Advances Vol. 4, No. 2


i

Editorial

Is It Possible to Be a “Radical Clinician”?
James G. Daley

SocialWork is a profession that dreams of radical change. A noble, targeted effort
that creates housing, expands medical coverage, changes public opinion on an
issue, reaches the forgotten, embraces the unacceptable, and perhaps even rec-

ognizes our profession as the stealth catalystwith aheart.The radical dreams call to us
like sirens sitting on the rocks of reality.We are drawn by our need, hungering for the
grand event.

Therehavebeenconcerted efforts tomake thedreamcome true. Someauthorshave
advocated for a specialty called radical social work, most schools of SocialWork have
concentrations that offer a “macro practice” choice. Authors have reminded us that all
of social work is “political.” Students face a fork in their educational path where they
oftendecidebetween“clinical” and“macro.” Some students assert from thebeginning
the path they will choose. Courses often have content that remind students of their
need to advocate for change, not to“settle” for clinical adaptation for issues that reflect
social injustice. The radical or macro camp share stories of program development,
political change, and wrongs exposed that excite students. These endless efforts rein-
force the importance of radical change as amandate of SocialWork.

SocialWork is also aprofessionheavily invested in the effective clinical interventions
that directly help our clients with psychosocial problems. Legends of SocialWork stu-
dents and graduates strive to learn the trade and take great pride in offering ethical,
evidence-based practice with clients who are in great pain and confusion. I was a cli-
nician for 21 years and savor thememories of families who presented initially in pain,
anger, and confusion but were transformed into a nurturing, empowering support
system. I recall the entrenched client who finally committed to recovery. As a teacher,
I share my experiences in class. Each case, successful or heart wrenching, is part of
SocialWork in action. Each story shared in class further ignites the passion in students
to help. The clinical camp continually strives to build better, clearer, more precise
methods for helping. I feel very comfortable as brethren of the camp.

Of course, there is nopure campof either view.Wemust be both advocate and inter-
vener. I have experienced this tug of war (clinical change and societal change) both as
student and faculty member and heard endless faculty meetings strive to balance the
two issues. I have seen some very creative faculty efforts to blend the issues. I believe
that we recognize this dual role. I suspect that we discretely (or boisterously) slip into
the camp that best feeds our passion. Students assert, “I justwant to be a clinician,” or,
“I could never work with clients.” They sift through the course offerings seeking the
content that fuels that passion. Macro change overwhelms some, clinical encounters
scare others. And, I think this self-selection is healthy. Neither choice is the exclusive
path to a productive career. Neither choice is “better” or “worse.” Each choice is a best
fit for the person.

So,whatdoes this discussionhave todowith the conceptof a“radical clinician?”The
two terms “radical” and “clinician,” when combined, seemweird.When you are a cli-



nician, youwork in an agencydefinedby rules, reimbursement policies, and the social
constructionof aperson inpaincalleda“client.”Payne (1997) eloquentlydescribes the
social construction of the client-social worker encounter.You are part of the “system,”
whether acknowledged or not. Making a diagnosis (either DSM or alternative frame-
work) commits the person/client to be part of a client-focused system. Supervision,
agency mission, and funding options are all mechanisms that reinforce clienthood
anda client-focused agenda. Social issues are distilled into interventionplans. Change
efforts are focused on resolving those plans. In other words, the clinician has a subtle
context to navigate in an effort to effectively help the client.

Can a clinician really be radical? Macro advocates firmly assert that the clinician is
tainted, even invested in the structure within which client issues are presented.
Radical change is best donebyoutsiderswhocan see the“real picture,” thewhole con-
text, and are not seduced by being part of the agency. Clinicians argue that they have
power within the agency, can develop programs, or change policies. Clinicians can
translate client need into agency-ese, so that new programs are more likely to occur.
Outside agitators have less credibility than an established clinician. Macro advocates
shout that agitation is needed and the agency should listen rather than wait for trans-
lation. And the argument goes on and on.

What would a radical clinician look like? I assert that the radical clinician would be
highly versed in effective intervention choices and able to provide appropriate care
that empowers and builds on the strengths of the client systems. The radical clinician
must first be credible as a clinician to have power and influence within the agency.
Clinical competence is a major currency in agency politics, though obviously not the
only skill valued. The radical clinician must be an effective program developer. You
have to have the ability to transform an idea or need into a viable program to know
what to do with a radical need. Finally, a radical clinician is sensitized to social justice
and connected to themacro advocates who can voice the unmet needs. Frankly, all of
these skills are a basic component of anMSWprogram.

In summary, an ongoing debate rages about radical change agents versus clinically
skilled interveners, whichmisses an important point. Each camp is a valuable place to
learn the arena forwhich students have a passion to learn and implement.There is no
“right” way to do SocialWork and each camp can be a partner in a jointly productive
endeavor. Radical clinicians are possible and can effectively challenge social injustice
and produce new programs tomeet client and societal need.We can all dream of that
magnificent social change but radical cliniciansmayhelp navigate us past the rocks of
reality into the safe bay of social justice.

References

Payne, M. (1997). Modern social work theory. (2nd ed.). Chicago, III: Lyceum Books.

ii