Living with and living within: Visions of ‘environment’ in contemporary social work

Introduction

Social work’s commitment to a person-in-environment perspective has been its hallmark, the feature that has distinguished it from other helping professions. Yet the definition, clinical utility, and operationalization of ‘person-in-environment’ have been inconsistent and poorly conceptualized, shifting with changes in the cultural climate and with the profession’s periodic efforts to redefine itself (Rogge and Cox, 2001), sometimes central to practice and at other times marginalized within a more psychological paradigm. While some scholars maintain that individual and environmental orientations operate interactively and that social work’s role is, and has always been, to intervene at the point of interface (Buchbinder et al., 2004; McLaughlin, 2002), others believe that ‘due to personal preferences and theoretical biases, almost all clinical social workers concentrate more intensively on either their clients’ intrapsychic states or the difficulties created by their environments’ (Alperin and Hollman, 1992: 96). This makes sense, Alperin and Hollman assert, since no single practitioner can be an expert in all models and a choice is always necessary (Meyer, 1983). Emphasis on environment thus varies by individual practitioner, as well as by cohort and era.

‘Ambivalence, disagreement and confusion over what person-in-environment means, what it should mean, and how it is implemented in practice are at the heart of contention over whether this elusive concept is, or should be, a central tenet of the social work profession’ (Rogge and Cox, 2001: 48). Those in favor of person-in-environment as social work’s signature concept maintain that it promotes more holistic assessment; those opposed say it is too broad a notion to guide practice. And yet, despite a lack of consensus about what the terms ‘environment’ and ‘person-in-environment’ include or denote, the environmental perspective has remained the base from which the profession has steadily evolved (Janchill, 1969), the ‘conceptual umbrella’ beneath which all clinical social work takes place (Meyer, 1983) and a pillar of every contemporary theory of human behavior (Goldstein, 2009).

Exactly how elements of the environment contribute to problems or to the process of change remains elusive, however. This has been a core difficulty for social work. Without being grounded in a theory of change, person-in-environment is simply an assumption or value position and cannot offer a clear theoretical contribution to understanding human behavior or ameliorating human suffering. In consequence, social workers find themselves embracing theories of change imported from other professions. At the same time, as the 30 clinical social workers who took part in this study attest, environment does play an essential role in their work.

Background

The notion that human development and behavior are shaped by multiple, nested, interacting environments was first articulated by developmental psychologist Urie Bronfenbrenner (1977, 1979) whose ecological systems theory has been applied across professional domains from psychology to education. Bronfenbrenner proposed five layers of environment, each embedded in the next: microsystems, mesosystems, exosystems, macrosystems, and chronosystems. The first four represent increasingly inclusive levels of socio-cultural influence, each with roles, norms, and rules that affect psychological functioning, patterns of interaction, and life course transitions. The fifth, the chronosystem, represents the evolution of these systems over time and is reflected in differences between historical cohorts.

Similarly, Germain and Gitterman (1980), credited as the architects of the person-in-environment perspective within social work, conceptualize environment as interwoven layers of social and physical context. The social environment encompasses human relationships from dyads and social networks to bureaucratic institutions and social systems such as geographic neighborhood and cultural community. The physical environment includes the built environment, the natural environment (geography, climate, events such as a hurricane or earthquake), and the economic-political environment (war, recession, exposure to terrorism, the impact of the media, and so on). These elements and systems, in dynamic interaction, affect and are affected by human lives.

This is a broad definition, situating the individual in nested and overlapping contexts that change over time. From this perspective, all problems, even if related to internal disorder, exist and need to be viewed in transactional or adaptive terms; thus, the onus for change, like the source of a problem, does not rest on the client alone. An ecological approach allows a more value-free exploration of the relational determinants of behavior through analysis of interacting systems (Janchill, 1969) and settings, each comprised of physical place, historical time, participants, social roles, and activities (Bronfenbrenner, 1977). This notion of simultaneous, mutually interacting components underscores the need to conceptualize the person-environment relationship as more than a simple interface. Viewed dynamically, it is a web with hubs, linkages, intersections, patterns of communication, and pathways for the exchange of social capital. People thus live ‘within’ their nested environments, as well as ‘with’ the cumulative effects of previous environments.

