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Social workers’ experiences of being cared for by their clients Alexander, Carla Elizabeth 2005

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SOCIAL WORKERS' EXPERIENCES OF BEING CARED FOR BY THEIR CLIENTS by CARLA ELIZABETH ALEXANDER B. S. W., McGill University, 1997 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK in THE FACULTY OF GRADUATE STUDIES (Social Work) THE UNIVERSITY OF BRITISH COLUMBIA August 2005 © Carla Elizabeth Alexander, 2005 Abstract The focus of this study is the experience of participating social workers of being cared for by their clients. The findings suggest several theoretical propositions that may be applied to enhance the way in which social work articulates the professional social worker-client relationship. Participants describe the nature of this enhancement as an increased awareness and appreciation of the potential benefits to both clients and themselves when they are open to receiving the care that a client may choose to offer. Further, the context of the professionalization of the social worker-client relationship plays a significant role in making this openness to giving and receiving care or engaging in reciprocal relationships a subversive activity for social workers. The summary propositions are grounded in both the analysis of the experiences described by practicing social workers and contemporary cultural human development theory. ii Table of Contents Abstract ii Table of Contents iii Acknowledgements i v CHAPTER I Introduction 1 CHAPTER II Context 4 The Professionalization of Social Work 4 Cultural Human Development and Identity 8 CHAPTER III Method 24 Grounded Theory 24 Data Collection , 27 Analysis 29 CHAPTER IV Findings 32 Community 37 Interpersonal 49 How do they know? 50 How does it happen? 54 How do the participants learn? 59 What happens to the quality of the relationship? 63 What happens to the work? 69 Personal 77 Identity 77 Philosophy 84 CHAPTER V Discussion 92 CHAPTER VI Implications 98 CHAPTER VII Conclusion 104 References • 106 Appendix I Contextualizing Story 109 Appendix II Interview Questions I l l iii Acknowledgments The completion of this work reflects my good fortune—the opportunity to work with/live with people who invite me into their lives and enter mine, and to study. My thanks to the following people for their contribution to this thesis: The social workers who participated in this study for generously sharing their experiences and insights with me, and now, the reader. I hope that I have captured some of their thoughtfulness within these pages so that others may be informed and moved by it as I am. Dr. Grant Charles for his exemplary advice and contributing his original and important ideas to this thesis. Dr. Sheila Marshall and Dr. Margaret Wright for serving on both the proposal and thesis defense committees, and for their advice on methodology and the application of relevant theory to the subject. Joanne Granek, Karin Cleven, and Lynda Edmonds for their mentorship, and all my colleagues at SHARE Family and Community Services for bringing their genuine and generous selves to our work and our relationships. The people I have worked with as a family support worker and now in community development for offering their humour, care, and patience as I continue to learn about the possibilities within human relationships. Mom, Dad, Jon, and Lorifor encouraging me to follow my heart. My friends for joining me in my enthusiasm for talking and learning about interesting things, and for their unfailing encouragement. The Granek family and Neil Patton for sharing their respective homes with me. CHAPTER I Introduction Social work is personally engaging and intimate work. These qualities are evidenced in the importance social work gives to relationships with clients. The relationship between worker and client has long been identified as a cornerstone of social work. This relationship is purposeful (not incidental)—social workers are expected to establish and use their relationships with clients to establish appropriate levels of intimacy to achieve goals (Brummer & Richards, 1979; England, 1986; Foley, 2001). At the same time, social workers are expected to be professional (Brown, 1992; Skidmore & Thackeray, 1982). The historical interest in the organization of social work as a profession and the culture of professionalism plays a role in creating a context wherein the focus on objectivity and the technical aspects of social work outweigh the focus on the workers' personal engagement with clients and their relational skills. Further, social worker client relationships are bound by professional guidelines (Canadian Association of Social Workers Code of Ethics, 1994). The professional guidelines create boundaries between workers and their clients that restrict the type of interactions that can occur. This is motivated by a need to protect clients from potential harm because of the power imbalances inherent in the relationship (Hundert & Appelbaum, 1995; Kagle & Giebelhausen, 1994; Kitchener, 1988; Reamer, 2003; Valentich & Gripton, 2003). However, I believe it can also serve to dehumanize the relationship and ultimately the participants by creating artificial barriers. Thus while social workers strive to create change through relationship social workers are restricting the potential for connection and paradoxically 1 limiting the effectiveness of the social worker's contribution to the client's desired change. As a result, the social worker can be left struggling to make sense of how to relate to clients. This struggle is further complicated by the conceptualization of professional relationships as being one-way thereby ignoring the two-way nature of human interaction. We give to the client but the client does not give to us (Brown, 1992; Rojek, Peacock & Collins, 1988; Skidmore & Thackeray, 1982). This understanding or misunderstanding ignores a basic premise of the interactional nature of all human relationships. Indeed, it appears evident from a review of the professional literature regarding social workers' relationships with clients that the reciprocal nature of these relationships is not typically examined. Attention to the client's response and its impact on the worker is conspicuously absent. The lack of attention to the reality of the mutual nature of human relationships may limit our ability to make full use of the relationship or to understand what it is about our relationships that is effective for clients and ourselves. This thesis will draw on a critical examination of the role professionalism plays in North American social work culture to provide context for the focus of the research. It is supplemented by an historical review and critique of the development of professionalism specific to social work particularly in relation to how it impacts social workers' relationships with clients. Following this, I have summarized several current perspectives on social workers' (and others') relationships with clients in a review of recent literature that examines the practice of engaging in dual relationships (where a social worker has both a non-professional and professional role with a client at the same time). Theory related to human development and identity provide further context for the study—it informs both the topic of the research and the methodology. The reciprocal nature 2 of human relationships is articulated within developmental