes recommendations that reflect a combination of the
sociologist's and clients' understandings of the problems and solutions. In each step of this
process, the sociologist takes note ofresistance and attempts to motivate members not only to
recognize change as necessary, but also to take the lead in making change. Because the
sociologist will eventually leave the organization, it is important not to create a state of
dependency on this person to solve their problems. The mobilization of systemic changes
344 DARLENE L. PINA

should set mechanisms in place for the organization to self-monitor their progress toward
goals developed in consultation with the clinical sociologist.

Communities

Community organizing involves helping community members, groups, or organizations

to organize and plan collective action that will create social change (Bruhn & Rebach, 1996). A
wide range of problems or community needs may be addressed, including physical facilities,
public services, political and economic issues, social conflicts, inequality and crime. The
clinical sociologist concerned about racism and inequality within communities can use com-
munity organization methods designed to create social environments that support social
justice. Social justice refers to equity, equality, and fairness in the distribution of societal
resources (Aynn, 1995). Organizers use a social justice framework in their work to influence
policies, legislation, and programs.
Multicultural community organizing involves recognizing and working to eliminate
social injustice and oppression based on specific group membership (Gutierrez et aI., 1996;
Gutierrez & Nagda, 1996; Jackson & Holvino, 1988; Mondros & Wilson, 1994). This process
is informed by the historical efforts of people of color to improve conditions within their
communities by building on existing networks within churches, voluntary organizations, and
workplaces (Evans, 1980; Gutierrez & Lewis, 1994; Heslan & Heffner, 1987; Medoff & Sklar,
1994; Munoz, 1989; Rivera & Erlich, 1995; West, 1990; Withorn, 1984). According to Gutier-
rez et aI. (1996), multicultural organizing builds on skills required for all community organiza-
tion practice, and emphasizes (1) understanding culture and social location, (2) recognizing
and building from community strengths, (3) working as a partner, and (4) dealing with conflict
within and between groups.
Understanding the significance of social location in affecting human experience has been
addressed earlier in this chapter. The community organizer must understand and value one's
own cultural heritage, as well as the culture of others, and have interest in gaining knowledge
about cultural differences. In building from community strengths, the community organizer
identifies areas of positive functioning, particularly the survival mechanisms that have been
used in struggles against oppressive structures (Gutierrez et aI., 1996; Saleebey, 1991). This
process must also involve acting as both a facilitator and a learner, as empowerment requires
that individuals and groups develop their own strengths and solutions (Green, 1995; Gutierrez
& Lewis, 1994). Conflict is another important process for the organizer to observe and
facilitate. Historically created racial and ethnic boundaries must be effectively negotiated and
dismantled so that community members can unify to improve the life conditions of all.
An example of community organizing to improve racial justice and equality is the Dudley
Street Neighborhood Initiative in Boston (Medoff & Sklar, 1994). Three factors led to the
success of their multicultural organizing efforts. First, they went beyond administrative and
assessment work and related to people at the level of feelings, as well as ideas. Second, they
followed the premise that being is more important than doing, that all groups have an inherent
value regardless of their social situation. Demonstrating trust in individuals and groups was a
way to bring together diverse community members. Third, they valued collectivity over
individuality, as community members did activities together to become united.
A second example of community organizing to improve racial justice and equality is the
Southeast Women's Employment Coalition. This organization worked in the 1980s to unify
working-class women in the South across racial lines (B. E. Smith, 1995). It specifically
RACISM AND DIVERSITY 345

attempted to implement a regional strategy that could address the economic disadvantage
experienced by working-class women of all races. Smith identified how the failures and suc-
cesses of this movement led to important conclusions about how to unite across the divisions
of race and class. First, defining one's specific race-class-gender experience is an important
step in a process of challenging oppression. Initially, this process can appear factional or
isolationist, and can lead to separatism. However, this fragmentation is also potentially
unifying because it shows that no single form of oppression (race, class, or gender) can stand
alone as a basis for social identity and political unity. Smith's second recommendation
involved the need to frame political goals from the standpoint of those disadvantaged by all
forms of oppression, and privileged by none. This "politics of solidarity" recognizes the
multiplicity of oppressions and supports struggles that do not come out of one's own lived
experience. Finally, Smith's research found that those who experience unjust privilege must
analyze and reject that privilege just as those who experience oppression must contest their
subordination. Looking at both sides of the privilege-oppression equation is needed to create
the genuine solidarity to end inequality in our society.
Participatory action research is another method of community organizing to create a more
just society through transformative social change (Park, 1993). This research not only involves
the creation of knowledge, but also the education of community members and the mobilization
of social action (Gaventa, 1988). The participatory research tradition emerged from work with
oppressed peoples in the Third World and has spread to disenfranchised groups in North
America (Gaventa, 1988; Hall, 1981; Park, 1993). This research developed from the search for
methods to enable oppressed and powerless people to gain access to scientific knowledge so
that greater social justice and equality could be achieved. Participatory research has also
emphasized education as a key to personal empowerment, emancipation, and social transfor-
mation (Freire, 1970, 1982).
Participatory researchers are openly political and emphasize large-scale structural forces,
conflicts of interest, and the need to overcome oppression and inequality through transforming
the existing social order (Brown & Tandon, 1983). One important outcome of this research is
the creation of organized political groups (Tandon, 1981). The collective sharing, learning, and
analysis within the research process can generate solidarity and awareness of a common cause
among researchers and participants (or co-researchers).

CONCLUSION

Clinical sociologists have many theoretical insights and research tools that make us well
suited for diversity work. This chapter has provided an overview of trends in racial and ethnic
inequalities, general strategies to achieve equality and justice, and specific clinical sociology
approaches to assessment and intervention in the areas of racism and diversity. Clinical
sociologists can play an important role in reducing racism and dismantling the power struc-
tures that perpetuate discrimination and inequality.

REFERENCES

Abramson, A. J., Tobin, M. S., & VanderGoot, M. R. (1995). The changing geography of metropolitan oppportunity:
The segregation of the poor in U.S. metropolitan areas, 1970-1990. Housing Policy Debate, 6, 45-72.
Alba, R., & Logan, J. (1991). Variations on two themes: Racial and ethnic patterns in the attainment of suburban
residence. Demography, 28, 431-453.
346 DARLENE L. PINA

Alba, R., & Logan, J. (1993). Minority proximity to whites in the suburbs: An individual-level analysis of segregation.
American Journal of Sociology, 98, 1388-1427.
Alexander, K. L., Cook, M. A., & McDill, E. L. (1978). Curriculum tracking and educational stratification. American
Sociological Review, 43, 47-66.
Alexander, K. L., Riordan, c., Fennessey, J., & Pallas, A. M. (1982). Social background, academic resources, and
college graduation: Recent evidence from the National Longitudinal Survey. American Journal ofEducation, 90,
315-333.
Alexander, K. L., Holupka, S., & Pallas, A. M. (1987). Social background and academic determinants of two-year
versus four-year college attendance: Evidence from two cohorts a decade apart. American Journal ofEducation,
96,56-80.
Allport, G~ W. (1954). The nature of prejudice. Reading, MA: Addison-Wesley.
Amir, Y. (1969). The contact hypothesis in ethnic relations. Psychological Bulletin, 71, 319-342.
Banks, J. A. (1992). The history of multicultural education. In M. C. Aikin & M. A. Linden (eds.), Encyclopedia of
educational research (6th ed.). New York: Macmillan Co.
Banks, J. A. (1993). Multicultural education: Historical development, dimensions, and practice. In L. Darling-
Hammond (Ed.), Review of research in education (Vol. 19.). Washington, DC: American Educational Research
Association.
Banks, J. A. (1995). Multicultural education and the modification of students' racial attitudes. In W. D. Hawley &
A. W. Jackson (Eds.), Toward a common destiny: Improving race and ethnic relations in America. San Francisco:
Jossey-Bass.
Basch, C. E. (1987). Focus group interviews: An underutilized research technique for improving theory and practice in
health education. Health Education Quarterly, 14(4), 411-448.
Bash, H. H. (1979). Sociology. race, and ethnicity: A critique ofAmerican ideological intrusions upon sociological
theory. New York: Gordon & Breach.
Bean, ED., & Tienda, M. (1987). The Hispanic population ofthe United States. New York: Russell Sage Foundation.
Bell, D. A. (1992). Faces at the bottom of the well: The permanence of racism. New York: Basic Books.
Bennett, C. E. (1995). The black population in the United States: March 1994 and 1993. In U.S. Bureau ofthe Census,
Current Population Reports (pp. 20-480). Washington, DC: U.S. Government Printing Office.
Bennett, C. I. (1990). Comprehensive multicultural education, 2nd ed. Boston: Allyn & Bacon.
Bianchi, S., Reynolds, E, & Spain, D. (1982) Racial inequalities in housing: An examination of recent trends.
Demography, 19, 37-51.
Bloom, A. (1997). The closing of the American mind. New York: Simon & Schuster.
Bound, J., & Freeman, R. B. (1992). What went wrong? The erosion of relative earnings and employment among
young black men in the United States. Quarterly Journal of Economics, 107(1), 201-233.
Braddock, J. H. (1989). Tracking of black, Hispanic, Asian, Native American, and white students: National patterns
and trends. Baltimore: Center for Research for Effective Schooling for Disadvantaged Students.
Braddock, J. H., Dawkins, M. P., & Wilson, G. (1995). Intercultural contact and race relations among American youth.
In W. D. Hawley & A. W. Jackson (Eds.), Toward a common destiny: Improving race and ethnic relations in
America. San Francisco: Jossey-Bass.
Brown, D., & Tandon, R. (1983). Ideology and political economy in inquiry: Action research and participatory
research. Journal of Applied Behavioral Science, 19, 277-294.
Bruhn, J. G., & Rebach, H. M. (1996). Clinical sociology: An agenda for action. New York: Plenum Press.
Bursik, R. J., Jr. (1988). Social disorganization and theories of crime and delinquency. American Journal ofSociology,
88,24-42.
Carlson, S. (1992). Trends in race/sex occupational inequality: Conceptual and measurement issues. Social Problems,
39, 268-287.
Chemers, M., & Murphy, S. (1995). Leadership and diversity in groups and organizations. In M. Chemers, S. Oskamp,
& M. Costanzo (Eds.), Diversity in organizations. Thousand Oaks, CA: Sage.
Chemers, M., Oskamp, S., & Costanzo, M. (Eds.). (1995). Diversity in organizations. Thousand Oaks, CA: Sage.
Chesler, M. (1994). Organizational development is not the same as multicultural organizational development. In E.
Cross, J. H. Katz, E A. Miller, & E. W. Seashore (Eds.), The promise of diversity. Burr Ridge, IL: Irwin.
Chess, W. A., & Norlin, J. M. (1988). Human behavior and the social environment: A social systems model. Boston:
Allyn & Bacon.
Cook, S. W. (1985). Experimenting on social issues: The case of school desegregation. American Psychologist, 40,
452-460.
Cose, E. (1993). The rage ofa privileged class: Why are middle-class blacks angry? Why should America care? New
York: HarperColiins.
Cox, T. H., Jr. (1993). Cultural diversity in organizations: Theory, research, and practice. San Francisco: Berrett-
Koehler.
RACISM AND DIVERSITY 347

Davidson, A. L. (1994). Border curricula and the construction of identity: Implications for multicultural theorists.
International Journal of Qualitative Studies in Education, 7(4), 335-349.
Davis, J. A. (1984). New money, an old man/lady and "two's company": Subjective welfare in the NORC general
social surveys, 1972-1982. Social Indicators Research, 15, 319-350.
Delatte, A. P., & Baytos, L: (1993). Eight guidelines for successful diversity training. Training, 30, 55-60.
DuBois, W. E. B. (1961). The souls of black folk. Greenwich, CT: Facwett. (Original work published 1903)
Early, G. (Ed.). (1993). Lure and loathing: Essays on race, identity, and the ambivalence ofassimilation. New York:
Allen Lane Press, Penguin Books.
Efran,.J. S., Lukens, R J., and Lukens, M. D. (1988). Constructivism: What's in it for you? Networker, 27-35.
Eggers, M. L., & Massey, D. S. (1991). The structural determinants of urban poverty: A comparison of whites, blacks,
and Hispanics. Social Science Research, 20, 217-255.
Eggers, M. L., & Massey, D. S. (1992). A longitudinal analysis of urban poverty: Blacks in U.S. metropolitan areas
between 1970 and 1980. Social Science Research, 21, 175-203.
Epstein,1. L. (1985). After the bus arrives: Resegregation in desegregated schools. Journal ofSocial Issues, 41(3), 23-43.
Essed, P. (1991). Understanding racism. Thousand Oaks, CA: Sage.
Evans, S. (1980). Personal politics. New York: Vintage Books.
Farley, R., & Allen, W. R (1987). The color line and quality oflife in America. New York: Russell Sage Foundation.
Feagin, J. R. (1991). The continuing significance of race: Antiblack discrimination in public places. American
Sociological Review, 56, 101-116.
Feagin, J. R., & Sikes, M. P. (1994). Living with racism: The black middle-class experience. Boston: Beacon.
Feldstein, S., & Costello, L. (Eds.). (1974). The ordeal of assimilation: A documentary history of the white working
class. Garden City, NY: Anchor.
Ferguson, S. A. (1996). Towards an anti-racist social service organization. Journal ofMulticultural Social Work, 4(1),
35-48.
Fernandez, 1. P. (1991). Managing a diverser workforce: Regaining the competitive edge. Lexington, MA: Lexington.
Fernandez, R M., Paulsen, R, & Hirano-Nakanishi, M. (1989). Dropping out among Hispanic youth. Social Science
Research, 18, 21-52.
Fligstein, N., & Fernandez, R M. (1985). Educational transitions of whites and Mexican Americans. In G. J. BoIjas &
M. Tienda (Eds.), Hispanics in the U.s. economy. New York: Academic Press.
Flynn, J. (1995). Social justice in social agencies. In R L. Edwards (Ed.), Encyclopedia of social work (19th ed.,
Vol. 3, pp. 2173-2179). Washington, DC: NASW Press.
Foner, E., & Garranty, J. (Eds.). (1991). The reader's companion to American history. Boston: Houghton Mifflin.
Fong, L., & Gibbs, 1. (1995). Facilitating service to multicultural communities in a dominant culture setting.
Administration in Social Work, 19(2), 1-24.
Frankenberg, R (1993). The social construction ofwhiteness: White women, race matters. Minneapolis: University of
Minnesota Press.
Freire, P. (1970). Pedogogy of the oppressed. New York: Seabury Press.
Freire, P. (1982). Creating alternative research methods: Learning to do it by doing it. In B. Hall, A. Gillette, & R
Tandon (Eds.), Creating knowledge: A monopoly, Participatory research in development. Toronto: International
Council for Adult Education.
Frey, W. (1994). Minority suburbanization and continued "white flight" in U.S. metropolitan areas: Assessing the
findings from the 1990 census. Research in Community Sociology, 4, 15-42.
Frey, w., & Fielding, E. (1995). Changing urban populations: Regional restructuring, racial polarization, and poverty
concentration. Cityscape: A Journal of Policy Development and Research, 1, 1-66.
Friedman, N. L., & Friedman, S. S. (1993). Dviersity management: An emerging employment/consulting opportunity
for sociological practitioners. Clinical Sociology Review, 11, 192-199.
Galen, M. (1994). White, male, and worried. Business Week, 50-55.
Galster, G. C., & Killen, S. P. (1995). The geography of metropolitan opportunity: A reconnaissance and conceptual
framework. Housing Policy Debate, 6, 7-43.
Gaventa, J. (1988). Participatory research in North America. Convergence, 24, 19-28.
Gay, G. (1992). The state of multicultural education in the United States. In K. Adam-Moodley (ed.), Education in
plural societies: International perspectives. Calgary, Alberta: Detselig.
Gerard, H. B. & Miller, N. (1975). School desegregation: A long-range study. New York: Plenum Press.
Gibson, M. (1984). Approaches to multicultural education in the U.S.: Some conceptions and assumptions. Anthropol-
ogy and Education Quarterly, 15(1), 94-119.
Gordon, M. M. (1964). Assimilation in American life: The role ofrace, religion, and national origins. London: Oxford
University Press.
Grant, C. A., & Millar, S. (1992). Research and multicultural education: Barriers, needs, and boundaries. In C. A.
Grant (Ed.), Research and multicultural education: From the margins to the mainstream. Bristol, PA: Falmer.
348 DARLENE L. PrNA

Green, J. (1995). Cultural agencies in the human services (2nd ed.). Englewood Cliffs, NJ: Prentice Hall.
Gutierrez, L., & Lewis, E. (1994). Community organizing with women of color. Journal ofCommunity Practice,1(2),
23-44.
Gutierrez, L., & Nagda, B. (1996). The multicultural imperative in human services organizations. In P. Raffoul & C.
McNeece (Eds.), Future issues for social work practice. Boston: Allyn & Bacon.
Gutierrez, L., Alvarez, A. R., Nemon, H., & Lewis, E. A. (1996). Multicultural community organizing: A strategy for
change. Social Work, 41(5), 501-508.
Hacker, A. (1992). Two nations: Black and white, separate, hostile, unequal. New York: Scribner's.
Hall, B. (1981). Participatory research, popular knowledge and power: A personal reflection. Convergence, 14, 6-19.
Haller, E. J. (1985). Pupil race and elementary school ability grouping: Are teachers biased against black children?
American Educational Research Journal, 22, 465-483.
Hallinan, M. T., & Teixeira, R. A. (1987). Students' interracial friendships: Individual characteristics, structural
effects, and racial differences. American Journal of Education, 95, 563-583.
Handler, R. (1991). Who owns the past? History, cultural property, and the logic of possessive individualism. In
B. Williams (Ed.), The politics of culture. Washington, DC: Smithsonian Institution.
Hanna, J. L. (1994). Issues in supporting school diversity: Academics, social relations, and the arts. Anthropology and
Education Quarterly, 25(1), 66-85.
Hasenfeld, Y. (1996). The administration of human services: What lies ahead. In P. Raffoul & C. McNeece (Eds.),
Future issues for social work practice. Boston: Allyn & Bacon.
Hauser, R. M., & Phang, H. S. (1993). Trends in high school dropout among white, black, and Hispanic youth, 1973
to 1989. Madison, WI: Institute for Research on Poverty DP 1007-1093.
Hawley, W. D., Banks, J. A., Padilla, A. M., Pope-Davis, D. B., & Schofield, J. W. (1995). Strategies for reducing
racial and ethnic prejudice: Essential principles for program design. In W. D. Hawley & A. W. Jackson (Eds.)
Toward a common destiny: Improving race and ethnic relations in America. San Francisco: Jossey-Bass.
Heath, S., & McLaughlin, M. (1993). Identity and inner city youth: Beyond ethnicity and gender. New York: Teachers
College Press.
Heslan, A., & Heffner, R. (1987). Learning about bilingual, multicultural organizing. Journal ofApplied Behavioral
Sciences, 23, 525-541.
Heyns, B. (1974). Social selection and stratification within schools. American Journal of Sociology, 79, 1434-1451.
Hoffman, D. M. (1997). Diversity in practice: Perspectives on concept, context, and policy. Educational Policy, 11(3).
Hogan, R., & Perrucci, C. C. (1998). Producing and reproducing class and status differences: Racial and gender gaps
in U.S. employment and retirement income. Social Problems, 45(4), 528-549.
Hughes, D., & DuMont, K. (1993). Using focus groups to facilitate culturally anchored research. American Journal
of Community Psychology, 21(6), 775-806.
Hughes, M., & Thomas, M. E. (1998). The continuing significance of race revisited: A study of race, class, and quality
of life in America, 1972-1996. American Sociological Review, 63, 785-795.
Hyde, C. (1999). From good intentions to meaningful practice: Multicultural development in human service organi-
zations. Paper presented at the 1999 CSWE-APM, San Francisco.
Hyde, C. (1998). A model for diversity training in human service agencies. Administration in Social Work, 22(4),
19-33.
Inglehart, A., & Becerra, R. (1995). Social services and the ethnic community. Boston: Allyn & Bacon.
Jackman, M., & Jackman, R. (1980). Racial inequalities in home ownership. Social Forces, 58, /221-1234.
Jackson, B., & Holvino, E. (1988). Multicultural organizational development. Ann Arbor: University of Michigan,
Program on Conflict Management Alternatives.
Jargowsky, P. A. (1997). Poverty and place: Ghettos, barrios, and the American city. New York: Russell Sage
Foundation.
Jaynes, G. D., & Williams, R. M. (1989). A common destiny: Blacks and American society. Washington, DC: National
Academy Press.
Jiobu, R. M. (1988). Ethnicity and assimilation. Albany: State University of New York Press.
Johnson, R. (1992). Diversity training: Integral steps for bridging race,language, gender gaps. Training, 29, 801-804.
Kasarda, J. D. (1993). Inner-city concentrated poverty and neighborhood distress: 1970 to 1990. Housing Policy
Debate, 4, 253-302.
Kessler, R. c., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., Wittchen, H., Kender, K. S.
(1989). Lifetime and 12-month prevalence of DSM-UI-R psychiatric disorders in the United States. Archives of
General Psychology, 51, 8-19.
Kirkland, S. E., & Regan, A. M. (1997). Organizational diversity training. In C. E. Thompson & R. T. Carter (Eds.),
Racial identity theory: Applications to individual, group, and organizational interventions. Mahwah, NJ:
Erlbaum.
RACISM AND DIVERSITY 349

Kluegel, 1. R. (1985). If there isn't a problem, you don't need a solution: The basis of affirmative action attitudes.
American Behavioral Scientist, 28, 761-784.
Kozol, J. (1991). Savage inequalities. New York: Crown Publishing.
Krivo, L. J. (1986). Home ownership differences between Hispanics and Anglos in the United States. Social Problems,
33, 318-333.
Krivo, L. J., Peterson, R. D., Rizzo, H., & Reynolds, J. R. (1998). Race, segregation, and the concentration of
disadvantage: 1980-1990. Social Problems, 45(1), 61-80.
Lawson, E. J., & Pillai, V. (1999). The persistence of racism in America's cultural diversity. In L. L. Naylor (Ed.),
Problems and issues of diversity in the United States (pp. 67-86). Westport, CT: Bergin & Garvey.
Lindsley, S. L. (1998a). Conununicating prejudice in organizations. In M.L. Hecht (Ed.), Communicating prejudice.
Thousand Oaks, CA: Sage.
Lindsley, S. L. (1998b). Organizational interventions to prejudice. In M. L. Hecht (Ed.), Communicating prejudice.
Thousand Oaks, CA: Sage.
Lipsitz, G. (1995). A possessive interest in whiteness: Racialized social democracy and the "white" problem in
American studies. American Quarterly, 47(3), 369-385.
Loden, M. (1996). Implementing diversity. Chicago: Irwin Professional Publications.
Loden, M., & Rosener, 1. B. (1991). Workforce America! Managing employee diversity as a vital resource. Burr Ridge,
IL: Irwin.
Logan, J., & Alba, R. (1993). Locational returns to human capital: Minority access to suburban community resources.
Demography, 30, 243-268.
Lyson, T. A. (1985). Race and sex segregation in the occupational structures of Southern employees. Social Science
Quarterly, 66, 281-295.
Marsiglia, E E, & Hecht, M. L. (1998). Personal and interpersonal interventions. In M. L. Hecht (Ed.), Communicat-
ing prejudice. Thousand Oaks, CA: Sage.
Masemann, V. L. (1983). Cultural reproduction in the bilingual classroom. In B. Bain (Ed.), The sociogenesis of
language and human conduct. New York: Plenum Press.
Massey, D. S., & Denton, N. A. (1987). Trends in the residential segregation of blacks, Hispanics, and Asians: 1970-
1980. American Sociological Review, 52, 802-825.
Massey, D. S., & Denton, N. A. (1993). American apartheid: Segregation and the making of the underclass.
Cambridge, MA: Harvard University Press.
Massey, D. S. & Eggers, M. L. (1990). The ecology of inequality: Minorities and the concentration of poverty, 1970-
1980. American Journal of Sociology, 95, 1153-1188.
Massey, D. S., Eggers, M. L., & Denton, N. A. (1994). Disentangling the causes of concentrated urban poverty.
International Journal of Group Tensions, 24, 267-316.
May, S. (1994). Making multicultural education work. Bristol, UK: Longdunn.
McEnroe, M. (1993). Managing diversity: Los Angeles before and after the riots. Organizational Dynamics, 2/(3),
18-29.
Medoff, P., & Sklar, H. (1994). Streets ofhope: The fall and rise ofan urban neighborhood. Boston: South End Press.
Mere1man, R. M. (1993). Black history and cultural empowerment: A case study. American Journal ofEducation, /01,
331-356.
Mincy, R. (1994). The underclass: Concept, controversy, and evidence. In S. H. Danziger, G. D. Sandefur, & D. H.
Weinberg (Eds.) Confronting poverty: Prescriptions for change. New York: Russell Sage Foundation.
Mobley, M. & Payne, T. (1992). Backlash! Training & Development, December, 45-52.
Mondros, I., & Wilson, S. (1994). Organizing for power and empowerment. New York: Columbia University Press.
Morgan, D., & Krueger, R. A. (1993). When to use focus groups and why. In D. L. Morgan (Ed.) Successful focus
groups: Advancing the state of the art (pp. 3-19). Thousand Oaks, CA: Sage.
Morrison, A. M. (1992). The new leaders: Guidelines on leadership diversity in America. San Francisco: Jossey-Bass.
Morrison, A. M., & Von Glinow, M. A. (1990). Women and minorities in management. American Psychologist, 45,
200-208.
Munoz, C. (1989). Youth identity and power: The Chicano movement. London: Verso.
Murdock, S., & Michael, M. (1996). Future demographic change: The demand for social welfare services in the twenty
first century. In P. Raffoul & C. McNeece (Eds.), Future issues for social work practice. Boston: Allyn & Bacon.
Musgrove, E (1982). Education and anthropology: Other cultures and the teacher. New York: Wiley.
Niemonen, J. (1993). Some observations on the problem of paradigms in recent racial and ethnic relations texts.
Teachning Sociology, 21, 271-286.
Nieto, S. (1994). Lessons from students. Harvard Educational Review, 64(4), 392-426.
Oakes, J. (1982). The reproduction of inequity: The content of secondary school tracking. Urban Review, 14, 107-120.
Oakes, 1. (1985). Keeping track: How schools structure inequality. New Haven: Yale University Press.
350 DARLENE L. PINA

Oakes, J. (1992). Grouping students for instruction. In M. Aikin (Ed.), Encyclopedia of educational research. New
York: Macmillan Co.
Oliver, M., & Shapiro, T. (1995). Black wealth/white wealth: A new perspective on racial inequality. London:
Routledge.
O'Sullivan, M. J., & Lasso, B. (1992). Community mental health services for Hispanics: A test of the culture
compatibility hypothesis. Hispanic Journal of Behavioral Sciences, 14, 455-468.
Ozawa, M. N., & Kim, T. S. (1989). Distributive effects of Social Security and pension benefits. Social Service
Review, 63, 335-358.
Parcel, T. (1982). Wealth accumulation of black and white men: The case of housing equity. Social Problems, 30,
199-211.
Parcel, T., & Mueller, C. (1989). Temporal changes in occupational earnings attainment, 1970-1980. American
Sociological Review, 54, 622-634.
Park, P. (1993). What is participatory research? A theoretical and methodological perspective. In P. Park, M. Brydon-
Miller, B. Hall, & T. Jackson (Eds.), Voices of change: Participatory research in the United States and Canada.
Westport, CT: Bergin & Garvey.
Patchen, M. (1982). Black-white contact in schools: Its social and academic effects. West Lafayette, IN: Purdue
University Press.
Pech, R. (1995). Affirmative action. Vista, 26-30.
Perry, R. 1. (1992). Why do multiculturalists ignore anthropologists? Chronicle of Higher Education, 52.
Piiia, D. L. (1998). Providing culturally sensitive services to Latino clients: A case study of a non-profit organization.
Clinical Sociology Review, 16, 67-91.
Piiia, D. L., & Canty-Swapp, L. (1999). Melting multiculturalism? Legacies of assimilation pressures in human
service organizations. Journal of Sociology and Social Welfare, 26(4), 87-113.
Pinkney, A. (1993). Book review of two nations. Science & Society, 57(4), 497-499.
Pope-Davis, D. B., & Coleman, H. L. K. (1997). Multicultural counseling competencies: Assessment, education and
training, and supervision. Thousand Oaks, CA: Sage.
Public Agenda Foundation. (1990). Remedies for racial inequality: Why progress has stalled, what should be done.
Dubuque, IA: KendalllHunt.
Rivera, E, & Erlich, J. (1995). Community organizing in a diverse society (2nd ed.). Boston: Allyn & Bacon.
Robbins, L. N., & Regier, D. A. (1991). Psychiatric disorders in America: The epidemiologic catchment area study.
New York: Free Press.
Roediger, D. (1994). Towards the abolition of whiteness. New York: Verso.
Rong, X. L., & Grant, L. (1992). Ethnicity, generation, and school attainment of Asians, Hispanics, and non-Hispanic
whites. Sociological Quarterly, 33, 625-636.
Rosenbaum, E. (1994). The structural constraints on minority housing choices. Social Forces, 72,725-747.
Rosenbaum, E. (1996). Racial/ethnic differences in home ownership and housing quality, 1991. Social Problems,
43(4), 403-426.
Rothbart, M. (1996). Category-exemplar dynamics and stereotype change. International Journal of Intercultural
Relations, 20, 305-322.
Rumberger, R. W. (1983). Dropping out of high school: The influence of race, sex, and family background. American
Educational Research Journal, 20, 199-220.
Rynes, S., & Rosen, B. (1994). What makes diversity programs work? HRMagazine, 68-70.
Rynes, S., & Rosen, B. (1995). A field survey of factors affecting the adoption and perceived success of diversity
training. Personnel Psychology, 48, 247-270.
Saleebey, D. (1991). The strengths perspective in social work practice. New York: Longman.
Sampson, R. J., & Groves, W. B. (1989). Community structure and crime: Testing social-disorganization theory.
American Journal of Sociology, 94, 774-802.
Sandefur, G.D. (1998). Race, ethnicity, families, and education. In H. I. McCubbin, E. A. Thompson, A. I. Thompson,
& 1. E. Fromer (Eds.), Resilency in Native American and immigrant families. Thousand Oaks, CA: Sage.
Sashkin, M., & Burke, W. (1987). Organizational development in the 1990s. Journal of Management, 13, 393-417.
Schneider, M., & Phelan, T. (1993). Black suburbanization in the 1980's. Demography, 30, 269-279.
Schein, E. (1992). Organizational culture and leadership. San Francisco: Jossey-Bass.
Schlessinger, E. G., & Devore, W. (1995). Ethnic sensitive social work practice: The state of the art. Journal of
Sociology and Social Work, 22(1), 29-57.
Schofield, J. W. (1991). School desegregation and intergroup relations: A review of the literature. In G. Grant (Ed.),
Review of research in education (vol. 17). Washington, DC: American Educational Research Association.
Schofield, J. W. (1995). Promoting positive intergroup relations in school settings. In W. D. Hawley & A. W. Jackson
(Eds.). Toward a common destiny: Improving race and ethnic relations in America. San Francisco: Jossey-Bass.
RACISM AND DIVERSITY 351