Perhaps the most comprehensive attempt to define person-in-environment (PIE) was the PIE system developed in the US by Karls and Wandrei in the 1990s. PIE grew out of a task force convened by the National Association of Social Workers (NASW) that identified ‘social well-being’ as the appropriate basis on which to build a social work classification system – as a counterpoint, perhaps, to the increasingly dominant taxonomy of the Diagnostic and Statistical Manual of Mental Disorders or DSM, shaped around internal pathology. Viewing environment as the product of forces within and between social institutions, and human behavior as the result of this interaction, the model relied heavily on social role theory. Role fulfillment served as the unifying construct for capturing the impact of environment on an individual and cataloguing problems in social functioning (Karls and Wandrei, 1992).

As its authors note, PIE does not produce a ‘diagnosis.’ Rather, it offers a system for describing and classifying problems that adult clients bring to social workers. It yields a portrait of a client’s difficulties by delineating interpersonal, environmental, mental, and physical issues in a four-factor system. Factor I addresses problems in social role functioning, defined as the performance of activities of daily living required by culture or community for the individual’s stage of life. Factor II, problems emanating directly from the environment that affect a person’s social functioning, includes difficulties with employment, education, legal/judicial systems, health/welfare, community participation, and social networks. Factor III refers to mental health and Factor IV to physical health.

PIE remains the most detailed model to date, yet has never been widely used. Part of the reason for this is that its categories are not linked to the types of assessment or treatment goals required for insurance billing in the US – despite Karls and Wandrei’s optimistic prediction that ‘in the future, when the third party reimbursement system is less oriented toward the disease model, it is hoped that practitioners will be reimbursed for services provided to ameliorate social role and environmental problems’ (Karls and Wandrei, 1992: 85). In addition, there has been no empirical research to validate its constructs or link them to interventions. Overall, PIEs clinical application has been limited since social workers have other templates they must utilize to meet agency or insurance requirements, and PIE constructs such as role functioning do not necessarily capture the reasons that clients seek help. Thus, even though environment clearly ‘matters’ to social workers, and even though the profession embraces environment as its signature concept, it has never been the primary organizing construct for clinical practice.

Still, person-in-environment has had an ongoing place in social work literature. To explore how environmental concepts have been used in the professional literature, Rogge and Cox (2001) conducted a content analysis of 40 social work journals over the 10-year period from 1987 to 1996. They found that specific manifestations of the person-in-environment construct were rare, however, occurring in only 7 percent of the abstracts reviewed. Approximately one-third of the references used the concept in broad, non-specific ways, lending credence to the view of Wakefield (1996) and others that person-in-environment is too broad and vague a notion to be prescriptive. ‘This flexibility constitutes one of the construct’s most important beneficial attributes or serious limitations, depending on one’s point of view.’ (Rogge and Cox, 2001: 64).

Weiss-Gal’s study (2008), approaching person-in-environment from the perspective of social work practitioners, compared the extent to which environment was part of Israeli social workers’ professional ideology with the degree to which they actually employed this approach in practice. Based on the responses of 400 social workers from a wide range of agencies, results pointed to a clear disparity between ideology and practice. Although the person-in-environment approach was strongly reflected in respondents’ stated views of the goals and activities of the profession, it was scarcely evident in their work. Ideologically, they endorsed both individual and society as social work domains, yet in practice the individual focus dominated.

The source of this disparity may lie in the fact that the ecological approach is not a practice model and does not offer any specific guidelines for clinical activities such as differential diagnosis, engagement, or facilitating change (Goldstein, 2007; Meyer, 1983). Nor does it offer a theory of why or how the person and environment affect each other (Wakefield, 1996). ‘Although the ecological and systems perspectives have helped social workers orient themselves to environmental factors influencing clients’ lives, the abstract nature of these perspectives may fail to promote practitioners’ understanding of the precise activities and experiences required for change to occur’ (Cameron and Keenan, 2010: 68). For the person-in-environment perspective to be useful as a guide for practice, pathways and relationships need to be isolated to show how specific aspects of the environment contribute to change within the treatment relationship, just as relationships need to be demonstrated to show how aspects of the environment led or contributed to the presenting problem.