theory and is used here as a basis for examining relationships between social workers and clients. While it is unusual to focus on the development and identity of social workers rather than clients, this process is necessary to fully understand social workers' participation in this type of work. Social workers are human beings and join in their work with clients as persons as well as through a professional identity. Cultural developmental theory, as articulated by Valsiner (2000), and Stets and Burke's (2003) sociological account of identity theory incorporate the development of personal identity in the context of an individual's interactions with others within a cultural community and has been used as a method for the focus on social workers' experience of reciprocity of care with clients and the social workers' subsequent personal and professional development. The focus of the study itself is an analysis of social workers' experience of being cared for by their clients as described to me in interviews. Both developmental and identity theory are integrated into the analysis of the phenomenology of this experience. The thesis concludes with a discussion of the findings, their implications, the limitations of this study and suggestions for further research. 3 CHAPTER II Context The Professionalization of Social Work There are several major influences related to the professionalization of social work that continue to inform relationships between social workers and their clients. The practical and ideological tensions within professions generally as well as those specific to social work set the stage for other developments, including social work's adoption of the medical model and concerns about dual relationships. This discussion will begin with an overview of professionalism and an outline of the historical movement within professionalized social work including the professions' own concerns about the impact of professionalism on relationships. Theories of professionalism and the role professions play in our society are continually evolving (Evetts, 2003). Before focussing on the specific issue of the professionalization of social work, I will present a contemporary perspective on the social role of professionalism to provide context relevant to this study. This analysis provides some insight into the potential for tension within any professionalized occupation -professionalized workers may be motivated by the intrinsic value of their work as well as a desire for a middle-class income and social status, but their ability to control the type of work and the way in which it is provided is likely severely constrained by organizational forces. It appears from Evetts' analysis that there is considerable 'double-think' required to maintain one's identity as a professional while working within an organizational system. Evetts identifies two traditional approaches to the analysis of professionalism; one that views it as a normative value system, the other as an ideology of occupational powers. 4 She argues that these two views must be examined together to fully understand the forces at play in the role of professionalism. Professionalism as a value system emphasizes the positive contributions professions can make to a democratic society. These contributions include a focus on the quality of service to clients over standardizing and bureaucratic methods typically employed by organizations and the market. The normative value system approach appeals to occupational workers as it promises what Evetts describes as a myth of "ownership of an area of expertise, autonomy and discretion in work practices and occupational control of work" (2003, p. 406). Professionalism infers that workers have the power to define the nature of problems and the solutions and further, they control access to those solutions (Evetts, 2003). As an ideology of occupational power, professionalism has been analyzed and criticized as a method of garnering self-interested status and market control of services on behalf of its (primarily middle class) membership (Evetts, 2003). This analysis has primarily been based on the traditional professions of law and medicine, and Evetts suggests that this limited focus has led to misconceptions about the ability of professions to establish market control, and further, on the ability of professions to set the standards of their normative value systems within the market. Evetts (2003) argues that the notion of most professions as an occupational power is simplistic, and that occupational workers undergoing professionalization are attracted to the ideal of professions as a method of implementing a normative value system but are more likely controlled by organizational values rather than professional normative values. The effect of this control is an emphasis on "bureaucratic, hierarchical and managerial controls 5 rather than collegial relations; budgetary restrictions and rationalization; performance targets, accountability and increased political control" (p. 407). The historical development of the professionalization of social work is well documented (Biestek & Gehrig, 1978; Leighninger, 1987; Wenocur & Reisch, 1989) and clearly illustrates the source of many current tensions within the profession, including those identified by Evetts as cited above. Early prominent social workers (Mary Richmond, Homer Folks, Edward Devine) involved in the development of social work as a profession were keen to ensure that the occupation gained professional status (Wenocur & Reisch, 1989). Within this process, considerable emphasis was placed on the use of the scientific method and the organizational efficiency of trained social workers. Practicing social workers were interested in the potential for greater financial remuneration and status that might come with a professional designation. Additionally, the ability to leverage resources on behalf of the people social work wished to serve depended on being seen as legitimate by philanthropists and later, by governments and the general public (Wenocur & Reisch, 1989). As social work organized as a profession in the context of the economic and social conditions of the industrial era, North American cultural values embraced rational, scientific and technical responses to problems. The Flexner Report of 1910 established the rational for legitimizing medical doctors as a modern profession. The success of medical practitioners in achieving professional status (and a good share of public and private resources) through the application of the scientific method and definition of the commodity to be provided served as an additional incentive for social workers to adopt medicine's articulation of professionalism (Wenocur & Reisch, 1989). Further, and particularly relevant to the topic of professional relationships, the medical model of diagnosis, treatment and (over time) the predominance of 6 psychoanalytic theory exerted considerable influence on how social work defined its own professional methods and attitudes towards workers' relationships with clients (Berg, 1967: Keith-Lucas, 1963; MacDonald, 1963; Rojek, Peacock & Collins, 1988; Specht, 1972). Thus the broader context of the historical moment and cultural values influenced the organization of professional social work. However, as Evetts (2003) has identified, workers within most occupations are intrinsically motivated by the idealization of their value systems, including the