Scott, J. C. (1990). Domination and the arts of resistance: Hidden transcripts. New Haven, CT: Yale University Press.
Segal, D. A., & Handler, R. (1995). U.S. multiculturalism and the concept of culture. Identities, 1(4), 391-407.
Sigelman, L., & Welch, S. (1991). Black Americans' views of racial inequality. London: Cambridge University Press.
Slavin, R. E. (1990). Cooperative learning: Theory, research, and practice. Englewood Cliffs, NJ: Prentice-Hall.
Slavin, R. E. (1995). Enhancing intergroup relations in schools: cooperative learning and other strategies. In W. D.
Hawley & A. W. Jackson (Eds.), Toward a common destiny: Improving race and ethnic relations in America. San
Francisco: Jossey-Bass.
Sleeter, C. E., & Grant, C. A. (1987). An analysis of multicultural education in the United States. Harvard Educational
Review, 57(4), 42l-444.
Sleeter, C. E., & Grant, C. A. (1988). Making choices for multicultural education: Five approaches to race, class, and
gender. Columbus, OH: Merrill.
Smith, B. E. (1995). Crossing the great divides: Race, class, and gender in Southern women's organizing, 1979-1991.
Gender & Society, 9(6), 680-696.
Smith, J. P. (1995). Racial and ethnic differences in wealth in the health and retirement study. Journal of Human
Resources, 30 (Suppl.), Sl58-S183.
Smith, J. P. & Welch, F. (1984). Affirmative action and labor markets. Journal of Labor Economics, 2, 269-301.
Smith, R. A. (1997). Race, income, and authority at work: A cross-temporal analysis of black and white men (1972-
1994). Social Problems, 44(1), 19-38.
Snyder, M., & Meine, P. (1994). On the functions of stereotypes and prejudice. In M. P. Zanna & J. M. Olsen (Eds.),
Ontario Symposium on Personality and Social Psychology, Vol 7: The psychology of prejudice. Hillsdale, NJ:
Erlbaum.
Solomon, C. (1991). Are white males being left out? Personnel Journal, 70(11), 88-94.
Somervell, P. D., Leaf, P, Weissman, M., Glazer, D., & Bruce, M. L. (1989). The prevalence of major depression in
black and white adults in five United States communities. American Journal of Epidemiology, 130, 725-735.
Squires, G. (1994). Capital and communities in black and white. Albany: SUNY Press.
Staples, R. (1982). Black masculinity: The black male's role in American society. San Francisco: The Black Scholar Press.
Stephan, W. G. (1978). School desegregation: An evaluation of predictions made in Brown v. Board of Education.
Psychological Bulletin, 85, 217-238.
Stephan, W. G., & Stephan, C. W. (1996). Predicting prejudice. International Journal of Intercultural Relations, 20,
409-426.
Stephenson, K. (1994). Diversity: A managerial paradox. Clinical Sociology Review, 12, 189-205.
Sue, D. W., Fujino, D. c., Hu, L., Takeuchi, D. T., & Zane, N. W. S. (1991). Comunity mental health services for ethnic
minority groups: A test of the cultural responsiveness hypothesis. Journal of Consulting and Clinical Psychol-
ogy, 59, 533-540.
Swinton, D.H. (1990). Economic progress for black Americans in the post-civil-rights era. In G. E. Thomas (Ed.), U.S.
race relations in the 1980's and 1990's: Challenges and alternatives. Washington, DC: Hemisphere Publishing.
Tandon, R. (1981). Participatory research in the empowerment of people. Convergence, 14, 20-29.
Tatum, B. D. (1987). Assimilation blues: Blackfamilies in II white community. New York: Greenwood.
Thomas, G. E., Alexander, K. L., & Eckland, B. K. (1979). Access to higher education: The importance of race, sex,
social class, and academic credentials. School Review, 87, 133-156.
Thomas, M. (1993). Race, class, and personal income: An empirical test of the declining significance of race thesis,
1968-1988. Social Problems, 40, 328-342.
Thomas, M. E., & Hughes, M. (1986). The continuing significance of race: A study of race, class, and quality of life in
America, 1972-1985. American Sociological Practice, 51, 830-841.
Thomas, M. E., Herring, c., and Horton, H. D. (1994). Discrimination over the life course: A synthetic cohort analysis
of earnings differences between black and white males. Social Problems, 41, 608-628.
Thomas, R. R., Jr. (1991). Beyond race and gender: Unleashing the power of your total workforce by managing
diversity. New York: American Management Association.
Trennert, R. A. (1988). The Phoenix Indian school: forced assimilation in Arizona, 1891-1935. Norman: University of
Oklahoma Press.
Turner, T. (1993). Anthropology and multiculturalism: What is anthropology that multiculturalists should be mindful
of it? Cultural Anthropology, 8(4), 411-429.
U.S. Bureau of the Census. (1994). Statistical abstract of the United States (114th ed.). Washington, DC: U.S.
Department of Commerce Bureau.
U.S. Bureau of the Census. (1996). Statistical abstract of the United States (pp. 229-231). Washington, DC: U.S.
Government Printing Office.
U.S. Department of Education. (1992). Are Hispanic dropout rates related to migration? National Center for
Education Statistics, U.S. Government Printing Office.
352 DARLENE L. PINA

U.S. Department of Labor Statistics. (1991). Employment and Earnings. Washington, DC: U.S. Government Printing
Office
Velez, W. (1989). High school attrition among Hispanic and non-Hispanic white youths. Sociology ofEducation, 62,
119-133.
Villemez, W. (1980). Race, class, and neighborhood: Differences in the residential return on individual resources.
Social Forces, 59, 414-430.
Watzlawick, P. (1984). The invented reality: How do we know what we believe we know? New York: W.W. Norton.
Watzlawick, P., Beavin, 1. H., & Jackson, D. D. (1967). Pragmatics of human communication. New York: W.W.
Norton.
Wax, M. (1993). How culture misdirects multiculturalism Anthropology and Education Quarterly, 24(2), 99-115.
Wendell, L., Bell, c., & Zawicki, R. (Eds.). (1989). Organizational development. New York: Urwin.
Wentling, R. M., & Palma-Rivas, N. (1998). Current status and future trends of diversity initiatives in the workplace:
Diversity experts' perspective. Human Resource Development Quarterly, 9(3), 235-253.
West, C. (1993). Race matters. Boston: Beacon Press.
West, G. (1990). Cooperation and conflict among women in the welfare rights movement. In L. Albrecht & R. Brewer
(Eds.), Bridges of power: Women s multicultural alliances. Philadelphia: New Society.
Wieviorka, M. (1998). Is multiculturalism the solution? Ethnic and Racial Studies, 21(5), 881-910.
Williams, D. R., Takeuchi, D. T., & Adair, R. K. (1992). Socioeconomic status and psychiatric disorder among blacks
and whites. Social Forces, 71, 179-194.
Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health:
Socioeconomic status, stress, and discrimination. Journal of Health Psychology, 2, 335-351.
Williams, N., & Sjoberg, A. E (1993). Ethnicity and gender: The view from above versus the view from below. In T. R.
Vaughan, G. Sjoberg, & L. T. Reynolds (Eds.), A critique of contemporary American sociology (pp. 160-202).
Dix Hills, NY: General Hall.
Williams, N., Himmel, K., Sjoberg, A. E, & Torrez, D. (1995). The assimilation model, family life and race and
ethnicity in the United States. Journal of Family Issues, 16(3), 380-405.
Wilson, W. J. (1987). The truly disadvantaged: The inner city. the underclass. and public policy. Chicago: The
University of Chicago Press.
Wilson, W. J. (1996). When work disappears: The world of the new urban poor. New York: Alfred A. Knopf.
Wojtkiewicz, R. A. & Donato, K. M. (1995). Hispanic educational attainment: The effects of family background and
nativity. Social Forces, 74(2), 559-574.
Woody, D. L. (1992). Recruitment and retention of minority workers in mental health programs. Washington, DC:
National Institute of Mental Health, Human Resource Development Program.
Yates, D. L., & Pillai, V. K. (1992). Frustration and strain among Fort Worth police officers. Sociology and Socia/-
Research, 76(3), 145-149.
Zeichner, K. M. (1995). Preparing educators for cross-cultural teaching. In W. D. Hawley & A. W. Jackson (&is.)
Toward a common destiny: lmproving race and ethnic relations in America. San Francisco: Jossey-Bass.
 CHAPTER 18

Poverty, Social Welfare,

and Public Policy
ANTOINETTE COLEMAN AND HOWARD M. REBACH

INTRODUCTION

Someone, we are not really sure who, said, "If you want peace, work for justice." We would
amend that to read, "work for economic justice." The purpose of this chapter is to discuss the
social problem of poverty. The world has certainly known "poor people." Being poor is a
condition that affects individuals and families. Poverty, on the other hand, is a social structure,
a component of the larger society. Hunger and deprivation and struggle for survival are older
than recorded history. For most of human history and for many people of the earth today, life
has been and continues to be a struggle to keep body and soul together even as modem
technology produces abundance. What is new is the recognition of poverty as a social
problem; a problem caused and maintained by social arrangements and one that has profound
bearing on social solidarity, the peace of civil society, and the development and maintenance
of democratic political institutions. That poverty brings aversive consequences for the poor
is to state the obvious; it also touches and is closely related to other widely recognized social
problems: disease, crime, delinquency, single parenthood, and substance abuse, to name a few.
And poverty itself occasionally enters the political arena as candidates and political leaders
declare war on it and attempt to deal with it.
The concept of "economic justice" can be a tricky concept. It certainly does not mean
some utopian idea of "From each according to his ability, to each according to his need." Nor
does it necessarily mean approaching equality of material circumstance for all. Even if this
were possible in a modem industrial society, it is not clear that it is just. Simply taking from
some because they have, to give to others solely for the purpose of creating equality, is not
justice. Jasso (1999) also reminded us that justice and injustice are subjective constructs that
"have no existence independent of an observer" and refer to judgments in specific situations
such as the distribution of wages, taxes, wealth, fines-rewards and punishments and receipt
of both "goods" and "bads." Issues of economic justice have a bearing on the material cir-

ANTOINETTE COLEMAN. School of Social Work, Norfolk State University, Norfolk, Virginia 23504.
HOWARD M. REBACH • Department of Social Science, University of Maryland Eastern Shore, Princess Anne,
Maryland 21853.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

353
354 ANTOINETTE COLEMAN AND HOWARD M. REBACH

cumstance of individuals and families and the distribution of life chances, which, in turn, refer
to the ability to obtain the rewards that society has to offer. Just social institutions not only
meet individual needs, and promote individual personal development, they also promote social
solidarity and social development.
The extent to which economic justice exists within a political economy emerges from its
social structures and institutions, its values and beliefs, its customs and laws, and its political
practices and policies. Dunn expressed the opinion that a just economic system is one that
(1) unifies, bringing together people from all segments of the economy, and (2) increases
access to economic participation for as many people as possible "to help address legitimate
'first step' needs so ... people ... can be made ready to move on to higher levels of personal
advancement"(1999:1). (3) Just systems also provide for fair distribution of the wealth to those
participating in producing it. A political economy that is biased in favor of those already
advantaged cannot be considered just. In particular, race-, class-, and gender-based inequal-
ities that have shaped distinctions among citizens are indicative of economic injustice (Glenn,
2000).
This view is close to that expressed by Kelso and Adler (1958) nearly a half- century ago.
Economic justice was defined by three principles: participative justice, distributive justice and
economic harmony. Participative justice requires equal access and opportunity though does
not guarantee equal results. Thus, economic justice rejects the presence of special privileges,
social barriers, and discriminatory practices. Distributive justice refers to a fair and reason-
able payoff for one's productive activity. Like participative justice, distributive justice breaks
down when discriminatory practices and exclusionary social barriers exist. Finally, the prin-
ciple of economic harmony refers to social processes, "balancing principles required to detect
distortions ... and to make whatever corrections are needed to restore a just and balanced
economic order for all. This principle is violated by unjust barriers to participation, by
monopolies or by some using their property to harm or exploit others" (CESJ, 1999:3).
Jasso (1999) discussed economic justice as a ratio between actual reward and "just
reward." By Jasso's analysis, the United States was found to be the most unequal-least
just-of the Western democracies (compared with Germany, The Netherlands, Great Britain,
and Japan) though certainly more just, defined in terms of income inequality (for the period
1991-1992) and underreward to workers, than former Soviet Bloc nations.
As President Clinton frequently stated, as the twentieth century ended, the United States
has had the longest period of peacetime economic expansion in its history. The U.S. economy
has been booming. Interest rates are low. Stock market indices have been at record highs.
Recent data, from the 1990s-the Clinton years-show downward trends in poverty rates and
record lows in unemployment rates. Welfare rolls have been reduced. Does this mean that an
end to poverty is in sight, that it will just fade away in a rising tide that lifts all boats? At this
writing, there is already talk of a cooling of the U.S. economy and new political leaders talk of
redirection of economic policies of the Clinton years that may have had something to do with
the prosperous times and downward trends in poverty headcounts and rates.
In previous times of prosperity and affluence, as Trattner (1989) reported, Americans
adopted the view that poverty would simply disappear; that general prosperity and the affluent
society with its high standard of living can and will deliver a fair share to all. But as we will
demonstrate, whether related to economic policies of various administrations or simply market
forces and economic cycles or some combination, the extent of poverty in the United States
has shown periodic rises and falls but no signs of disappearing. As we will also show, the
present prosperity has not reached all sectors of society and, as Lenski (1966) generally
suggested, inequality has increased along with affluence.
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 355

In this chapter, we will briefly review ideas on poverty, the definition of poverty, and
recent data bearing on poverty and inequality. Then we will tum to the major recent policy
development called "welfare reform" and close with consideration of roles for clinical
sociologists and other professionals in dealing with poverty-related issues.

THEORIES OF POVERTY

Why are some people poor? Why does poverty exist? For many these two questions may
seem redundant, but they are, in fact, two quite different questions. The answer to the first is
simple: some people are poor because they do not make enough money. For some, the reason
may be poor health or disability. Others may face discrimination due to race, ethnicity, class,
gender, age, or some other categorical membership. Unfortunately, some still use an explana-
tion that harks back to social Darwinism: some persons or cultures are simply "unfit" or
"inferior" and thus cannot compete effectively in the struggle for economic resources. The
people who usually say this are those who were born with advantages and inherited more.
Human capital theory explains that some people are poor because they do not have the
human capital, the knowledge or education or skills or training or experience or intelligence-
some special ability with which to enter the labor market and receive a high return. Thus, for
example, data generally show that poverty rates are inversely related to educational attain-
ments while income is positively related. Specifically, human capital theory suggests that if
the poor are given job training or skills or education, they can rise out of poverty. Or, if dis-
crimination by age, gender, race, and so on were eliminated, that poverty would recede. But
these steps, a microlevel approach, will merely redistribute poverty.
To illustrate, imagine that all basketball players in the NBA are about 5'10" and along
comes a man 7 feet tall with average athletic skills. This man could probably receive a
substantial contract. But what happens as the number of 7-foot-tall men increases? When all
the candidates for positions are close to 7 feet tall, the 5'10" players are out and only the most
gifted of the taller get chosen. The choice positions and payoffs have simply been redis-
tributed. This example illustrates the effect of increasing the human capital of individuals: the
bar goes up; poverty is redistributed.
While human capital theory and other individually oriented approaches may explain why
some people are poor, they miss the point that poverty is created by social arrangements, the
way the society is organized, and the structure of the labor market which includes the hours
worked and the pay received. Today, the average worker is working longer, productivity per
worker is high, and corporate profits are high as indicated by the surge in stock prices and other
indices. But it is not clear that workers are sharing in the bonanza. The rewards are inequitably
distributed. Poverty is caused by structural inequality-the unequal distribution of payoffs to
whole categories of people that is built into the social system.
Writing early in the twentieth century, Lilian Brandt (1908) took exception to a social
Darwin approach that a3signed the cause of poverty to intemperance, idleness, dishonesty,
shiftlessness, and other moral defects. These she saw more as the consequences of poverty
while she identified causes among social conditions. Some examples were poorly paid
employment, instability of employment, child labor, and defective education for children,
inadequate sanitation, healthcare, and disease control as well as unsafe working conditions
that resulted in the death of wage earners leaving no supports for their families.
The view that poverty arises out of social arrangements rather than moral defects may
have been a novel approach in Brandt's time, but it is not clear that it is generally accepted even
356 ANTOINETTE COLEMAN AND HOWARD M. REBACH

now. Poverty arises out of the basic stratification within society, from the unequal distribution
of payoffs to persons based on their position within the division of labor. Macroeconomic
forces contribute. Wilson (1987, 1991) identified "the shift from goods-producing to service-
producing industries, increasing polarization of the labor market into low-wage and high-wage
sectors, innovations in technology, relocation of manufacturing industries out of the central
city, periodic recessions, and wage stagnation" (1991:6) and the shift to information process-
ing industries and away from more traditional industries that produced blue-collar jobs. Balke
and Slottje (1993) analyzed 40 years of census data and found that unemployment and inflation
were associated with poverty growth. These trends particularly hit urban minority poor very
hard.
Structural functionalists explained this inequality as serving a function for the mainte-
nance of society. Certain roles in the division of labor are thought to be more essential and
therefore more valuable to the society. Some of these require relatively rare skills, intelligence,
and/or expertise. Some of them, such as physicians and sociologists also require significant
investment of time, energy. and money in preparation. Thus, higher rewards are necessary to
see that persons are attracted to these roles and will persist in getting the training to achieve
them. This point of view falls short in explaining the high payoffs to less essential roles such as
entertainers and sports figures and low payoffs to such essential workers as elementary school
teachers who teach us to read, write, and do arithmetic, often under trying circumstances. The
rewards seem to go more toward those who can produce big money for entrepreneurs rather
than for being essential to society. Generally the profit system of corporate capitalism operates
to favor some groups and not others.
Conflict theorists generally explain stratification as the product of the domination of the
many by the few. The many live off of their work and the few live off of the work of others.
Those who obtain wealth, usually inherited, obtain political power and influence laws and the
political process to benefit their class and increase corporate wealth and power.
The distribution of power emerges from the form of the political economy. The recent
trend within the corporate capitalist system of the United States has been toward increasing
corporate power and increasing concentration of this power through mergers and interlocking
directorates. As a result, competition is reduced and prices go up. Wealth is concentrated. Jobs
are eliminated. Workers, consumers, and unions have little effect on the power and wealth of
these megacorporations. Government is the only agency left that could offset corporate power
but corporate power and wealth has been able to control the political process leading to
passage of laws and tax codes favorable to the corporate system.
Gustafsson and Johansson (1999) studied the Gini coefficient for 16 industrialized nations
from 1966 to 1994. The Gini is a complex statistical measure of inequality that varies from zero
indicating perfect equality-everyone has the same share-to 1.00 which is perfect inequality-
one person or group has it all. They found that inequality increased generally through the
1980s. Among the principal causal factors that explained increasing inequality were found to
be deindustrialization and increases of imports of manufactured goods from developing
nations. Factors associated with reduced inequality were the percent of the work force in
unions and the contribution of the public sector to the economy, either through public
employment or through welfare-type money transfers. Of the 16 Western democracies studied,
their data showed that the United States consistently maintained the highest indices of income
inequality. The decrease in industrial production and the change to an information based and
service economy, the importation of goods from abroad and the decline in union membership
are all trends in the United States that are consistent with these findings.
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 357

The corporate profit motive operates to keep labor costs as low as possible including
moving outside the United States where labor costs are lower. This may mean unemployment
for industrial workers or relocation to lower-paying service jobs like fast food service, the
McJob. Others, the so-called underclass, those unable to locate new jobs, those unable to
migrate to seek work, and those without new marketable skills, fall out of the labor force
altogether. Thus, as Brandt concluded nearly a century ago, poverty is caused by those features
of a political economy that result in poor pay, job instability, and inequitable distribution of
rewards. We can add that, in poor and minority areas, discriminatory structural patterns restrict
access to life chances. Education, safe housing, healthcare, recreation, good jobs, and other
resources are less available and what there is is of lower quality. And the lack of safe
neighborhoods, an organized community, and political powerlessness help maintain these
groups' poverty status.

DEFINING POVERTY

Everyone "knows" what poverty is or at least can say they know it when they see it. It
may mean short finances, lack of power, substandard housing, disenfranchisement, certain
lifestyles and attitudes (Bell, 1983). The problem of trying to understand poverty begins with
the problem of trying to define and measure poverty: the issue involves trying to decide
whether a person or a family is poor and trying to define a minimum standard of living below
which a person or family is considered poor. The definition of poverty and the establishment of
criteria are important for public policy. The criteria that are set are used to produce the annual
headcount of persons in poverty provided by the U.S. Census Bureau and the Current
Population Survey (CPS). These headcounts identify the extent of the problem, which in tum
can influence political judgment on the needs for policy and programs of intervention.
O'Boyle expressed the view that "the definition of poverty is inherently value-laden
because it reflects the value systems of the persons who use it" (1999b:349). DiNitto (1995:75)
was more blunt: "defining poverty is a political activity." Those who may favor government
programs or who see poverty as a persistent problem even in affluent times, may favor an index
that produces high numbers of people in poverty. Others may favor lower indices that
minimize the problem. The definition of poverty in the United States gets somewhat more
complex when images of the poor in India, Bangladesh, Ethiopia, and other places around the
world are invoked.
O'Boyle wrote that "poverty is a problem in unmet human physical need," that people in
poverty "lack the goods and services needed to sustain and support life and the income to
purchase the goods or services which would meet those needs." Thus begins the difficulty in
defining poverty: O'Boyle asked, "Is the totality of human physical need to be expressed in
an absolute or relative sense?" (1999a:282). Is unmet human need to be measured strictly in
terms of subsistence, some "minimal standard of living"? Or is it relative to a standard of
living available to members of a population? In the United States, the official poverty level or
poverty line or poverty threshold, used for estimating the extent of poverty and used as the
basis for means-tested programs, is based on an absolute definition of poverty.
Absolute poverty usually refers to the lack of basic resources necessary to sustain life:
lack of food, water, and shelter. It is thought to be an "objective" criterion, but as O'Boyle
(l999a) correctly pointed out the absolute poverty level is socially defined within a culture and
historical period and is measured "relative to income required" to maintain a minimal
358 ANTOINETTE COLEMAN AND HOWARD M. REBACH

standard of living. And it is annually adjusted in line with prices uninfluenced by changes in
lifestyles, overall material well-being, median income, or spending patterns (Sawhill, 1996;
Callan et aI., 1996).
The following brief history of the development of the official poverty threshold comes
from the U.S. Census Bureau (2000). The official poverty threshold was developed in the early
1960s by Orshansky of the Social Security Administration. The U.S. Department of Agricul-
ture had developed a set of four basic economy food budgets called nutritionally adequate by
the USDA. The USDA described the economy food plan as "designed for temporary or
emergency use when funds are low" (Fisher, 1997:1). Orshansky referred to an earlier USDA
study, reported in 1955, that showed that U.S. families of three or more persons spent about
one-third of their after- tax income on food. Thus, the poverty thresholds for families of three
or more persons were set by multiplying the cost of the economy food plan for each size family
by 3.
The procedure assumed that the average family spending one-third of its income on food
could cut back on nonfood items (like rent) at the same rate. Orshansky herself referred to the
multiplier of 3 times the cost of the economy food plans as an interim guide. No direct cost-
estimates of needs such as housing, clothing, medical care, or transportation were included
(O'Boyle, 1999b). Orshansky also suggested a second set of thresholds to identify the "near
poor" creating three categories, poor, near-poor, and nonpoor (Bishop et aI., 1999).
Thresholds for one- or two-person households were set differently to account for large
fixed expenses. For two people the multiplier was 3.7 which was prorated for one person.
Annual updates were based on price changes in the economy food plan. In 1964 the poverty
threshold for a four-person household was $3169.00. Computation of the thresholds was
revised in 1969 and again in 1981. In 1969, annual adjustments were tied to the Consumer Price
Index (CPI) rather than changes in the cost of the economy food plan and farm families'
thresholds were raised from 70% of nonfarm families to 85%. Thresholds were adjusted only
for price changes, not for changes in the overall standard of living (Fisher, 1997). In 1981,
separate thresholds for farm families were eliminated. Differences between female- headed
households and male- headed households were also eliminated by averaging. Thresholds were
established for households up to nine persons. The 1981 revision, annually adjusted by the
CPI-U (CPI for urban households) is now in use. Table 18.1 shows selected thresholds from
1980 to 1999 in current dollars, dollar values as they were for the index year.
The Federal Poverty Thresholds, as reported in Census Bureau data, is not without its
critics. On one side are criticisms that the existing thresholds do not include various in-kind
benefits-Medicaid, food stamps, school breakfasts and lunches, housing assistance, and so

TABLE 18.1. Poverty Thresholds, 1980-1999 by Size of Family

1980 1990 1995 1998 1999

One person, under 65 $4,290 $6,800 $9,929 $8,480 $8,667

over 65 3,949 6,268 7,309 7,818 7,990
Two person, household head under 65 5,537 8,794 10,259 10,972 11,214
over 65 4,983 7,905 9,219 9,863 10,075
Three 6,565 10,419 12,158 13,003 13,290
Four 8,414 13,359 15,569 16,660 17,029
Five 9,966 15,795 18,408 19,680 20,127
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 359

TABLE 18.2. Poverty Levels by Definition of Income, Numbers of Persons below Poverty
by Definition, Rates in Parentheses
Numbers (xl000) and rates below poverty level
Definition All White Black Hispanic

Income before taxes

1. Money income (excluding capital gains) 35,574 (13.3) 24,396 (11.0) 9,116 (26.5) 8,308 (27.1)
2. Definition 1 less govt. money transfers 56,390 (21.0) 41,794 (18.9) 12,027 (34.9) 9,894 (32.3)
3. Definition 2 plus capital gains 56,161 (20.9) 41,620 (18.8) 11,977 (34.8) 9,855 (32.2)
4. Definition 3 plus health insurance 54,573 (20.3) 40,500 (18.3) 11,600 (33.7) 9,472 (30.9)
supplements
Income after taxes
5. Definition 4 less Social Security payroll 57,138 (21.3) 42,315 (17.7) 12,194 (35.4) 10,103 (33.0)
taxes
6. Definition 5 less federal income taxes 57,520 (21.4) 45,582 (17.6) 12,276 (35.6) 10,202 (33.3)
7. Definition 6 plus earned income tax 53,601 (20.0) 39,800 (16.7) 11,377 (32.9) 9,038 (29.5)
credit
8. Definition 7 less state income taxes 54,036 (20.1) 40,132 (16.8) 11,398 (33.1) 9,076 (29.6)
9. Definition 8 plus non-means-tested 35,849 (13.4) 24,266 (10.3) 9,418 (27.3) 7,950 (25.9)
govt. cash transfers
10. Definition 9 plus value of Medicare 34,748 (12.9) 23,503 (10.6) 9,120 (26.5) 7,801 (25.5)
11. Definition 10 plus value of school lunch 34,748 (12.9) 23,503 (10.6) 9,120 (26.5) 7,80 I (25.5)
12. Definition 11 plus means-tested govt. 32,113 (12.0) 21,901 (9.9) 8,267 (24.0) 7,336 (23.9)
cash transfers
13. Definition 12 plus value of Medicaid 30,119 (11.2) 20,624 (9.3) 7,719 (22.4) 6.803 (22.2)
14. Definition 13 plus means-tested govt. 26,940 (10.0) 18,680 (8.4) 6,648 (19.3) 6,018 (19.6)
noncash transfer
15. Definition 14 plus net imputed return on 24,659 (9.2) 16,902 (7.6) 6,200 (18.0) 5,676 (18.5)
equity in own home

Source: u.s. Census Bureau.

on. These critics assert that the poverty rates and numbers would be substantially reduced if the
values of these benefits were included in family income. The Census Bureau provided data on
these poverty rates according to 15 different definitions as shown in Table 18.2. The table
certainly points up the political aspect of the definition. Depending on which definition is used,
poverty rates vary from less than 1 in 10 to more than 1 in 5 persons living in poverty.
Critics with a different perspective assert that poverty thresholds are set too low. First, the
poverty line is set based on gross income (before taxes) though the poor must pay taxes. Note
the difference in the poverty rate between Definition 1, the current definition, and Definitions
5-8 in Table 18.2. Second, the poverty thresholds do not take regional differences in the cost
of living into consideration. For example, in 1997, median monthly apartment rental in the
Northeast was over $850.00 versus $780.00 in the West and $624.00 in the Midwest (U.S.
Census Bureau, 1999). Nor do poverty thresholds consider special circumstances such as
chronic illness, handicap, or a child with special needs.
Fourth, it has been suggested that the estimate of one-third of family income-recall that
this was based on a 1955 study of families of three or more-is out of date. In 1989 the poorest
families spent one fourth of their income on food. Families with income higher than poverty
averaged 12% nationally in 1989. In 1997 a family of four also spent an average about 12% of
its income on food (U.S. Census Bureau, 1999). Housing costs, which are now a major expense
360 ANTOINETTE COLEMAN AND HOWARD M. REBACH

TABLE 18.3. Intlation Rates of Shelter (Housing) Compared with General

Intlation Rates, 1985-1998
1985 1986 1988 1990 1992 1994 1996 1998

General inflation rates 3.6 1.9 4.1 5.4 3.0 2.6 3.0 1.6
Shelter costs inflation rate 5.6 5.5 4.8 5.4 3.3 3.1 3.2 3.3

Source: U.S. Census Bureau.

for most families, have increased greatly. In general, Census Bureau data (1999) show that,
since 1980, inflation in housing costs runs ahead of the overall inflation rate (see Table 18.3).
Households below the poverty threshold that own their home, spend, as a national
average, 55% of their income on housing while those that rent spend 65.5% of their income on
housing compared with the national average renter spending about 29% of income on housing.
It should also be noted that the poverty threshold has not kept up with median incomes.
The gap between the poor and the nonpoor has been increasing with median income increasing
more rapidly than the poverty threshold. Overall, the poverty line was 54% of median income
in 1960 and 38% of median income in 1996. Table 18.4 is based on four-person households. In
1970 the poverty threshold for such households was $3968, which was 36% of the median
income for four-person households which decreased to 29% by 1999.
As the thresholds declined, relative to median income, some families classified as poor
are falling further behind other families. This relative decline could also partially explain some
of the decline in the poverty rate. Some (Bell, 1983) have suggested setting the poverty index at
a fixed percent of median income, perhaps somewhere between 40 and 50%. Such an index
would automatically correct for rising prices, but would certainly inflate the proportion of the
population below the poverty line beyond what would be politically acceptable.
Finally, the income standard that currently establishes the poverty line in the United
States does not fairly index deprivation. Small income gains by persons just at the poverty line
bring them just over the line and out of poverty thereby reducing the headcount measure.
Similar transfers to much needier persons will have little impact.

TABLE 18.4. Median Income, Poverty Threshold, and Poverty

Threshold as a Percentage of Median for Four-Person
Households,1970-1998
Median income, Poverty threshold, Poverty threshold
4-person household 4-person household as % of median income

1970 $11,176 $3,968 36%

1975 15,849 5,500 34.7
1980 24,410 8,414 34.4
1985 32,703 10,989 33.6
1990 41,473 13,359 32.2
1995 49,531 15,569 31.4
1998 55,886 16,660 29.8
1999 59,768 17,029 28.5

Source: U.s. Census Bureau and authors' calculations.

POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 361

O'Boyle has suggested an approach based on the work of Callan et al. (1996) in Ireland
which was based on the concept of deprivation. Through survey research Callan and co-
workers identified certain aspects of human physical need, "the things which everyone should
be able to have and which no one should have to do without" (1999a:286). These included a
telephone, refrigerator, indoor toilets, and central heating. The researchers constructed a set of
eight basic indicators; poverty was defined as missing one or two of these basic "necessities."
The approach incorporates both the absolute or minimal living standard and relative or income
distribution standard.

DATA ON ABSOLUTE POVERTY

Government measurement procedures minimize the extent of poverty. First, the Census
misses the poorest of poor, many of whom are homeless, transients, migrant workers, or live in
slum areas where many people may share a single housing unit and are not reached by Census
workers. The poverty threshold itself also minimizes the extent of poverty. The thresholds
have not kept up with inflation, and do not consider the cost of housing and other necessities
such as healthcare.
Official data show that in 1998 there were 34.5 million Americans officially poor, which
declined to 32.2 million in 1999. Table 18.5 summarizes these data. As Table 18.5 shows, in
1998 about two-thirds of the poor were white, about 4 out of 10 were children though they
represent about 26% of the total population. The poverty rate for all children under age 6 in
1998 was 20.6%-1 in 5. For children living with single mothers the rate was 54.8% compared
with a rate of 10.1% for children living in married couple families. Lavelle (1995:38) reported
that children in the United States were 2 times as likely to live in poverty than Canadian
children, 3 times as likely as British children, 4 times as likely as French children, and 7 to 13
times as likely as German, Dutch, and Swedish children (Hill, 1998).
Table 18.6 provides data on rates and number of persons below the poverty line over the
past two decades. Since 1980 the overall population poverty rate fluctuates within about 1%
of an average 14% of the total population that fall below the federal poverty threshold. While
an annual change-up or down-of 1% refers to over 2 million people in any of the years of
the past two decades, the trend is fairly stable over this period: between 1 person in 7 and 1
person in 8 in the United States is officially "in poverty." This does not account for the near-
poor, those just over the line.
Poverty risk factors vary by age, race, and household type. As Figure 18.1 shows,
minority status significantly increases the likelihood of poverty. Figure 18.2 provides a
comparison for children only (persons under age 18). Figure 18.3 rounds out the picture:
minority children living in single-parent female-headed households are most at risk. There are
presently over 3 million such households in the United States.
A number of observers have suggested that the current poverty thresholds should be
increased by 50% to account for the outmoded bases in present use. Table 18.7 presents data on
number and rates of persons at various percentages of the existing poverty threshold. Note that
the column labeled "Under 100%" provides data using the current or actual threshold for 1998.
Note also that if the actual poverty threshold were increased by 50%, the poverty rate would
exceed 1 in 5 persons, over 58 million people. Looked at another way, the figures in Table 18.7
begin to give an estimate of the "near-poor" by comparing the actual numbers and rates with
those for 150% of the poverty thresholds. Note further the extent to which some groups,
362 ANTOINETTE COLEMAN AND HOWARD M. REBACH

TABLE 18.5. Extent of Poverty, 1998 and 1999; Numbers and Rates
of Persons Officially Poor by Selected Characteristics
1998 1999

Number Percent Number Percent

(x I(00) Rate of total (x 1(00) Rate of total

Persons in poverty 34,476 12.7 100.0 32,258 11.8 100.0

White total 23,454 10.5 68.0 21,922 9.8 68.0
White non-Hispanic 15,799 8.2 45.8 14,875 7.7 46.0
Black 9,091 26.1 26.4 8,360 23.6 26.0
Hispanic 8,070 25.6 23.4 7,439 22.8 23.0
Other 1,516 N/A 4.4 1,584 N/A 5.0
Male 14,712 11.1 42.7 N/A N/A N/A
Female 19,764 14.3 57.3 N/A N/A N/A
Under age 18 13,467 18.9 39.1 12,109 16.9 37.5
65 and older 3,386 10.5 9.8 3.167 9.7 9.8
Families in poverty 7,186 10.0 100.0 6,676 9.3 100.0
White total 4,829 8.0 67.2 4,377 7.3 65.6
White non-Hispanic 3,264 6.1 45.5 2.942 5.5 44.1
Black 1,981 23.4 27.5 1,898 21.9 28.4
Hispanic 1,648 22.7 22.9 1,525 20.2 22.8
Other 293 4.1
Married couples 2,879 5.3 40.0 2,673 4.8 40.0
White 2,400 5.0 33.4 2,161 4.4 32.4
White non-Hispanic 1,639 3.8 22.8 1,547 3.3 21.8
Black 290 7.3 4.0 294 7.1 4.4
Hispanic 775 15.7 10.7 728 14.2 10.9
Female-headed HH 3,381 29.9 53.3 3,531 27.8 52.9
White total 2,123 24.9 29.5 1,883 22.5 28.2
White non-Hispanic 1,428 20.7 19.9 1,255 18.6 18.8
Black 1,557 40.8 21.6 1,499 39.3 22.4
Hispanic 756 43.7 10.5 686 38.8 10.3

Source: u.s. Census Bureau.

especially minorities, fall below 50% of the poverty threshold. These are the "very poor,"
over 40% of whom are children. Over 29% of children live in households under 1.5 times the
official poverty level and about half live in households less than twice the official level.
These figures do not tell a complete story. The two year panel survey, Survey of Income
and Program Participation (SIPP), for 1993-1994 provides longitudinal data to show move-
ment into and out of poverty for the same people during the panel-study period (Eller, 1996).
The annual poverty rate given for that period was around 12.5% though the average montWy
rates were higher, around 15.5%. However, SIPP data showed that, overall, 30.3% of persons
were poor sometime during the panel period. About 52.7 million people-about 1 person in 5
(22.3%)-were poor two or more months in 1993. Among minorities, the rate, ever poor,
during the panel, was 50.5% for blacks and 53.9% for Hispanics. The rate for persons under
age 18 was 41.9%. More than half of blacks and Hispanics and 4 out of 10 children lived below
the official poverty line sometime during the two year period. Table 18.8 summarizes these
data.
SIPP data for the 28-month period in 1992-1994 revealed that working does not always
lift persons and families out of poverty. "In 1994, 16.2% of all persons who usually worked full
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 363

TABLE 18.6. Number of Persons below the Poverty

Threshold and Poverty Rates, 1980-1999
Resident population Number below poverty Poverty rate
(x 1000) (x 1000) (% in poverty)

1980 225,027 29,272 13.0

1985 236,594 33,064 14.0
1990 248,644 33,585 13.5
1995 263,733 36,425 13.8
1998 271,059 34,476 12.7
1999 273,493 32,358 11.8

Source: U.S. Census Bureau.

time ... year-round ... had annual earnings below the poverty threshold for a four person
family" compared with 14.6% in 1984. During the 28 months of the panel, 27.1% of workers
had federally defined low-wage work in at least one month. Note that the federally defined low
wage is generally higher than minimum wage. The percentages of those experiencing low-
wage work for a year or more of the panel was 5.7% compared with 4.2% a decade earlier.
Significantly, 77% of those who had a year or more of low-wage work had a high school
diploma or less education.
In an average month in 1993, 37.8% of female headed households were below the official
poverty threshold; 46.5% were poor at least two months and 17.2% were poor for the two-year
period of the panel. During the 1993-1994 SIPP panel, single female-headed households, no
husband present, made up half (50.5%) of the total number of persons labeled as chronically in
poverty. Overall, 61.3% of the chronic group were female.
Average duration in poverty showed, overall, half (54%) of all spells of poverty lasted
five months or longer with duration also associated with age and minority status; minorities
and children experienced longer spells. About 15% of spells lasted for the duration of the
panel.