Bronfenbrenner actually proposed a research agenda more than three decades ago (1977) to investigate the impact of specific ecological elements on human development. He suggested a series of ‘rigorously designed experiments, both naturalistic and contrived’ (p. 513) – i.e. by random assignment to experimental design groups, or by working with naturally occurring groups that differ along dimensions of interest – to explore the changing relationships between person and environment through progressive accommodation over the life span. ‘Systematic contrast between two or more environmental systems or their structural components, with a careful attempt to control other sources of influence’ (p. 517) could, he believed, illuminate the role of environmental elements in development.

As Wakefield (2005) points out, however, establishing explanatory (theoretical) connections is not so simple. The notion of equifinality (different causes can lead to the same effect) means that a symptom can be a result of a ‘true’ mental dysfunction in the medical or neurological sense or an attempt to cope with an adverse environment. Yet, as Kirk and Hsieh demonstrated in their 2004 study, disorder and context are intertwined, and information about social context has a marked effect on diagnostic choice. Clinicians in their study presented with a vignette that only included behavioral symptoms gave more severe diagnoses than clinicians who were also given information about the individual’s circumstances. Contextual knowledge helped to explain and ‘soften’ the behavior, leading to a milder DSM diagnosis and casting doubt on the assumption that diagnostic acuity is primarily a matter of matching observed symptoms with DSM criteria. as the medical model implies.

Kirk and Hsieh’s study raises the question of how much information about context is really needed in order to arrive at an accurate diagnosis. In an era dominated by managed care – where approved interventions are often limited to those that have demonstrated their efficacy for a specific diagnosis – diagnostic accuracy is critical for making helpful treatment decisions. To diagnose without knowledge of context puts client and clinician at risk of misdiagnosis and subsequent mistreatment. Understanding how much information, and what kind of information, clinical social workers actually elicit and incorporate into their work is thus of vital importance.

Methods

This was an exploratory, inductive study within a realist epistemology exploring how clinical social workers think about, experience, and navigate two distinct worldviews: the diagnostic perspective that focuses on internal psychiatric disorder, and the person-in-environment perspective that focuses on the individual in context. The purpose of this study was to explore the following open-ended questions:

How do clinical social workers view, experience, and utilize the diagnostic perspective, given the dominant role of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in contemporary clinical practice?

A qualitative approach was selected as the best way to access participants’ subjective meanings in rich detail; within the qualitative paradigm, thematic analysis (Boyatzis, 1998; Braun and Clarke, 2006) was chosen for its blend of flexibility and precision. Thematic analysis is an inductive method for identifying, analyzing, and reporting patterns that emerge directly from the data, without the use of a priori concepts. Unlike grounded theory, it allows a researcher to begin from a bounded, theoretical question as the starting point for identifying significant concepts, patterns, and relationships. An iterative approach was sustained throughout the study, with data collection and analysis taking place in a simultaneous, mutually interactive fashion as a check against simplistic or premature conclusions.

The sampling frame for the study consisted of members of Westchester County, New York chapters of two professional social work organizations, the National Association of Social Workers and the New York State Society for Clinical Social Work. Volunteers were solicited through presentations and via email to the organizations’ electronic listservs. The final sample consisted of 30 clinical social workers from a range of backgrounds. Nearly all had worked in a variety of settings during their careers including comprehensive social service agencies (47%), psychiatric hospital inpatient and outpatient units (37%), community mental health clinics (13%), residential treatment centers (10%), and public schools (10%). At the time of the interview, more than half (57%) were in private practice only; 20 percent were in clinic, hospital, or agency practice only; another 13 percent worked in prison or school settings, and 10 percent had a small private practice in addition to other work. Although it was anticipated that practice setting might affect participants’ views of the role of these two perspectives (depending on whether a psychiatrist or senior social worker was in charge, whether inter-disciplinary teams were utilized, etc.), in fact there were no significant differences between settings.

Demographically, participants resembled the American population of social workers (Center for Health Workforce Studies & National Association of Social Workers, 2006). Respondents were 87 percent female, 80 percent white, with an average of 22 years of experience; in the NASW survey, respondents were 81 percent female, 85 percent white, with an average age of 49 (although data about age was not collected for this study, years of experience can serve as a rough proxy). Overall, this was a group with a great deal of professional training: two people had doctorates in social work, seven had advanced training in psychodynamic or psychoanalytic therapy, four had a second master’s degree in a field such as education or psychology, and six had other formal post-masters training. All, however, stated that they had been taught about person-in-environment during their MSW coursework.