usefulness of the service they provide, and this too affects the professional role. While collective self-interest of these early social workers was evidently one motivation for professionalization, this movement was also influenced by the interest of workers to mitigate the problems faced by growing numbers of people as societies adjusted to the impact of industrialization (notably on immigrants and others living in poverty), and to recruit and maintain skilled workers. While often complicated by notions of charity, judgement and the desire to 'civilize' the lower classes, the services provided by social workers in hospitals, settlement houses, and in the provision of relief and family services were also guided by front line social workers' and leaders' interest in promoting public health, social justice, and genuine concern for the people within their communities, particularly for those living in poverty (Biestek & Gehrig, 1978; Irving, Parsons & Bellamy, 1995; Wenocur & Reisch, 1989). While it is not necessary that the needs of the organization of professionalization be at odds with the interests of individual workers or the broad purpose of social work, there is some evidence that the professions' desire to be seen as systematic, rational, and scientific may contradict the practice of effective social work practice and the ability to make a 7 difference to individuals and communities. The following section provides an historic overview of this perspective. Social works' critique of professionalization A review of published social work opinion indicates that since the late 1800's social workers have taken a critical stance towards the usefulness of an emotionally distanced posture and the workers' emphasis on expertise in the name of professionalism. While valuing the increase in attention to knowledge, theory, and skills with professionalization, various writers warn of the potential loss in what they consider the most meaningful contribution social work makes to human service—an authentic, caring relationship (Brummer & Richards, 1979; Clarke & Asquith, 1985; Dillon, 1969; Foley, 2001; MacDonald, 1963). Published opinion explicitly in favour of social workers' personal engagement with clients is relatively rare. Among those views, the authors' tone and method of contrasting the common practice of distance and expertise with human relationships suggests that this practice is typically perceived as somewhat counterculture. The following citations offer a sample of criticisms whose authors have connected professionalism to (variously) concepts of rationality, the moral superiority of the worker, technique, the concept of objectivity, expertise, an impediment to client self-determination, a barrier to intimacy and sense of shared humanity, and an unethical depersonalization of clients. Each writer offers a contrasting approach that speaks to a value of friendship, caring, faith in the capacity of the client to live their lives well, a call for genuine warmth and personal intimacy in relationships with clients, and the primacy of the human relationship over one that is delimited by professional dictates. 8 The early stages of this critique of professionalism are reflected in public dialogue between Jane Addams and Mary Richmond; leaders in both the development of social work method and professionalization. In an historical account of social work's professional development, Wenocur and Reisch cite an early example in their summary of Addam's response (published in 1899) to Richmond's call for standardized, scientific methods in social work: Addams rejected the methods Richmond espoused because of their excessive rationality and their assumptions about the social relationship between worker and client, which, she argued, forced the worker upon the needy in the role of a moral guardian. The role widened the social gap between workers and clients and made it impossible to establish the friendship and engage in the 'moral uplift' Richmond proposed. Addams also attacked the "negative, pseudo-scientific spirit" which underlay Richmond's work, its "cold and unemotional' tone (1989, p. 50). Conflict among social workers regarding the emphasis on technical expertise and concerns that this would provide a basis for a sense of separateness from the people whom social workers served continued as the move to professionalism developed strength (Wenocur & Reisch, 1989). A sense of distinction between a community of professionals and a community of all human beings is evident in Lindeman's criticism published in 1924, again cited in Wenocur and Reisch. He articulates the concern that the social worker would become '"the symbol of technique' rather than 'the embodiment of sentiment'" (p. 127) and that workers would become "the modern symbol of autocracy, since the expert functions by virtue of what he knows, not by virtue of what he shares in knowing" (p. 127). 9 Over time, perhaps because social work became more firmly established as a profession, the concern over the conceptualization of social work as a technical practice shifted away from the topic of professionalization to a more specific focus on the role of social work expertise, particularly in relation to the social workers' relationships with clients. Professionalization itself appears to be taken for granted. In 1954 Bowers wrote of his concerns of the role of the expert in being truly helpful to people within the context of relationships and connects this to the principle of self-determination. For Bowers, the use of expertise in social work should focus on the way in which workers join with people and that the privileging of the social worker's expertise undermines the clients' development. He exhorts the reader to remember that rather than technical skills, the only method that makes a difference is to maintain "a deep and constant faith in man" (p. 189) and that social works' unique contribution is its focus on the medium of relationship. Like Addams, he too is skeptical of an objective approach and doubts whether neutrality is even possible. For him the client's subjective meaning of any situation is of greater importance. He writes that while the professional's "presumed detachment might enable them to determine the best objective solution, clients do not function in some objective dimension" (p. 189). Bowers maintains that one of the greatest challenges within the social worker's relationship with a client is to maintain a practice of faith in the client's capacity to choose for themselves, rather than impose an expert's solution. He acknowledges that within the relationship, "much discipline of self is involved in leaving the client free" (Bowers, 1954, p. 189). This discipline of the self is required to create professional relationships with clients, but for Bowers these relationships are not impersonal. He writes, "the effective medium of help for the client lies in the dynamic interplay between the person of the worker and the 10 person of the client" (p. 191). This emphasis on the person is what is meant by the call to engage in social work with the "disciplined use of self in the service of the client" (Bowers, 1954, p. 192). In 1969, Dillon presented a pointed criticism of the professions' methods of distancing from clients through the use of labels such as 'borderline', 'multi-problem', and 'hard to reach'. Given her eloquence, I quote her at length. She writes: We will have to risk, and experiment