35 --,--------,-----,.------,----.,

-.-.- .. _.-'
30 ,11_..,."..-_.__
-.
11'1'1 11 . . nll.II,II.n."II.1I •

''''''~
25 --F=-----+-----+-----+--~__""lor.c/•. --1

-
20 - t - - - - - + - - - - + - - - - - + - - - - -
151;;;;;;;;;;;;;.;....-F=~~
10 ~
........"""*o;;;;;;;;;;,;;:=-1
• _
5 +---------.- -----'1--------1
o -t--------j--- ----1----- - - - - -

1980 1985 1990 1995 2000

ALL
WHITE, NON-HISPANIC
BLACK/AFRICAN AMER.
HISPANIC
FIGURE 18.1. Poverty rates by race and Hispanic origin, 1980-1999.
364 ANTOINEITE COLEMAN AND HOWARD M. REBACH

50

, " ""
""1 ••
, , • ,"'\"'1'" , , •• , • I I

.
,-- '- ••
' ••
40
/ ........ '- 1',-" '~'
.,. . 'I ,..
;,'

-
- --..
~ iolIIl""""

" ........... ~ ...... ~- ....

10
~."..
.............. ~--...

o I I
,_,~,~,~,*,.,.,~,.,_,.,~,~,.,~,_,_,~,_,_aoo
I

years
All children - - White, non-Hispanic
I I I I I I Black - I - Hispanic
FIGURE 18.2. Poverty rates, persons by under age 18 by race and Hispanic origin.

50

.. _.......
/ " , - a'--" *,,'-. ,
~' . ; I'
40
'
.

. .... •
, -' ..
- -
, ,,' ,
,,
" 1 ,,,111" ......• • '"

-...... _--1----.. ---

~
10 "",---

o 1110 1881 1~ 1~
I I I
, . . , . , . 1887 , . , . , . '88'
I
,~ , . , . . , _ , . 1887 , _ , . 2lIIlO
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 365

TABLE 18.7. Number (xl000) of Persons and Rates by Selected Characteristics by Ratio
of Income to Poverty Thresholds, 1998
Under 50% Under 100% Under 125% Under 150%

Number Rate Number Rate Number Rate Number Rate

All persons 13,914 5.1 34,476 12.7 46,036 17.0 58,316 21.5
Persons under age 18 5,774 8.1 13,467 18.9 17,135 24.0 21.041 29.5
Persons 65 or older 750 2.3 3,386 10.5 5,447 16.8 7,685 23.7
Male 5,978 4.5 14.712 11.1 19,714 14.9 25,287 19.1
Female 7,935 5.7 19,764 14.3 26,262 18.9 33,029 23.8
White 9,012 4.0 23,454 10.5 31,916 14.3 41,433 18.6
Black 3,901 11.2 9,091 26.1 11,662 33.4 13,805 39.6
Hispanic 3,079 9.8 8.070 25.6 10,484 33.3 13,229 42.0
Persons living in married couple 3,321 1.9 10.982 6.2 15,986 9.0 22,498 12.7
family
Persons Jiving in female-headed 5,993 15.4 12.907 33.1 16,165 41.4 18,693 47.9
households, no spouse

Source: U.S. Census Bureau.

The homeless in the United States present a clear example of absolute poverty. Actual
numbers of persons homeless are hard to come by; the National Coalition for the Homeless
(NCH) noted methodological problems in identifying and counting homeless persons. First,
persons move in and out of homelessness; it is often a temporary circumstance. Persons may
move off the streets to crowd in, temporarily, with friends or relatives. Others, especially those
in rural areas or living in caves, vehicles, or other makeshift arrangements, are inaccessible to
researchers. Studies have often based counts on the number of people who show up at shelters,
food kitchens, or other service providers. But a 1998 study in 30 U.S. cities found that 26% of
requests for emergency shelter went unmet (NCH, 1999a).
Thus, estimates of the homeless vary widely and are likely to be low estimates. A 1988
estimate based on persons found in shelters or soup kitchens in one week placed the number at
about half a million people. Projecting a 5% annual increase, a 1999 estimate was 700,000
persons per night, 2 million per year. Instead of estimates of the number of homeless persons
each day, NCH suggested that a better measure is the prevalence of homelessness over a given
period of time. NCH (l999a) reported a 1990 telephone survey that found 7% of respondents

TABLE 18.8. SIPP Panel Data, 1993-1994 by Selected Characteristics

% poor 24 months Months median
% ever poor % poor 2 or 1993-1994 duration in poverty,
during panel more months (labeled chronic) 1993-994

All persons 30.3 20.8 5.3 4.5

White non-Hispanic 23.8 17.6 3.8 4.2
Black 50.5 41.1 14.1 6.8
Hispanic 53.9 40.0 13.5 5.0
Children (under 18) 41.9 30.3 9.4 5.3
Elderly (65 and over) 18.2 13.3 5.4 6.7
Employed full time 17.4 8.8 0.5 3.8
Employed part time 29.6 18.9 1.6 4.3

Source: U.s. Census Bureau, SIPP report, 1999; Eller (1996) CPS 70-55; Naifeh (1998) CPS 70-63.
366 ANTOINETTE COLEMAN AND HOWARD M. REBACH

had a "spell" of homelessness at some time in their lives and 3% had been homeless at some
time between 1985 and 1990. This led to an estimate of between 4.9 million and 9.3 million
people having experienced at least one spell of homelessness during the 5-year period. A
second study in 1994 used improved definitions and found that 6.5% had experienced home-
lessness at some point in their lives and 3.6%-about 6.6 million adults in the United States-
had experienced a homeless spell between 1989 and 1994. Finally, a 1991 study of 182 U.S.
cities estimated that homeless rates tripled, 1981 to 1989 (NCH, 1999a)
The demographics provide another dimension of the story. A 1998 study of 30 U.S. cities
sponsored by the U.S. Conference of Mayors found that 25% of the urban homeless were
children-persons under age 18. Three percent of the total urban homeless populations were
unaccompanied children. Single men constituted 45% and single women 14% of the urban
homeless. Families with children made up about 40% of the urban homeless. The survey also
found that 49% of the urban homeless were black/African-American, 32% white, 12%
Hispanic, 4% Native American, and 3% Asian. Of particular interest, 22% were employed
(NCH, 1999b).
The rise in homelessness has been prompted by the growing scarcity of housing afford-
able to low-wage workers and poor people and increases in the number of people in poverty,
especially those with earnings below one-half the poverty threshold. Recent income growth
has not reached everyone. In 1967 a worker earning minimum wage earned enough for a
family of three to be above the poverty line. However,
From 1981-1990 ... the minimum wage was frozen at $3.35 an hour while the cost of living increased
48% over the same period. Congress raised the minimum wage to $5.15 per hour in 1996. This increase
made up only slightly more than half of the ground lost to inflation in the 1980s; thus, the real value of
the minimum wage in 1997 was 18.1% less than in 1979 (Mishel, Bernstein, & Schmitt, 1999). Full-time
year-round minimum-wage eamings currently equal 84% of the estimated poverty line for a family of
three. Contrary to popular belief, the majority of minimum wage workers are not teenagers. 71.4% are
age 20 or older (Mishel, Bernstein, & Schmitt, 1999). (National Coalition for the Homeless [NCHj,
1999c:l)

RELATIVE POVERTY

One feature of economic justice is a fair distribution of the payoffs for productivity. One
index of such productivity has been the rise in the stock market which is tied to corporate
profitmaking. In this section we explore the growing inequality in the United States. Inequality
points to relative poverty and relative deprivation.
Table 18.9 shows that some have benefited more than others over the past quarter century.
The proportion of the total annual income for households at the lower end of the scale has
remained relatively unchanged, the proportion in the middle has decreased, while the propor-
tion just above the middle has not changed significantly. However, the proportion of total
annual income going to households at the top has doubled. It would appear that the gains in
income have gone to the top earners, which has been responsible for the reported rise in
median income.
Table 18.10 shows the shares of income for each quintile of the population, revealing the
drift of income toward the top. It includes an additional index of income inequality, the Gini
coefficient. In 1997 the Gini in the United States was about .450 up from .323 in 1973 and
considerably higher than all other industrialized nations.
Table 18.11 continues the story of income inequality. The data are presented in constant
1998 dollars, which allows us to compare purchasing power by putting all income values on
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 367

TABLE 18.9. Proportion of Total Annual Income for Household Income Categories,
1970-1997
Median income
Under $25,000 $25,000-50,000 $50,000-75,000 Over $75,000 in 1997 dollars

1970 26.0 37.2 17.7 9.0 $33,942

1975 37.2 34.7 18.3 9.9 $33,699
1980 36.4 33.2 18.4 12.0 $34,538
1985 35.6 32.0 17.9 14.4 $35,229
1990 34.3 31.5 18.2 16.0 $36,770
1995 35.1 30.7 17.7 16.5 $35,887
1997 34.0 29.6 18.1 18.4 $37,005

Source: U.S. Census Bureau.

the same scale. Notice barely significant changes over almost a quarter of a century for the
bottom 40% of families and the extent of gains for the upper quintile and especially for the top
5% of families. Even during the 1990s and the time of heralded prosperity, the gains made by
the lower 80% of families have been modest compared with the upper decile and the top 5%.
Shapiro and Greenstein analyzed data from the Congressional Budget Office (CBO) that
showed a major shift in after-tax income for the period 1977 to 1999. The top 1% of households
had a dramatic increase, the middle had a modest increase, and the bottom fifth showed a
decline over the period. The after-tax income was found to be "more heavily concentrated
among the richest one percent ... than at any time" since 1977 when the CBO began keeping
track (1999:1). Average after-tax income for the middle fifth of the population rose 8%-less
than 0.5% per year. For the bottom fifth, it declined 9% from 1977 even with substantial
increases in the Earned Income Tax Credit (EITC). Even when various in-kind benefits are
counted such as are included in the various definitions presented in Table 18.2, they are not
large enough to change the trends in income inequality. Even using the most comprehensive
inclusion of benefits, the share of the national income received by the bottom fifth only rises
0.7%. If MedicarelMedicaid benefits are not included, the share increases by only 0.4%
(Shapiro & Greenstein, 1999).
By contrast, the top fifth showed a 43% gain in after-tax income adjusted for inflation for
the same period. For the top 1%, average after-tax income, also adjusted for inflation-real

TABLE 18.10. Share of Aggregate Income Received by Families by Each

Fifth and the Top 5% and Gini Ratio, 1970-1998
Lowest fifth 2nd fifth 3rd fifth 4th fifth Highest fifth Top 5% Gini

1970 5.3 12.2 17.6 23.8 40.9 15.6 .394

1975 5.6 11.9 17.7 24.2 40.7 14.9 .397
1980 5.3 11.6 17.6 24.4 41.1 14.6 .403
1985 4.8 11.0 16.9 24.3 43.1 16.1 .419
1990 4.6 10.8 16.6 23.8 44.3 17.4 .428
1995 4.4 10.1 15.8 23.2 46.5 20.0 .450
1998 4.2 9.9 15.7 23.0 47.3 20.7 .456

Source: U.s. Census Bureau.

368 ANTOINETTE COLEMAN AND HOWARD M. REBACH

TABLE 18.11. Mean Income Received by Each Fifth and Top 5% of Families (AU Races
in Constant 1998 DoUars)
Lowest fifth 2nd fifth 3rd fifth 4th fifth Highest fifth Top 5%

1998 $12,526 $29,482 $46,662 $68,430 $140,846 $246,520

1995 12,049 27,760 43,463 63,592 127,761 219,112
1990 12,263 28,603 44,051 63,351 117,734 184,730
1985 11,921 27,354 42,233 60,537 107,585 160,775
1980 12,697 27,641 41,756 57,931 97,539 138,659
1975 12,666 26,776 39,813 54,512 91,863 134,756
1970 12,093 26,739 38,662 52,152 89,682 136,561
Ratio: 1998 income to 1970 1.04 1.10 1.21 1.31 1.57 1.80
income

Source: u.s. Census Bureau, CPS, 1999.

income-was projected to increase 115%. The top fifth was projected to receive just over half,
50.4%, of the total national income in 1999. The middle 60% was "expected to be at the lowest
level CBO has recorded since 1977," and
Income disparities have widened to such a degree that, in 1999, the richest one percent ... is projected
to receive as much after-tax income as the bottom 38 percent combined. That is, the 2.7 million
Americans with the largest incomes are expected to receive as much after-tax income as the 100 million
Americans with the lowest incomes. (Shapiro & Greenstein, 1999:2)

In 1974, the top 10% of U.S. households had incomes 31 times those of the poorest 10%
and 4 times the median household income. By 1994, incomes of the top 10% had risen to 55
times those of the poorest 10% and 6 times the median household income.
The rising inequality has been due, in part, to economic developments and in part to the
fact that substantial tax cuts for the richest segment of the population have resulted in their
paying a smaller percentage of their income in taxes than in 1977, an average of $40,000 less
computed in 1999 dollars.
A particularly dramatic factoid on the increasing polarization of U.S. society has been
CEO income relative to that of workers. In 1960 the CEOs of the largest corporations averaged
12 times the income of the average worker. In 1970 the average CEO made 42 times what the
average worker was paid. This has increased 1000%; "the average CEO now makes 419 times
what the average blue collar worker is paid" (Hightower, 1999:1). That was in 1998. The ratio
was 475 times in 1999 (Hartman, 1999). The average CEO earns over $10,000,000 per year-
this even as company profits decline, and stock prices rise while CEOs downsize and eliminate
jobs. And let us not forget "the Golden Handshake," millions in severance benefits to CEOs
ousted by their boards of directors when company profits and stock prices fall. Obviously,
those producing the wealth, the workers, are not exactly participating in a fair share of the
wealth they have created.
Income is only part of the story. Income usually refers to the money obtained during a
period such as annual income. Wealth, on the other hand, refers to ownership of valuable assets
such as homes, real estate, stocks, bonds, bank accounts, cars, boats, and the like. Table 18.12
shows the distribution of wealth.
As Table 18.12 demonstrates, the wealthiest quintile of the distribution hold over 80% of
the nation's wealth, the top 5% offamilies control over half the wealth of the nation and having
enjoyed over a 40% gain in wealth in the period shown. Considering only stocks, mutual
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 369

TABLE 18.12. Percent Distribution of Net

Worth by Population Segments, 1983-1998
Wealth class 1983 1989 1992 1995 1998

Bottom 40% 0.9 -0.7 0.4 0.2 0.2

Middle 20% 5.2 4.8 4.4 4.5 4.5
Fourth 20% 12.6 12.3 11.5 11.4 11.9
Next 10% 13.1 13.0 12.0 12.1 12.5
Next 5% 12.1 11.6 11.8 1l.S 1l.S
Next 4% 22.3 21.6 22.8 21.8 21.3
Top 1% 33.8 37.4 37.2 38.5 38.1

Source: Wolff (2000).

funds, and retirement accounts, the bottom 90% of households held 21.3% while the top 10%
held 78.7% in 1998 with 42.1% held by the top 1% (Wolff, 2000). In 1998 the top 1% of stock
owners owned 47.7% of all stock while the bottom 80% owned 4.1%.

EFFECTS OF POVERTY

Poverty, along with gross inequality and unemployment have adverse consequences for
poor people and for society as a whole. The deprivation experienced by poor families affects
their quality of life, their health and life expectancy, and the educational outcomes of their
children. Poverty brings despair and fear. Wilson (1991) noted that poverty in the United States
is more urban, more concentrated, especially for minorities. At the same time businesses and
industries have moved out of urban centers creating a "spatial mismatch between central-city
residence and the location of employment" (p. 6) making employment difficult for central-city
residents. These inner-city residents experience "joblessness reinforced by social isolation"
and "decreasing access to job information network systems" (p. 9) and weak attachment to the
labor force brought on by structural constraints including limited opportunity near their
homes, accessible to them.
Wilson also called attention to the effects of poverty, joblessness, weak attachment to the
labor force, and inner-city residence on the socialization of young people in terms of their
attachment to the labor force; they lack the models, exposure to collective beliefs, and
incentives that can create stronger attachment to the labor force. The social context and the
structural problem of weak labor force attachment also produces low perceived self-efficacy,
the belief in one's ability to act and successfully achieve goals.
Cohen and Dawson (1993) asserted that the social isolation of ghettoized people men-
tioned by Wilson also fosters weak attachment to the political system. In tum, political
isolation inhibits the development of a group or community consciousness. Weak labor force
attachment, crime, social isolation, and alienation persist in these neighborhoods and people
become disconnected from social structures and networks that could provide coping resources.
These include political participation. Cohen and Dawson found that people in these neighbor-
hoods did indeed experience social isolation with political and economic networks lacking.
People were less likely to engage in group action given their perception of the effectiveness of
political action, community efficacy, and group influence. This was found to be a consequence
of the structure of the neighborhood, not individual poverty. Residents of these African-
370 ANTOINETTE COLEMAN AND HOWARD M. REBACH

American neighborhoods in Detroit were less likely to participate than other African-
Americans. Cohen and Dawson expressed concern about this as a source of political instability
as people challenge the legitimacy of the state and their obligations to the state. Political
disruption may be the only way to challenge the state.
Poverty and economic deprivation, and the associated substandard housing, employment
insecurity, and dangerous environments, bring chronic stress leading to poor health and mental
health outcomes. Sorlie et ai. noted "the continued and pervasive role that socioeconomic
condition plays in morbidity and mortality" (1995:949). Using data from the National Longi-
tudinal Mortality Study, they followed over 500,000 men and women, 25 years of age and
older, from 1979 to 1989. Their results showed higher mortality rates for African-Americans
compared with non-Hispanic whites under age 65, higher rates for persons not in the work
force, higher rates for persons with lower incomes and less education and lower status
occupations. They reported, "Mortality declined strongly and steadily with increasing income
for men and women less than 65 years of age" (1995:951). For men and women between 25
and 64 years old, those with a family income of $50,000 or more had mortality rates that were
approximately 30% of the rates for those with incomes of $5000 or less. There was a
significant relationship between increasing income and lower mortality in each age and sex
group.
Hill (1998) focused on the effects of poverty on the children of the poor and working poor,
effects that seem to consign them to a life in poverty: poor nutrition, poor health and
healthcare, poor education. Malnutrition, a chronic problem for poor infants and children, can
affect the immune system and lead to poor health. It also affects development of the central
nervous system, which may result in brain damage and retardation, cause learning disabilities,
and may affect development of cognitive and social skills. These limit academic achievement.
Compared with nonpoor children, poor children are two or three times more likely to have
physical and/or mental disabilities (Lavelle, 1995:131; Sidel, 1996:142-144).
Compared with nonpoor children, poor children also receive inadequate healthcare.
About half are eligible for Medicaid but care is often uneven due to time constraints and
transportation problems. Medical attention is often delayed allowing conditions to get worse.
Preventive medical care and immunization are often unavailable. Children of the working poor
are often ineligible for Medicaid.
Lantz and House studied the relationship between education, income, and health-risk
behaviors and mortality. They reported that "lower levels of education and income are asso-
ciated with significantly higher prevalence of health risk behaviors.... The results also show
that lower income leads to a significant increase in mortality risk, yet the influence of major
health risk behaviors explains only a modest proportion of this relationship" (1989: 1707).
That is, Lantz and House found a poverty effect over and above the presence of specific health-
risk behaviors and lifestyle factors. Poverty is itself a "cause" of mortality. Causal mecha-
nisms may include environmental health hazards, exposure to pollutants, and inequalities in
access to and use of prevention measures and treatments. However, Lantz and House also
noted that stratification may, itself, be a social force that has adverse health effects: social
isolation and lack of social relationships and supports, personality factors such as lack of
optimism, heightened levels of anger and frustration, and reduced sense of self-efficacy, and
chronic and acute stressful life events including patterns of discrimination and racism and
powerlessness. The findings of Lantz and House also prompt us to suggest that perhaps even
health-risk behaviors are themselves a response to the social isolation and other destructive
and stressful features of economic marginality.
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 371

Kawachi et ai. (1997) studied data from 39 states and found a high correlation between
income inequality and low per capita group membership and lack of social trust. Both of
these were associated with total mortality and heart disease deaths, malignant neoplasms, and
infant mortality. They noted that income inequality was related to a decrease in social cohesion
and disinvestment in social capital. As inequality increases, those in the upper strata become
more removed from those in the lower strata and are less likely to invest in those things that
produce social capital and social trust. This suggests that poverty erodes social cohesion,
which, in turn, leads to increased mortality.
Kennedy et at. (1998) collected data on income distribution from all 50 states in 1993 and
1994. Using the Gini coefficient to measure statewide inequality, they found that when
personal characteristics and household incomes were controlled for, persons in states with the
greatest inequality were 30% more likely to report fair or poor health compared with persons
in states with smaller Gini coefficients. They concluded that inequality in income distribution
was associated with adverse health effects independent of household income. The effects of
income distribution were not limited to those with low income. Those in middle income
groups in states with greater inequality reported poorer health than those in middle income
groups in states with small inequalities. The authors concluded that the effects of statewide
income inequality on self-ratings of health were as strong as individual risk factors.
To conclude this section on health, we note that the general finding is that of an inverse
relationship between income, education, and job status and health status and mortality. The
material deprivation, lack of knowledge and opportunity, and the psychosocial impact of
stress, frustration, and a culture devoid of trust and caring are the consequences of a life in
poverty and of income inequality. The decrease in social capital-trust, political participation,
community organization, social connectedness-is also related to the investment in public
goods such as education and healthcare. As the gap between the rich and the poor increases,
the upper strata have less of a stake in what happens to the rest and are less likely to support
social spending (Lefkowitz, 2000)
Children in poverty have higher levels of conduct disorder and behavior problems,
depression, low self-esteem, and lower levels of social adaptation Risk of teenage pregnancy
and school dropout is high (McLeod & Shanahan, 1993). McLeod and Shanahan analyzed data
from the National Longitudinal Survey of Youth from children aged 4 to 8. The sample
contained 1733 children of 1344 mothers. They found that the length of time spent in poverty
was an important predictor of children's mental health. As the length of time in poverty
increased, so did stress and feelings of unhappiness, anxiety, and dependence. The stress of
poverty erodes parenting skills; poor mothers use more physical punishments, which affects
children's mental health. Paternal abuse also increases with poverty. Other stressors, including
poor nutrition, exposure to hazardous environments, violence, and crime, may contribute to
higher symptom levels. Keegan (1999) studied the socio-emotional development of children
aged 4-9. Poverty influenced externalizing and internalizing behaviors by increasing emo-
tional umesponsiveness to children, physical discipline, reduced stimulation, and poor quality
of the physical environment.
McLeod and Stranahan also found little evidence of differences due to racial or ethnic
differences. "The total effects of poverty do not vary significantly by race/ethnic group"
(1993:361). Also parenting behaviors are "substantially similar" across ethnic groups among
those in poverty. "Poor children appear to experience the same parenting disadvantages
regardless of race" (1993:361) though minorities may experience greater stress because they
enter poverty with fewer resources and live in more distressed neighborhoods. The authors
372 ANTOINETTE COLEMAN AND HOWARD M. REBACH

also noted that their findings, though robust, might have shown a stronger effect but families
who live at or slightly above the official poverty line face many of the same stressors as those
officially in poverty.
Poverty and poverty neighborhoods also affect intellect (Brooks-Gunn et aI., 1996). The
risk factors of poverty were found to explain 34% of the variance in IQ scores of 4-year-olds
(Sameroff et aI., 1993). Duncan et al. (1994) found that for poor children living in affluent
neighborhoods, the IQ scores of 5-year-olds were raised 1.6 points for every 10% increase in
affluent neighbors.
Schools in poor areas are often the worst schools with inexperienced or less capable
teachers. Pagani et al. (1999) studied the effects of poverty on academic achievement and
delinquency. Controlling for mothers' education and early childhood behavior, poverty was
found to affect both academic failure and extreme delinquency. Poor parents may have low
expectations for performance and may not provide the support and encouragement. They may
also be among the most politically powerless in being able to demand quality education for
their children. Hill cited research that "adolescents who have lived in poverty for four years
are approximately 75 percent less likely to graduate from high school than non-poor adoles-
cents" (Duncan & Brooks-Gunn, 1997:338-399, cited in Hill, 1998:281). Thus they are even
less likely to graduate from college: 4% of youth from lower quartile families compared with
75% of children from the highest quartile families. Even when children from poor families do
graduate from high school, employment opportunities for them are limited and low-paying as
the economy and work force moves toward high tech.
Brenner, testifying before a Congressional hearing, reported that for each 1% rise in the
unemployment rate, the societal consequences are
• 4% increase in people incarcerated
• 5.7% more people murdered
• 4.1% more suicides
• 4.3% more men and 2.3% more women admitted to state mental hospitals
• 1.9% more heart disease deaths, cirrhosis of the liver, and similar illnesses (Jenson,
1998:1)

CURRENT PERSPECTIVES-PUBLIC POLICY: WELFARE REFORM

After six decades of federal policy that guaranteed cash and other benefits to eligible low-
income individuals and families living at or below the federal poverty level, President Clinton
signed into law, despite his objections to several cuts in benefit provisions for the poor, new
legislation that revamped the public social welfare system in the United States. This law,
entitled the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of
1996 (HR3734-PL 104-193) or commonly referred to as the Welfare Reform Act, legislated
the most broad-based changes in the U.S. public social welfare system since the Social
Security Act of 1935 (Anderson et aI., 2000). The new policies and provisions of this law made
welfare reform a reality in the United States.
PL 104-193 firmly expounds the principle of "welfare-to-work" (WTW). Under the
WTW principle, government assistance is now temporary and the poor must take responsibil-
ity to become self-sufficient through employment. Getting the unemployed dependent poor
into the labor force is the focal point of the WTW principle. Even though PL 104-193 is
expected to reform our welfare system, much skepticism exists among social workers,
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 373

sociologists, political scientists, economists, human services administrators, and even some
elected and government officials about the extent to which this law will improve the problem
of poverty in the United States.
PL 104-193 brings several challenges for the country as it attempts to change the 61-year-
old public social welfare system that is believed to have fostered dependency and latent
poverty. The first challenge has been to convince stakeholders in the public welfare system that
needy individuals and families should not live in latent poverty as a result of their dependence
on government cash and in-kind benefits. The authors of PL 104-193 asserted that needy
individuals and families must go to work, even though they may initially receive some support.
But support must not be rendered in a manner that allows needy individuals and families to
enter the population of the latent poor who are unable to sustain themselves in the economic
marketplace without public assistance. Second, state governments and local human services
professionals are being challenged and held responsible for implementing the federal require-
ments established in accordance with welfare reform. However, nationwide, the consensus of
state administrative and local social services agencies on caseload reduction and service
delivery needs continues to be a challenge. Third, public assistance recipients are challenged
to meet the expectation of achieving a level of self-sufficiency within a restricted period of
time. Now adult recipients must learn to negotiate the employment arena as the safety net of
public assistance becomes smaller.
The strong WTW principle of the welfare reform was created to prevent the reoccurrence
of the indictments noted against the former welfare system. These indictments were:
• It did not provide sufficient state flexibility.
• It did not encourage work.
• It was responsible for the breakdown ofthe family, especially for the rising tide of out-
of-wedlock births.
• It has done little to reduce poverty, especially among children (Sawhill, 1996).
The new law enacted federal policy reforms that placed new reliance on states to deal with
poverty and the needs of the poor in their jurisdictions. Through this new reliance on states, the
federal government now provides lump-sum payments, in the form of block grants, to states to
administer public welfare programs for people in poverty. Block grant funding allows states
almost complete control over eligibility and benefits determination (Katz, 1996). Many
professionals have questioned whether states will move in the direction of helping the poor in a
way that will improve their quality of life. The concern is that states will pay more attention to
reducing the number of welfare cases in order to achieve the requirements stipulated in PL
104-193.
From a global perspective, PL 104-193 may give the impression that states now have
more resources to help their citizens at risk of or already living in poverty. But several
significant federal mandates contradict this view. To illustrate, states now have the responsibil-
ity to reduce the number of recipients dependent on public social welfare programs by
requiring them to work within two years of receiving benefits. The policy has not been without
trials and tribulations for local departments of social services, the direct public services
providers for the needy, in an overwhelming number of jurisdictions nationally. In an effort to
reduce caseloads, local agencies were designated to work vigorously to move recipients into
the labor force. First, workers in local departments of social services were confronted with
many recipients who required jobs skills training, completion of high school education
through GED programs, work ethics training, and who had personal and situational barriers
(e.g., alcohol and substance abuse, mental illness, no or limited work experiences). Second,
374 ANTOINETTE COLEMAN AND HOWARD M. REBACH

these workers were confronted with the obstacle of helping recipients find jobs in communities
where jobs were scarce or the available jobs were part time with minimum wage pay and no
benefits. Furthermore, local agency staff found weak commitment on the part of employers to
hire and train poor people for success.
Other reforms in the law include cuts in the food stamps program, denial of various
federal benefits to legal aliens, more stringent eligibility requirements for disabled children to
qualify for federal aid, reorganization of federal childcare assistance programs, and tougher
enforcement of child support orders. Such federal mandates burden states with the responsibil-
ity of keeping their welfare population small while simultaneously helping those in need
within their state.
It is important to recognize that the PRWORA of 1996 made good on President Clinton's
1992 campaign promise to "end welfare as we know it" (Anderson et aI., 2000; Katz, 1996).
President Clinton had vetoed two earlier Republic welfare reform efforts, the first on Decem-
ber 6,1995, as a part of the deficit-reducing budget-reconciliation bill (HR 2491), and again on
January 9,1996, as a freestanding welfare bill (HR4) (Katz, 1996). However, the signing ofPL
104-193 ended the federal guarantee of providing welfare checks to all eligible mothers with
dependent children. Essentially, PL 104-193 allows states to create their own welfare programs
and impose new work requirements and time limits on welfare benefits. Advocates of PL
104-193 feel that the strong philosophy of required employment for poor persons receiving
welfare benefits and time-limited benefits clearly suggests more substantial policies for
addressing poverty than found in previously legislated efforts enacted over the past 30 years.
These included the Comprehensive Employment and Training Act (CETA), Job-Training
Partnership Act (JTPA), Manpower Development and Training Act (MOTA), and Work
Incentive Program (WIN).
By creating tougher work rules and cracking down on fraud and abuse in means-tested
programs (e.g., TANF, food stamps, Medicaid), the current climate of welfare reform seeks to
reduce poverty by having the poor take personal responsibility for their well-being. The
Welfare Reform Act is intend to improve the future for poor children by promoting parental
employment over welfare, parental self-reliance over dependency. It includes discouraging
illegitimacy and teen pregnancy, and encouraging stable families. Thus, the principles of PL
104-193 are:
• Work, not Welfare-the requirement that at least one person in every welfare family
become employed within two years after receiving benefits or benefits will be lost.
• No More Welfare for Non-Citizens and Felons ends welfare for most non-citizens
during their first five years in the United States. There is an exception for refugees,
persons who have worked and paid taxes in the United States for 10 years, and non-
citizens who have served in the U.S. military. Benefits are terminated for fugitive felons
that flee prosecution or violate parole.
• Power and Flexibility to the States-gives block-grant-type flexibility to states to find
solutions because states are closer to the problems than "the bureaucrats in Washington."
• Encouraging Personal Responsibility to Halt the Rising Illegitimacy Rate is an effort to
reduce the rising illegitimacy rate by improving efforts to establish paternity and
require fathers to pay child support. Furthermore, for states that reduce their out-of-
wedlock birth statistics, cash rewards will be provided. (Anderson et aI., 2000)
These principles reflect the substantive provisions ofPRWORA-PL 104-193 that address
factors contributing to individuals and families living in poverty. This legislation implies that
the U.S. welfare system will now be more consistent with American values and will provide
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 375