Informed consent was obtained from all participants in accordance with Fordham University’s Institutional Review Board.

Each participant took part in an individual one-hour, face-to-face interview during the Fall of 2010. In order to guard against an implication that one perspective was more important than the other, an alternating protocol was used, with half the interviews beginning with questions about use of psychiatric diagnosis and the other half beginning with questions about person-in-environment. Follow-up interviews were conducted approximately two months later by telephone with one-third of the participants, selected to capture demographic representation. These second interviews served as a member check to review preliminary findings for authenticity and trustworthiness, and also as a means for collecting additional data about emergent themes and alternative viewpoints. Finally, a peer review was conducted with a similar group of clinical social workers, approximately one-fourth of whom had been participant. This peer review took place in group format at a Clinical Social Work Society meeting; since participation was confidential, no one who attended this meeting knew who had or had not been previously interviewed and thus peer feedback was given ‘blindly.’

Interviews were recorded, transcribed, coded using hyperRESEARCH, a qualitative data analysis program, and analyzed thematically. A three-step coding procedure was employed: in vivo codes were identified within individual interviews; codes were collapsed across interviews, sorted, and renamed into groups; and then codes were clustered into themes. Both codes and themes were re-checked by a repeated return to the raw data, in both its original (audio) and transcribed forms. This iterative process helped to guard against cognitive heuristics of availability and anchoring that can cause a researcher to ‘see’ data only in light of earlier categories. Authenticity and trustworthiness were also addressed by a periodic return to the literature and by memo-writing and journaling that provided an audit trail to document questions, choices, hunches, and observations.

Given the researcher’s previous work critiquing the assumptions and categories of the diagnostic perspective, special effort was made to unpack and remain mindful of potential bias against DSM diagnosis, including a ‘hidden agenda’ or secret hope that findings would support this bias and show that participants did not find diagnosis as valuable as a more contextualized approach. At the same time, since participation was confined to clinical social workers, excluding those solely engaged in casework or community organization, there was a potential skew in the other direction toward respondents who relied more heavily on psychiatric diagnosis, a requirement for service and payment in most settings, than on ecological factors. Both researcher positioning and possible respondent positioning were considered throughout the research process.

Study limitations included the voluntary nature of the sample and the time-limited data collection. A voluntary sample, by its nature, may exclude those with more neutral or moderate views who may feel less motivated to dedicate time for an interview; the sample was also limited to one locale in the urban northeast, potentially affecting generalizability. For a qualitative study, of course, representativeness and generalizability are not of primary importance, yet it is important to know if certain viewpoints have been omitted – if voices have been silenced, disconfirming evidence overlooked. While there is no way to know for certain if this was the case, a request at the end of each interview for other ideas and experiences did help to elicit additional data, often leading to ‘but on the other hand’ comments.

The second limitation of the study was its time-limited nature. Data constituted a snapshot taken at a single moment, potentially favoring participants’ most recent experience and not fully capturing their overall experience during the course of their careers. An important component of the interview, however, consisted of asking participants to compare their work across settings and to think about how their attitudes may have changed over time.

Findings

Participants embraced a broad definition of environment, spanning diverse elements from political climate to the culture of poverty, life stressors, power hierarchies in the workplace (or, conversely, the experience of chronic unemployment), personal crises, relational support or isolation, situational triggers and ruptures, and the overall effects of culture, geography, and community. Reminiscent of the ecological layers proposed by Bronfenbrenner (1979), participants’ notions of environment included proximal groups such as family, school, and peers; contextual, physical, and socio-cultural elements, both formal and informal; and large-scale enduring factors such as poverty, ethnicity (identity, heritage, and values), and political structures.

Environment was also seen as something existing over time and shaped by time, the cumulative effect or enduring totality of ‘what people have had to bear’ and how they have survived. This ‘vertical’ or historical sense of environment included both family history (how the person was raised, events in the family narrative such as loss or transition, how the family coped and adapted at times of crisis or change, often going back to earlier generations and culture of origin) and personal history (salient events and relationships, presence or absence of models and mentors, traumas or attachment ruptures, experiences of resilience).

I will ask them, where did your mother grow up, where did your father grow up; what was their life like growing up – the history of the generation preceding the current one. And it helps not only the practitioner, but it helps the client understand a little bit more, have a little bit greater tolerance for the idiosyncrasies that they’re struggling with.