boldly in, being more responsive and warm, so that we may provide flesh-and-blood models toward or against which clients can grow. Curiously, all caseworkers currently speak easily of client growth through identification with the worker, while many maintain that the exposure of worker identity through honest reaction or comment may work such grievous results as destructive transferences, fury because of the worker's humanity, and fright because of the worker's closeness. It seems to me that clients need a consistently graspable and real person that they can identify before identifying with if they are to grow. We, in turn need to search ourselves to see whether it is just the client who is hard to reach, to feel close to, and to define as a person... Our client's search [for love and encouragement] requires that we be ourselves, that we deal with our fantasies of objective detachment, and that we feel, respond, and extend ourselves to reach them (p. 339-340). Dillon provides a direct criticism of the profession's rationale for creating distance and speaks to the role of the individual social worker in providing a context for the clients' wellbeing through a personal and intimate relationship. Her article captures the contrast 11 between social works' idealized acceptance of the importance of the relationship to clients and the actual practice of being impersonal. These themes of distancing, labeling and the need to take personal risk on behalf of the client are echoed in Clark and Asquith's (1985) examination of social work ethics. The authors identify the need to protect clients not from the personal nature of relationships, but from the 'expert'. They express concern that the expert, in his or her attempt to rely on scientific evaluation of the client, may not see the client as a whole person who deserves to be treated according to principles of everyday morality, or by "the most ordinary moral obligations toward the client as a fellow human being" (p. 7). This concern is extended to the practice of professional distancing. While acknowledging the potential need to defend one's personal boundaries, avoid emotional fatigue and exploitive situations, they write: There is however a substantial danger that these norms lead to a negation of the attitude of respect for persons. The detachment which categorises clients to make them easier to deal with paves the way for treatment by category. In a more extreme form it may lead to clients being, in effect, depersonalised; they are treated not as persons but as problems... Such an attitude [of cynicism] may be accompanied and reinforced by a scientistic approach to human beings...The social worker should be prepared sometimes to go beyond the confines of the conventionalised professional relationship, where these threaten to stultify its authenticity...To transcend professional relationships needs daring, imagination, and trust; but to do so it may sometimes be necessary to give full recognition to the moral status of persons (p. 21 -22). 12 This sample of criticisms ranging from early to contemporary social work is consistent yet the invocation to relate to clients personally and from the heart rather than (primarily) the mind are but undertones in the overall philosophy of social work method. I would argue that this is a consequence of the continued equation of professionalism with objective and impersonal relationships and emphasis on social work codes of conduct rather than a more complex understanding of ethical human relationships. Again, this emphasis reflects the organizational needs of the profession to be seen as scientific, rational, standardized, and efficient. This standardized approach can be seen in codes of conduct which attempt to regulate professional behaviour by explicitly prohibiting certain kinds of relationships. Dual relationships Both the organizational needs of the profession and the interest in providing ethical and effective service to clients are reflected in codes of conduct, regulations, opinions and practices of social workers and other related professions. These considerations are outlined here to provide further context for the examination of social workers' relationships with clients. From a psychotherapeutic perspective, Hundert and Appelbaum describe boundaries in relationships as the rules which create a separation between the professional relationship and other relationships. They write that "the purpose of such rules is twofold: to maintain the therapeutic efficacy of the relationship, and to avoid situations in which patients, because of their vulnerabilities, might be subject to harm" (1995, p. 345). Others add the problem of loss of objectivity on behalf of the worker to this list (Brownlee & Taylor, 1995; Reilly, 2003). Crossing these boundaries results in a dual relationship. Dual relationships in this sense are 13 those in which "the social worker has a professional relationship with a client, and a simultaneous relationship with the client in another context, such as business partner or friend" (Brownlee & Taylor, 1995, p. 133). Additional, or more specific rationales for avoiding dual relationships include maintaining a standard of care (meaning that everyone gets the same treatment), the potential for the abuse of power within the second relationship, the need for objectivity (inferring that if he/she is not objective, the practitioner may become too invested in the outcome), that clients may expect differential treatment (such as special accommodations along the lines of receiving service after the practitioners' standard hours or other flexibility), and a concern that the shift from a non-sexual dual relationship to sexual relationship is a slippery slope (Borys & Pope, 1989; Brownlee & Taylor, 1995; Hundert & Apelbaum, 1995; Kagle & Elhausen, 1994; Reilly, 2003). Rules regarding dual relationships are being re-examined by social workers, clergy, doctors, and marriage and family therapists (Gottlieb, 1993; Gripton & Valentich, 2003; Kagel & Giebelhausen, 1994; Kitchener, 1988; Reamer, 2003; Reilly, 2003; Ryder & Hepworth, 1990; Smith & Smith, 2001). The current debate over the permissibility of dual relationships reflects both a continued rigidity and some apparent flexibility within these professions' articulation of appropriate relationships with clients. Interestingly, one oft-cited reason for increasing flexibility regarding dual relationships and the re-examination of this issue is based on the needs of the practitioner to live a normal integrated life within small rural communities rather than being driven by the interests of clients. Re-thinking the boundaries certainly includes serious consideration of the clients' interests, but in some cases the shift to allow dual relationships is clearly motivated by the needs of practitioners (Gripton 14 & Valentich, 2003; Reilly, 2003). Those advocating reform also indicate an interest in insuring that the code reflects the actual social work practice; if the code is too far from practice it will be discredited or completely ignored (Brownlee & Taylor, 1995; Ryder & Hepworth, 1990). Among those providing analysis and recommendations regarding the regulation of (non-sexual) dual relationships are those advocating for the maintenance of absolute restrictions. Arguments against allowing dual relationships centre on the potential for exploitation with particular concern that the shift from potentially harmless dual