"hope for the future" as depicted by the 1996 House of Representative Report 104-725 (House
of Representatives Report 104-725, July 30, 1996). Many critics of the legislation question
whether it truly addresses the social problem of poverty in this country, or will just expand the
existing population of the "working poor" or create a new category of people living in poverty
without public benefits.
Since PRWORA-PL 104-193 represents the current perspective in our social welfare
system for helping to alleviate poverty, the following critical welfare reform efforts enacted in
this legislation will be discussed:

• Title I: Block Grants for Temporary Assistance for Needy Families (TANF)
• Title II: Supplemental Security Income (SSI)
• Title III: Child Support
• Title VI: Child Care
• Title VII: Food Stamps and Commodity Distribution

Title I: Block Grants for Temporary Assistance for Needy Families (TANF) of PL
104-193 represents the most sweeping and critical changes Congress felt obligated to make in
order to replace Aid to Families with Dependent Children. TANF is a needs-based, means-
tested program of cash assistance operated by state departments of health and human services,
territories, and Tribes. TANF addresses poverty among needy families with children by (1)
promoting work, job preparation, and marriage; (2) seeking to reduce and prevent out-of-
wedlock pregnancies; and (3) encouraging formation and maintenance of two-parent families
(U.S. Department of Health and Human Services, 1998). The emphasis has changed from
public assistance to temporary assistance with mandatory work and job-training and time
limits for receipt of benefits. It includes components for establishing paternity, education
about statutory rape, establish second-chance homes for teen mothers, and strong enforcement
of child support collection. The TANF program attempts to intervene at a microlevel to prevent
and reduce poverty by attempting to address the social ills that are thought to contribute to
poverty though may also be effects of poverty.
The TANF program is funded through block grants, which gives administering entities at
the state, territory, and tribal levels more flexibility on how they can spend the money. The
program is funded through a combination of federal family assistance grants, contingency
fund allocations, and state funds dedicated to activities related to TANF. There are also
provisions for appropriations of funds to reward states that reduce welfare rolls or reduce the
number of out-of-wedlock births. The provisions of the TANF program reflect clearly that
"welfare is no longer just welfare." Now welfare includes needy individuals and families
becoming self-reliant and self-sufficient. The TANF program, the most radical and compre-
hensive welfare reform, attempts to impact poverty by having the poor take personal responsi-
bility for themselves through engaging in work opportunities.
PL 104-193 places strong emphasis through the TANF program on the WTW philosophy,
which requires work registration and/or work training for all nonexempt household members
included in the TANF cash assistance program. Exempt household members are:

• An incapacitated or temporarily disabled person, or pregnant female between the ages

of 16 and 59
• A child aged 16, 17, or 18 enrolled in school full time
• A household member under age 16 or age 60 or over
• A caretaker required to remain home to care for a disabled child not attending school
or a disabled adult
376 ANTOINETTE COLEMAN AND HOWARD M. REBACH

• A household member caring for a child living in the home under the age of 4 months
• A parent or other relative personally providing care to a child under age 3
• A household member employed working 30 hours or more a week, or above minimum
wage, or working under 30 hours but earning an equivalent of working 30 hours per
week at minimum wage
• A household member already registered for working/training
• A victim of domestic violence when complying with the work/training requirement
would place the family in danger
• Migrant or seasonal farm worker under contract to begin work within 30 days
• A Full-time volunteer for the Volunteers in Service to America (VISTA) program
(Anderson et ai., 2000).
Furthermore, in PL 104-194 for the TANF program, states are required to have a certain
percentage of their welfare caseload (TANF participants) in work activities between fiscal
years 1997 to 2002. The work participation rates for states to achieve are:
• Fiscal year 1997: 25%
• Fiscal year 1998: 30%
• Fiscal year 1999: 35%
• Fiscal year 2000: 40%
• Fiscal year 2001: 45%
• Fiscal year 2002: 50%.
In addition, States must also meet higher required work participation rates for two-parent
families that receive cash assistance. The following participation rates were implemented for
the fiscal year period of 1996 to 1999:
• Fiscal year 1996: 50%
• Fiscal year 1997-1998: 75%
• Fiscal year 1999 and thereafter: 90% (Katz, 1996).
States have the option to exempt from the work requirement and the participation rates a
parent of a child under age 1. A parent can only receive this exemption for a total of 12 months,
consecutive or not consecutive (Katz, 1996).
Furthermore, the TANF program places restrictions on aid to children and unwed
teenagers; other restrictions involve time limits, paternity, drug abuse, and fraud. For children,
only families with a minor child residing with a custodial parent or other adult relative or
pregnant women may receive TANF benefits. The TANF block grant places a time limit on
funds used by adults who cannot receive benefits for more than five years. However, adults
requiring assistance beyond the time limit can still apply and qualify for other federal, state,
and local funds. This time limit is applicable to only those adults who are heads of households
or their spouses. Children of households receiving TANF benefits can apply for aid when they
become parents regardless of the number of years they received aid as a minor child. Only
benefits received after a state accepted its welfare block grant must comply with the time limit.
States have the option to exempt 20% of their caseload from the five-year time limit or they
can opt to impose a shorter time limit (Anderson et ai., 2000; Katz, 1996; Schott, 2000).
Parents must cooperate with local authorities to establish paternity or assist the child
support enforcement agency to collect child support payments. Parents not cooperating will
have their family's benefits reduced by a minimum of 25%. The option is available to states to
eliminate entirely the benefits of noncompliant parents or exempt parents from this responsi-
bility for good causes (Anderson et ai., 2000; Katz, 1996; Schott, 2000).
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 377

When drug abuse is or has been a problem, welfare benefits and food stamps are denied to
individuals convicted of a felony offense of possessing, using, or distributing an illegal drug.
Eligibility for benefits is still available, however, to family members or dependents of the
individual. In addition, emergency benefits including emergency medical services are also
available to penalized drug abusers. States can exempt drug abusers by opting out of this
restriction if legislation is passed (Anderson et a!., 2000; Katz, 1996).
Fraud restrictions are on persons convicted of fraudulently misrepresenting themselves to
obtain benefits in two or more states from TANF grant, Medicaid, food stamps, or SSI. If
convicted, individuals become ineligible for aid from the family assistance grant for 10 years.
Finally, unmarried parents under age 18 can qualify for TANF block grant funds only if they
attend high school or an alternative education or training program and must reside with a
parent or a supervising adult. The options states have for unmarried parents under age 18 in-
clude the following:
• Deny TANF assistance to children born to welfare recipients
• Deny benefits to all unwed parents under age 18
• Newcomers from another state can be provided the same benefits they would have
received from their former state for up to 12 months.
While recipients must comply with these regulations, they also create an increased case
management role for public social services workers who now have the responsibility for
determining whether recipients are eligible and remain compliant while receiving benefits.
Workers have concerns that these restrictions may indeed increase the incidence of needy
individuals and families being further at risk of living in poverty and blocked from moving
toward self-sufficiency (Anderson et al., 2000; Katz, 1996).
The work activities stipulated in the TANF program require that individuals must engage
in one or more work-related activities in order for a state to be able to count them in their work
participation rate. TANF program work activities include:
• On-the-job training
• Job search and job readiness assistance for up to six weeks, but no more than four
weeks of which may be consecutive
• Unsubsidized employment
• Subsidized public sector employment
• Subsidized private sector employment
• Community service programs
• Job skills training directly related to employment
• Providing childcare to another welfare recipient engaged in community service pro-
grams
• Vocational educational training for up to one year
• Education directly related to employment for those under age 20 who do not have a
high school diploma or GED
• Satisfactory attendance at a secondary school by recipients under age 20 who have not
completed high school.
A state cannot count more than 20% of all families in the state's work participation rate
for vocational education, education directly related to employment, or secondary school
attendance (Anderson et al., 2000; Katz, 1996; Schott, 2000). In addition to the stipulated work
activities, the TANF program has a minimum number of hours that must be worked per week
by recipients in order for the state to count an individual in the work participation rate. The
378 ANTOINETTE COLEMAN AND HOWARD M. REBACH

following schedule shows the minimum number of work hours required per week under the
TANF program:
• Fiscal 1996-1998: 20 hours
• Fiscal 1999: 25 hours
• Fiscal 2000 and thereafter: 30 hours.
For the primary wage earner in a two-parent household, the number of hours worked must
be a minimum of 35 per week to count toward the state's work participation rate. For two-
parent households, both parents in the household must be engaged in work activities if they
also receive federally funded childcare. The exemption to this latter policy would include
cases where one parent is disabled or is caring for a severely disabled child (Anderson et ai.,
2000; Katz, 1996; Schott, 2000).
Beyond the restrictions on aid and work requirements, the TANF program includes
related provisions. Welfare recipients are often eligible for additional aid through Medicaid,
federal waivers, and charitable and religious organizations. Medicaid must be offered in the
state for one year after recipients lose their TANF benefits due to an increase in earnings.
Medicaid benefits remain, however, if recipients' income is below the poverty line (Katz,
1996; Schott, 2000). States that previously received waivers of federal laws and regulations to
conduct experimental welfare programs can continue those programs until the waiver expires
and TANF recipients can continue to receive the benefits offered by the program. Moreover,
charitable, religious, or even private organizations within states are allowed to provide family
assistance services through contracts. These organizations also provide contracts to deliver
services to welfare recipients under SSI, foster care, adoption assistance, and independent
living programs (Katz, 1996; Schott, 2000). Federal waivers serve as a limited poverty pre-
vention safety net for welfare recipients who lose their TANF benefits (Katz, 1996) and related
provisions also serve as a safety net to help prevent welfare recipients falling further into
poverty.
Since the implementation of the TANF programs, many have questioned the impact of
the policies, regulations, and guidelines established by PL 104-193. Evaluations as of 1997
indicated that 55% ofTANF recipients participated in work-related activities, compared with
12% reported in 1995 under Aid to Families with Dependent Children. In 1997 the National
Survey of American Families indicated that more than half of the TANF recipients were either
working (20%), in school (10%), or involved in job searches (24%) (Kenney et ai., 1999;
Zedlewski, 1999).
Findings on the obstacles that recipients confronted are not so positive; more than 4 out of
10 recipients reported at least two significant obstacles to work, obstacles such as low educa-
tion, no recent work experience, or mental or physical health problems. Seventeen percent
indicated three or more obstacles, and 23% reported no significant obstacles to work (Kenney
et ai., 1999; Zedlewski, 1999). Of those reporting no significant obstacles to work, only 14%
reported no current work activity, and 52% reported working for pay. For those with one
obstacle, 60% indicated some work activity and 22% indicated working for an employer or
business. For TANF recipients with three or more obstacles, 73% reported no work activity,
and only 3% reported working. TANF recipients indicating two or more obstacles to work
(44%) and no current work activity (63%) represent a group at high risk of remaining on
welfare longer and being at risk for living in poverty when TANF benefits are lost (Kenney et
ai., 1999; Zedlewski, 1999).
Further data preliminarily showed that as states continue to move TANF recipients into
jobs, those still receiving TANF are likely to be confronted with increasing obstacles for
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 379

successfully moving from welfare to employment. This finding is based on data collected on
available jobs in the communities nationwide and the skills and education required for
available jobs. As the transition from welfare to work is inhibited at the mesosystem level (the
employment and human services delivery communities) or the microsystem level (TANF
recipients), the more recipients are at risk for remaining in poverty. However, the data for
states instituting work-focused welfare reforms prior to TANF showed a 1997 caseload with
fewer obstacles to work compared with states with fewer or no work focused reforms before
TANF became law (Zedlewski, 1999).
The evaluation of obstacles to employment revealed that almost half of the recipients
indicated they had poor general health or scored low on a standard mental health scale.
Findings further indicated that more than 4 out of 10 reported they had less than a high school
education and had not worked in the last three years. Ten percent of the recipients indicated
having no car and lived outside a metropolitan area and 15% reported they had a child age 1or
younger (Kenney et al., 1999; Zedlewski, 1999).
In practice, the TANF program is not simply a welfare cash-assistance program for needy
individuals and families. The program has multiple stipulations that require work and/or
training, restrictions on aid, and supportive related provisions. The TANF program places new
demands on participants, human services professionals, and employers to absorb a new labor
force. Also, the program changes the view of dependence on cash assistance to one of
temporary assistance. This view is promoted as a way to reduce the number of families living
in poverty or latent poverty.
Title II: Supplemental Security Income (SSI) as reformed in PL 104-193 focuses on the
provisions for disabled children. The eligibility criterion for disabled children has made
qualifying for SSI more difficult under welfare reform. SSI is the means-tested case assistance
for the low-income aged, blind, and disabled. The reform efforts applied to disabled children
are directed at reducing the expenditures of this means-tested public assistance program. The
Congressional Budget Office estimated that this provision of the welfare reform bill would
eliminate 315,000 (22%) of the children who would have been eligible for SSI in 2002. The bill
no longer defines a child under age 18 eligible for SSI with an impairment of "comparable
severity" to what is considered a work disability in an adult. Eligibility is redefined for child
disability to add that they must have a medically determinable physical or mental impairment
that results in marked and severe functional limitations. In the current law-PL 104-193-the
child's disability must be one that is expected to result in death or last more than 12 months
(Anderson et al., 2000; Katz, 1996; Whiteman, 2001).
Specifically, the bill requires that the Social Security Administration conduct assess-
ments on children, establish the effective date for eligibility, engage in redeterminations,
require savings accounts for children, and assess the availability of private insurance. A child's
eligibility under welfare reform eliminates qualification under an Individualized Functional
Assessment (IFA). The existing law requires the Social Security Administration to decide the
child's eligibility according to whether he or she meets or exceeds a Listing of Impairments.
Children not meeting the Listing of Impairments can still qualify for SSI through an analysis of
whether the child's mental, physical, and social function is substantially lower than children of
the same age. The legislation also eliminates references to maladaptive functioning (Anderson
et al., 2000; Katz, 1996; Whiteman, 2001).
The bill also requires the Social Security Administration to establish the effective date for
children now on SSI to meet the new, more restrictive standard for determining SSI eligibility.
The Social Security Administration has the responsibility to determine if persons receiving
SSI at the time PL 104-193 was implemented would continue to receive SSI benefits until July
380 ANTOINETTE COLEMAN AND HOWARD M. REBACH

1, 1997, or until the date of their redetennination, whichever is later (Anderson et aI., 2000;
Katz, 1996; Whiteman, 2001).
The reforms to redetennination require the Social Security Administration to reevaluate
the eligibility of each child who receives SSI at least once every three years. For low-birth-
weight infants, reviews must occur one year after birth. Exemption for redetennination is
generally granted to children whose medical condition is not expected to improve. When a
child is to be redetennined, the child's parents or guardians must present evidence showing
that the child is receiving treatment that is medically necessary. To ensure that the Social
Security Administration conducts thorough continuing disability reviews, the legislation
granted additional funding and lifted the limits on discretionary spending. The legislation to
provide funds to support reviews does help to reduce the number of disabled children falling
through the cracks and living in poverty because their families cannot afford the medical
expenses of their condition(s) (Anderson et aI., 2000; Katz, 1996; Whiteman, 2001).
The Social Security Administration requires that a separate savings account must be
established for disabled children by their parents or guardians. This savings account must
include any past-due SSI payments that exceed six times the maximum monthly payments.
Specifically, the money may be used to cover expenses such as education or job skills training,
special equipment or housing modifications, and medical treatment (Anderson et aI., 2000;
Katz, 1996; Whiteman, 2001).
Private insurance(s) that children are enrolled in must be considered in detennining SSI
benefits. To illustrate, children who are hospitalized and whose medical costs are covered by
the insurance(s) will receive no more than the $30 monthly SSI benefit paid to children whose
medical bills are covered by Medicaid (Anderson et aI., 2000; Katz, 1996; Whiteman, 2001).
The reforms to the SSI program under PL 104-193 also included provisions regarding
multistate benefits, fugitive felons, prisoners, and large past-due payments. Multistate benefits
involve persons convicted of fraudulently trying to get benefits from two or more states for
several social services programs including food stamps, welfare (TANF), and SSI. They will
not be eligible for SSI benefit for 10 years (Anderson et aI., 2000; Katz, 1996; Whiteman,
2001). Fugitive felons, which includes anyone fleeing to avoid prosecution, custody, or con-
finement after being convicted of a felony or in violation of probation or parole, are ineligible
for SSI. Provisions for prisoners under SSI were reformed to include financial incentives
awarded to state and local prisons and jails to report inmates fraudulently receiving SSI
(Anderson et aI., 2000; Katz, 1996; Whiteman, 2001). Correctional institutions would receive
$400 for each prisoner who loses benefits, if prisoners are reported within 30 days. If prisoners
are reported within 30-90 days, the institution would receive $200 (Anderson et aI., 2000;
Katz, 1996; Whiteman, 2001).
Individuals eligible for past-due SSI payments that exceed 12 times the maximum
monthly benefit payable to an eligible individual or couple generally must now be paid in three
installments at six-month intervals, rather than a lump sum. First and second installments
cannot exceed 12 times the maximum monthly payable benefits. These stipulations are
implemented in PL 104-193 to control public dollar expenditures and ensure that the monies
are strictly being used for the needs of the disabled child (Anderson et aI., 2000; Katz, 1996;
Whiteman, 2001).
Historically, the SSI program has been viewed as having fewer stigmas than AFDC,
TANF, or food stamps (Whiteman, 2001). It functioned over the decades to provide benefits to
individuals at risk of being impoverished because of age, medical conditions, or physical
disability. With the enactment ofPL 104-193, the reforms to the SSI program focused on more
stringent eligibility requirements for disabled children. Other reforms to SSI included provi-
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 381

sions that restricted benefits payment dissemination and benefit fraud. Many concerns exist
among social workers, sociologists, psychologists, and physicians about the extent to which
SSI reforms target disabled children. These professionals suggest that the reforms enacted
regarding disabled children in the SSI program may indeed exclude a significant number of
children who have disabilities, leaving them without needed benefits increasing the risk that
these children and their families will be living in poverty, as the needs of these children cannot
be met (Anderson, et aI., 2000; Katz, 1996; Whiteman, 2001).
Title III: Child Support as reformed in PL 104-193 institutes new procedures that enforce
the establishment of paternity and enforces child support orders. Specifically, the legislation
changes the way child support payments-and overdue payments known as arrearages-are
disbursed to welfare recipients. Previously, welfare recipients had to assign to the states the
right to collect child support payments and any past-due payments for them. Families received
the first $50 collected. This amount was called a pass-through and did not affect the family's
welfare (AFDC) eligibility or benefits. Federal and state governments were then reimbursed
for the AFDC monthly expenditures paid to families. If money was left, the family could
receive the current amount for the child support monthly payment. Any money beyond that
was used to pay the arrearages, first to the state and federal government, then to the family
(Anderson et aI., 2000; Katz, 1996).
The bill legislated reforms to child support that changed its structure in several ways.
Beginning October 1, 1997, child support received for arrearages that accumulated after the
family leaves welfare will be paid to the family before the state can use the money to reimburse
itself or the federal government. Next, as of October 1, 2000, child support received for
arrearages that accumulated before the family went on welfare will also be paid to the family
before the state can use the money to reimburse itself or the federal government. In addition,
PL 104-194 gives states the option to "pass-through" the first $50 of child support collected
on behalf of a family on welfare, but no longer requires it. If states choose this option, how-
ever, it is required that the federal government be paid its share of the child support (Anderson
et aI., 2000; Katz, 1996).
Next, the legislation provides for the locating and tracking cases. The guidelines estab-
lished for locating and tracking include state registries, state disbursement units, state direc-
tory of new hires, income withholding, federal parent locator service, and the use of social
security numbers. The state registries guidelines required states to establish a central case
registry to track the status of all child support orders modified or initiated. State registries
record demographic and basic information about parents involved in a child support order.
Moreover, states regularly must update and share with other entitles, e.g., federal registry,
information maintained in the state registries (Anderson et aI., 2000, Katz, 1996).
The bill legislated income withholdings from noncustodial parents. States enacted laws
that required income withholding for noncustodial parents where arrearages had occurred.
This stopgap measure allows states to decrease the cost of welfare through the receipt of child
support. In line with income withholdings, states now operate a centralized disbursement unit
to locate and track cases, as a result of welfare reform. The unit collects child support from
employers, noncustodial parents, and from other states. Also, the centralized disbursement
unit handles the distribution of money to custodial parents (Anderson et aI., 2000; Katz, 1996).
To further ensure child support payments are made to help prevent children from living in
poverty and to reduce welfare expenditures, the legislation established that states maintain a
new hire registry. The new hire registry requires employers to send demographic information
of all new employees to the state child support enforcement agency. States are responsible for
comparing information on new hires with the state and national registries of child support
382 ANTOINETTE COLEMAN AND HOWARD M. REBACH

orders. The infonnation states maintain in this registry must be used to establish paternity, as
well as create, modify, and enforce child support obligations. The new hire registry is also used
for the purpose of verifying individuals' income eligibility for TANF, Medicaid, unemploy-
ment compensation, food stamps, and SSI. Therefore, infonnation contained in the new hire
registry is shared with the state agency administering the aforementioned programs (Anderson
et aI., 2000; Katz, 1996).
Coupled with the state directory of new hires, the federal parent locator service was
expanded to include a federal registry of child support orders and a national directory of new
hires. The state directory of new hires and state registries in tum supply the federal registry
with infonnation. The federal parent locator service is used to identify and locate parents who
are subject to child support orders and to establish paternity. This service is similar to the state
registries, but operated at the federal level. Confidentiality is mandated within this service for
cases involving domestic violence or child abuse (Anderson et aI., 2000; Katz, 1996).
Also, as a part of locating and tracking child support cases, social security numbers are
used to assist in handling child support orders. Specifically, states track through professional
licenses, commercial driver's licenses, occupational licenses, and marriage licenses to locate a
noncustodial parent delinquent in child support payments. States must ensure that social
security numbers are listed on divorce decrees, child support order, paternity determinations,
and death notices. The use of social security numbers on multiple documents that would
impact children has helped to increase the state child support enforcement agencies' ability to
locate and track parents (Anderson et aI., 2000; Katz, 1996).
Through the welfare refonn activities delineated under child support, the establishment
of paternity is required at the state level. The Welfare Refonn Act amended laws to improve
states' ability to establish paternity. The changes were for the specific purpose of reducing the
dollars expended on welfare for children as a result of delinquent child support payments. The
changes listed below are among those enacted by states:
• States can permit paternity to be established until the child reaches at least the age of 18.
• Children and other parties are required to undergo genetic testing if a party involved
requests and it is warranted given the circumstances of the case.
• Procedures to allow men to voluntarily acknowledge paternity through a simple civil
process and through hospitals.
• Fonns used by fathers to voluntarily acknowledge paternity must include the basic
elements.
• Procedures used to acknowledge paternity is considered a legal judgment after 60 days,
and can be challenged beyond that date on the basis of fraud, duress, or mistake of fact.
• Voluntary acknowledgments and adjudications of paternity must be filed with the state
registry of birth records and that infonnation must be compared with the child support
registry.
Essentially, the refonns to child support enforcement and the establishment of paternity
reflect the efforts of the federal and state governments to reduce current and future expendi-
tures on welfare. These changes are 100% directed at having noncustodial parents who are
delinquent, to make payments. When directly addressing the problem of children and poverty,
the expansion of child support enforcement and paternity acknowledgment presents a salient
argument in favor of the refonn efforts established. More stringent policies may help decrease
the number of children who become welfare dependents and live in poverty.
Title VI: Child Care under PRWORA-PL 104-193 created block grants to state to provide
childcare services. Specifically, several federal childcare programs were folded into the Child
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 383

Care and Development Block Grant to states. This block grant renders childcare services to
low-income families. It attempts to improve the activities, quality, and availability of childcare
for this population. PL 104-193 ends the guarantee of federal matching funds to states without
limits. Through block grant childcare programs, welfare recipients are able to participate in
work or training programs to help them obtain and keep jobs. Childcare programs can be
available to welfare recipients up to one year after leaving the welfare rolls in an effort to
further support them in remaining employed.
For states to qualify for mandatory funds, basic allocations, and limited matching funds,
they are obligated to spend all basic childcare allocations. Funds are distributed to states based
on their proportion of children under age 13 . Essentially, Title VI: Child Care supports the
WTW principle mandated in Title I: Temporary Assistance to Needy Families (TANF).
Through childcare funding sources, the success of TANF recipients to become employed is
increased (Anderson et aI., 2000; Katz, 1996; Schott, 2000).
Finally, in order to receive block grants, states are required to have licensing require-
ments for childcare services that are certified and in operation. Welfare reform requires states
not only to have licensing requirements, but also to explicitly describe how these requirements
are enforced. Therefore, states are to ensure that childcare services are monitored on a regular
basis. Even more specific, welfare reform efforts on childcare require states to detail how they
are meeting the particular childcare needs of welfare recipients for those attempting to leave
the welfare rolls and those at risk of needing welfare to reduce the incidence of living in
poverty (Anderson et aI., 2000; Katz, 1996; u.S. Bureau of the Census, 1997).
Title VIII: Food Stamp and Commodity Distribution remained largely structurally intact
to provide vouchers (food stamps) for poor families to purchase food and the provision of food
commodities (food items and meals). The food stamp program under PL 104-193 Title VIII
continues to be an in-kind means-tested program. But the welfare reform legislation cut more
funds from the food stamp component of Title VIII than any other public assistance program.
Benefits, per person, were reduced and the legislation generated cost savings by making
over I million food stamp recipients ineligible. Most legal immigrants are now ineligible to
receive food stamps. In addition, able-bodied adults between the ages of 18 and 50 who do not
have dependents are only eligible for food stamps for 3 months in any 36-month period, if they
are working fewer than 20 hours a week (Anderson et aI., 2000; Whiteman, 2001).
Even as a result of the welfare reform changes, the food stamp program does continue to
provide benefits to individuals who meet eligibility requirements. The legislation enables the
food stamp program to expand or contract with other services on demand. However, welfare
reform reduces individual food stamp allotments to 100% from 103% of the U.S. Department
of Agriculture's "Thrift Food Plan" which is intended to reflect the benefits needed to
purchase food for minimal nutritional requirements (Anderson et aI., 2000).
Three criteria must be met under welfare reform to qualify for food stamp benefits.
Qualifying households must be both income and asset poor. That is, the gross income of a
household must be at or below 130% of the poverty line. Next, the net income of the household
is assessed; after subtracting from cash income such items as standard deductions and credit
given for earned income, the household income must be below 100% of the poverty line.
Finally, in order for a household to qualify, it must also have assets worth less than $2000
(Anderson et aI., 2000; Katz, 1996).Specific changes in regulations that impact food stamp
eligibility are in the areas of:

• State and local energy assistance will be considered as income.

• Earnings of students will be considered as part of the family income.
384 ANTOINETTE COLEMAN AND HOWARD M. REBACH

• No longer will the minimum monthly allotment in food stamp benefits for one or two
persons be indexed to inflation.
• The threshold above which the fair market value of a vehicle is counted increases
subsequent to inflation.
• The maximum shelter expense deduction will increase annually.
• All parents and children 21 years of age or younger living together must apply for food
stamps as a single household (Executive Office of the President, 1998; Katz, 1996; U.S.
Department of Health and Human Services, 1998).
In addition to the "food stamps" program, Title VIII of the welfare reform bill includes
the commodity food program. Welfare reform consolidated the Emergency Food Assistance
Program, which distributed commodities to emergency food operations, with soup kitchens
and food banks. Through welfare reform, funds are now provided annually to buy commodi-
ties to be used for soup kitchens and food bank programs. Commodities will be distributed to
dates based on the poverty and unemployment rates (U.S. Census Bureau, 1997).
Even with the changes enacted by welfare reform, the non-cash assistance food stamps
and commodity programs remain critical resources to lessen the degree of impoverishment
experienced by poor individuals and families. The food stamp program, in particular, con-
tinues to be the major public assistance program that operates to meet the increased demands
of the poor when society is confronted with periods of economic downturns. As part of the
social safety net, the food stamp program is to expand to help individuals and families on the
brink of poverty. Food stamps enable households that have exhausted their five-year limits for
TANF benefits to still meet their daily nutritional requirements. Unfortunately, the social
safety net offered by the food stamp program to help reduce poverty becomes quite unreliable
for the nonworking able-bodied adults without dependents and immigrants, in that they now
do not quality under welfare reform.

Successes and Failures

Assessment of the successes and failures of welfare reform at this stage should be done
with a cautionary note. Declining caseloads are a success for welfare reform. However, they do
not, in and of themselves, provide enough information as to whether families are better or
worse off. The decline in caseloads however, does indicate a form of "success" in that fewer
people are on the welfare rolls. What is needed to gauge the degree that caseload decline
denotes success involves a more in-depth analysis of the overall well-being of poor households
before and after the implementation of welfare reform. To date analyses of welfare reform
have primarily examined employment rates, hours worked, and type of employment.
Of the states examined, Maryland and Wisconsin indicated significant employment rates
for recipients leaving welfare. Maryland had 51% employment in the first quarter after
recipients left welfare and Wisconsin reported 66% (Brauner & Loprest, 1999). According to
studies on hours worked per week, over half of the employed recipients leaving welfare
worked 30 or more hours, nearly full time (Brauner & Loprest, 1999). Of those leaving welfare
in Iowa and South Carolina, 57 and 87% respectively were employed 30 hours per week.
Indiana reported 62% of leavers worked 35-plus hours. The mean number of hours worked in
Wisconsin and Washington was 36 hours per week. Texas reported leavers worked 34 hours
per week (Brauner & Loprest, 1999).
Studies examining types of employment obtained by recipients leaving welfare showed a
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 385

consistent pattern. Maryland and Wisconsin indicated wholesale or retail trade jobs including
jobs at eating and drinking establishments, and minimum-wage service jobs as the major types
of employment for recipients leaving welfare. Texas reported that 41% of those leaving wel-
fare were employed in restaurant, fast food, clerical, or retail sales jobs. Sales and minirnum-
wage service jobs were the most commonly reported occupations for leavers in Washington
and South Carolina (Brauner & Loprest, 1999). The types of employment obtained by
recipients leaving welfare paid at or only slightly above minimum wage, and affordable
healthcare or no healthcare benefits were available to former recipients.
From January 1996 to May 1997 several months before the implementation of PL 104-193
in some states, the food stamp participation fell from 25.9 to 22.4 million (Gundersen, 1998).
This decline was attributed to the economic expansion that occurred during that period.
However, in the latter part of 1997, 90% of TANF recipients receiving food stamps tended
to move on and off multiple welfare programs such as Medicaid and childcare (Gundersen,
1998).
Declines in the food stamp caseload have occurred since the implementation of welfare
reform. The exclusion of many immigrants and unemployed childless able-bodied adults plays
a significant role in the decline of the food stamp caseload. Also, in part, some of the decline in
the food stamp caseload may be coupled with the growth in the economy, a low unemployment
rate, and a low inflation rate. Essentially, future recessions in food stamp participation rates
will be mitigated if welfare reform produces permanent changes in welfare caseloads. How-
ever, economic expansion is always an intervening factor that contributes to the decline in food
stamp participation rates. But the decline that occurs in conjunction with economic expansion
is a temporary situation, in that the decline will last only as long as the economy demonstrates
growth.
Further examination of the impact of welfare reform shows that the influx of welfare
recipients into the low wage labor market is projected to lower the welfare rolls. However, the
wage-depressing effects of welfare reform will cause not only an increase in poverty among
welfare recipients, but also an increase in the number of working poor. A study conducted by
the Tufts University Center on Hunger and Poverty on the federal lifetime limit of 60 months
to receive welfare suggests this measure will have catastrophic consequences for more than
half of the current welfare recipients who have serious barriers to employment, such as child's
or their own poor health, physical or psychological disabilities, or low education or low job
skill levels (White, 1998).
The impact of the welfare cuts is already being felt in major urban areas. To illustrate,
Detroit reported in 1998 that area homeless shelters had overflowed and many in need had been
turned away. During 1998, Michigan reported that their shelters were 15 to 50% busier. Shelter
providers in Michigan saw the welfare reform rules that eliminated food stamps to certain
groups and changes in disability payments as major contributors to the increased need for
shelter services (White, 1998).
In addition, homeless shelters have noted a particularly large increase in the number of
impoverished women and children seeking help (White, 1998). To a considerable extent since
welfare reform, a regular cycle has developed among women and children being consumers of
shelters services. This growth in need for shelter services is largely attributed to work rules that
force mothers on welfare to take low-paying jobs and lose cash benefits. To illustrate, a former
female welfare recipient loses her job, or does not earn enough to pay rent and other expenses,
gets evicted, and ends up with her children in a homeless shelter.
A study conducted in Oklahoma indicated that 57% of former welfare families reported
household incomes at or below the federal poverty level (Fagnoni, 1999). In addition, Indiana
386 ANTOINETTE COLEMAN AND HOWARD M. REBACH

reported that 57% of the families no longer on welfare had monthly household incomes below
$1000. And Washington indicated an average total family income, including child support
payments, equal to 130% of the federal poverty level for a family of three (Fagnoni, 1999).
The impact of welfare reform on smaller rural counties experiencing already high
unemployment rates is now being confronted with the difficulties of absorbing new workers
into their already saturated labor marketplace. Nonmetropolitan counties adjacent to metro-
politan areas are affected by the employment cycles of the metropolitan area. As nearby
metropolitan areas experience employment saturation, welfare recipients in nonmetropolitan
areas seeking employment do not have metropolitan areas as an option (Goetz & Freshwater,
1997).
To deal with the considerable pressure of welfare reform on recipients, some states have
chosen to provide safety net assistance for families that have exhausted the time limit and
extensions for aid. Programs in various states primarily provide vendor or voucher payments.
Vendor or voucher payments take care of the basic needs of the family, but the parents receive
very little to nothing in the form of cash payment. Work is still necessary for the adult(s) head
of household. New York has a state-funded pro g ram entitled "Safety Net Assistance." This
program is for families that can no longer receive assistance under TANF due to the 6O-month
time limit. The benefit levels are the same as for New York's TANF program, but benefits are
primarily in the form of vendor payments rather than cash (Goetz & Freshwater, 1997).
Like New York, Connecticut established a state program entitled "Safety Net." The
Safety Net program in Connecticut serves families that have reached the state's 21-month time
limit and do not qualify for an extension (Goetz & Freshwater, 1997). Families participating in
the Safety Net program first receive a comprehensive assessment of work readiness and
intensive case management. The Connecticut program then provides voucher or vendor
payments to meet the family's basic needs such as food, clothing, childcare, and shelter (Goetz
& Freshwater, 1997).
Overall, a preliminary look at the impact of welfare reform suggests that states do move
many TANF recipients into jobs. However, a large number of those recipients still live at or
below the poverty line. Furthermore, there is still the problem of TANF recipients who
continue to face major obstacles-person and situational-moving from welfare to work. The
success of welfare reform is greatly impacted due to the increased risk of recipients remaining
on welfare as a result of multiple personal and environmental obstacles. Even with these
factors present, states have been able to meet the caseload participation rates required of them.
Finally, a more complete understanding of the variations in caseload characteristics
across states is not presently available. However, it is clear that states are confronted with the
dilemma of moving recipients off of welfare and the concern of whether these former
recipients are now becoming members of the working poor still in need of assistance.