Any adversities that happened to the parents, any adversities that happened to the child, and what has been the quality of the relationships between adults and children, parents and child, siblings, and extended family.

All the ingredients of a client’s life are important, and especially the ingredients involving the close people in their lives, the people they lived with, the people whose influences were important to them. Who in their history helped them get through the chaos? Who populates their life in a way that they find nurturing and sustaining? Who’s in their life that they find toxic and denigrating and damaging?

Components of environment can be viewed as a two dimensional grid, along one side a value dimension of positive and negative elements in a client’s current situation (which he or she lives ‘within’), along the other a temporal dimension of enduring and situational features carried into the therapeutic encounter (which he or she lives ‘with’). Negative aspects – which can be enduring (historical and cumulative) and/or situational (occurring at the present moment) – include chronic poverty, exposure to violence, crime, drugs, or discrimination, and awareness of the economic gap between oneself and others, as well as specific situational barriers or stressors such as events at school or workplace and disruptions in relationships or housing. Positive aspects include ongoing social support, a sense of belonging or feeling safe, and availability of community resources, as well as specific mentors, opportunities, and experience of connectedness. Although this image may help to organize an array of diverse elements, it is important to remember that these elements are also overlapping and concentric, salient for varying periods of time, and variable in their meaning and effect on an individual.

Major categories of environment for participants were neighborhood, housing, cultural and religious resources, work or school, and family. Housing included the use of space (crowded or unsanitary conditions, lack of privacy, in turn affecting patterns of family interaction), stability or instability (fear of eviction, frequent moves), and setting, including opportunity for play and exercise.

Whether they have their own bed, whether they share a bed. Does the family sit around the kitchen table, or does everybody just take food from the pot on the stove and eat in front of the TV set in their room? Those are all factors you have to consider when you’re trying to understand what’s going on.

What’s their relationship with how they store food in their home? What’s their refrigerator look like? What books do they have, and do they read them or just kind of accumulate them? What’s their closet look like? Orderly or very messy? What’s the relationship between chaos and order, and the different ways they’ve tried to save themselves from chaos or order or disorder?

Culture, another component of environment, referred to customs, holidays, rites of passage, folkloric beliefs about illness and health, the impact of immigration and stage of acculturation, the role of superstition and ritual, and the presence or absence of a local religious or ethnic community. For adults, work environment included the physical setting, power dynamics, discrimination or harassment, pressure from childcare needs, financial stressors. For children, a primary environment was school: peers, friends, teachers, educational and recreational resources. Family environment included relationships with members of the immediate and extended family; conflicts, triggers, patterns of coping and communicating, models or lack of models; the family’s lifestyle, level of structure or chaos, order or disorganization, the capacity to adapt and nurture one another, ways of having fun or solving problems, the role of food (or food stamps); attachment and communication; child care, mobility, stories, secrets.

I really want to know how they live and what they do and when they have good times and if they’re connected, how they’re connected to the community they live in. And that means everything from the sports they play to what they watch on TV, if there are religious affiliations, what their supports are in terms of who’s out there, who do you have taking care of your kids?

These elements created a ‘laundry list’ of factors that might matter, however, rather than a clear conceptualization of how they mattered. This echoes Rogge and Cox’s conclusion (2001) that environment tends to be conceived by social workers in broad, flexible, non-specific ways and that ‘either the perspective is so ingrained in social work practice that there is no need to name it, or that it is much less a guiding perspective than the profession may claim or believe’ (p. 64). Some authors such as Wakefield (1996) maintain that environment, as a concept, is simply too vague to be useful for explanation, prediction, or intervention planning. This study appears to support Wakefield’s views: while participants agreed that clients needed to be seen in their full life context. This was for the sake of greater empathy and understanding, not as a guide to practice.

At the same time, participants felt that environmentally driven distress and dysfunction should be seen as legitimate needs without having to be couched in the language of mental disorder. They felt pressured and compromised by having to find a psychiatric term to justify helping someone with relationship issues or problems in living, although they often struggled with distinguishing problems exacerbated by the environment (yet possibly neurobiological in origin) with problems created primarily by environmental stressors. While authors such as Wakefield (2005) emphasize the importance of distinguishing ‘true’ mental disorders from problems caused by a ‘normal’ response to a difficult environment, participants in this study saw the two kinds of distress as complexly interwoven. Sometimes, but not always, they were able to distinguish situational from internal disorder by history and chronicity; nonetheless, they felt environment played a role in the manifestation and trajectory of all disorders, even those of organic origin.