relationships or activities outside the professional service to sexual relationships is a slippery slope (Borys & Pope, 1989; Hundert & Apelbaum, 1995; Kagle & Giebelhausen, 1994). Kagle & Giebelhausen (1994) cite evidence where practitioners have been found by courts or other investigatory bodies to have engaged in sexual relationships with clients and find that a precursor to these relationships was a non-sexual dual relationship. The nature of the link between non-sexual dual relationships and sexual relationships between practitioners and clients is not clear; however the correlation appears to be the basis of rationale for prohibiting dual relationships of any sort (Borys & Pope, 1989; Kagel & Giebelhausen, 1994). Dual relationships are also seen to interfere with the efficacy of therapeutic treatment. This "psychological rationale for excluding dual relationships rests primarily in the psychoanalytic concepts of transference and counter-transference as important elements of the therapeutic relationship" (Gripton & Valentich, 2003, p. 112). Social work has borrowed heavily from psychoanalytic practices which inform its' code of ethics and applied theories about relationships across all fields of social work practice (Berg, 1967; Brownlee & Taylor, 1995). Further, it appears that much of the research and analysis conducted regarding 15 practitioners' behaviours and attitudes toward dual relationships has focussed on psychologists, psychiatrists and social workers practicing psychotherapy (Borys & Pope, 1989; Hundert & Appelbaum, 1995; Kagel & Giebelhausen, 1994; Sharkin & Birky, 1992). The interpretation and application of some elements of psychoanalytic practice to social workers' relationships with clients has been challenged directly and indirectly by both historical and contemporary writers, however (Berg, 1967; Dillon, 1969; Ryder & Hepworth, 1990). The substance of these challenges is that while some elements of psychoanalytic theory are applied within social work practice, in many cases practice is informed by other theories and/or different perspectives on the nature and purpose of the relationship, particularly for those attempting to create more egalitarian relationships or those focussing on the clients' subjective experience (such as feminist, narrative, and solution-focused approaches) rather than the practitioners' interpretation of the problem (or the solution). Other social workers and psychologists make a distinction between engaging in dual relationships and the exploitation of clients (not all dual relationships are exploitive) and suggest that there are potential benefits to both client and worker when they engage in dual relationships, and offer models for ethical decision-making in these cases (Gottlieb, 1993; Gripton & Valentich, 2003; Reamer, 2003). As described above, in some cases the realities of working in rural communities is a driving force for this reconsideration. For these practitioners, dual relationships are unavoidable yet codes of conduct do not provide guidance or flexibility in these situations. These writers and others are motivated to re-examine codes by the need to ensure that practice and code are congruent so that the code retains legitimacy and that these practitioners are not in constant violation of the code (Gripton & Valentich, 2003). 16 Aside from the practical difficulties of avoiding dual relationships, some writers believe that the dual relationship can be beneficial for clients. Reamer (2003) suggests that social workers distinguish between boundary violations and boundary crossings. Some boundary crossings may by helpful in that these secondary relationships may increase the sense of connectedness between the two parties, increase the self-confidence of the client or supervisee, or normalize the relationship. Marriage and family therapists Ryder and Hepworth (2003) suggest that all relationships (not only those between helping professionals and clients) are complex and that therapists should learn how to manage this complexity rather than legislate simplicity through an attempted elimination of dual relationships. In addition to the potential for a direct benefit to the client, Gripton and Valentich (2003) cite Tomm (1991) who suggests that dual relationships may mitigate against, rather that increase, the opportunity for exploitation of clients in that subtle exploitation may be more likely to become apparent through the secondary relationship than within the professional relationship. Ryder & Hepworth (1990) suggest that the practice of allowing dual relationships may encourage practitioners to be open and provide opportunities for those relationships to be scrutinized by others. As indicated by this review, there is considerable disparity between theory, regulation, and practice regarding social workers' relationships with clients. One shared feature of both perspectives (those in favour of maintaining a prohibition of dual relationships and those advocating reform) is the emphasis on the protection of clients from potential exploitation. There are, however, fundamental differences on the method of creating that protection. The resolution of these differences appears to hinge on an absence of research on the effects of dual relationships on clients. While the evidence regarding the 17 negative impact of exploitation on clients may be uncontested, arguments for or against dual relationships that differentiate between those that are harmless or helpful and those that are exploitive appear to be based on expert opinion or an adherence to a particular philosophy of the appropriate conditions for therapeutic intervention. There appears to be an absence of information based on the client's experience. Ultimately this emphasis on regulating interactions between practitioners and clients serves to create distance between them. The interest of the profession and the institutions within which they work to create protection (for themselves and clients) from the potential exploitive behaviour of workers contributes to a bureaucratized approach to relationships. While social work regulators and those responsible for establishing codes of ethics are integrating more flexibility and acknowledging the complexity of managing dual relationships within their codes and regulations, there is much to be resolved in order to develop a clear understanding of how social workers will (realistically) manage relationships in the best interest of their clients. Cultural Human Development and Identity While the specific phenomenon is not documented in social work literature, the assumption is that social workers, like all people, experience reciprocity in relationships. This assumption can be further grounded in theories of identity and development. These concepts of identity are fundamental to the discussion of personal and professional relationships as well as the process of change that occurs within that context. In the following description of developmental theory, it will be demonstrated that while social work has typically viewed their relationships with clients as one-way, studies of human development 18 and identity reveal that, in fact, all human relationships are jointly created and reciprocal (Valsiner, 2000). Development In the context of this study, development refers simply to individual change over time (either maintenance or innovation) and is value neutral (Valsiner, 2000). Human beings develop over time in an