Welfare Reform: Summing Up

Today's system of public social welfare to the poor is quite complex and no longer self-
effectuating. It continues to involve categorically separate cash assistance and in-kind benefits
that the poor need. Primarily, the new welfare reform policies and programs enacted in PL
104-194 are directed at legislating change to reduce the welfare roll in our society.
Of the social welfare reform policies, TANF represents the most controversial program.
TANF with its strong emphasis on requiring welfare recipients' head of households to engage
in employment and to achieve a level of self-sufficiency in a limited time period poses
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 387

tremendous concerns. The concern among social workers, clinical sociologists, political
scientists, economists, and other human services professionals is whether the reforms in TANF
create another level of poor people.
Similar concerns exist about changes to SSI in regard to disabled children. While many
valid criticisms have been put forth about the number of children receiving SSI due to learning
disabilities, the welfare reform policy changes make it much more difficult for children to
qualify, and could eliminate children who need SSI benefits. Like the TANF program, the SSI
program as reformed may also increase the number of children who continue or are at risk of
living in poverty due to the more stringent criteria that have been established for the program.
In addition, the welfare reform efforts cut more funds from the food stamp component of
the food stamp and commodities distribution program than any other public assistance
program. The changes now exclude certain groups of people and the asset requirement level
for the groups still eligible is lower. The major concern is whether the number of persons not
having a nutritionally sound diet increases as a result of the changes in the food stamp
program.
While the reforms to the child support and childcare programs do not reflect the degree of
reduction to services as the aforementioned cash and in-kind assistance program, the changes
do implement new criteria that welfare recipients must adhere to. The changes within the child
support program demonstrate an effort on the part of the federal and state governments to
reduce financial expenditures on welfare through taking comprehensive measures to enforce
support payments from noncustodial parents. For the childcare program the issue is that
limited funding has become available to states. This change has a dual effect. Limiting funding
to the childcare program directly affects the major resource-childcare-TANF recipients
need in order to become and remain employed. Thus, the concern is whether recipients can
become self-sufficient through employment if for the most part the jobs they have pay
minimum or slightly above minimum wages and affordable daycare is not available.
The welfare reform policies and programs do very little to help the poor move truly from
dependence on governmental assistance to a level of self-sufficiency. These reforms do not
address the barriers that prevent self-sufficiency such as (1) implementing a more realistic
living wage that addresses inflation and is beyond the existing minimum wage that currently
cannot meet the needs of a family in today's marketplace, (2) progressive employment
opportunities, and (3) affordable healthcare, just to name a few.
Overall, the changes and cuts embodied in PRWORA: PL 104-193 present the question as
to whether it strengthens the opportunity for the poor to move out of poverty or whether it
creates growth in the number of poor people who fall deeper into living in poverty. The data
available to date indicate varying outcomes on the different factors that serve as measures for
determining the law's impact. Therefore, the question regarding what effect has welfare
reform had on poverty has not reach a definable level. Continued monitoring of welfare reform
is critical to determine what is happening to people already or at risk of living in poverty in this
country.

ROLES FOR CLINICAL SOCIOLOGISTS

AND OTHER PROFESSIONALS

The problems of poverty cannot be ameliorated without a nationwide commitment to do

so. Clinical sociologists, social workers, and other human services professionals concerned
about individuals and families who are poor or near poor need to recognize that poverty is a
388 ANTOINETTE COLEMAN AND HOWARD M. REBACH

societal problem that will require an integrated effort across the spectrum, at the micro-,
meso-, and macrolevels, involving individuals, communities, businesses, and all levels of
government. In this section we suggest critical roles for professionals working to address
poverty in the United States under the current welfare reform.

At the Microlevel

Those who work directly with individuals and families need to recognize the effects of
poverty and unemployment on the development of coping styles and strategies. The lack of
resources, substandard housing, living in rundown neighborhoods, social isolation, and sense
of powerlessness and frustration may produce the conditions often cited as the "causes" of
poverty. An unemployed worker who is depressed or a family who has lost its income source
and has become dysfunctional may need counseling but they also need resources and jobs.
Even at the microlevel we must remember that poverty results from a lack of resources, not
from some maladaptive or deviant value system or lifestyle. Professional helpers may need to
adopt roles as broker or advocate.
As a broker, professionals must work on behalf of the poor to make linkages between
providers of resources and clients (Anderson et ai., 2000). Professionals can help persons
bridge the gaps between needs and resources. Tangible results, such as goods or services, are
the outcome of brokerage activities (Ezell, 2001). To obtain the outcome of tangible goods,
professionals must broker at the micro-, mezo-, and macrolevels of the social welfare system.
Tangible products may be secured at the microlevel through directly helping the clients receive
needed resources from various services providers. Connecting people with goods and services
requires knowledge of local and national regulations and laws and knowledge of the services
array as well as eligibility requirements. In conjunction with or on behalf of clients, brokering
also means direct contact and negotiation with those who have goods and services to provide.
Often clients lack the basic resources-transportation, a telephone, or knowledge and
information-to identify and connect with services.
For social workers, clinical sociologists, and other human services professionals, broker-
age enhances the credibility of less visible outcomes when working with poor individuals and
families.
Crisis intervention services are also essential in working with and on behalf of the poor
(Anderson et ai., 2000). Crisis intervention services use the approach of problem partializa-
tion (Anderson et ai., 2000), which involves assessing the physical conditions of the poor-
access to food and shelter-to restore equilibrium to their lives, then moves to explore
interpersonal and intrapsychic functioning. These professions also examine the degree to
which needy individuals and families are able to maintain themselves, beyond a state of living
in poverty, through the use of available resources such as services delivery, and employment
(Anderson et ai., 2000). The issue of helping needy individuals and families obtain an
adequate standard of living, becomes primary for change agents and therapists working to aid
people to move from dependence on public assistance programs to a level of self-actualization
and self-sufficiency.
An advocate speaks for those who cannot speak for themselves. The role of advocate in
working on behalf of the poor requires a thorough knowledge of the laws, regulations, and due
process (Ezell, 2001), as well as an understanding of how internal agency policies can cause
inappropriate denials of benefits, especially in an era of welfare reform. Being an advocate
requires realizing that the broader aspects of social welfare policy and programs reflect the
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 389

macrolevel political climate of Congress, state legislatures, and local governments of the time
(Ezell, 2001). In the advocacy role, professionals must acknowledge that laws established to
make positive changes, in the final analysis, might not benefit the poor. Through understanding
the laws that enforce service delivery to the poor, advocates position themselves to sometimes
confront, sometimes negotiate with schools and agencies, and sometimes mobilize those social
actors (individuals, agencies, constituencies) that can rectify power imbalances on behalf of
clients. Professionals, in the role of advocates, have the responsibility of reminding society
that the poor are the major consumers of our reformed public social welfare system.

At the Mesolevel

Policy experts, agency consultants, teachers, and community organizers work with
communities, neighborhoods, and local government agencies. In the role of technical expert,
the professional develops specialized knowledge and expertise in the policies that drive
programs to assist individuals and families in need (Anderson et at., 2000). This role necessi-
tates the professional gaining and sharing information about how various programs affecting
the poor are currently working. As agency consultants, technical experts working on behalf of
the poor have the primary responsibility of maintaining current data on the full range of
barriers to client self-sufficiency. This aspect of the role of technical expert is necessary to
ensure that policymakers and administrators understand what welfare recipients experience
under the new policies and provisions, and what resources are available to overcome existing
barriers (Anderson et at., 2000; Ezell, 2001). To illustrate, technical experts give particular
attention to understanding how income support resources, human services agencies capa-
bilities, availability of jobs, and legislative actions impact needy individual and families.
As agency consultants, policy experts, and teachers, we must also teach agency workers
and the public, that poverty stems from social arrangements; that reduction of poverty cannot
depend on the efforts of the poor alone. As consultants, professionals contract with agencies
and organizations in an effort to bring about social change for persons at risk of living in
poverty (e.g., children, single female-headed households, the disabled, aged, mentally or
physically challenged). This role involves helping these organizations create activities that
clearly define how social change will be achieved for the designated population to be served.
The tangible activities rendered by consultants most often involve formulation, implementa-
tion, expansion, reduction, and/or evaluation of policies, programs, and service delivery.
This role requires that professionals go beyond the role of technical expert and assess
what is in the best interest of the clients to be served (i.e., needy individuals and families), and
how the agency or organization should best proceed. Consultants must draw on and use
knowledge of human behavior and the social environments-micro- and mezosystems-to
understand and most appropriately address social change on behalf of the poor. They must also
remain current on the changes in public social welfare policy-macrosystems-that indi-
rectly or directly places persons in our country at risk for living in poverty.
Community organization can be an effective strategy in poor areas. Community orga-
nizers help mobilize community members to form a more or less formal organization and to
exert collective action on shared problems. Often, collective action can deal with power
imbalances if a unified constituency can be formed that can get the attention of local political
leaders through voting and perhaps activist activities. An organized community can confront
power structures to address a wide range of community needs and concerns: school issues,
sanitation, health problems, housing codes, transportation, police protection, and so on. An
390 ANTOINETTE COLEMAN AND HOWARD M. REBACH

organized community can negotiate with governments and businesses to explore creative ways
to keep jobs and businesses in the community.
The advocate and broker roles are also relevant at the mesolevel, especially in conjunc-
tion with community organization. Brokering at the mesolevel may involve engaging in
collaboratively sponsored efforts with community services agencies to benefit community
members and clients immediately and for the future. Advocates take appropriate action to
strengthen, change, or combat policies and agency decisions that adversely affect people.

At the Macrolevel

At the macrolevel we enter the political arena of policy and program development at the
state and national levels. Active intervention roles include administrators, planners, consul-
tants and policy experts, and, of course, researchers.
Again, we emphasize, for persons in these roles, that reducing poverty requires involve-
ment of all levels of society and the recognition that poverty emerges out of the basic structure
of society. We agree with Eitzen and Zinn "that poverty cannot be eliminated by the efforts of
the poor themselves, by the private sector of the economy, by charitable individuals or groups,
or by the efforts of state and local governments alone ... that poverty is a national problem and
must be attacked by massive, nationwide programs" (2000:204). Policies and programs must
provide increased participation and access to resources and opportunities without discrimina-
tion. Decision making in all areas of public life must evaluate the effects of decisions on all of
us including the poorest and least vocal and powerful segments of society if we are to reduce
poverty and the other social problems it creates. And programs and policies must undergo
rigorous evaluation and scrutiny to determine their effectiveness at meeting objectives as well
as their failures and dysfunctions.
Not only must those who work at the macrolevel keep these issues in mind, they must
work to spread this awareness to stakeholders and constituencies throughout all levels of the
society.

REFERENCES
Anderson. L. P., Sundet, P. A., & Harrington, l.. (2000). The social welfare system in the United States: A social
worker's guide to public benefits programs. Boston: Allyn & Bacon.
Balke, N. S., & Slottje, D. 1. (1993). Poverty and change in the macroeconomy: A dynamic macroeconometric model.
The Review of Economics and Statistics, 75, 117-122.
Bell, W. (1983). Contemporary social welfare. New York: Macmillan Co.
Bishop, J., Formby, J., & Zheng, B. (1999). Distribution sensitive measures of poverty in the United States. Review of
Social Science Economy, 3, 307-343.
Brandt, L. (1908). The cause of poverty. Political Science Quarterly, 23, 637-651.
Brauner, S., & Loprest, P. (1999, May). Where are they now? What states' studies ofpeople who left welfare tell Us.
Series A. Washington, DC: Urban Institute.
Brooks-Gunn, J., Klebanov, P., & Duncan, G. (1996). Ethnic differences in children's intelligence test scores: Role of
economic deprivation, home environment and maternal characteristics. Child Development, 67, 403-405.
Callan, T., Nolan, B., Whelan, B. J., Whelan, C. T., & Williams, J. (1996). Poverty in 1990's: Evidencefrom the 1994
Living in 1reland Survey. Dublin: Oak Tree Press.
Center for Economic and Social Justice. (1999). Defining economic justice and social justice. Washington, DC:
Author.
Cohen, C. J., & Dawson, M. C. (1993). Neighborhood poverty and African American politics. The American Political
Science Review, 87, 285-301.
POVERTY, SOCIAL WELFARE, AND PUBLIC POLICY 391

DiNitto, D. M. (1995). Social welfare: Politics & public policy (4th ed.). Boston: Allyn & Bacon.
Dunn, D. (1999). Economic justice and fairness. Word wizards. Washington, DC: Center for Economic and Social
Justice.
Duncan, G., & Brooks-Gunn, 1. (1997). Consequence of growing up poor. New York: Russell Sage Foundation.
Duncan, G., Brooks-Gunn, J., & Klebanov, P. (1994). Economic deprivation and early childhood development. Child
Development, 65, 312-315.
Eitzen, D. S., & Zinn, M. B. (2000). Social problems (2nd ed.). Boston: Allyn and Bacon.
Eller, T. J. (1996). Who stays poor? Who doesn't? Current Population Reports (p. 70-55). U.S. Bureau of the Census.
Executive Office of the President, Office of Management and Budget. (1998). Income security: Budget of the United
States government, 1998 (Chapter 24). Washington, DC: GPO.
Ezell, M. (2001). Advocacy in the human services. Belmont, CA: Brooks/Cole-Wadsworth Thomas Learning.
Fagnoni, C. M. (1999). Effects of changes to the welfare system. Testimony Before the Subcommittee on Human
Resources of the House Committee on Ways and Means. Washington, DC.
Fisher, G. M. (1997). The development and history of the U.S. poverty thresholds: A brief overview. GSS/SSS
Newsletter, Winter.
Glenn, E. (2000). Citizenship and inequality: Historical and global perspective. Social Problems, 47, 1-20.
Goetz, S. 1., & Freshwater, D. (1997). Effects of Welfare reform on rural counties labor markets. American Journal of
Agricultural Economics, 5, 1608-1613.
Gundersen, C. (1998, January). Economic growth, Welfare reform, and the Food Stamp Program. Food Review.
Gustafsson, B., & Johansson, M. (1999). In search of smoking guns: What makes income inequality vary over time in
different countries. American Sociological Review, 64, 585-605.
Hartman, C. (2000). Facts and Figures. inequality.org.
Hightower, J. (1999). American CEOs are wallowing in wealth and firing workers to get even richer. The Hightower
Lowdown. October, 1999.
Hill, L. (1998). The institutional economic of poverty: An inquiry into the causes and effects of poverty. Journal of
Economic Issues, 32, 279-286.
House of Representatives Report 104-725. (1996, July 30). Personal Responsibility and Work Opportunity Reconcilia-
tion Act of 1996: Conference report. Washington, DC.
Jasso, G. (1999). How much injustice is there in the world? Two new justice indexes. American Sociological Review,
64, 133-168.
Jenson, G. O. (1998). Unemployment and the family-news/reference. PENpages on-line service of College of
Agricultural Sciences, Penn State University.
Katz, J. L. (1996). Welfare overhaul law. Congressional Quarterly, 54(38), 2696-2705.
Kawachi, I., Kennedy, B. P., Lochener, K., & Prothrow-Stith, D. (1997). Social capital, income inequality and
mortality. American Journal of Public Health, 87, 1491-1498.
Keegan, E. (1999). A structural model of the effects of poverty on the socio-emotional development of children.
Dissertation Abstracts International Section: A Humanities & Social Science, 59, 3207.
Kelso, L. 0., & Adler, M. J. (1958). The capitalist manifesto. New York: Random House.
Kennedy, B. P., Kawachi, I., Glass, R., & Prothrow-Stith, D. (1998). Income distribution, socioeconomic status, and
self rated health in the United States: Multilevel analysis. British Medical Journal, 317, 917-921.
Kenney, G., Sheuren, F., & Wang, K. (1999). National Survey of American Families: Survey methods and data
reliability. Methodology Series No.1. Washington, DC: Urban Institute.
Lantz, P. M., & House, J. S. (1998). Health behaviors don't explain high death rates among the poor. Journal of the
American Medical Association, 279, 1703-1708.
Lavelle, R. (1995). America's new war on poverty. San Francisco: Blackside.
Lefkowitz, B. (2000). Dollars count more than doctors. www.inequality.org
Lenski, G. (1966). Power and privilege. New York: McGraw-Hill.
McLeod, J. D., & Shanahan, M. J. (1993). Poverty, parenting, and children's mental health. American Sociological
Review, 58, 351-366.
Mishel, L., Bernstein, J., & Schmitt, J. (1999). The state of working America: 1998-99. Washington, DC: The
Economic Policy Institute.
Naifeh, M. (1998). Trap door? Revolving door? Or both? Current Population Reports, Census Bureau.
National Coalition for the Homeless. (1999a). Homeless families with children. NCH Fact Sheet #7.
National Coalition for the Homeless. (1999b). Why are people homeless? NCH Fact Sheet #1.
National Coalition for the Homeless. (1999c). Employment and homelessness. NCH Fact Sheet #4.
O'Boyle, E. (1999a). Toward an improved definition of poverty. Review of Social Economy, 3, 281-301.
O'Boyle, E. (1999b). Distribution sensitive measure of poverty in the United States: Comment. Review of Social
Economy, 3, 344-350.
392 ANTOINETTE COLEMAN AND HOWARD M. REBACH

Pagani, L., Boulerice, B., Vitaro, E, & Tremblay, R. (1999). Effects of poverty on academic failure and delinquency in
boys: A change and process model approach. Journal ofChild Psychology and Psychiatry and Allied Disciplines,
40, 1209-1219.
Sameroff, A., Seifer, R., Baldwin, A., & Baldwin, C. (1993). Stability of the intelligence from preschool to
adolescence: The influence of social and family risk factors. Child Development, 64, 94-95.
Sawhill, 1. V. (Ed.). (1996). Welfare reform: An analysis of the issues. The Urban Institute, 17(14), 46-47.
Schott, L. (2000, June 21). Ways that states can serve families that reach welfare time limits. Center on Budget and
Policy Priorities.
Shapiro, 1., & Greenstein, R. (1999). The widening income gulf. Center on Budget and Policy Priorities.
Side1, R. (1996). Keeping women and children last: America's war on the poor. New York: Penguin Books.
Sorlie, P. D., Backlund, E., & Keller, J. (1995). US mortality by economic, demographic, and social characteristics:
The national longitudinal mortality study. American Journal of Public Health, 85, 949-955.
Trattner, W. 1. (1989). From poor law to welfare state: A history of social welfare in America. New York: Free Press.
U.S. Census Bureau. (1997). Poverty: /997 highlights. Washington, DC.
U.S. Census Bureau. (1999). Statistical abstract of the United States, /999. Washington, DC.
U.S. Census Bureau. (2000). Definition of income and poverty terms. Washington, DC.
U.S. Department of Health and Human Services. (1998). Catalog of federal domestic assistance 93.558. Washing-
ton, DC.
White, J. (1998, March). Welfare cuts increase hunger and homelessness. News and analysis: North America, on the
Internet at http://www.wsws orglnews/1998/marI998/welf-m06.shtml.
Whiteman, V. L. (2001). Social Security: What every human services professional should know. Boston: Allyn and
Bacon.
Wilson, W. J. (1987). The truly disadvantaged: The inner city, the underclass, and public policy. Chicago: University
of Chicago Press.
Wilson, W. J. (1991). Studying inner-city social dislocations: The challenge of public agenda research. American
Sociological Review, 56, 1-14.
Wolff, E. (2000). Recent trends in wealth ownership, 1983-1998. Available on the Website of the Jerome Levy
Economics Institute at www.levy.org/wrkpap/papers/300.html.
Zedlewski, S. R. (1999). Work activity and obstacles to work among TANF recipients. Policy Brief No. B-2 Series.
New federalism: National Survey of American Families. Washington, DC: Urban Institute.
 PART V

IN CLOSING

Hopefully we have provided insight into "what clinical sociologists do" in the previous
sections of the book. Now we come to the final part of the book to address a frequent question
students ask: "How do I become a clinical sociologist?" There is no single pathway. While
there are a few baccalaureate programs in clinical sociology, there are even fewer graduate
programs. Funding policies and shortages in colleges and universities have reduced the
initially small number of programs. But, the majority of clinical sociologists did not obtain
graduate degrees in clinical sociology or sociological practice.
Many sociologists who call themselves "clinicians" or "practitioners" arrived at this
destination through a myriad of routes. These are illustrated by three clinical sociologists who
describe their personal and professional journeys that led them to become clinical sociologists.
Perhaps one of the most important influences in becoming a clinical sociologists is associating
with role models who are admired for what they do to create a more healthy society.

393
 CHAPTER 19

On Becoming a Clinical Sociologist

JOHN G. BRUHN

INTRODUCTION

Most clinical sociologists will tell you that they did not select clinical sociology as a career
goal during their professional education. This was partly due to the lack of curricula or degree
programs in clinical sociology and partly because there were few role models and advocates
for clinical sociology. Clinical sociology did not have visibility as a career choice. This
situation persists today. Most individuals became clinical sociologists by circuitous routes as
their careers evolved and when opportunities presented themselves. There have always been
sociologists who have been more concerned with the application of sociology to real problems
or with intervening to prevent or correct problems. However, they have identified themselves
only as "sociologists" rather than "clinical sociologists." It, indeed, is easier to maintain
collegiality if one does not state that one is different from the majority of one's colleagues.
However, times have changed and it is now fashionable to become a specialist or
subspecialist, to become an independent practitioner of one's discipline, or to form new
professional groups of colleagues who may come from different disciplines but share common
perspectives. Furthermore, career paths can change as opportunities present themselves and as
it becomes more common to mix teaching, research, and practice in nontraditional ways.
There is an enormous need for sociological expertise in preventing and treating current
societal problems. This call for action conflicts with the traditional sociologist's view as an
observer and commentator on social behavior and not as an active agent of intervention and
change. However, it is the author's belief that using sociology is the best way to ensure its
relevance as a subject to study as well as to ensure its longevity and vitality in college and
university curricula, and its attractiveness as a career.
The purposes of the present chapter are to (1) explore the different routes clinical
sociologists have taken to become so identified, (2) review what kinds of activities clinical
sociologists are engaged in, and (3) predict future opportunities in the field.

JOHN G. BRUHN • College of Health and Social Services, New Mexico State University, Las Cruces, New Mexico
88003.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

395
396 JOHN G. BRUHN

Definitions

The terms clinical sociology and sociological practice are used interchangeably in the
literature and here. Both terms imply an intervention or action mode for the sociologist. Glass
(1991) established the Clinical Sociology Association in 1978, and provided leadership in the
reemergence of the field from its beginning in the late nineteenth century (Fritz, 1991). Glass
(1991, 1999) stressed that sociology has a central and legitimate role in intervention and change
facilitation that necessitates the consideration of social systems. He advocated that by defining
sociology narrowly as an academic discipline we have short-sightedly given up by default the
opportunity to train and develop practitioners in social change and human services ...
sociology can be both an academic discipline and a practicing profession analogous to the
academic and clinical branches in psychology (Glass, 1991, 1999).
Freedman (1989) was concerned about the range of practice of clinical sociology and
explored the literature for definitions to help focus the field. He located 9 definitions with
several common themes. Clinical sociology:
1. Is practice-oriented
2. Focuses on case studies
3. Works with individuals, groups, organizations, and communities
4. Is diagnostic
5. Is change-oriented
6. Is humanistic
7. Tries to comprehend the societal factors that restrict the individual from being
effective
8. Can move beyond the client's formulation of the problem to consider other factors
that affect functioning, especially broad social trends
9. Uses insights derived from immersion in the critical sociological tradition; uses
sociological imagination
10. Leads to behavior change and growth
11. Tends to have a liberal/cynical or radical ideological cast
Kirshak (1998) sees sociological practice as a broad concept that includes applied
sociology and clinical sociology. He sees the two approaches as different but complementary.
Applied sociology, according to Kirshak, is based on a research model that uses a sociological
perspective and methods such as policy analysis, needs assessment, program evaluation, and
problem solving. The client of an applied sociologist is more likely to be an organization,
agency, or social program.
Clinical sociology, according to Kirshak, is usually focused around intervention at one or
more levels (individual, group, organization, community, or societal). The clinical sociologist
uses qualitative and/or quantitative research methods, or a combination of them, in an inter-
vention as part of an action plan (Kirshak, 1998). Basically, what clinical sociology and
sociological practice are about is what Straus (1985:9) calls "using theory to make sense out of
life." He pointed out that we bother about sociology because it offers a scientific alternative to
common sense. Sociology provides a way (or approach, or perspective) for understanding and
doing something about the ways things are (Straus, 1985).
The basic idea of linking the words clinical and sociology by Louis Wirth in 1931 was in
linking what sociologists do (observe, comment, "diagnose") with some action, intervention,
or treatment to achieve some objective or consequence. Similarly Saul Alinsky saw the
community as the unit for investigating crime and community organization as a way of
ON BECOMING A CLINICAL SOCIOLOGIST 397

preventing it. Throughout the nearly seven decades of its existence clinical sociology has
persisted primarily because, as Foote (1996:13) said, "sociological practice is not an exotic
specialty within academic sociology, but embraces the entire discipline."

PREPARATION FOR A CAREER

IN CLINICAL SOCIOLOGY

Clark (1989) noted that there were over 90 graduate programs in sociological practice in
1985 and a growing number of undergraduate ones. According to the recent Directory of
Programs in Applied Sociology and Practice of the American Sociological Association
(Vaughn & Krause, 1996) there were 6 colleges/universities offering degrees in clinical
sociology, 9 offering programs in sociological practice, and 92 applied sociology and social
research programs (see Table 19.1) in 1996. It is obvious that degree programs in clinical
sociology and sociological practice are not flourishing. There are many reasons for this
including downsizing in universities, the lack of knowledge among students about these areas
as career choices, and the insufficient promotion of clinical sociology and sociological practice
by the Sociological Practice Association and the American Sociological Association. How-
ever, as Kallen (1995) pointed out, while there is a decline in interest in sociology in general in
the public and in academia, there is interest in applied sociology, especially as social problems
are reaching epidemic proportions.
Glassner and Freedman (1979) listed the knowledge base necessary for clinical sociology.
It includes (1) a theoretical grounding in historical, systems, dramaturgical, conflict, and
interactional approaches with the ability to generate new or integrate existing theoretical
approaches; (2) a strong methodological grounding in the basic skills of observation, listening,

TABLE 19.1. Programs in Clinical Sociology and

Sociological Practice
Degree(s) offered

Clinical sociology
Boston College PhD, MA
George Mason University MA
Indiana University of Pennsylvania MA,BA
Ithaca College BA
University of Northern Colorado MA
Valdosta State College MS,BA
Sociological practice
Brigham Young University PhD, MA
California State University-Hayward MA,BA
City University of New York-Hunter College MS,BA
Humboldt State University MA,BA
North Dakota State Unviersity MA
Northern Michigan University BA
Northwestern University PhD, MA
Southwest Texas State University BS
West Texas State University MA

Source: J. C. Vaughan & J. Krause (Eds.), Directory of programs in applied

sociology and practice (2nd ed.). American Sociological Association, 17222 N
Street, NW, Washington, DC 20036, 1996.
398 JOHN G. BRUHN

questioning, reporting, and critical thinking, and how these are used in participant observation,
survey research, interviewing, evaluation, and documentary analysis; (3) a clinical sociologist
should also be a student of social change, its theories and processes, in individuals, groups,
organizations, communities and societies. In other words, a clinical sociologist must first be a
well-educated, doctorally prepared, competent sociologist or have obtained the necessary
areas of sociological knowledge while studying for a degree in a closely related field such as
social work or community or social psychology.
Freedman (1989) stated that anyone can claim to be a clinical sociologist without any
challenge to that designation. Therefore, the Clinical Sociology Association has established a
procedure for certification as a clinical sociologist (Clark, 1990) (see Appendix). The Associa-
tion changed its name to The Sociological Practice Association: A Professional Organization
of Clinical and Applied Sociologists in 1986 to broaden its base of membership.
The most exciting aspect of becoming a clinical sociologist is that one can link sociologi-
cal knowledge with different types of practice applications. For example, a person could be-
come a teacher of sociology and have a clinical practice as a therapist, consultant, or mediator,
or a person could serve full time in any of these roles. It is also possible to be an administrator
or researcher and also practice sociology. Indeed, being a practitioner (an interventionist!
change agent) is embedded in many administrative positions, for example as a boundary
manager (Bruhn & Chesney, 1995) or in implementing a merger (Bruhn, 1998). It is more
common for clinical sociologists to blend two or more roles as they practice clinical sociology
today. This may be partly for economic reasons and partly because their interests are equally
strong in several areas and they prefer not to make a choice. Below we examine some of the
possible career possibilities and blending of roles.

CAREER COMBINATIONS

Practitioner-Researcher

Clinical sociologists may engage in independent practice or join a group practice as a

therapist or counselor and this may be the basis for their income. Time permitting, a practi-
tioner may develop a research interest in a particular category of problem and systematically
study clients with that problem. Research interests may extend to problems or clients who may
be unusual or cases where a new approach was used to intervene that warrants being written up
and submitted for publication and/or for discussion with colleagues at a professional meeting.
Not all research is formally designated as such and all research need not be published in a peer-
reviewed journal to be useful (Stringer, 1996).
Practitioners with research interests usually keep abreast of the literature in their field and
attend conferences and workshops to maintain their knowledge and skills as well as their
licensure or certification. As such, research is a natural partner of clinical practice. But many
practitioners have difficulty finding time to write or to plan a research project. Therefore, many
practitioner-researchers team up with a colleague, or join a new or ongoing research project
at a college or university in their locale, or provide leadership in initiating a research project
with an agency. Graduate students and community volunteers are often resources available to
assist with data collection and analysis.
The practitioner-researcher has the practical knowledge and clinical insights that are
important in formulating hypotheses and testing assumptions that exist in theory. The unique
blend of the practitioner-researcher roles also enables practitioners to stay on top of their field
and incorporate new ideas and techniques into practice. All practitioners are in some way
ON BECOMING A CLINICAL SOCIOLOGIST 399

researchers-they learn what works best for them and their clients. Not all researchers are
practitioners and are often naive about what might work or not work in practice. Therefore,
practitioners who also have a strong interest in research can contribute to their own practice
and to the profession as well (Jarvis, 1999).

Practitioner-Teacher

In a reflective article about his 35-year career as a full-time academic and practitioner,
Shostak (1996) discussed how being both a practitioner and a teacher enabled him to test and
tweak reality. A practitioner works in the real world; the world of academia is often considered
too theoretical and removed from the real world. The roles of practitioner and teacher have
much in common: they intervene in lives to provide information and facilitate learning.
Practitioner-teachers use information from their practice in the classroom; classroom inter-
action, in tum, can lead to their own personal growth and perhaps lead to new ventures in
practice. Weber (1994) showed how the theoretical insights (symbolic interactionism) of
George Herbert Mead were integrated into a therapy session with an agoraphobic patient.
Thoresen and Miller (1990) described how legal briefs can be used effectively to teach students
the process of legal analysis and to think analytically about sociological issues. Practitioners
usually find it useful to obtain a part-time affiliation with a college, university, or community
college to teach a course or two. This enables the practitioner to maintain a link with academic
colleagues, to keep current in the discipline, and to help supplement a sometimes fluctuating
practitioner's income. On the other hand, universities have utilized full-time faculty in
sociology and psychology to teach useful skills in community meditation centers (Miller,
1985).

