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Even social work—despite our unique brand of systemic, contextual
thinking—falls prey to the American tendency to polarize ideas, to go to
extremes. During my first year of social work graduate school, various
debates (concrete services versus individual treatment, ecosystems versus
medical model, community organizing versus psychotherapy) shaped my
belief that our profession has strayed from its original commitment to social
justice, vulnerable populations, and a person-in-environment focus. Yet I
continued to feel certain that, while I applauded community organizing and
case-to-cause advocacy, my talents and interests ultimately lay in casework.
That was when the cognitive dissonance set in: is it possible to specialize in
clinical social work without abandoning our profession’s mission and 
values?

I began to see that extreme positions preclude possibilities for social work
practice that draws upon sophisticated clinical insights and interventions yet
remains contextual and empowernment-based. For example, it is hardly use-
ful to demonize the medical model when basic knowledge of psychopathol-
ogy often sheds light on human behavior. On the other hand, it seems count-
er-productive to suggest that clients faced with multiple, interacting prob-
lems are best served by manualized interventions designed for clinical pop-
ulations. Another polarity: by renouncing casework altogether, proponents of
community organizing fail to recognize that “it might be necessary to pro-
vide skilled, patient interpersonal help to some families on a long-term basis”
(Halpern, 1999, p. 244). Yet when clinical social workers insist that advoca-
cy and concrete service provision are beyond the scope of therapy, they
rarely meet their clients’ needs. 

During my second year of social work school, I was lucky enough to
encounter a community-based family support center that offers a “third

TTHEHE FFORESTOREST ANDAND THETHE TTREESREES::
NNEIGHBORHOODEIGHBORHOOD-B-BAASEDSED CCLINICALLINICAL SSOCIALOCIAL WWORKORK

Erin Segal

Social work education gives lip service to systems-based, integrative
approaches to practice, yet the profession tends to create unnecessary

polarities between clinical practice and social work’s original commitment
to vulnerable populations, person-in-environment, and social change. The
author describes a model of community-based family services that bridges

this gap.



Columbia University Journal of Student Social Work Volume 1, Number 1
6

space” between polarities (Kemp, 2003). Like the early settlement houses,
the Center for Family Life provides comprehensive, non-stigmatizing,
neighborhood-based services: after-school arts programs for children, youth
development, summer camp, parent education, an employment center, an
advocacy clinic, and a program that meets families’ emergency needs for
food, clothing, and financial support. By organizing these components
around a core family counseling program, the Center also draws on the best
of contemporary professional clinical social work, thus attaining a “unique
combination of community rootedness and clinical sophistication” (Hess,
McGowan & Botsko, 2003). 

Instead of placing “bio,” “psycho,” and “social” aspects of clients’ expe-
riences side by side, social workers at the Center for Family Life seek inte-
gration, offering students a rich—and rare—representation of systems-based
practice that receives so much lip service in social work education. Not sur-
prisingly, the clinical program’s focus is not the individual, but the family.
By avoiding labels and prescriptive treatments, practitioners acknowledge
the uniqueness of each family member and minimize social distance
between themselves and families. Overwhelmingly, social workers believe
that their role is to support and enhance family functioning throughout all
phases of development. In refusing to differentiate between therapy and case
management, they honor the inextricable connections between environment
and psychology and recognize that therapeutic work (for example, modeling
or creating a holding environment) often occurs beyond the pale of psy-
chotherapy. Caseworkers keep abreast of social justice issues and participate
in advocacy efforts undertaken by the agency. Unlike therapists in tradition-
al mental health settings, social workers at the Center for Family Life count
on in-house resources—therapeutic groups, after-school programs, an emer-
gency food program, and housing subsidies—as they develop individualized
treatment plans.

This is not to say that counseling at the Center for Family Life survives
on service-brokering alone. Rather, it remains grounded in professional clin-
ical social work values and methods. All caseworkers hold Masters’ degrees
in social work. Journal articles and descriptions of continuing education cir-
culate freely at casework meetings. Staff members are articulate and
thoughtful as they discuss their work in terms of object relations, counter-
transference, the therapeutic alliance, group work theory, cross-cultural
issues, and so on. Yet interventions are not informed by an over-reliance on
a single theoretical perspective; instead, in the spirit of general systems the-
ory, the therapeutic process is flexible and open to creativity (Janchill,
1969). Such flexibility—along with the horizontal nature of the issues at
stake—hardly seems to lend itself to traditional methods of program evalu-



ation, which rely on neat, pre-determined outcomes. Nevertheless, a recent
evaluation suggests that children and families who take part in the Center’s
programs do indeed achieve positive changes (Hess, McGowan & Botsko,
2003)— a testament to the effectiveness of the Center’s staff.

I emphasize the accomplishments of Center for Family Life’s casework
staff to stress that these frontline workers are creative, thoughtful, competent
and kind. To me, it’s quite clear that clinical social work’s identity crisis—
call it “psychiatry envy” if you will—is part of a search for legitimacy in the
eyes of a society that undervalues our profession. Of course social workers
choose private practice, policy analysis, and program development over
community-based social services—note the differential in salary and pres-
tige! Yet unfortunately, our profession’s response to its identity crisis is a
retreat to polarities: at one extreme, repudiating the notion that social work
should incorporate elements of psychotherapy; at the other, relying all too
heavily on managed care’s short-term therapeutic prescriptions for alleviat-
ing human suffering. Instead of going to extremes, why not revitalize our
profession and support our frontline workers by sharing more examples,
more stories, and more dialogue about possibilities for operationalizing sys-
tems approaches to clinical social work? The Center for Family Life’s flex-
ible, comprehensive model of casework offers a marvelous point of depar-
ture.

References
Halpern, R. (1999). Fragile families, fragile solutions. New York: 

Columbia University Press.
Hess. P., McGowan, B., & Botsko, M. (2003). Nurturing the one, 

supporting the many: The Center for Family Life in Sunset Park, 
Brooklyn. New York: Columbia University Press.

Janchill, Sister M. P. (1969). Systems concepts in casework theory and 
practice. Social Casework, 50, 74-82.

Kemp, S. (2003). “Preface.”  In Hess P., McGowan, B., & Botsko, M. 
Nurturing the one, supporting the many: The Center for Family 
Life in Sunset Park, Brooklyn. New York: Columbia University 
Press. 

Erin Segal is a second-year MS student at the Columbia University School
of Social Work concentrating in Clinical Practice with Families, Children

and Youth. She is currently an intern at Center for Family Life in Brooklyn,
New York. She holds a BA in American Studies from Amherst College. 

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