ongoing cycle through experiences, creating meanings and forming ideas about the world. Experiences are loaded with subjective meaning—there are few experiences without some meaning attributed to them. Further, experience and subsequent development happens within an historical and memorable context, and grows out of previous lived experiences. All experiences take place within other more specific contexts such as culture and other social events that will influence the meaning humans make of their experiences (Valsiner, 2000). Humans pay attention to the environment as they seek to understand it, and take cues from that environment. The environment can be described as having three locations: the cultural or social context (community), relationships with other individuals (interpersonal), and personal history and sense of identity (personal). These three 'locations' of development are not completely distinct from each other, but overlap and depend on some integration of the three in all meaning-making events (Rogoff, Topping, Baker-Sennett, & Lacasa, 2002). For example, as I interpret an event such as witnessing my friend breastfeeding her newborn I draw on my own previous experiences (being present while my niece and nephew were breastfed) and the meaning I made of that experience and recall now, my interpretation of my friend's behaviour (she feeds her infant in front of me, she invites me to stay) and my interpretation of her response to my behaviour (I stay and am comfortable, she continues 19 feeding and seems comfortable), as well as cultural norms (e.g. breastfeeding in the company of others is generally acceptable). I attribute many meanings to that event, including a sense of being welcomed and included in an intimate environment with her new baby. This tells me something about how my friend views me, which influences the way I see myself, and contributes to my sense of who I am. One such event may have only a minor influence on my overall sense of identity, but it will contribute to the perspective I take in the future. Bi-directional ity The example above also illustrates the concept of bi-directionality, a process fundamental to the understanding of human development within the context of interpersonal relationships. Interpersonal relationships are the location of potentially intense developmental processes as it is within this context that both parties influence the construction of the meaning of the event. A theory of bi-directional development suggests that each person in the interaction continually attends to each others' actions and responses and that in this way an understanding of events is jointly created (Kuczynski, Marshall & Schell, 1997; Valsiner, 2002). M y comfort in being present while she breast-fed informed my friend's comfort, and vice-versa. We both communicated our comfort through words and gestures not only in response to events, but to convey meaning both to each other and to ourselves. A bi-directionality approach suggests that we are oriented to create meaning in the immediate future, not simply to express a meaning we hold separately (in the present or past) from others. It is this openness to meaning-making in the immediate future that provides the potential for innovation in development. The meaning created in this mutual process becomes an external event, which is again interpreted and internalized. The concept of bi-directionality is important to this study in that it explains how within an interpersonal 20 context, individual development is derived from a process of mutual meaning-making (not only the meaning conferred on the event by one person). Identity Stets and Burke (2003) provide a sociological account of the development of self and identity from the perspective of a structural approach to symbolic interactionism. Like development, identity formation is also an ongoing process of creation and re-creation. Our identity becomes known to us as we try on various roles and engage in activities in the three contexts or locations identified above: community, interpersonal, and personal. Through actions (witnessing ourselves) in roles and the responses of others, individuals may come to realize who they are. Patterns in these actions and responses create a sense of structured self (a combination of all identities) and structured social world. Included in this theory of self (Stets & Burke, 2003) is the idea that a sense of self relies on the ability to reflect on oneself as an object. In order to see one's self, individuals take the perspective of the other and imagine how they are seen. It is through this process that we internalize cultural expectations of the roles in which we are engaged as well as negotiate our specific role with any individual person. Ultimately our personal identity or self concept is a combination of how we see ourselves in the variety of roles we inhabit at any given time (Stets & Burke, 2003). There is no role that is not personal in the sense that all roles contribute to an understanding of how a human being sees themselves. Interpersonal relationships involve this process of reflexivity as individuals imagine themselves in the mind of the other. These concepts described above can be applied to the topic at hand—personal identity naturally incorporates social roles. Further, any individual development will be based 21 on all social experiences, including both personal and professional contexts. The identity of social workers cannot be neatly separated into categories of personal and professional selves. Drawing on all experiences and personal identity, relationships are co-create relationships with others. In turn, experiences with others contribute to identity formation. Given this process of identity formation, imagine how the internalization of professional roles affects relationships with clients, and subsequently the social worker's identity. Social workers relate to others—and invite others' relation to them—using the schemas of social roles they have internalized. Social workers have two central schemas to draw on for their use of self in their work—one is warm and authentic, the other objective and not personal (Brummer & Richards, 1979; Clarke & Asquith, 1985; Dillon, 1969; Foley, 2001; MacDonald, 1963). The tension between personal and professional roles, as described above, is present in these differing articulations of relationships between social workers and clients. Both central schemas may be appropriate at different times—in order to develop a purposeful and ethical use of either way of being, social work practice must understand the effects of these orientations both for workers and their clients. There are three locations of development reflected in this study. Community is represented by the culture and institution of social work, particularly the professionalization of social work. The interpersonal location is the central theme in that the focus of the study is on relationships between people and the phenomenon of reciprocity. It is apparent from the findings and consistent with developmental and identity theory that interpersonal experiences clearly have an important effect on personal development, and themes relating to personal development are categorized accordingly. 22 By focussing on social workers' experience of the reciprocal nature of care within the social worker-client relationship, and how the social worker develops through this exchange, this study and analysis directs attention to the importance of understanding the relational aspect of social work, and how relationships with clients are personal as well as professional. 