Practitioner-Consultant

There are numerous ways practitioners can also serve as a consultant in their areas of
expertise. Thoresen (1993) pointed out that sociological practitioners can be "experts" as
consultants to attorneys in the preparation of cases for trial, as adjuncts to the judiciary in
serving as clinicians or investigators for the courts, or as expert witnesses (Gordon, 1986).
Shahidullah (1998) called attention to the clinical sociologist's role in policy and analysis,
stressing that the choice of problems for applying sociology should be proactive and include
such areas as child care, quality of life issues, domestic violence, teen pregnancy, single
parenting, and cyberpornography.
Forsyth (1995) detailed his experience as a mitigation expert team member in first-degree
murder cases. Morton (1998) described her role as a consultant to government and private
sector organizations to assemble and analyze research reports and provide policy recommen-
dations to nontechnical decision makers. Weber (1991) wrote that health promotion program-
ming is a field in which sociological practitioners can utilize their research and/or consultant
skills to help design and structure change. Clark et ai. (1990) outlined a host of opportunities
for sociological practitioners ranging from planning intervention programs for cancer patients,
to effective education on safer sex practices, to teaching the sociology of dying and death
(Clark et aI., 1990). These opportunities could be as a consultant and/or teacher and/or
researcher. Finally, Kirshak (1985) reported that practitioners can use their consulting skills to
help organizations in trouble. Friedman and Friedman (1993) discussed opportunities in
diversity management.
400 JOHN G. BRUHN

Practitioner-Researcher-Teacher-Consultant

A few practitioners are engaged in all four of these major roles, although one role may
predominate. This is not to say that clinical sociologists are all things to all people, but rather
that the practitioner role opens up opportunities for consulting and research, in particular.
Schon (1983:325) expressed the opinion that "the roles of practitioner and researcher will have
permeable boundaries, and research and practice careers will intertwine as a matter of course."
An affiliation with a college or university as a part-time teacher gives some status to the
clinical sociologist's reputation in the community, which, in tum, may lead to client referrals.

Career Paths Change

Career paths can change just as individual practitioner's lives change. Glass (1999)
quotes Maslow, who said ''I'm someone who likes plowing new ground then walking away
from it. I get bored. I like discovery, not proving." There are more opportunities for clinical
sociological intervention, advice, and research than there are clinical sociologists to do these
things. So new opportunities abound. Boredom, new funding opportunities, new colleagues,
and a host of factors can change one's career path. What is important is that clinical sociolo-
gists not become opportunists but maintain a link with the national association to help to build
a strong, coordinated national network where needs, opportunities, and results can be shared
and disseminated to colleagues in sociology and allied fields about the work of clinical
sociologists.

WHAT CLINICAL SOCIOLOGISTS DO

A summary of the primary specialty areas of current members of the Sociological

Practice Association who specified an area of expertise on their membership application is
shown in Table 19.2. First, of particular note is the wide range of specialty interests that
characterize sociology in general. Second, almost one-half of the members have expertise in
some form of intervention such as therapy or counseling, or are directly or indirectly involved
with research, or are working with small groups, or studying social deviance, or race and
ethnic relations. Again, these are core areas of sociological knowledge. Many members have
obtained additional credentialing as counselors and therapists. Several have degrees in social
work or related disciplines in addition to a Ph.D. degree in sociology. Another indication of
what clinical sociologists do, or are interested in, is the topics they write about. A review of 130
articles in the 16 annual issues of the Clinical Sociology Review, 2 issues of Sociological
Practice, and the first issue of the new Journal ofSociological Practice: A Journal of Clinical
and Applied Sociology ascertained the most prevalent topics that clinical sociologists have
written about from 1983 to 1999. Table 19.3 summarizes these findings. Generally most articles
could be placed in one of six categories, with some articles related to more than one category.
Table 19.3 lists representative articles for each of the six categories. In this rather crude theme
analysis several things stick out. The majority of articles written by contributors (clinical
sociologists and others) over the past 16 or so years focus heavily on theories, concepts and
models, and techniques and methods in clinical sociology. Comparatively there are fewer
"research" or data-based articles, very few on ethical issues, and only one or two on social
policy matters. It is to be expected that there would be articles on clinical sociology as a
profession and evolving roles for clinical sociologists as well as documenting clinical soci-
ON BECOMING A CLINICAL SOCIOLOGIST 401

TABLE 19.2. Primary Specialty Areas Indicated by Members of the Sociological

Practice Associationa
Specialty area Frequency listed

Psychotherapy, counseling, biofeedback, grief, conflict management 14

Social research, research methods II
Clinical sociology, intervention 11
HIV, drug, alcohol abuse treatment, prevention 10
Social psychology, small groups 10
Pluralism, race, and ethnic relations 9
Criminology, social deviance 9
Mental health 8
Medical sociology 7
Social, psychological, cultural aspects of health and illness 7
Sociology of work 7
Sociology of education 7
Sociology of the family, abuse, violence, adoption 7
Organizational development, complex organizations, community development 5
Sex, gender, and ethnic issues 4
Gerontology 2
Religion 2
Rehabilitation, adaptive functioning 2
Legal aspects, law 2
Voluntary socialization, resocialization 2
Terrorism 1
Urban youth, homelessness 1
Distance learning I
Social change 1
Social policy 1
Futuristics 1
History of sociology 1

'Not all members of the Association listed their specialties.

ology's early history and key advocates along its development. It also appears that the majority
of scholarly contributions are focused on the individual or dyadic level. Relatively speaking
there are few contributions dealing with organizational and societal issues, especially with the
effects of powerful forces of mergers, downsizing, early retirements, the use of technology in
the work force, and displaced workers. There are no articles related to how sociologists can
help affect social and public policy, or debates on current issues of violence, human abuse,
terrorism, homelessness, healthcare, and the impact of technology on privacy.
What sociologists do and what they write about coincide as one might expect. What this
exercise points out are the gaps in what clinical sociologists, indeed sociologists, should and
could be doing, regarding the current state of society. Maybe this is why sociology appears to
have lost its importance and relevance in and outside of academia (Snow, 1999). There are
enormous challenges and opportunities for a new generation of clinical sociologists.

WHAT SOCIOLOGISTS DO: A NATIONAL SURVEY

Results from a national survey conducted by the National Science Foundation in 1995 of
doctoral recipients show that sociologists' self-perceptions are inconsistent with the reality of
their professional activities (Dotzler & Koppel, 1999). Less than half of all sociologists
402
TABLE 19.3. Topics of Articles by Category Written by Clinical Sociologists from 1983 to 1999
Clinical sociology as a profession: characteristics of
sociological practitioners
Sociological practice's midlife crisis
Tomorrow's most challenging practice issues
NSF survey on what sociologists do
Roles for sociologists in policy analysis
The sociologist as expert witness
On reconstructing trust
Humanizing sociological thought and practice
Clinical sociology in France and Quebec
Clinical sociologists as health brokers
Sociologists as sex educators
Sociologists as mediators
Sociologists and processing conflicts
Sociology as advocacy
Clinical sociologist as a boundary manager
Clinical sociology in service learning
History of clinical sociology definitions, theory of
clinical sociology
Lifetimes in humanist sociology
Clinical sociology and religion
Sociolegal definitions of the family
The emergence of U.S. clinical sociology
Saul Alinsky: A pioneer clinical sociologist
The clinical sociology of Jessie Taft
Charles Gommillio, educator
Defining clinical sociology
History of applied social science
Techniques and methods of clinical sociology
Interviewer attitudes about the mentally ill
Field researcher as therapist
Deep learning groups
Mechanisms to avoid sexual harassment in the
workplace
A technique for predicting interorganizational action
Legal cases as a teaching tool
Perspectives on video self-confrontation
A case study of a nonprofit organization serving
Latino clients
The sociological technique in criminology
The clinical sociologist as family therapist: the
strategic communicatoin approach
Successful facilitation of a children's support group
Verstehen methodology as a source of data
Grounded encounter therapy
Participatory research
Problem-solving sociology
JOHN G. BRUHN
Theories, concepts, and models of sociological
problems/issues
A model of suicide
Symbolic interactionist framework for sociological
practice
Biophysical role therapy
Understanding paranoia
Using sociology to end chemical dependency
Sudden Infant Death Syndrome and stress buffer
model of social support
Combining sociology and epidemiology
A model for coping with the stigma of obesity
New models of service delivery to aged victims
Dysfunctional role maintenance
W. E. B. DuBois
A sociology of emotions
The social reconstruction of emotions
Clinical sociology and the individual client
Six problem-solving contexts for intervention
decision making
Sociotherapy with married couples
Unforeseen perils in intensive interviewing
Research/data on problems
Latino immigrants and paid domestic work
Predicting work motivation among vocational rehab
clients
Diversity management
Intervention among children of substance abusers
and schoool success
Comparing psychological impact of battering,
marital rape, and stranger rape
New drug trends
Sociological isuses in mergers
A study of workers in self-managed teams
An alcoholism program for Hispanics
Workplace dispute resolution
Consumer complaints and public policy
Research and policy implications
Clinical approach to successful program
development
The use of social system theory in marriage
counseling
An intervention model for homeless youth
Resocialization
Haberrnas's theory as a basis for clinical practice
with small groups
A conflict resolution model
Triadic analysis: a conceptual tool
Ethical issues, standards of the profession
Roles and ethics of the practicing criminologist
Ethical limitations on sociological counseling
Ethical standards of sociological practitioners
ON BECOMING A CLINICAL SOCIOLOGIST 403

(45.8%) teach sociology. The majority of sociologists spend their time managing and adminis-
trating, conducting applied or basic research, training in areas other than sociology, and
engaging in tasks that are divergent from the traditional image of teaching.
Most sociologists work in educational settings such as four-year colleges. Of the sociolo-
gists working in noneducational settings, half work in private for-profit or private not-for-
profit institutions, 30% work for various levels of government, and 20% are self-employed
(Dotzler & Koppel, 1999). Dotzler and Koppel stated, p. 82, "we find there are a lot of
sociologists out in society practicing sociology." The authors argue that the practice side of
sociology needs to be cultivated and understood by all sociologists. Academe and practice will
both benefit if sociologists are equipped technically and intellectually for work in practice
(Dotzler & Koppel, 1999). Academe will benefit if practitioners can bring the real world of
practice into the classroom and practitioners will benefit if they team up with academicians to
evaluate their interventions.

BECOMING A CLINICAL SOCIOLOGIST

The process of becoming a clinical sociologist is a personal journey that is best illustrated
by vignettes from some of the early leaders in the field who continue to promote the field by
their active involvement nationally and locally in their practices. I asked three clinical
sociologists to write brief synopses on "How I Became a Clinical Sociologist." These are
shown as Exhibits A, B, and C. Drs. Brabant, Glass, and Cuthbertson Johnson share parts of
their life stories to show how career choices and turns in careers are influenced by events and
experiences in their lives. Despite their uniqueness as individuals, all three share several
attributes: (1) they saw gaps and needs in sociology that they thought could be filled by putting
sociological knowledge into practice-they were visionaries and thought about new oppor-
tunities for sociology; (2) personal experiences led them to identify with and seek out others
with similar needs and experiences-in this sense they were collaborators and network
builders; (3) they were outspoken in their beliefs, and although they may have been "on the
fringes" in sociology in terms of some of their thinking, they persisted in forging new paths for
themselves; and (4) they are energetic persons involved in many activities-they each have
been successful because they made things happen for themselves and others; indeed, they went
beyond theories and facts to plans for action. There are many other clinical sociologists like
Drs. Brabant, Glass, and Cuthbertson Johnson who could share similar stories.
It is not uncommon for a sociologist to say "what I have been doing for a long time is
clinical sociology, but I didn't call it that" or they have been applied or practicing sociologists
and kept their views and activities low key because they knew they would not be accepted by
mainstream sociologists. So the process of becoming a clinical sociologist has been largely
personal and individualistic. It is only in the last two decades that more sociologists are
beginning to come out of the closet and advocate practicing the field and attempting to
formalize courses and degree offerings in the area.

THE FUTURE: CAREER OPPORTUNITIES

AND PRACTICE CHALLENGES

Ruggerio and Weston (1994) reported the results of a practitioner survey in which mem-
bers of two practitioner groups (the Sociological Practice Association and the Sociological
404 JOHN G. BRUHN

Practice Section of the American Sociological Association) were asked to identify the three
most important issues facing sociology at the time of the survey (1988) and five years into the
future (1993). The authors then compared practitioners' responses to the content of articles
published from 1988 to 1992 in the American Sociological Association's publication provided
to all members, Footnotes.
The three issues of greatest concern to both practitioner groups were specific social issues
or problems at the macro- and microlevel (29%), issues pertinent to the discipline (20.5%), and
career and professional concerns (19.5%). These responses were compared with the themes
from 126 articles from 44 issues of Footnotes. The majority of articles (73%) reflected the
major concerns practitioners thought confronted the discipline: disciplinary concerns and
career or professional concerns. Interestingly, only 4% of the articles dealt with societal issues
or problems. These findings are similar to the review of 16 annual issues of the Clinical
Sociology Review reported earlier.
Ruggerio and Weston (1994) concluded that the vitality and future directions of sociology
and sociological practice will involve its coming to terms with issues both as a discipline and
of a societal nature. They suggested that Footnotes and other mainstream journals in sociology
increase the number of practice-relevant articles. And they suggested that increased practi-
tioner involvement in the American Sociological Association and its meetings would help to
reduce the perception that practitioners are both marginal and a minority in the profession.
These findings continue to be relevant six years later as the vitality and relevance of the
discipline of sociology are being questioned within academia and by the public.
Practitioners and applied sociologists have always struggled to find their niche and some
degree of acceptance from colleagues. Maybe this and the fact that the number of practitioners
has never been large (compared with some specialty or interest groups in the American Socio-
logical Association) has led to an extended midlife crisis in sociological practice (Robinette,
1992). There needs to be greater reaching out to "tell the practitioner story," of recruiting new
members to practitioner workshops and meetings, and practitioners need to share their clinical
experiences, research results, and success and failures with others. Being introspective is a part
of growing up and forming a strong self-image, but navel contemplation will not help
sociological practice grow. The field will continue to experience periodic reemergences until it
reaches greater maturity and acceptance. Sociological practice need not be discovered acci-
dentally or surreptitiously. Becoming a sociological practitioner is a choice to make sociologi-
cal theory real by testing and revising it, discovering new facts, trying out, revising, and
finding new ways to "do" sociology, and being a concerned and involved citizen and
professional with respect to social policy and global issues. If the majority of sociologists are
outside of academia, their work is unknown and unappreciated by the many academicians and
the general public who perceive them to be ensconced in universities removed from contempo-
rary social issues and problems.

CREATING THE FUTURE

A futurist, Shostak (1999), outlined tomorrow's most challenging practice issues in

sociology. First, he noted that the Commission on Applied and Clinical Sociology, formed by
the Sociological Practice Association and the Society for Applied Sociology, has recently
developed criteria for the accreditation of B.A. programs in sociological practice and is
currently piloting the accreditation process. When the B.A. accreditation is operational, the
Commission will move toward the accreditation of M.A. and Ph.D. programs. Accreditation
ON BECOMING A CLINICAL SOCIOLOGIST 405

will not only give legitimacy to sociological practice inside and outside of sociology, but it will
structure what now seems to be haphazard and accidental career paths to sociological practice.
Shostak noted that cyberspace will have a large impact on sociological practice in the future.
New kinds of groups and organizations composed of members who may never meet each
other, will cross all kinds of boundaries throughout the world. Decision making in organiza-
tions will become more technological and less interpersonal. Ethical questions and issues
about access to information, its use and dissemination will increase. Universities and work-
places will become more decentralized as faculty, employees, and students work at a variety of
sites, communicate via technology to their home base, and turn in computer disks rather than
hard copies of their products. The large, complex organization as we know it will become more
complex as organizations merge, becoming larger and more international in terms of location
and work force composition. This will create challenges in managing new types of workplace
diversity and conflict.
Perhaps most exciting about sociological practice is that the Association and the individ-
ual practitioner can create their own futures. There is no shortage of problems or issues to
tackle. Two aspects are key to the future of sociological practice: thinking must be proactive
rather than reactive. We will become what we spend the most time thinking about. In being
proactive sociological practitioners need to learn the theories and techniques of prevention-
what works and what does not work. The second aspect important to the future of sociological
practice is that practitioners become leaders in helping individuals, groups, and organizations
negotiate change. While change is with us for the long haul, all of the components of society
seem to handle change badly. We know change happens as we help create it, yet we usually do
not plan for it, or anticipate its possible outcomes and consequences, so we do little to direct
change. We seem to say "change happens," and then we deal with the human relations fallout.
Clinical sociologists can take the lead and playa significant role in applying their knowledge
and skills to assist in helping to make change a positive experience.

CODA

We have identified academic programs that offer degree programs in clinical practice and
sociological practice to help prospective practitioners. One of the other sources of information
useful in becoming a clinical sociologist is reading autobiographies written by clinical
sociologists or accounts of their career transitions (Deegan, 1986; Freedman, 1997; Glass,
1999; Lee, 1984; Lee & Lee, 1991). Another source is the history of clinical sociology and early
pioneers in the field (Fritz, 1991, 1989).
It is also useful for prospective practitioners to read Schon (1987) to understand the
challenges to teaching practice in universities and to gain insight into current views of
sociologists about practice and its place in sociology (Turner, 1998). Even though from its
beginning sociology was an interventionist discipline, toady's sociologists have to defend their
craft against criticisms of rigor and "fit" (Boros, 1989). To be workable and relevant sociology
has to be used-it has to work. Practicing sociology makes it useful.

SUMMARY

This chapter explored the routes to becoming a clinical sociologist or sociological

practitioner. Most practitioners did not begin their career intending to do what they do now. It
406 JOHN G. BRUHN

has only been in the last decade or so that academic programs in clinical sociology, sociologi-
cal practice, and applied sociology have grown and become more accessible. Most practi-
tioners have used their education in sociological theory and methods in solving, intervening,
or preventing a variety of individual, group, organizational, and community problems. Socio-
logical practice or clinical sociology presents an exciting array of opportunities in teaching,
research, and/or consulting. It is important for practitioners to become certified and members
of the Sociological Practice Association to help shape the future of the field and open greater
opportunities to "do" sociology.

REFERENCES

Boros, A. (1989). A workable sociology. Clinical Sociology Review, 7, 62-64.

Bruhn, J. G. (1998). Mixing apples and oranges: Sociological issues in the process of an academic merger. Clinical
Sociology Review, 6, 1-21.
Bruhn, J. G., & Chesney, A. P. (1995). The clinical sociologist as a boundary manager: The case of university
administration. Clinical Sociology Review, 13, 38-56.
Clark, E. J. (1989). The clinical approach to successful program development. Clinical Sociology Review, 7,194-202.
Clark, E. J. (1990). The development of contemporary clinical sociology. Clinical Sociology Review, 8, 100-115.
Clark, E. J., Fritz, J. M., & Rieker, P. P. (Eds.). (1990). Clinical sociological perspectives on illness & loss: The linkage
of theory and practice. Philadelphia: Charles Press.
Deegan, M. (1986). The clinical sociology of Jessie Taft. Clinical Sociology Review, 4, 30-45.
Dotzler, R. J., & Koppel, R. (1999). What sociologists do and where they do it-the NSF survey on sociologist's work
activities and workplaces. Sociological Practice: A Journal of Clinical and Applied Sociology, 1(1), 71-83.
Foote, N. N. (1996). Frontiers in sociological practice. Clinical Sociology Review, 14, 1-13.
Forsyth, C. J. (1995). The sociologist as mitigation expert in first degree murder cases. Clinical Sociology Review, 13,
134-144.
Freedman, J. (1989). Defining clinical sociology. Sociological Practice, 7, 53-56.
Freedman, J. (1997). Flirtation with autobiography. Clinical Sociology Review, 15, 183-209.
Friedman, N. L., & Friedman, S. S. (1993). Diversity management: An emerging employment/consulting opportunity
of sociological practitioners. Clinical Sociology Review, n, 192-199.
Fritz, J. M. (1989). The history of clinical sociology. Clinical Sociology Review, 7, 72-95.
Fritz, J. M. (1991). The emergence of American clinical sociology. In H. M. Rebach & J. G. Bruhn (Eds.), Handbook of
clinical sociology (pp. 17-30). New York: Plenum Press.
Glass, J. F. (1991). Forward. In H. M. Rebach & J. G. Bruhn (Eds.), Handbook of clinical sociology (pp. ix-xi). New
York: Plenum Press.
Glass,1. F. (1999). The founding of the Clinical Sociology Association: A personal narrative. Sociological Practice: A
Journal of Clinical and Applied Sociology, 3(1). 75-86.
Glassner, B., & Freeman, J. (1979). Clinical sociology. New York: Longman.
Gordon, L. (1986). The sociological expert witness in a case of collective interracial violence. Clinical Sociology
Review, 4, 107-122.
Jarvis, P. (1999). The practitioner-researcher: Developing theory from practice. San Francisco: Jossey-Bass.
Kallen, D. J. (1995). Some history of clinical sociology and sociological practice, part 1. Clinical Sociology Review,
13, 1-23.
Kirshak, R. (1985). Developing organization consulting skills in clinical sociology. Clinical Sociology Review, 3,
150-157.
Kirshak, R. (Ed.). (1998). Sociological practice: Its meaning and value. International Journal ofSociology and Social
Policy, 18(1), 1-6.
Lee, A. M. (1984). Overcoming barriers to clinical sociology. Clinical Sociology Review, 2, 42-50.
Lee, B. E., & Lee, A. M. (1991). Lifetimes in humanist sociology. Clinical Sociology Review, 9, 27-36.
Miller, J. S. (1985). Sociologists as mediators: Clinical sociology in action. Clinical Sociology Review, 3,158-164.
Morton, M. A. (1998). From research to policy: Roles for sociologists. Clinical Sociology Review, 16, 93-96.
Robinette, P. D. (1992). Sociological practice's mid-life crises. Clinical Sociology Review, 10, 21-36.
Ruggerio, J. A., & Weston, L. C. (1994). Results of a practitioner survey and comparison with the themes of articles
published in the ASA Footnotes: Major issues facing the discipline of sociology. Clinical Sociology Review, 12,
17-28.
ON BECOMING A CLINICAL SOCIOLOGIST 407

Schon, D. A. (1983). The reflective practitioner. New York: Basic Books.

Schon, D. A. (1987). Educating the reflective practitioner. San Francisco: Jossey-Bass.
Shahidullah, S. M. (1998). Useful sociology: Can sociological knowledge be useful in policy-making? International
Journal of Sociology and Social Policy, 18(1), 86-112.
Shostak, A. B. (1996). On backtracking my path to applied sociology: An exercise in lesson-seeking autobiography.
Clinical Sociology Review, 14, 167-189.
Shostak, A. B. (1999). Tomorrow's most challenging practice issues: 21st century surprises. Sociological Practice: A
Journal of Clinical and Applied Sociology, 1(1), 3-17.
Snow, D. A. (1999). 1998 PSA Presidential Address: The value of sociology. Sociological Perspectives, 42(1), 1-22.
Straus, R. A. (1985). Using sociology: An introduction from the clinical perspective. New York: General Hall.
Stringer, E. T. (1996). Action research: A handbook for practitioners. Thousand Oaks, CA: Sage.
Thoresen, J. H. (1993). The sociologist as expert witness. Clinical Sociology Review, 11, 109-122.
Thoresen, J. H., & Miller, 1. L. (1990). Legal cases as a teaching tool. Clinical Sociology Review, 8, 158-163.
Turner, J. H. (1998). Must sociological theory and sociological practice be so far apart? A polemical answer.
Sociological Perspectives, 41(2), 243-258.
Vaughn, J. C., & Krause, J. (1996). Directory ofprograms in applied sociology and practice (2nd ed.), Washington,
DC: American Sociological Association.
Weber, L. (1991). The sociological practitioner in organizational health promotion programming. Clinical Sociology
Review, 9, 106-124.
Weber, L. (1994). On the development of reflexive thinking: A practice note. Clinical Sociology Review,l2, 276-280.

APPENDIX: CERTIFICATION

The Sociological Practice Association's Certified Clinical Sociologist Program (C.C.S.) provides an important
credentialfor practicing sociologists. The Sociological Practice Association is an established organization which has
offered certification since 1984.
In a society that needs to better utilize sociological insights, given its range of problems, exclusion of practicing
sociologists because their credentials do not fit licensure or job specifications wastes talent. Sociological knowledge,
when harnessed to intervention and assessment strategies, can lead to innovative problem-solving. The Sociological
Practice Association's Certified Clinical Sociologist Program, or C.C.S., provides an important credential for
many practicing sociologists. For some it has opened doors, for others it has turned barriers into frontiers.
Many sociological practitioners work in interdisciplinary settings, such as health care, business, and private
sociotherapy, where legitimacy can become an issue. Issues concerning legitimacy are quite evident in many settings,
and the special contributions of sociologists can be downgraded as each field fights to define its turf. Certification is a
tool for tomorrow that will help sociologists to claim their right to practice. Why would disciplines such as social
work, psychology, and marriage counseling claim the exclusive right to practice in areas in which sociologists are
equally or more competent?
Under such conditions, Certification as a Clinical Sociologist can make a difference. It indicates that a
professional peer group has determined that a person's knowledge, attitudes, and skills meet the standards of
practitioners of Clinical Sociology. The standards are important in legitimating professional work. Certification
reassures consumers that practitioners meet specified criteria set by a professional association in a specialty area. For
sociologists, it indicates a progression beyond the usual course-based academic training. Certification attests that
sociological practitioners have the knowledge, skills, and experience to use sociological theory, findings, and methods
in real world settings.
Members urged the Sociological Practice Association (SPA) to develop a credential that would indicate to
peers, colleagues, and clients that they are competent to provide various sociological-based services. Since this was
ground breaking work, the SPA certification process had to be quite comprehensive. The SPA certification process
requires a public demonstration of an aspect of the candidate's sociological practice. A candidate's credentials are
reviewed and they must delineate their theoretical, practice, and ethical orientation. Recommendations are required
from persons who know the quality of the candidate's clinical work.
The certification process is practice-based, emphasizing the candidate's ability to use sociology. The Sociologi-
cal Practice Association strongly believes that certification must be based on a judged demonstration of competency,
not by passing a multiple choice or written test. For many, it is one of those rare times-a learning experience-in a
professional career when background, philosophy, clinical practice, and presentation skills are assessed by a group of
attentive peers. Certification is not automatic. Some candidates do not pass on their first attempt. If requested, an
experienced mentor can work with candidates who have difficulty.
408 JOHN G. BRUHN

The Sociological Practice Association, established in 1978 as the Clinical Sociology Association, began
credentialing Ph.D. sociologists as Certified Clinical Sociologists in 1984. Master's level sociologists were
offered credentialing several years later.

SOCIOLOGICAL PRACTICE ASSOCIATION

Requirements for Doctoral Certification

I. Be a member in good standing of the Sociological Practice Association (SPA).

2. Have completed a doctorate in sociology or closely related field from an accredited school.
3. During the past five years, have completed 1,500 hours OR I year full-time of clinical work. Hours need not be
supervised by a sociologist, however a sociological focus must be maintained. Both paid and unpaid supervised
experiences are acceptable.
4. Submit a portfolio that demonstrates competence in clinical sociology consisting of
a) A detailed resume that includes information about all relevant work experience.
b) Three letters of recommendation from supervisors, co-interventionists, reviewers of the applicant's intervention
work, or recipients of the applicant's intervention services as appropriate. These letters must evaluate the
candidate's expertise as a practitioner.
c) Other evidence that the applicant feels is relevant. Applicants are encouraged to include documentation that
shows the completion of non-degree training in the area of specialization.
d) A $50.00 non-refundable processing fee.
5. Demonstrated commitment to lifelong education through 12 non-degree contact hours in a related discipline.
Detailed information must be provided.
6. Complete at least one SPA Training Workshop or Training Conference for which continuing education credit has
been granted by SPA.
7. In addition to your resume, an application must be completed in detail. This form consists of the following sections:
Section I. General Information
Section 2. Educational Background
Section 3. Area of Specialization
Section 4. Description of Clinical Work
Section 5. Statements About Competency
Section 6. Additional Documentation
Section 7. List of Assessors
Section 8. Affirmation of Accuracy
Section 9. Return of Cards
8. Successfully complete a Certification Demonstration. This presentation must be made within 3 years after
application has been approved by the Certification Committee.
9. Application due date is December I for June demonstration.
EXCEPTIONS: Exceptions to these requirements will be considered by the Certification Committee on an individual
basis.
FEE SUMMARY: a) To receive application: $10
b) Upon application: Processing fee of $50
c) Upon approval of Application: Demonstration fee of $75
In order to become certified, a sociologist must have at least 1,500 hours of supervised experience as a
practicing sociologist. Applicants must be members of the Sociological Practice Association. The applicant
develops a portfolio that includes transcripts, a detailed listing of past clinical work, letters of recommendation,
an agreement to abide by the Code of Ethics of the SPA, and a written statement to indicate how his or her
practice is sociological.
When complete, the application is reviewed by three already certified reviewers appointed by the Certi-
fication Committee of the SPA. If the portfolio is approved, the applicant must then present a one-hour
discussion or demonstration of an aspect of their practice at a meeting in which members of the Certification
Committee and other practicing sociologists are present. The audience is then given an opportunity to ask
questions of the applicant. Following the public session, the applicant meets with members of the Certification
Committee for further discussion and review of his or her presentation and credentials. In recent years, the
certification demonstrations have been given primarily at meetings of the SPA, although when the volume of
applications so indicates, the demonstration may take place at the SPA's mid year board meeting, or at a meeting of a
regional sociological association, or of the ASA.
ON BECOMING A CLINICAL SOCIOLOGIST 409

Being a Certified Clinical Sociologist (C.C.S.) adds value to the work of many practicing sociologists. For
example. one C.C.S. who teaches in a medical school finds the clinical credential provides a measure of legitimacy
which is not provided by the Ph.D. Another C.C.S. finds that it opens doors to lucrative business consulting. A third
finds it is valuable in work in a private mental health agency. A fourth finds that the C.C.S. credential is desirable for
work as an expert witness in court. A fifth finds it a very useful credential in doing the work of a mediator. A sixth finds
the C.C.S. experience helpful in becoming more effective in administrative settings.

Certification and Licensure:

Many sociologists have asked about the difference between certification and licensure. Certification is an
organizational credential that, while respected, is not officially recognized by State governments. Certification
is generally provided by national organizations. In contrast, Licensure is provided by State governments under
laws passed by the various state legislatures. At this point in time there are not enough practicing sociologists in any
state to persuade their legislators to provide a license for the practice of sociology. Some state laws will permit a
registry (a step toward licensure) to exist which lists people who offer a particular service. However, there is usually a
requirement such as 200 or more people offering the same service.
The American Sociological Association has taken the lead in this area, with their licensure survey project which
monitors every state and reviews what is happening in the legislatures. In a number of states SPA members have
actively defended the rights of sociologists to practice. If licensure is to ever come about, it will take a majority of
sociologists in any given state to achieve the political power to bring it about. In the meantime, certification by the
SPA may be the best way that practicing sociologists have of presenting their credentials to the public. Every
sociologist engaged in professional practice may not need to be certified. Many practice arenas do not require such
credentialing. Neither licensure nor certification is a guarantee of competence or ethical behavior. For sociologists,
certification can be a benchmark in the continuation of their professional development.

The Importance of Certification:

Sociologists are increasingly moving into practice positions where they interact with the public, provide services
to clients, and determine policy. Both the protection of the public and the legitimation of practice require that an
impartial group attest to the competence of practicing professionals. Certification by the Sociological Practice
Association accomplishes this. The SPA feels that it is an important protection to the public that Certification be done
by an established sociological association with a long history of involvement in practice. The Sociological Practice
Association was organized nearly twenty years ago. Its primary journal, The Clinical Sociology Review, now called
Sociological Practice: A Journal of Clinical and Applied Sociology, first appeared in 1982 and has become a
standard reference in the field. The annual meeting of the association provides practitioners an opportunity to meet
with each other, learn new skills and examine new applications of theory for practice.

Persons to Contact:
There is a $10.00 charge of the actual certification application forms, which is credited to the application fee when
the formal process is initiated. For application forms and additional information about the certification practice,
contact:
Ann Marie Ellis, Ph.D., C.C.S.
Chair, SPA Certification Committee
313 FH, Southwest Texas State University
San Marcos, Texas 78666-4616
e-mail: AE02@swt.edu
 EXHIBIT A

Discovering Clinical Sociology

JOHN F. GLASS

The 1976 roundtable, entitled "Clinical Sociology: A New Profession?" which I organized at
the American Sociological Association meetings, and which led to the founding of the Clinical
Sociology Association (CSA) two years later, was the direct culmination of my interest in and
involvement with humanistic psychology and sociology, educational innovation, and applied
behavioral science. This followed four years of being the only sociologist on the faculty of
the California School of Professional Psychology in Los Angeles. While coordinating a series
of courses under the rubric of "Culture and Society" and teaching psychology graduate
students how to do community and organizational consulting, I thought about the absurdity
that we were not training sociologists to do the same. Why couldn't sociology be both an
academic discipline and a practicing profession analogous to the academic and clinical
branches in psychology (Glass, 1979)?
Many of the founding members of CSA were marginal persons, in the sociological sense
used by Simmel and Stonequist. Marginal people see things others don't, they think outside the
box, so to speak, by virtue of being bicultural or outside the mainstream in one way or another.
My "marginality" began with being born Jewish in Nazi Germany in 1936. My immediate
family was extremely lucky to leave Germany in 1939. I grew up in Chicago, among many
other refugee families, another marginal status, officially an enemy alien. In 1945, my parents
sent me to Circle Pines Center, an interracial educational center and summer camp, cooper-
atively owned by its members. Circle Pines' mission was to promote cooperation, a marginal
value in a highly competitive society, as a way of life. It was a haven for people who were
marginal-politically, racially, socially. Even today, I feel a sense of community and belong-
ing there that I have never really found anywhere else. The liberal, cooperative, and social
activist values I learned there have influenced me greatly, and that, together with a strong need
to make a difference in the world, undoubtedly influenced my becoming a sociologist.
In 1962 I moved to Los Angeles and began working on my Ph.D. in sociology at UCLA. I
had a research assistantship at the Institute of Industrial Relations, part of which was heavily
involved with sensitivity training (T-Groups), with its origin in the work of Kurt Lewin. The
faculty of the Division of Behavioral Science in the Graduate School of Management collabo-
rated with Carl Rogers, Abraham Maslow, Eric Trist (Socio-technical Systems), and Warren
Bennis, and did some of the pioneering work in group dynamics, experiential learning, and

JOHN F. GLASS • Studio City, California 91604.

Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic / Plenum Publishers, New York, 2001.

411
412 JOHN F. GLASS

organization development. I became very much involved as a group leader, researcher, and
participant. I saw the T-Group as a means for individuals to see themselves as others see them,
to try out new behaviors, to learn about group process, power, identity, roles, leadership,
socialization, and other sociological concepts (Glass, 1973; Glass & Frankiel, 1968; Glass &
Glass, 1981).
In 1972 I attended a four-week training program in Social System Change at the National
Training Laboratory in Bethel, Maine, where the curriculum was small-group leadership,
organizational development, consulting skills, and group relations theory, all of which looked
like sociological practice to me!
The human potential movement also began flourishing in California in the 1960s while I
was a graduate student. I became very active in the Association for Humanistic Psychology
(AHP), established as a "third force," an alternative to the behaviorism and psychoanalytic
traditions that were so much part of mainstream psychology. Humanistic psychologists took a
normative position that advocated the development of human growth and potential, choice,
awareness, and freedom (Bugenthal, 1967). I saw a parallel to mainstream sociology which
was increasingly coming under attack by radical sociologists and others who were rebelling
against the dominant structural-functional, "value free" sociology, based on quantitative
research, much of it trivial, that had an adjustment, adaptation, conformist outlook on human
nature and had little interest in solving social problems.
Sociology had a grand tradition of humanist thinkers: Marx, Cooley, Mead, W. I.
Thomas, C. Wright Mills, Herbert Blumer, Alvin Gouldner, and Alfred McClung Lee, to name
just a few, but their work did not constitute a recognized force in sociology. In a 1970 issue of
the AHP Newsletter I wrote:
Consulting, doing research, working with groups does not mean going in and telling them what to do,
but rather helping them to define their own goals, problems and possible courses of action. This is
essentially at the sociological level what the good clinical psychologist does at the individual level, and
I am sure that someday the profession of clinical sociology... will become recognized and esteemed.
(Glass, 1970)

Alfred McClung Lee, one of the other two or three sociologis~s who were AHP members,
responded to the article and this was the beginning of a continuous dialogue with him which, I
believe, contributed to his cofounding the Humanist Sociology Association in 1976.
In 1971, while on the faculty at California State University, Northridge, I collaborated
with John Staude, a sociologist at Sonoma State College, in editing a collection of humanist
writings from sociology, psychology, and organizational change, Humanistic Society: Today's
Challenge to Sociology (Glass & Staude, 1972), another step toward clarifying the possibilities
of sociological practice.
At the 1972 ASA meetings I picked up a copy of H. Warren Dunham's paper "Clinical
Sociology: Its Nature and Function" (Dunham, 1972), which led me to the all-but-forgotten
article "Clinical Sociology" written over 40 years earlier by Louis Wirth (Wirth, 1931) in the
American Journal ofSociology. This discovery strongly justified and reinforced my interest in
developing clinical sociology. Wirth made a strong case for the significant role that sociolo-
gists can and did play in the study, diagnosis, and treatment of personality disorders. He
emphasized the necessity of combining theoretical with practical interests and gave examples
of sociologists working in child guidance clinics to bring their perspective together with those
of the psychiatrist, social worker, and psychologist.
The rebel in me, the inclination to see things in new ways, see things others don't see,
make connections, and create networks, are qualities related to my rediscovering and advocat-
ing clinical sociology. In tum, my own career as therapist, teacher, and consultant has been
DISCOVERING CLINICAL SOCIOLOGY 413

greatly influenced. I have been a facilitator and networker much of my life. I like getting
people and ideas together in hopes that an outcome will emerge beyond what I could do
myself. I feel extremely proud of my part in the evolution of sociological practice.

REFERENCES
Bugenthal, J. E T. (1967). ChaLLenges of humanistic psychology. New York: McGraw-HilI.
Dunham, H. W. (1972). Clinical sociology: Its nature and function. Paper presented at the ASA Meetings, New
Orleans; edited version reprinted in Clinical Sociology Review, 1, 23-33.
Glass, J. (1979). Renewing an old profession: Clinical sociology. American Behavioral Scientist, 22(4), 513-529.
Glass, J. E (1970). Toward a humanistic sociology. Association for Humanistic Psychology Newsletter, 6(4), 1-2.
Glass, J. E (1973). The presentation of self and the encounter culture: Notes on the sociology ofT-groups. SmaLL Group
Behavior, 4(4), 449-457.
Glass, J. E, & Frankiel, H. H. (1968). The influence of subjects on the researcher: A problem in observing social
interaction. Pacific Sociology Review, 11(2), 75-80.
Glass, J. & Glass, J. (1981). Humanistic education: A tale of two professors. Journal ofHumanistic Psychology, 21(2),
71-77.
Glass, J. E, & Staude, J. R. (Eds.). (1972). Humanistic society: Today's chaLLenge to sociology. Santa Monica, CA:
Goodyear.
Wirth, L. (1931). Clinical sociology. American Journal of Sociology, 37, 49-66. Reprinted in Clinical Sociology
Review, 1, 7-22, 1982.
 EXHIBIT B

How I Became
a Clinical Sociologist
SARAH BRABANT

I have often said in partial jest that I was born a sociologist. Within a two-year span my
mother's aunt and surrogate mother died following an automobile accident, her father died by
suicide, and my sister died of cancer. I was born the following year and learned as a small child
that saying or doing the wrong thing ("wrong thing" was defined as upsetting anyone,
particularly my mother) could get me in big trouble. Since saying or doing something wrong
depended on the particular person and the particular situation, I learned quite early in life to be
very observant of other people's behaviors, both individual and in interaction. Without
realizing it, I was "practicing" sociology in order to make life easier for myself. Despite this
early experience, my first encounter with sociology as a discipline was uneventful. I was 19
years old at the time and college courses were what one did to pass the time between
weekends. Evidently I took sociology because it's on my transcript; I have no memory of what
the course was about. In sharp contrast, my second encounter with sociology 11 years later was
one I shall never forget.
I was married with three small children and my world was falling apart. My husband's
behavior was increasingly becoming more bizarre (only later did I realize that he was bipolar),
and it had become apparent that I would need to support myself and our children. My skills at
that time were limited to making perfect cup custard, delicious teacakes, and fine hand sewing.
In desperation I decided to return to school in the hope that I could better prepare myself for the
job market. Years of emotional abuse had left me with little sense of self-worth. Indeed, I
questioned my own sanity. I can only describe this new encounter with sociology as akin to a
drowning person being thrown a lifeline. I had always assumed that there was a fixed reality,
one with which everyone I knew seemed to be in contact. I, alone, was out of touch. The notion
of individually constructed realities opened up a new world for me. The idea of role identity
was exhilarating. At last I had an explanation for why I felt I was "losing it." I was, but the
"it" I was losing was the no longer viable roles I had been trained to play since childhood. The
"social self" was dead, but the "self" who played. those roles still existed and was capable of

SARAH BRABANT • Department of Sociology and Anthropology, University of Louisiana at Lafayette, Lafayette,
Louisiana 70504.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

415
416 SARAH BRABANT

creating new roles and, thus, a new "social self." It would not be an easy task, but it was
possible. In a real sense, I became a clinical sociologist in the 1960s, for it was then that I
consciously began to use sociological concepts to intervene in my own downward spiral.
It was not until I had completed my doctorate, however, that I began to "practice'
sociology with others. My own experience prompted me to reach out to other women who had
suffered emotional and/or physical abuse in their relationships. As a result of my concern and
my educational credentials, I was asked to present workshops for these women and/or those
who worked with them. The material available at that time relied on psychological concepts
that often focused on the inadequacies of the women's personalities. I knew that these women
needed empowerment, not further debasement. They needed to be able to step back and look at
their situations (the "sociological imagination") as they presently defined them and learn to
redefine them. To do this, they needed to understand roles, the impact of role behavior, the
response of "other" as well as culture on self-esteem, and techniques for creating new roles.
Concepts like" construction of reality," "the self-fulfilling prophecy, and "the looking glass
self" were much more useful than "masochistic," "neurotic," and "immature personality."
Sociology had the concepts that could empower these women to take charge of their lives. My
workshops were enthusiastically received both by the women and by their advocates. As the
years passed, my audiences grew to include displaced homemakers, sexually assaulted
women, persons impacted by AIDS, and a variety of other physically, emotionally, and age-
challenged groups, both men and women.
I had been born into a grieving family and had worked during my teen years in a cancer
clinic with my father, a pioneering oncologist. Those experiences now led me to the emerging
grief literature for I recognized my own grief and the grief of men and women as a result of lost
roles. The grief literature, however, was primarily psychoanalytical or psychologically ori-
ented. The focus was on the emotional response to loss and the delineation between "normal"
and "abnormal" grief. The influence of "culture" on the grieving process was limited for the
most part to rituals. Type of death and/or relationship of the bereaved to the deceased were
critical determinants in predicting intensity and appropriate time for the grief process. Little
attention was given to interactions with others following a death. Once more I turned to
sociology to find the concepts that could both explain prolonged grief and empower individ-
uals to move through the process. The sociological perspective allows the bereaved person to
see the loss of roles that accompanies the loss of a beloved. For example, when a husband dies,
the wife dies as well. Thus, there are always two deaths; his biological death, her social death
as wife. Both deaths need to be grieved. Others, however, may perceive her focus on self, i.e.,
she as wife, as selfish and, thus, interfere with her grief work. Understanding the social and
cultural aspect of grieving allows her to pick the time, place, and manner to do the grief work
she needs to do without the additional burden of guilt or shame.
Following my mother's death in 1980, I became even more interested in the sociology
of death and dying, and, as a result, offered what I thought at the time would be a once-only
seminar. Three years later I was asked by students to give the seminar one more time. 1 have
been teaching this course twice a year since 1985. What was to be to a one-time venture
became my life's work. My classroom teaching, my research, and my community involvement
with grieving persons continue to affirm for me the value of sociology as an intervention for
change. When an individual looks only at him- or herself as the source of all that is wrong, he
or she is limited. When this same person is able to look at him- or herself as part of a system, as
impacted by both the others within that system as well as the system itself, and by the cultural
context within which the system operates, the individual can then make the changes that will
allow him or her to become who he or she has the potential to become. This is elaborated
HOW I BECAME A CLINICAL SOCIOLOGIST 417

further in my book Mending the Tom Fabric: For Those Who Grieve and Those Who Want to
Help Them. Through the use of a sociologically based analogy, the grieving person and those
who want to help him or her can step back to "see what grief looks like," and thus, determine
the best course of action for him- or herself as well as for his or her significant others.
For further elaboration, see the following articles by the author:
• "Guilt and Shame: Problematic Emotions in Grief Counseling" 1997, in David D.
Franks (Ed.), Social Perspectives on Emotion (Vol. 4, pp. 103-124). Greenwich, CT:
JAI Press.
• "Special Moments, Special Times: Problematic Occasions Following the Death of a
Child," 1995, Clinical Sociology Review, 13, 57-69 (with Craig Forsyth and Glenda
McFarlain).
• "Defining the Family Following the Death of a Child," 1994, Death Studies, 18,197-
206 (with Craig Forsyth and Glenda McFarlain).
• "Old Pain or New Pain: A Social Psychological Approach to Recurrent Grief," 1989-
90, Omega, 20(4), 273-279.
 EXHmIT C

How I Became a Clinical

Sociologist
BEVERLEY CUTHBERTSON JOHNSON

As a young woman, the wisdom of clinical sociology developed within me. How? I saw from
early on significant others with particular emotional sensitivities and the thoughts, behaviors,
and social contexts associated with those sensitivities. I also saw how society treated those
people. My aunt, my mother's older sister, was an individual who developed bipolar disorder.
As a young girl, I went with my parents twice a month to visit her at the state mental hospital. I
learned how she had adapted to many anguishing social experiences through withdrawing into
her own world or lashing out at reality, ending up in an institution where she eventually
committed suicide. Also, from witnessing the experiences of my beloved younger brother, I
developed deep insight into how established expectations regarding social roles can influence
individuals profoundly. My brother was not the typical male role model; he loved art and
music, not sports or finances. As a result, he was often put down for his artistic talent and
bullied by peers for his gentle, considerate ways. Ultimately, he, too, in spite of having become
a husband, father, and special Florida artist, committed suicide. I also experienced a number of
extremely distressful life experiences like my father being drafted into the Navy and having to
leave his family to go to World War n. In addition, I experienced some abusive social
interchanges through which I developed a deep, self-capturing fear of loss and abandonment.
Furthermore, I participated in different broad social contexts and came to understand
their influence on individuals' thoughts, feelings, and behaviors. I spent my youngest years in
New York City, a completely different environment than the small, Connecticut beach town to
which I moved when I was five. I also spent three, post-bachelor's degree years living and
working in Sao Paulo, Brazil, a very unique, culturally diverse, sociocultural environment.
Overall, through my personal life journey, I developed a broad, integrated biopsycho-
social perspective in regard to emotional patterns, problems, and disorders. I really learned
about "life in context" and that it was highly imperative to understand and honestly reflect on
one's patterns and processes of thinking, feeling, and behaving and the contexts within which
they developed so that you would have the opportunity to preserve your own dignity and
integrity as well as that of others.

BEVERLEY CUTHBERTSON JOHNSON • Southern Desert Medical Center, Tempe, Arizona 85282.
Handbook of Clinical Sociology, Second Edition, edited by Howard M. Rebach and John G. Bruhn. Kluwer
Academic/Plenum Publishers, New York, 2001.

419
420 BEVERLEY CUTHBERTSON JOHNSON

Based on my continually emerging wisdom regarding emotion and its relationship to

individuals and their social environments, I enrolled in a sociology graduate program and
discovered, in the process of completing the program, that the sociology of emotions was a
"pioneer" area to which I wanted to become deeply committed. I was thrilled to learn about
sociologists like Thomas Scheff and Arlie Hochschild, who were on the sociology of emotions
path I was trodding. That path also led me to commit to and complete, under the excellent
mentorship of Dr. Julia Mayo, a pioneer clinical sociologist, the first two-year internship in
clinical sociology at St. Vincent's Psychiatric Hospital in New York City.
My two years at St. Vincent's Hospital were highly educative. I had the opportunity to
view and understand the traditional medical model setting. I came to appreciate and respect
some of the positive aspects of medicine, psychological testing, and psychotherapy but at the
same time "blossom" in my understanding and commitment to socioemotional understanding
and re-creation. I developed the process of carrying out socioemotional assessment, which led
to an integrated, deep understanding of the individuals with whom I worked and how they had
come to develop, in relation to certain social contexts and experiences and their adaptation to
those contexts and experiences, particular emotional repertoires (or lack of) and emotion
management strategies (or lack of). I also noted that although there were at times certain
similar patterns among individuals labeled with particular diagnoses, it was extremely impor-
tant to work with the individual and his or her unique patterns and processes of thinking,
feeling, and behaving. I especially learned how a clinical sociologist could assist individuals in
not just "playing a role," not just replacing negative reality with a positive fantasy, not just
removing themselves from social reality, and not just using exaggerated, fabricated, or unusual
accounts or behavioral disclaimers to distract from reality. Instead, a clinical sociologist could
help individuals acknowledge their "real life, current reality" and be open to creating new,
more positive selves as well as self/life intersections.
Furthermore, while completing the internship, I discovered how important it was to
facilitate the individuals as well as their significant others and the community in developing
responsible emotionality/emotional responsibility. For example, I initiated and led an
education/support group for the spouses and significant others of individuals with bipolar
disorder. The "I, You, and We" of sociology then blossomed!
We are still on the path! As clinical sociology pioneers, we can, with great effort, continue
to assist individuals respecting, facilitating, and supporting those labeled mentally ill from an
integrated, socioemotional perspective. As clinical sociologists, we are particularly skilled at
understanding how individuals come to make sense of and adapt to particular sociocultural
contexts. We can therefore facilitate people's understanding how he, she, and they can reflect
on and choose to create and enact contexts and patterns and processes of thinking, feeling, and
behaving that are compassionate and respectful to themselves as well as others. The socio-
emotional worlds of the individual and humanity are inseparable.
Clinical sociologists! Facilitate individuals and the community in:
• Understanding and reducing distressful feelings of inadequacy, deprivation, and injus-
tice
• Decreasing feelings of social isolation and alienation
• Supporting people developing desired social identities and meaningful social roles
• Improving personal, family, and social relationships
• Identifying and altering personal habits or social circumstances that contribute to
ongoing frustrations and dissatisfaction
• Creating patterns of thinking, feeling, and behaving that contribute to feelings of
personal control and self-worth
HOW I BECAME A CLINICAL SOCIOLOGIST 421

• Identifying and managing anger and conflict (yea, clinical sociologist pioneer, Dr.
Melvyn Fein, for your work on integrated anger management!)
• Increasing individual's abilities to deal with anxiety-provoking relationships and cir-
cumstances
• Developing new facilities to educate and work with individuals with socioemotional
disorders
• Helping facility graduates learn to understand themselves and renavigate the estab-
lished social system in positive ways as well as playa part in recreating new selves as
well as social systems
 Index
Page numbers followed by "b" indicate pages containing boxed text; those followed by "f" indicate pages containing
figures; and those followed by "t" indicate pages containing tabulated text.

Absolute poverty, 357-358, 361-366 Alignments in family. See Family alignments

Academic research, 6-7 Alinsky, Saul, 4, 396
Acceptance, 25 Allport, Gordon, 335-336
Accommodating, 114, 124 Alternative dispute resolution (ADR), 198, 199, 215,
Accountability, 29, 85, 190 221,222
Accounts, 50 AMA. See American Medical Association
Accreditation, 404-405 Ambiguity, 103
Achievement Place Program. See Teaching-Family Ambivalence, 96
Program American Association for Labor Legislation, 298
Active listening, 45-48, 215, 256 American Association for Public Opinion Research, 53
Activities, 15 American Association of Community Colleges, 171
Adaptation, 92, 114 American Association of Marriage and Family
Additive approach, 337 Therapy, 53
ADR. See Alternative dispute resolution American Association of Public Administrators, 53
Adult children of alcoholics, 16, 30-31, 34, 78, 86, 92 American Association of University Professors, 55
Advanced technological society, 81-88 American Bar Association (ABA), 199
Advertising, 64, 70-71 American Dental Association, 64
Advocacy coalitions, 256 American Dilemma, An (Myrdal), 4
Advocates, 388-389, 390 American Evaluation Association, 53, 68
AFDC. See Aid to Families with Dependent Children American Hospital Association (AHA), 298, 299
Affective component of clinical relationships, 40 American Indians. See Native Americans
Affiliative style, 40 American Medical Association (AMA), 53, 64, 298,
Affirmative action, 229, 333 299, 300
African Americans. See Blacks American Psychological Association (APA), 56
Age Discrimination Act of 1975, 67 American Society for Public Administration, 70
Agency for Health Care Policy and Research, 304 American Sociological Association (ASA), 53, 55-56,
Agency for International Development, U.S. (USAID), 66,67,68,69,397,404,411
260-261 Americans with Disabilities Act of 1990, 67
Agoraphobia, 99 Animal rights activism case, 62-63
AHA. See American Hospital Association Anorexia nervosa, 76, 86
AHP. See Association for Humanistic Psychology Anthony, Susan B., 315
AIDS, 86, 303 Antispeeding campaign, 237-238
domestic violence and, 316 Anxiety, 94, 95, 102-103
focus groups and, 137 APA. See American Psychological Association
preventive programming and, 278, 279, 280-282 Applied research, 4, 11-12
support groups for, 134-135 Arbitration, 198
Aid to Families with Dependent Children (AFDC), Arlington County Victims of Violence, Volunteer
230,375,378,380,381 Training Manual, 314
Alcohol abuse, 86, 87 Army, U.S., 4
automobile accidents and, 279 Arthur Anderson (firm), 85
domestic violence and, 314-315 Articles written by sociologists, 400-401, 402t
preventive programming and, 278 ASA. See American Sociological Association
violence and, 272 Asians
Alcoholics Anonymous, 136 clinical relationships with, 43

423
424 INDEX

Asians (cont.) Blue Cross, 297, 299

families of, 124 Blue Shield, 297, 299
healthcare equity and, 304, 305 Blumer, Herbert, 412
poverty and, 366 Bosnia, 6, 18
racism and, 331 Boys Town, 272
Assessment, 33 Brain mapping, 101-102
clinical relationships and, 44 Brainstorming, 207-208
of communities, 153-156 Brandt, Lilian, 355, 357
description of, 26-28 Breaching paradigm, 183
in family work, 114, 116, 126-127 Brokers, clinical sociologists as, 388, 390
in group work, 146 Brown v. Board of Education, Topeka, 5-6
impact, 230, 234-238, 239 Building-based planning, 173, 174
Individualized Functional, 379 Bulimia, 76, 86
needs, 137, 335 Bureaucratized organizations, 179, 180-181, 189
outcomes, 85 Business-Higher Education Forum, 257
of racism and diversity, 339-341
relationship, 146 CAP. See Cultural assessment framework
socioemotional, 93-97, 420 California, 213, 216, 221, 279
systematic, 228 California School of Professional Psychology, 411
Assimilation, 328-329, 340 Cambodians, 201
Association for Humanistic Psychology (AHP), 412 Canada, 219, 274, 278, 280, 284, 309, 361
Association of Governing Boards, 171 Cancer, 275, 282, 303
A Su Salud, 275 Caring concern, 25
Attention deficit disorder, 76 Carnegie Forum on Education, 173
Attention DeficitlHyperactivity Disorder, 91, 102-107 Carter, Jimmy, 301
Australian Health Service, 221 Case studies, 26
Authoritarian leadership, 142-143 of Attention DeficitlHyperactivity Disorder, 105-107
Authority of family-focused intervention, 126-129
in group work, 141 of mediation, 200b
in public schools, 189 of social policy development, 256-264
Authorship credit, 65, 66 Catholic Church, 281
Census Bureau, U.S., 357, 358, 359, 360, 361
Battered women. See Domestic violence Centers for Disease Control and Prevention, 314, 315
Baxter, Les, 239f CEO/worker income disparity, 368
Baylor University, 298 Certificate of Confidentiality, 63
Beginning phase of group work, 146, 147 Certification, 9, 398, 407-409
Behavior, 93, 94-97 CETA. See Comprehensive Employment and Training
Behavior change, 25 Act
barriers to, 33-34 Chechnyans, 18
as goal, 32-33 Child abuse, 83, 206, 213, 314
Behavior modification, 86 poverty and, 371
Bell, Daniel, 82 preventive programming and, 273, 274
Belmont Report, 55 programs for prevention of, 155
Bennis, Warren, 411 sexual, 83, 273
Biddle, Joan, 243f welfare reform and, 382
Binding arbitration, 198 Child care assistance, 374, 375, 382-383, 387
Bipolar disorder, 415, 419, 420 Child custody and visitation, 213, 214, 215
Blacks, 33, 34 Children
AIDS in, 135,281 disabled, 221, 374, 379-381, 387
domestic violence and, 314 poverty in, 361. 362, 364f, 366, 370, 371-372
families of, 117 welfare reform and, 376
healthcare equity and, 303, 304, 305 Children's Health Insurance Program, 302
poverty and, 362, 366, 369-370 Child support, 213, 374, 375, 376, 381-382,386, 387
in public schools, 187-188 China, 18, 198, 200-201
racism and, 329, 330-332, 333 Circle Pines Center, 411
youth violence and, 271 Cirrhosis of the liver, 372
Block grants, 373, 374, 375, 383 Civil Rights Act of 1964, 67, 332
INDEX 425

Civil Rights for Women, 317 Communication (cant.)

Civil rights movement, 308, 329 barriers, breakdowns and problems in, 48-50
Claims makers, 315 in community work, 160, 166
Client-centered approach, 40 preparing for, 42-43
Client-centered collaborative effort, 23 social policy and, 254-255, 259, 260-263, 265-
Clients 266
client system distinguished from, 27 Communities, 151-167
clinician training by, 49-50 assessment of, 153-156
defined,I5 defined, 152
exploitative relationships with, 23 developing programs in, 161-162
Clients' statement, 27 emotionally close, 153
Client system, 27, 38, 39 ethnic, 152, 153, 154
Clinical relationships, 37-50 evaluation of, 162-164
approaching clients, 44-48 geographic, 152, 153, 154-156, 166
communication in. See Communication identificational, 153, 154, 166
initial meetings in, 43-44 intellectual, 153
presenting condition in, 39-41 intentional, 152
Clinical sociology intervention in, 156-162, 164
career combinations, 399-400 literature review, 151-153
career preparation, 397- 398 natural, 152
definitions, 396-397 organizing against poverty in, 389-390
developmental review, 4-5 preventive programming in, 274-275, 276f
future of, 403-405 preventive programming in multicultural, 277-278
knowledge and skills base provided by, 21-22 psychological, 152
maturity of, 8-13 purposive, 153, 156, 166
as sociology, 7-8 racism reduction in, 344-345
specialty areas, 400-401 religious, 152, 153
"Clinical Sociology" (Wirth), 412 social, 152
"Clinical Sociology: Its Nature and Function" spiritual, 153
(Dunham),412 strengths of work in, 164-165
Clinical Sociology Association (CSA), 56, 396, 398, types of, 152-153
411. See also Sociological Practice Association weaknesses of work in, 165-166
Clinical Sociology Review, 400, 404 Community colleges, 17l
Clinton, Bill, 297, 302, 317, 354, 372, 374 Community health centers (CHCs), 300
Clinton, Hillary Rodham, 302 Community Mediation Service (CMS), 222
Closed-ended groups, 136, 137 Community Relations Service, U.S., 199
Closed-ended questions, 46, 138 Competence, 57, 68-69, 258
CMS. See Community Mediation Service Complementary family structures, 119
Coalitions Complementary roles, 120, 121
advocacy, 256 Comprehensive Employment and Training Act
detouring, 122, 123, 127, 128 (CETA),374
family, 115, 116, 122-124, 127, 128, 130 Comprehensive Health Services, 300
stable, 122-123 Computerization, 85
Code of Federal Regulations Governing Research on Comte, Auguste, 4, 75
Human Subjects, 55 Conciliation, 198
Codes of Ethics, 53, 54-57 Conciliation Service, U.S., 199
Coleman Report, 187-188 Condom use, 280
Collaborative problem solving, 198 Conduct disorder, 371
Colorado, 222 Conference of Mayors, U.S., 366
Comic (hopeful) frame, 212 Confidentiality, 23, 62-63
Coming of Post-Industrial Society, The (Bell), 82 in group work, 143, 144
Commission on Applied and Clinical Sociology, 404 in mediation, 204, 206
Commitment, in group work, 141 Confirming approaches to mediation, 214
Committee on the Cost of Medical Care, 298 Conflict, 344
Commodity distribution, 375, 383-384, 387. See also role, 121, 134
Food stamps social, 197
Communication, 37, 41-43 Conflicting emotions, 96
426 INDEX

Conflict model of social policy, 254 Democratic leadership, 142, 143

Conflict of interest, 59-61 Demographic changes, 82-83
Conflict theory, 15-16, 356 Department of Agriculture, U.S. (USDA), 358, 383
Conformity, in formal organizations, 171 Department of Health and Human Services, U.S., 62, 63
Confrontation, 145 Department of Housing and Urban Development
Confucius, 198 (HUD), U.S., 155
Congressional Budget Office (CBO), 367-368, 379 Department of Justice, U.S., 316, 319
Connecticut, 386 Depression, 96, 99, 107, 316, 371
Consensus building, 198 Deprivation, 360-361
Constructivist theory, 339, 340, 341 Descriptive data, 9
Consultants, 59, 389, 399, 400 Detouring coalitions, 122, 123, 127, 128
Consulting professions, 57 Devaluation, 103
Consumer Price Index (CPI), 358 Dextroamphetamine, 102
Contact theory, 335-336 Differentiation, 92
Contamination of research, 244, 246 Directory of Programs in Applied Sociology and
Content integration, 337 Practice, 397
Contracts, in group work, 139-140, 147 Disabled children, 221, 374, 379-381, 387
Contributions approach, 337 Disabled persons, 221-222
Controlling style, 40 Discourse analysis, 341
Cooley, Charles Horton, 92, 412 Discrimination, 328
Cooperative learning activities, 336 Dispute Management in the Schools Project (DMSP),
Cooperative Solutions Inc. (CSI), 222 217
Corporate Higher Education Forum (C-HEF), 257 Distraction techniques, 103
Corporate restructuring, 85 Distributive justice, 209, 306, 354
Corwin, R. G., 179-180, 181 Distributive negotiation style, 218
Court Annexed Mediation Services Project, 213 Divergent emotional experiences, 96
Crime, 270. See also Violence Diversity. See also Multiculturalism
Crisis intervention services, 388 affirming, 338
Critical theory, 15 practice issues in, 339-345
Cross-cultural practices, 278 Diversity training, 333-335
CSA. See Clinical Sociology Association Divorce, 83
CSl. See Cooperative Solutions Inc. Divorce mediation, 201, 205, 213-217
Cultural assessment framework (CAF), 277-278 DMSP. See Dispute Management in the Schools
Cultural competency, 334 Project
Cultural tailoring, 277 Domestic Abuse Intervention Project (DAIP), 318-319
Culture Domestic violence, 6, 154, 155, 313-324, 416. See
AIDS and, 135 also Child abuse
clinical relationships and, 43 current perspectives on, 314-316
communities and, 156, 158 defined, 314
families and, 117, 119, 121, 126, 130 four major dimensions of, 316
preventive programming and, 277-278 future of intervention, 323-324
Culture lag, 77, 83 homelessness and, 282
Current Population Survey (CPS), 357 intervention for, 318-319
mediation and, 205, 213, 215-216
DAIP. See Domestic Abuse Intervention Project preventive programming and, 273-274
Dauphin County, Pennsylvania (STOP grants), 319- scope of problem, 314
321, 323 social costs of, 316-317
Dauphin County Domestic Violence Task Force, 321, welfare reform and, 376, 382
323 Domestic Violence and Sexual Assault Rapid
Debunking frame, 211-212 Response Teams (RRTs), 319-320, 321, 322
Deep learning groups, 16 Dopamine, 102
Deficit-reducing budget-reconciliation bill (HR2491), Dotzler, Bob, 247f
374 Double blind studies, 244
Definition of the situation, 79, 92 Dramaturgical perspective, 211
Deliberative justice, 307 Drug abuse, 87
Delusions, 104 contextual determination of, 78-80
Delusions of grandeur, 98 domestic violence and, 315
INDEX
Drug abuse (cant.)
homelessness and, 282
intravenous, 281
preventive programming and, 278
violence and, 272
welfare refonn and, 377
Dual-career marriages, 83
Du Bois, W. E. B., 4
Dudley Street Neighborhood Initiative, 344
Duluth, Minnesota (domestic violence prevention
program), 318-319, 321, 323
Durkheim, Emile, 4
Earned Income Tax Credit (EITC), 367
Eating disorders, 76, 86
Eclecticism, 16
Economic harmony, 354
Economic inequality, 366-368
health and, 371
racism and, 329-331
theories of, 356
Economic justice, 353-354,366
Economy food plan, 358
Education. See also Schools
for disabled children, 221
healthcare equity and, 305
poverty and, 372
racism and, 331-332
Education groups, 134, 135
EEOC. See Equal Employment Opportunity
Commission
Effective Schools movement, 173-174, 178, 191
Elder abuse, 155, 206, 274
Electroconvulsive shock therapy, 86
Emergency Food Assistance Program, 384
Emotional careers, 96, 97
Emotional generalization, 101
Emotional honesty, 101
Emotional intersections, 97
Emotionally close communities, 153
Emotional repertoires, 91, 95-96, 107
Emotional resocialization, 101
Emotional spirals, 100, 107
Emotional stalemates, 97, 100
Emotional standpoints, 96, 97
Emotional tenninations, 97
Emotion management, 96, 103
Emotions, 93, 94-97
absence of, 96, 107
conflicting, 96
divergent experiences, 96
sociology of, 101
Emotion work, 101
Empathic responding, 46
Empathic understanding, 25
Employment. See also Unemployment
poverty and, 362-363, 366, 369
427
Employment (cant.)
welfare refonn and, 372-373, 375, 379, 384-385
Empowennent
community, 158-159, 165-166,274
of domestic violence victims, 322-323
through infonnation, 201-202
mediation and, 201-203
of school culture and social structure, 337
Empowennent zones, 155
Empty nest syndrome, 116
Enactment, 124, 125
Ending/transition phase of group work, 146, 148-149
English as a Second Language (ESL), 135
Enlightenment model, 13
Environmental problems, 154-155
Equal Employment Opportunity Commission (EEOC),
332-333
Equity pedagogy, 337
Ethics, 23-24, 53-73
challenges for practitioners, 68-72
confidentiality and, 62-63
conflict of interest and, 59-61
crosscutting principles, 57-58
infonned consent and, 61-62
publication issues and, 65-66
public statements and, 63-64
standards for practitioners, 58-68
in the workplace, 67-68
Ethiopia, 6, 18
Ethnic communities, 152, 153, 154
Ethnic conflict, 6, 18
Ethnic integrity, 340
Ethnicity, 80. See also Race; specific ethnic groups
families and, 117, 119, 121, 123-124, 126, 130
poverty and, 371
preventive programming and, 277-278
Ethnocentrism, 328-329
Euphemistic frame, 211, 212b
Europe, 220, 295
Evaluation, 20, 21b, 26, 225-250
audience for reports, 248-249
of communities, 162-164
definitions, 228-229
expert, 226, 231, 241-242
in family work, 114, 116, 128-129
focus groups and, 137
fonnative, 240, 242
history of, 229-230
journals and professional associations, 230f
naturalistic investigation, 231, 240-241
object-based, 230, 231-234
objectives of, 28
outcome-based, 230, 234-238
portraits and stories of, 147f, 235f, 239f, 243f
of preventive programming, 286
process, 230, 238-240
recommended reading, 227
428 INDEX