Participants identified three core benefits of using a person-in-environment approach:

Thinking about the person in context brings a fuller, deeper understanding. Participants considered the ecological perspective to be the essence, core, heart of social work, and believed it was not possible to meaningfully separate a person from his or her context. Environment widened the lens, integrated aspects of the ‘whole picture’ or ‘whole puzzle,’ fostered empathy, led to a richer understanding of why the person was coming for help, how the distress had arisen, what was maintaining it, what tools and supports might be available, and what the problem meant to the client as an individual rather than as a member of a category. Excluding environment would ‘do the person an injustice’ and prevent a true assessment.

It helps me get closer to working with that person fully. It tells me the context in which those symptoms are arising. I want to know where this person is in their life, get a sort of 360 degree picture. I don't think you can meaningfully understand anyone without understanding the neighborhood they live in and the family they live in and their economics. It’s just not seeing the whole picture.

You’re a product of your environment, whether you like it or not. So to artificially separate them from their environment is against what we know.

Understanding where and how people grew up also brings insight into the source of their affective style and beliefs about themselves, others, and the world.

We do a lot of talking about belief systems that you grew up with, and how the environment you grew up in shaped you to have a certain view of the world, and people, and yourself, and how did that get you where you are today?

Sometimes it’s an effect based on what their family lifestyle is. They come from a great extended family, or they come from a family where the grandparent is raising many siblings and cousins, and there’s a lot of conversation and nobody really listens to each other, and they all cut each other off, and that characteristic is brought to the learning environment, and that’s the way the child behaves.

The environment can exacerbate or be the cause of the problem. Participants noted that an individual’s struggle or dysfunction might be a reaction to a pathology-inducing context, rather than the result of internal disorder, and felt it was important to avoid medicalizing issues that were actually psychosocial.

I’m thinking of a client who was under a lot of stress because, typical of the recession, her husband was out of work, and everything was falling on her, the whole financial burden. And then things that he was doing were adding to her stress, and they weren’t communicating about it, but it’s not pathological, they don’t really have a diagnosis per se, they just have a lot of outside stressors.

Changing the environment can be part of the intervention. For some children, finding a more appropriate school setting can help to alleviate their presenting problems; for troubled adolescents, the ‘milieu therapy’ of the residential treatment center is itself the primary intervention; and for some adults, adjusting the environment can provide opportunities for what may have been missed or distorted during development.

I’m thinking in terms of a context, a current context of family, of friends, of school, of work – or the absence of school, the absence of work or the absence of family and friends. And to what extent can we recreate in our program, an environment that would support the developmental gaps or the arrests or limits, limitations, that this person is manifesting now in their adult life.

There were also limitations to the person-in-environment approach:

Emphasizing the environment can lead to false generalization. Several participants felt it would be a mistake to place too much emphasis on the environment. In their view, environment was not the major determinant of a person’s dysfunction; temperament, resilience, luck, and nurturing could compensate for an oppressive or deficient environment, and making inferences based on environment could lead to stereotypes and unwarranted generalization. They did not see environment as predictive, given the plethora of other factors, and did not find it useful for formulating explanations or interventions.

Environment is a determinant, but not the total determinant. If we look at any proportion of the population, some kids are not going to make it. I mean, this is just simple math. Some kids are, and then other individuals are going to have something about them that will make them susceptible to falling off the deep end or becoming involved in negative behavior or detrimental behavior. But it’s not just their environment.

Environment does not have much weight as a clinical concept. For many, environment did not have the same clinical power as psychiatric diagnosis, internal structure, or psychodynamic principles such as transference, mirroring, and dyadic attunement for helping them understand what a client needed and what to offer as a direction for work.

Person in environment just doesn’t resonate as much for me. It’s pertinent but it’s not on par with diagnosis in that it doesn’t have equal amount of power or weight in helping a therapist understand what to offer and how to help. It’s there but it doesn’t provide as much of a guide.

I’m cognizant of it but it doesn’t capture the feeling of therapist empowerment, the therapist feeling like a source of help and change through what he or she brings.