23 CHAPTER III Method Methodology includes the entire process of conceptualizing the focus of the research question, the integration of previous experience or knowledge, the perspective of the researcher, and the processes utilized for the research itself (Valsiner, 2000). Transparency in this process provides the reader with a basis for evaluating the findings and analysis. This section on method provides a description of these aspects of the methodology guiding this study. Grounded Theory The phenomenon that is the central focus of this research was originally derived from conversations between myself and Grant Charles, my graduate advisor, about our experiences as social workers in relationships with clients. Through several discussions we refined the focus of the study to an exploration of social workers' experience of being cared for by clients. Given our perception of the impact the experience has on our own development we wanted to know whether other social workers have this experience and if so, how the experience transforms them. Specifically, the aim of the research is to explore the phenomenon in question as it is made meaningful by participating social workers and to generate theoretical ideas through the analysis of their stories. Given that the phenomenon in question has not been previously documented, an exploratory methodology is appropriate. Constructivist grounded theory methodology suits exploratory study (Charmaz, 2003) and thus was chosen to provide primary guidance to the research design, data collection and analysis. 24 Constructivism reflects the epistemological stance that the world is real as it is made real through our perspective. This reality is created through individuals' responses to the world based on that perspective (Charmaz, 2003). Charmaz recommends constructivist grounded theory methodology for the examination of "slices of social life" and states that its "quest for the study of basic social processes fosters the identification of connections between events" (p. 522). Emerging from the data provided by participants, connections or patterns in the data in turn yield theoretical propositions. While some grounded theory methodologists recommend that researchers avoid immersing themselves in ideas that have already been proposed to prevent conventional thinking from limiting the researcher's ability to discover new ideas (Kuczynski & Daly, 2003), Strauss and Corbin (1990) recommend being familiar with the topic area to provide a useful sensitization to the issues and phenomenon. These latter theorists identify literature, professional experience, personal experience, and analytic process as additional sources of sensitivity. As a practicing social worker, I am immersed in the cultural expectations of the profession. I am aware that engaging in mutual relationships with clients conflicts with the ideals of professional practice. In order to enhance my ability to think critically as well as build on the range of my understanding, I familiarized myself with both current and historical literature on these topics. Rather than limit my ability to make sense of participants' experiences in new ways, this immersion and analysis of social work policy and practice regarding relationships was useful in preparing me to think critically about the concepts before and after engaging participants in conversations about their experience. This familiarization clarified the usefulness and relevance of the research question to the field of social work. 25 During the quest for a research methodology appropriate for the research question, members of my thesis committee referred me to the concept of bi-directionality in human development which in turn led to readings on Valsiner's (2000) human cultural developmental theory. Both Valsiner's developmental methodology and Charmaz's (2003) constructivist grounded theory methodology assume that the identification of patterns in meaning-making enhances our ability to understand the processes underlying human behaviour. Together, they are compatible with and complimentary to the topic and purpose of this research. Further, human cultural development theory, particularly the concept of bi-directionality, provides a comprehensive challenge to social work's conceptual frame for professionalized relationships (that they are non-personal and one-way). Because the research question asks how the phenomenon contributes to change or transformation of the social worker, I have drawn on human developmental theory to explicitly inform the data analysis and construction of conceptual categories. Developmental theory informs the analysis of the process of change based on the experiences of participants, but not the nature of change or development (Valsiner, 2000). The findings reflect the qualities of these changes and are derived from the information provided by the participants. The findings, analysis and subsequent theoretical ideas emerge from the integration of specific developmental patterns identified by participants and the qualities of the experiences themselves. Thus, the findings and discussion are a product of an analysis of the experiences of participating social workers, my own experiences and perspective as well as the integration of pre-existing theory. This research process provides an opportunity to expand conventional thinking about this phenomenon. In this way, the method reflects a process consistent with a 26 constructivist approach to grounded theory methodology and the way humans, in everyday life, draw on multiple sources of information to co-construct meaning from our experiences, learn, and develop. Data Collection Theoretical Sampling Charmaz (2003) describes theoretical sampling as the method used to refine ideas throughout the research process. In grounded theory methodology, the researcher continually hones her focus based on concepts emerging from the information being collected and uses that as a basis for further investigation. Here, the process of theoretical sampling involved individual interviews where I followed a set of pre-determined questions. Refinement of the interview process occurred through spontaneous adaptation of the interview format to include additional probing and prompting questions when participants introduced topics related to concepts identified through previous interviews, or some new element related to the question. While each interview was unique, all participants were asked (and answered) the original set questions. The use of personal interviews as the method for collecting data provides a context for developing rapport with participants as well as allowing for real-time accommodation of information and further exploration of ideas presented by the participants. Given that the practice of engaging in personal relationships with clients is considered risky (by some) in the professional context, having the researcher present to reflect an acceptance and interest in the practice and the person sharing their stories may be important to the process of revealing one's experience. It also seems fitting to engage in a process that parallels the majority of work that social workers engage in—iri-person, two-way conversations. 