Evaluation (cont.) Formal organizations. See also Public schools

rese~ch, 85, 228, 242-246 classic and contemporary views, 170
selecting an evaluator, 247-250 clinical sociologists in multiply-involved, 170-172
summative, 240, 242 Formative evaluation, 240, 242
Evaluative mediation, 200, 201, 202 Formed groups, 133-134
Executive Order 11373, 333 France, 361
Executive subsystem, 31 Freedom of Information Act, 70
Expert evaluation, 226, 231, 241-242 Functionalism, 15, 117, 119. See also Structural
Expert witnesses, 58, 60 functionalism
Exploitative relationships, 23, 67 Functions of f~ly, 118-119
Exquisite emotional sensitivities, 91, 96, 99, 101, 107, Fundamental attribution error, 209
108
External evaluators, 248 Gemeinschaft, 153
Extracurricul~ activities, 336 Generalizations, 107
Exxon Valdez oil spill, 63 metageneralizations, 96, 99, 107
overgeneralizations, 98, 103, 107
Facilitation skills, 254, 255-256, 259, 263-264, 265 undergeneralizations, 98, 103, 107
Facilitative mediation, 200, 201, 202 Genuineness, 25
Falsification of data, 65-66 Geographic communities, 152, 153, 154-156, 166
Families USA, 296 Georgia, 218
Family alignments, 115, 116, 121-122, 123-124, 127, Germany, 354, 361
128, 130 GI Bill, 4
F~ly eco-maps, 146 Gini coefficient, 356, 366, 371
Family-focused intervention, 115, 116, 118, 123, 124- Global Strategy for Health for All by the Year 2000,
129,130 274
case study of, 126-129 Gouldner, Alvin, 412
F~ly homeostasis, 115, 116, 117-118, 119, 121, 124 Grandiose self, 98
F~ly organization theory, 115 "Graying of America," 82
F~ly size, 82-83 Great Britain, 17, 315, 321-322, 354, 361
F~ly structure, 115, 116, 118-120, 127 Great Depression, 298-299
complementary, 119 Great Society, 229
F~ly subsystems, 115, 116, 120-121, 127, 130 Grief work, 416-417
F~ly systems approach, 113-131 Grounded Encounter Therapy, 16
literature review, 115-124 Group interviewing, 137, 138
strengths and weaknesses of, 129-130 Group level of intervention, 16, 308
techniques for, 124-126 Group living, 113-114
F~ly transactional patterns, 115, 118, 119, 125, 130 Group norms, 133, 142
F~ly violence. See Domestic violence Groups
Family Violence Project, 313 closed-ended, 136, 137
Federal Emergency Management Agency (FEMA), defined, 133
256 education, 134, 135
Federal Mediation and Conciliation Service, 199 focus, 137-138, 342
Federal Poverty Thresholds, 358-360 formed, 133-134
Federal Trade Commission (FTC), 64 growth, 134, 135
Feeling rules, 101 natural, 133
Feeling traps, 100 open-ended, 136
Felons, 374, 380 p~ent effectiveness, 135
FEMA. See Federal Emergency Management Agency primary, 133
Female-headed households, 358, 361 small, 133
Rorida, 221, 309 socialization, 134, 136
Focus groups, 137-138, 342 support, 134-135, 136
Food pyr~d, 232f therapy, 134, 136
Food stamps, 358, 374, 375, 377, 380, 382 treatment, 134, 140
concerns about program, 387 types of, 134-137
decline in participation rates, 385 Group structure, 133, 141
provisions of program, 383-384 Group work, 133-149
Footnotes, 404 benefits and concerns, 149
INDEX 429

Group work (cont.) Health status, 302, 303-304

counseling skills and, 146 Health Systems Agency, 301
defined, 134 Healthy Cities Project, 274
for domestic violence, 322 Healthy People initiative, 302
dynamics and activities, 140-141 Heart disease, 269, 275, 303, 371, 372
fees and financial support for, 140 High School and Beyond, 188
ground rules for, 140 Hill-Burton Act, 300
leadership in, 141-145 Hispanics/Latinos,21-22
literature review, 138-139 AIDS in, 281
planning and preparation for, 139-140 clinical relationships with, 43
stages of, 146-149 communities and, 154
Growth groups, 134, 135 families of, 119
Guide to Community Preventive- Services, 275 healthcare equity and, 303, 304, 305
Guiding Principles for Evaluators, 67, 70, 72 poverty and, 362, 363f, 364f, 366
Gun ownership, 19, 271, 272 racism and, 330, 331, 332, 339, 340, 341
youth violence and, 271
Handbook of Clinical Sociology (Saunders), 169, 170, Historical controls, 244-245
186 HMOs. See Health maintenance organizations
Harassment, 67 Hochschild, Arlie, 420
Harlem (New York City), 272 Holmes Group, 173
Hawaii, 216, 217, 309 Homeless persons, 282, 365-366, 385
Hawthorne effect, 77 Homeostasis of family. See Family homeostasis
Head Start, 229 Homicide, 18-19, 267, 268, 270-272, 316, 372
Health Homosexuals, 84, 86, 135, 280, 281
poverty and, 370-371 Hospitals, 298-299, 300, 301, 322-323
racism and, 332 Hospital Survey and Construction Act of 1946, 300
welfare reform and, 379 House of Representatives Report 104-725, 375
Healthcare Access, Portability, and Renewability Act Housing costs, 359-360
of 1996, 302 Human capital theory, 330, 355
Healthcare equity, 293-310 Human Development Index, 270
current perspectives on, 306-307 Humanistic Society: Today's Challenge to Sociology
definition of problem, 294-295 (Glass & Staude), 412
definition of terms, 293-294 Humanistic values, 22-24
dilemmas and practice issues in, 307-310 Humanist Sociology Association, 412
effective vs. ineffective measures, 307 Human potential movement, 412
extent of problem, 303-305 Hypothesis formulation, 20, 21b
historical perspective on, 297-302
right vs. privilege debate, 295-296, 301 IDEA. See Individuals with Disabilities Education Act
social arrangements and, 295-297 Identificational communities, 153, 154, 166
social cost of, 305-306 Identified client, 113
social indicators of, 302-303 Identity, 9, 104
Healthcare services Identity work, 50
access to, 302, 304-305, 306 Ideographic explanations, 20
barriers to, 302-303 Illegitimacy, 374, 375. See also Teenage pregnancy
history of, 297-302 Illiteracy, 22-23
mediation and, 221 Illusions, 104
preventive programming and. See Preventive Imipramine, 102
programming Immigrants and immigration, 83, 374, 383
utilization of, 302, 304-305 Impact assessment, 230, 234-238, 239
Health insurance, 304-305 Improvement, evaluation of, 229
historical perspective on, 298-299, 300, 301 Income
national, 297, 298, 299, 300, 301,307,308,309 of former welfare recipients, 385-386
SSI benefits and, 380 mean received by each fifth, 368t
uninsured population, 295 median, 360, 368
Health Maintenance Organization (HMO) Act of 1973, poverty by definition of, 359t
301 share of aggregate received by families, 367t
Health maintenance organizations (HMOs), 299-300 total annual, 367t
430 INDEX

Income inequality. See Economic inequality Intervention (cont.)

Indiana, 219, 384, 385-386 scientific method of, 19-21
Individualism, 202, 203, 306, 308 in social policy, 253-256
Individualized Functional Assessment (IFA), 379 social problems concept in, 17-19
Individual level of intervention, 308 world level, 16, 308
Individuals, 91-111 Intervention activities, 20, 21b
assessment of, 93-97 Intervention plan, 20, 21b
relevant literature, 92-93 Intravenous drug abuse, 281
socioemotional disorders in, 97-100 Iowa, 384
socioemotional re-creation in. See Socioemotional IQ scores, poverty and, 372
re-creation Iran, 80-81
socioemotional understanding of. See IREs. See Institutional review boards
Socioemotional understanding Ireland, 6, 18, 361
Individuals with Disabilities Education Act (IDEA), "I statements", 144
221-222
Inequality Japan, 84, 85, 201, 354
attempts to end, 332-338 Job-Training Partnership Act (JTPA), 374
economic. See Economic inequality Johnson, Lyndon B., 300, 333
racism and, 327-328 Joining, 114, 124
structural, 355 Joint planners, 215
Infant mortality rates, 295, 303, 371 Journal of Sociological Practice, 400
Inflation in housing costs, 360 JTPA. See Job-Training Partnership Act
Informed consent, 61-62 Juvenile offenders, 220-221
Innovation, 170, 172
Institute of Industrial Relations, 411 Kerr-Mills Act, 300
Institutional review boards (IRBs), 55, 61 Knowledge
Integration, 335-336 in behavior change, 33
Integrative negotiation style, 218-219 clinical sociology as source of, 21-22
Integrity, 57 Knowledge construction, 337
Intellectual communities, 153 Kosovo, 6, 18
Intentional communities, 152
Interactionist theory, 15 Labeling, 45, 77, 144
Interest-based bargaining, 202 relabeling, 124, 125
Internal evaluators, 59, 70, 71, 248 Labor-management disputes, 221-222
Internal representations, 47 Labor unions, 299, 301, 356
Internal Revenue Service, 247f Laissez-faire leadership, 142
Internet, 85, 152 Language, 93, 94-97, 103
Interrupted time series research design, 245 Latent poverty, 373
Intervention, 8, 15-34, 396 Latinos. See Hispanics/Latinos
behavior change as goal of, 32-33 Law Enforcement Assistance Administration (LEAA),
in communities, 156-162, 164 199
defined, 15 Leadership
diversity and unity of, 15-17 authoritarian, 142-143
for domestic violence, 318-319, 323-324 community, 159-160
in family work, 114, 116, 128 democratic, 142, 143
group level, 16, 308 group, 141-145
guiding themes, 17-24 laissez-faire, 142
healthcare equity and, 308-310 Learned helplessness, 273
humanistic values in, 22-24 Lee, Alfred McClung, 412
individual level, 308 Lewin, Kurt, 411
knowledge and skills base for, 21-22 Libraries, 172
organizational level, 16, 308-309 Life cycle stages of family, 115-116, 129, 130
outcomes or effectiveness of, 228 Life expectancy, 295, 303, 304
personal level, 16, 308 Lifelong Learning and the World of Work
as a process, 24-32 (LL-WOW), 258
in public schools. See Public schools Like-me assumption, 48
for racism reduction, 341-344 Limited structural looseness, 181
INDEX 431

Listening Mediation (cont.)

active, 45-48, 215, 256 mystique theory of, 209
open, 45 neutrality in, 201, 202, 203, 213-214
LL-WOw. See Lifelong Learning and the World of option enhancing strategy for, 201
Work peer, 217-219
Loose coupling, 180-181 premediation sessions, 205
Low-birth-weight infants, 304, 380 problematic frames for, 211-212
referrals to, 203
Macroeconomic forces, 356 structuring approaches to, 214
Macrolevel transformative, 202-203
defined,19 victim-offender, 205, 219-221
family systems approach in, 114, 116, 117, 118, 121, Medicaid, 296, 300, 301, 307, 358, 367, 370, 374,
122, 123, 124, 125, 126, 130 377, 378, 380, 382, 385
intervention in, 16, 17, 19 Medical Expenditure Panel Study, 304
poverty in, 390 Medical model, 77, 306, 420
social change in, 76, 77, 78, 79, 80-81, 82-84 Medicare, 296, 300, 301, 307, 367
social issues of concern at, 404 Megalopolitan growth, 83
Maine, 313 Melting pot model, 329, 337
Maize-marketing system, Zimbabwe, 260-261 Men
Male-headed households, 358 clinical relationships and, 41
Malnutrition, 370 households headed by, 358
Management, 92 Mending the Tom Fabric (Brabant), 417
Manhattan Family Court, 213 Mental health
Manpower Development and Training Act (MOTA), change in treatment and, 86
374 of children, 371
Marketing Research Association, 53 of homeless, 282
Marx, Karl, 4, 170, 412 poverty and, 370, 371
Maryland, 213, 215, 384, 385 preventive programming and, 284
Masking, 104 racism and, 332
Maslow, Abraham, 400, 411 welfare reform and, 379
Massachusetts, 221 Mesolevel
Matching samples, 244 defined, 19
Maternal and Child Health Program, 300 family systems approach in, 114, 116, 117, 118, 120,
Mayo, Julia, 420 121, 122, 123, 124, 125, 126, 127, 130
MOTA. See Manpower Development and Training intervention in, 16, 19
Act poverty in, 389-390
Mead, George Herbert, 92, 399, 412 social change in, 76, 77, 78, 79, 80, 81, 82, 84-85
Mean income, 368t welfare reform in, 379
Meaning-expanding approaches to mediation, 214 Metageneralizations, 96, 99, 107
Media, 162, 165, 309 Methylphenidate, 102
Median income, 360, 368 Mexicans, 331
Mediation, 197-222 Michigan, 62, 385
applications in practice, 213-222 Microlevel
confinuing and meaning-expanding approaches to, defined,19
214 family systems approach in, 114, 116, 118, 119, 121,
defined, 198 124, 125, 127, 130
divorce, 201, 205, 213-217 intervention in, 16, 19
evaluative, 200, 201, 202 poverty in, 355, 388-389
facilitative, 200, 201, 202 social change in, 76, 78, 80, 81, 82, 85-88
flow chart of case, 204b social issues of concern at, 404
flow chart of session, 206b welfare reform in, 379
history of, 198-199 Midrange strategy for mediation, 201-202
interventionism in, 203, 213-214 Migrant farm workers, 376
making contact, 203-205 Mills, C. Wright, 76, 412
mediation sessions, 205-208 Minimal prompts, 45
midrange strategy for, 201-202 Minimum wage, 363, 385, 387
models of, 199-203 Minnesota, 222, 309
432 INDEX

Minnesota Heart Health Program, 275 Near-poor, 358, 361

Minorities. See Ethnicity; Race Near randomization research design, 244
Mortality rates, 304 Needle exchange programs, 280
infant, 295, 303, 371 Needs assessment, 137, 335
poverty and, 370-371 Neighborhood collective action, 155
Motivation, 33 Netherlands, 354, 361
Motor Vehicle Safety Act, 279 Neurolinguistic programming (NLP), 47-48
MR FIT, 269 Neutral case evaluation, 198
Multiculturalism, 336-338. See also Diversity New Deal, 229
in communities, 344-345 New York (City), 213, 221
preventive programming and, 277-278 New York (State), 386
Multinational corporations, 84 New York Office for the Prevention of Domestic
Multiple realities, 108 Violence, 215
Multiple selves, 108 New York Society for the Prevention of Cruelty to
Multi-system thinking, 32 Children, 213
Myrdal, Gunnar, 4 NIDR. See National Institute for Dispute Resolution
Mystique theory of mediation, 209 NLP. See Neurolinguistic programming
Nomothetic explanations, 20
National Academy of Sciences, 55, 255 Nondirective approach, 40
National Association of Blue Shield Plans, 299 Nonverbal behavior, 41-42
National Coalition for the Homeless (NCH), 365-366 North Carolina, 280
National Commission for the Protection of Human Northern Ireland, 6, 18
Subjects of Biomedical and Behavioral Research, Nuremberg Code, 54
55 Nuremberg Trial, 54
National health insurance, 297, 298, 299, 300, 301, Nutrition education, 261-262
307, 308, 309
National Health Planning and Resource Development Object-based evaluation, 230, 231-234
Act, 301 Objectifying passions, 215
National Health Service, British, 17 Observation, 20, 21b
National Heart, Lung, and Blood Institute, 279 Office of Health Promotion and Disease Prevention,
National Institute for Dispute Resolution (NIDR), 199, 302
222 Office of Justice, 319
National Institute of Justice (NU), 314, 315 Oklahoma, 385
National Longitudinal Mortality Study, 370 Open-ended groups, 136
National Longitudinal Survey of Youth, 371 Open-ended questions, 46, 138
National Organization for Women, Legal Defense Open listening, 45
Fund, 317 Operations of family, 118
National Research Act, 55 Option enhancing strategy for mediation, 201
National Rifle Association, 253 Oregon, 309
National Science Foundation survey, 401-403 Organizational development theory, 334
National Survey of American Families, 378 Organizational level of intervention, 16,308-309
National Training Laboratory, 412 Organizations
Nation At Risk, A, 173 adaptation to environment of, 228-229
Nation Prepared, A: Teachers for the 21st Century, communication in, 42-43
173 communities and, 160-161
Native Americans preventive programming in, 275-277
clinical relationships with, 43 preventive programming in multicultural, 277-278
communities and, 154 racism reduction in, 339-344
poverty and, 366 Other, 38, 39, 44, 416
racism and, 329, 332, 337-338 radical, 338
youth violence and, 271 Other-distraction, 104
Natural communities, 152 Other-focus, 104
Natural experiments, 245-246 Outcome-based evaluation, 230, 234-238
Natural groups, 133 Outcome objectives, 28
Naturalistic investigation, 231, 240-241 Outcomes assessment, 85
Nazi experiments, 54-55 Outreach, 341-342
NCH. See National Coalition for the Homeless Overgeneralization, 98, 103, 107
INDEX 433

Pacific Islanders, 304 Power (cont.)

Pan American Health Organization (PAHO), 262 in families, 115, 116, 122, 123-124, 127, 128
Paralinguistic behavior, 41 in groups, 134
Paraphrasing, 45-46 in mediation, 210
Parent effectiveness groups, 135 poverty and, 356
Parenting programs, 155, 272 social policy and, 254
Participative justice, 354 Practitioner-consultant, 399
Participatory action research, 164, 345 Practitioner-researcher, 398-399
Peer mediation, 217-219 Practitioner-researcher-teacher-consultant, 400
Pennsylvania Commission on Crime and Delinquency, Practitioner-teacher, 399
319, 320 Predicates, 47
People of color. See Racism Prejudice, 328
Performance, 104 Prejudice reduction, 337
Personal, social, and civic action approach, 338 Preliminary phase of group work, 146-147
Personal level of intervention, 16, 308 Pre-post design, 245
Personal Responsibility and Work Opportunity Presenting problem/condition, 26-27, 39-41, 126
Reconciliation Act (PRWORA), 372-387. See President's Commission for the Study of Ethical
also Welfare reform Problems, 301
Pew Charitable Trusts, 239f President's Commission on Law Enforcement and the
Philadelphia Municipal Court, 199 Administration of Justice, 199
Phobias, 99 Preventive programming, 267-287
Physicians, 299-300 art and science of, 283-284
Physicians for National Health Insurance, 296 in communities, 274-275, 276f
Plagiarism, 65 concept of, 268-270
Plessy v. Ferguson, 5 decision tree for, 276f
Police, domestic violence and, 322 domestic violence and, 273-274
Policy. See Social policy; Welfare reform effective vs. non-effective techniques, 282-283
Policy advocacy, 256 failed self-regulation and, 270
Policy analysis, 256 failure of, 284
Policy entrepreneurs, 255 in multicultural settings, 277-278
Policy experts, 389 in organizations, 275-277
Policy Implications of an Evaluation (report), 261 primary, 269, 273
Politics secondary, 269, 270
adaptation to environment of, 228-229 for society, 278-282
social policy and, 253, 254, 259 steps in, 284-286
Politics of solidarity, 345 tertiary, 269
Polls, 83-84 youth violence and, 270-273
Portland, Oregon, Domestic Violence Reduction Unit, Previewing, 281
322 Primary groups, 133
Position bargaining, 215 Primary prevention, 269, 273
Poverty, 353-390 Principled negotiators, 215
absolute, 357-358, 361-366 Privacy, 62
defining, 357-361 Problem partialization, 388
by definition of income, 359t Problems
domestic violence and, 315 conceptualized as social, 17-19
effects of, 369-372 social policy and, 253, 259
extent of, 362t Procedural equity, 294
healthcare and, 304 Process evaluation, 230, 238-240
latent, 373 Process objectives, 28
number below threshold and rates, 363t Professional and scientific responsibility, 58
race and, 330-331, 361, 362, 364f, 371 Professionalization
relative, 357, 366-369 Codes of Ethics and, 54-57
roles for clinical sociologists, 387-390 in public schools, 178-180
by selected characteristics, 365t Program implementation, 26, 29-32
theories of, 355-357 Program operation, 228
Power Program planning, 26, 28-29, 33
in communities, 158-160 Project Impact, 256
434 INDEX

Project monitoring, 230, 238-240 Recruiting profiles, 137

Promotion, 64, 70-71 Referrals, 44, 203
Proposals, social policy and, 253, 254, 259 Reflection in action, 37
Protection for Battered Immigrant Women and Reframing, 124, 125, 210, 215
Children, 317 Rehabilitation Act of 1973, 67
Protection from abuse orders, 319 Relabeling, 124, 125
PRWORA. See Personal Responsibility and Work Relational ideology, 202, 203
Opportunity Reconciliation Act Relationship assessment, 146
Psychological communities, 152 Relationships. See also Clinical relationships
Publication issues, 65-66 in general, 38-39
Public Health Service Act, 300 in group work, 141
Public policy. See Welfare reform Relative poverty, 357, 366-369
Public schools, 169-191 Religion, 77, 84
assessing the intervention, 185-186 Religious communities, 152, 153
as bureaucratized organizations, 179, 180-181, 189 Research
dedicated staff characteristic, 175, 176-178 academic, 6-7
Effective Schools movement in, 173-174, 178, 191 applied, 4, 11-12
making the intervention, 181-182 in community work, 163-164
pathological interventions in, 187-191 evaluation, 85, 228, 242-246
planning the intervention, 174-176 participatory action, 164, 345
professionalization in, 178-180 pure, 4, 6-7, 11-12
protecting, 186-187 social policy, 254, 259, 260-262, 265
reformers of, 184-185 Research brokers, 255
reform legislation in, 188 Researchers, 398-399, 400
reform movements in, 173 Resocialization, 29-32, 102
Public statements, 63-64 emotional, 101
Puerto Ricans, 303 Resource deprivation, 315
Pure research, 4, 6-7,11-12 Respect for others, 58
Purposive communities, 153, 156, 166 Restorative justice, 220
Retributive justice, 220
Qualitative data, 9 Rhode Island, 221
Qualitative Research Consultants Association Right-to-life advocates, 84
(QRCA), 68, 69 Ritalin, 102
Quality circles, 85 Robotics, 85
Questions, closed- and open-ended, 46, 138 Rogers, Carl, 24, 40, 411
Role change, 102
Race, 5-6. See also Ethnicity; specific racial groups Role conflict, 121, 134
AIDS and, 135 Role play, 42, 92
communities and, 158 Role problems, 29-32
families and, 117, 119, 121, 123, 124, 126, 130 Role relationships, 16
poverty and, 330-331, 361, 362, 364f, 371 Roles
Racism, 80, 327-345 complementary, 120, 121
attempts to end, 332-338 in formal organizations, 170; 171, 172
definition and scope of problem, 327-328 reciprocal, 119
economic disparities and, 329-331 trans-situational, 30
educational attainment and, 331-332 Role theory, 120-121
of food pyramid, 232f Routines, 170
inequality and, 327-328 RRTs. See Domestic Violence and Sexual Assault
legislation on, 332-333 Rapid Response Teams
practice issues in, 339-345 Rule of thumb, 315
Radical other, 338 Rural areas, 300, 305, 386
Random assignment research design, 242-244 Russia, 18
Rape, 314. See also Sexual assault Rwanda, 6, 18
Reagan, Ronald, 301, 333
Rebellion, 104 Safe Homes for Women, 317
Reciprocal roles, 119 Safe Streets Act, 317
Recognition, mediation and, 202-203 Safety Net, 386
INDEX
Safety Net Assistance, 386
SI. Vincent's Psychiatric Hospital, 420
Salad bowl model, 337
SAS. See Society for Applied Sociology
Scapegoating, 147
Scheff, Thomas, 420
Scholarly professions, 57
School drop-out rate, 331, 371
Schools. See also Educalion; Public schools
desegregation of, 336
multicultural education in, 337-338
violence in, 217, 253
Scientific management, 85
Scientific methodology, 19-21
Seasonal farm workers, ]76
Seat belt use, 278, 279-280
Secondary prevention, 269, 270
Self-determination, 23, 25, 39
Self-disclosure, 141, 144
Self-esteem, 136
Self-focus, 103
Self-help model of social policy, 253-254
Self-object focus, 103
Self-regulation, failed, 270
Self-talk, 97
Self-upon-other emotion work, 96
Self-upon-self emotion work, 96
Sensitivity training (T-Groups), 411-412
Sensory language, 47-48
Settlement conferences, 198
Sexual abuse of children, 83, 273
Sexual assault, 316, 320. See also Rape
Sexual exploitation, 23
Sexual harassment, 67, 83
Shame-rage spiral, 100
Shelters for battered women and children, 315
Silence, in group work, 141
Single-parent families, 83
SIPP. See Survey of Income and Program
Participation
Skills
in behavior change, 3]
clinical sociology as source of, 21-22
Small, Albion, 13
Small groups, 133
Smoking cessation, 275, 278, 279
Social action, evaluation and, 229
Social arrangements, 5, 17-18
Social behavioral approach, 16
Social capital, 371
Social change, 75-88
in the advanced technological society, 81-88
conceptual considerations, 75-78
contextual determination, 78-81
Social class, 124, 269, 303-304
Social communities, 152
Social conflict, 197
435
Social constructionist approach, 15, 16
Social Darwinism, 355
Social dynamics, 75
Social identification of problems, 18-19
Socialization, 92. See also Resocialization
Socialization groups, 134, 136
Social justice, 306, 334, 344
Social movement techniques, 162, 165
Social networks, 18
Social policy, 251-266
case studies, 256-264
intervention in, 253-256
literature review, 252-256
process of, 252-253
strengths and weaknesses of, 264-265
Social problems, 17-19
Social reality, 40
Social responsibility, 58
Social Security Act of 1935,299,372
Social Security Administration, 358, 379-380
Social Security Amendments, 300
Social Security Old Age Benefits, 330
Social statics, 75
Social structure, 92
Society for Applied Sociology (SAS), 53, 55, 56, 68,
70, 404
Society for College and University Planning, 171
Sociocultural contexts
emotion relationship to, 93, 95-97
language relation to, 93, 94-95
Sociocultural themes, 104
Socioemotional artistry, 101
Socioemotional assessment, 93-97, 420
Socioemotional disorders, 97-100
Socioemotional journals, 109-111
Socioemotional re-creation, 91, 100-102,420
case study of, 105-107
Socioemotional self, 93, 94
Socioemotional understanding, 91, 101, 107,420
assessment of, 93-97
case study of, 105
Sociological imagination, 76
Sociological Practice, 400
Sociological Practice Association (SPA), 53, 55, 56,
397, 398, 400, 403, 404, 406. See also Clinical
Sociology Association
Sociology, 5-7
Sociology of emotions, 101
South Africa, 18
South Carolina, 384, 385
Southeast Women's Employment Coalition, 344-345
South Korea, 201
Soviet Union, former, 18, 354
SPA. See Sociological Practice Association
Specialty areas for sociologists, 400-401
Spencer, Herbert, 4
Spiritual communities, 153
436 INDEX

Spousal support, 213 Task forces, 159

SSI. See Supplemental Security Income Tax cuts, 368
Stable coalitions, 122-123 Teachers, clinical sociologists as, 389, 399, 400
Stakeholders, 236, 249, 254 Teaching-Family Program, 272, 273
Stalking, 314 Technical assistance model of social policy, 254
Standard model, 27 Technical experts, 389
Standards for evaluation, 228 Teenage pregnancy, 371, 374. See also Illegitimacy
Stanton, Elizabeth Cady, 315 Telecommunications technology, 83
State v. Oliver, 315 Telles, Joel, 235f
Statistical controls, 244 Temporary Assistance for Needy Families (TANF),
Status, 9, 134, 170, 172 230, 374, 380, 382, 383, 384, 385
Status equality, 25, 40 controversy over, 386-387
Steering committees, 159 provisions of, 375-379
Stepfamilies, 83 Tennessee, 309
Stock market, 366 Termination
STOP Violence Against Women, 313, 318, 319-321 of clinical relationships, 44
Stories, community, 152, 160 of group work, 145, 148-149
Stress, 87,96, 107, 371 Tertiary prevention, 269
Structural functionlism, 356, 412. See also Texas, 275, 384, 385
Functionalism Therapeutic alliance, 24-25
Structural inequality, 355 Therapy groups, 134, 136
Structuralism, 119 Thomas, W. I., 79, 92, 93, 412
Structural models, 330 Thrift Food Plan, 383
Structure Tibet, 18
family. See Family structure Tight coupling, 181, 182
group, 133, 141 Time series research design, 245
Structure of Magic, The (Bandler and Grinder), 48 Title IV of Violent Crime Control and Law
Structure promoting activities, 21 Enforcement Act. See Violence Against Women
Structuring approaches to mediation, 214 Act
Studies in Social Psychology in World War II, 4 Title VII of the Civil Rights Act of 1964, 332
Substance abuse, 213. See also Alcohol abuse; Drug Tracking
abuse classroom organization system, 332
Substantive equity, 294 family systems technique, 124-125
Subsystems of family. See Family subsystems Tragic frame, 211, 212b
Suicide, 87, 267-268, 270, 372,415,419 Training, 38, 49-50
Summative evaluation, 240, 242 Transactional patterns of families. See Family
Superpredators, 18-19 transactional patterns
Supplemental Security Income (SSI), 375, 377, 378, Transcultural practices, 278
382 Transformation approach, 337-338
concerns about program, 387 Transformative mediation, 202-203
provisions of, 379-381 Trans-situational roles, 30
Support groups, 134-135, 136 Treatment groups, 134, 140
Supreme Court, U.S., 62, 64, 317 Triangulation, 122, 127, 128
Survey of Income and Program Participation (SIPP), Trist, Eric, 411
362-363, 365t Trivializing, 103
Surveys, 83-84 Truman, Harry, 300
Sweden, 295, 361 Trust, 24, 144, 210
Symbolic interaction, 47, 92, 160, 166, 211 Tufts University Center on Hunger and Poverty, 385
Systematic assessment, 228 Typification, 315
Systematic assignment research design, 244
Systems perspective, 339, 340, 341 Underclass, 357
Systems theory, 115 Underemployment, 330
Szasz, Thomas, 77 Undergeneralization, 98, 103, 107
Unemployment, 330, 333, 354, 357, 372, 386. See
Taboos, 147, 148 also Employment
TANF. See Temporary Assistance for Needy Families Unemployment compensation, 382
Task Force on Community Preventive Services, 275 Unfreezing, 277
INDEX 437

Unintended consequences, 78 Welfare reform (cant.)

United Nations, 262 principles of, 374
United Way, 155 successes and failures of, 384-386
University of Guelph, Canada, 257-260 Welfare-to-work (WTW) principle, 372-373, 375
University of Kansas, 272 White privilege, 328-329, 340
Urban areas, 330-331, 385 Whites
U.S. v. Morrison, 317 domestic violence and, 314
Utah, 218 healthcare equity and, 303, 304, 305
poverty and, 366, 370
in public schools, 187-188
Value free sociology, 4, 7, 412
Wholeness of family system, 115
VAWA. See Violence Against Women Act
Whyte, W. H., 171
Vendor payments, 386
Whyte, William Foote, 4
Victim-offender mediation, 205, 219-221
Williams, Robin, 4
Victim Services Manhattan Mediation Program, 213
WIN. See Work Incentive Program
Victim-warriors, 215
Wirth, Louis, 4, 8, 93, 396, 412
Videotaping, 42
Wisconsin, 221, 384, 385
Violence
Withdrawal, 104
domestic. See Domestic violence
Women
preventive programming and, 267-268
clinical relationships and, 41
in schools, 217, 253
domestic violence and. See Domestic violence
against women, 83
healthcare equity and, 303
youth, 18-19,270-273
homelessness in, 282
Violence Against Women Act (VAWA), 313, 317-318
households headed by, 358, 361
Vision 95, 258
violence against, 83
Volunteers in Service to America (VISTA), 376
violence committed by, 271
Voucher payments, 386
Women's Coalition, 318
Vulnerable populations, 61-62
Women's movement, 308, 315
Worker ownership, 85
Wang Yang-ming, 9 Work Incentive Program (WIN), 374
Ward, Lester, 11-12 Work phase of group work, 146, 147-148
War on Poverty, 185, 229, 300 Workplace, ethics in, 67-68
Washington (State), 221, 384, 385, 386 World Health Organization, 262, 274
Washington, D.C., 222 World level of intervention, 16, 308
Watergate crisis, 301 World War I, 298
Wealth, 368-369 World War II, 229, 300
Weber, Max, 4, 170
Welfare reform, 62, 230, 354, 355, 372-387 Yale University, 4
critical efforts in legislation, 375 Youth violence, 18-19, 270-273