For most, environment played a more central role in assessment and a more peripheral role in intervention. While information about environment contributed directly to understanding the nature and meaning of a client’s problem, it shifted to the background during the treatment process, providing a context for change but not serving as an actual mechanism of change. The change agent, for these clinicians, had to do with the therapeutic relationship and the growth of a new understanding. This may be due, at least in part, to the nature of the sample: had caseworkers and community organizers been included, a more direct role for environment may have emerged.

Discussion

As this study reveals, ‘environment’ has both broad and specific meanings for contemporary social workers. It captures horizontal (current) and vertical (historical) dimensions that include situational triggers as well as cumulative adversity and family narrative – ‘what people have had to bear and how they’ve survived.’ In the moment of the clinical encounter, the client is situated, as it were, at the intersection of the horizontal and vertical axes, a point that is always in motion, always changing. Clients are living ‘with’ and carrying their entire history, yet also living ‘within’ nested and overlapping contexts that comprise their present situation. Together, these contexts create a panorama, a ‘360 degree picture’ of the person’s life, necessary for effective work. Separating out specific influences and understanding their relationships, patterns, and trajectories is elusive, however. There are simply too many, their permutations too complex. Although participants felt strongly that environment ‘mattered,’ exactly how it mattered was unclear.

One line of inquiry for identifying pathways through which environment exerts its influence may be resilience research, which has identified clusters of contextual variables that promote positive adaptation over the life course, similar to what Bronfenbrenner (1979) proposed. ‘These potential protective influences stem from multiple levels of the client’s context … factors external to the individual, including aspects of their families and care-giving environments, and characteristics of their wider contexts’ (Tedeschi and Kilmer, 2005: 232). Assessment can thus take into account aspects of ecological context, both formal and informal, that can be incorporated into the intervention in order to facilitate change, suggesting a way to develop treatment plans based on an ecological model that links clients to resources and systems associated with resilience. Though not yet a true ‘environmental theory’ capable of explaining and predicting specific relationships between people and their contexts, it is a promising beginning.

More research is needed, however, if social work is to develop and test its own theory of how individuals are shaped by their environments and then, by applying identified theoretical relationships, how environmental change can help to alleviate dysfunction. Such a theory would serve to clarify what social workers can offer that other professionals cannot.

As a social worker, what do I have to offer? I don’t do testing. I don’t offer medication. So in the absence of powerful tools like that, I have to use the skills and experience and knowledge I have. And in many ways it’s intangible. It comes from the relationship I’m attempting to create, and in that is the channel or the conduit through which I’m going to come to understand the person and know them and work with them and help them.

I see myself as part of the environment if somebody actually is receptive to therapy, to working together to develop insight and, in a safe place, visit the terrible sorrows and very painful places that made their lives incline in a certain way.

What I’ve been able to offer her is just being in her corner for a lot of significant life circumstances and helping her to make different kinds of choices in ways that she hadn’t before – to be part of the journey, and to even participate with her in it.

These clinicians are speaking about a uniquely ‘social work’ place that intersects internal and external worlds. Even the language they use is spatial: the clinician offers a safe space, a corner, a channel, so clients can revisit painful places in the landscape of their lives. The social worker provides a holding environment where the client’s past and present can be contained. The client carries a cumulative life story with him or her, while existing within a multi-faceted present that also includes an ‘intangible’ therapeutic space where client and social worker can meet.

This conceptualization of environment, connecting ecological and psychodynamic perspectives, offers a powerful vision for clinical practice. It moves beyond an outdated, static conception of environment as buildings and streets, conveying instead a dynamic relational environment in which the client is held, contained, and supported. This new vision of person-in-environment – or, more accurately, persons-in-environments, since worker and client co-create and co-habit a therapeutic space penetrated by and penetrating their separate environments – captures the essence of a uniquely ‘social work’ approach to alleviating human suffering. As the ‘hallmark’ or ‘central tenet’ of the profession, person-in-environment is also the conceptual basis for field education, now identified by the US Council on Social Work Education as the ‘signature pedagogy’ for preparing entrants to the profession.

Environment has, in one way or another, always been the discipline’s primary and distinguishing feature. Perhaps it is time for social work to take the next step and make theoretically explicit what its practitioners have long been doing.