27 In describing grounded theory methodology, Charmaz (2003) suggests that researchers end their research when the information gained through the sampling process fits into categories already created. The level of richness and depth of information within each category varies from study to study. In this study, the main conceptual themes were consistent throughout each interview, and while many of the emergent concepts could be explored further, by the tenth interview it was apparent that the purpose of the study had been fulfilled. The findings reflect a richness in depth and variation in information as well as consistency in the themes arising from the interviews. Participants Participants were recruited through the distribution of posters displayed at the School of Social Work and Family Studies, University of British Columbia and by word of mouth through colleagues and fellow students. Ten social workers volunteered and all were interviewed over a period of 7 months. Practice experience among participants ranged from 5 to 35 years, with most having more than 20 years of experience in the field. In the course of their career to date, participants had worked in various practice settings including child protection, child and youth care, individual and family counselling, senior administration of public services and non-profit agencies, community development, aboriginal services, social work education, policy development, health care for acute and chronic illness, geriatrics, mental health, palliative care, private practice, employee assistance programs, and family mediation. Of the ten participants, three were men and seven were women. Social workers were asked to self-identify as eligible to participate in the research on the basis of their having worked with clients, having practiced for a minimum of five years, and having had an experience of reciprocal care between themselves and a client. 28 Interviews Prior to each interview, participants were provided with a short story of my experience of reciprocally caring relationships with clients (see Appendix I). Al l but two participants read the story before our interview. The purpose of this preparation was to offer some disclosure of my experience and perspective regarding the concept of receiving care from clients. Given the unconventional nature of the topic, this initiation into conversation was chosen both to mirror the process of reciprocity as well as to develop trust between myself and participants. The story further supported the interview process by describing an example of the phenomenon I meant to study. Several participants noted that this story made them more comfortable and helped them understand what it was I wanted to talk about with them. Each interview was held at a location chosen by the participant, usually in their home or office and lasted between 50 minutes to 1.25 hours. Participants were asked a series of nine questions as well as follow up or prompting questions throughout the interview (see Appendix II). The questions asked participants for a description of their experience of a reciprocal relationship with a client and how that affected them. Interviews were audio recorded and transcribed. Given the internal consistency of the participants' responses, post-interview clarification regarding the meaning of their statements was not required. Analysis A close analysis of the data yielded common themes that in turn provide useful insights into the experiences of social workers receiving care from their clients. I have identified emergent concepts within the data and in a repetitive, circular fashion utilized a 29 constant comparison method of analysis to refine the conceptual findings. This method provides a basis for internal consistency in the concepts (Charmaz, 2003). After the sixth interview, I created a preliminary list of conceptual themes. After the tenth and final interview, all transcripts were analyzed again and statements corresponding to the identified themes were sorted into those themes. Each theme and corresponding statements were repeatedly analyzed comparing: (1) the statement to the context from which it came (each whole interview); (2) the meaning of each statement with others within that theme; (3) to the theme itself; and (4) to other themes. Themes were refined and some were eliminated during this process. The same circular, constant comparative method was used to sort the themes into the three broader categories of community, interpersonal and personal. These categories reflect the three foci of analysis recommended by Rogoff, Topping, Baker-Sennett, and Lacasa (2002) as a method of understanding the process of human development through an analysis of activities. I have adapted Rogoff et al's method to this context. Here the community category includes statements that reference culture, institutions (including workplace and professional bodies), colleagues, and others that may represent aspects of society at large rather than a particular individual. The interpersonal category includes participants' statements that are mainly about the meaning they attribute to events that happen between themselves and their clients, and (may) continue to be applied to those and other relationships. Finally, the personal category represents participants' beliefs, the meaning they have made (for themselves as an individual) of events, and how that is connected to their sense of who they are and the meaning of their work and life. Each theme within these 30 categories represents at least one participant's statement or story. Most themes represent an idea common to several participants. Before presenting the findings, I would like to clarify a potential paradox within this study between the acceptance of the idea that all human relationships are reciprocal and the way in which I describe the participants' engagement with clients as mutual or reciprocal as a choice. This paradox is perhaps one source of tension experienced by the participants as they examine their relationships. I invite the reader to be mindful of the paradox and potentially make sense of it and these findings through an appreciation of the potential influence a conscious choice to embrace reciprocity or the awareness of this inherent mutuality in relationships has for the meaning given to events. Thus, the differences described here are not meant to compare a non-mutual relationship and a mutual relationship, but rather the differences when the meaning attributed to a relationship includes a conscious acknowledgement of mutuality and when it does not. 31 CHAPTER IV Findings As an introduction to the emergent themes within the findings, I will clarify the meaning of the terms reciprocity, mutuality and care, and how they have been used by myself and participants. Because the selected quotes represent only part of our conversations, these definitions will provide context for the themes and supporting excerpts from interviews. The following definitions of these concepts are the product of my interpretation of their use in participants' statements and stories. First, the concepts of reciprocity and mutuality are used interchangeably and participants used these words themselves as they described their relationships. Prior to the interview with each participant, some clarification was made of the concept of reciprocity. I explained my interest in instances when the social worker had an experience of being cared for by the client. I articulated my assumption, given the mandate of social work, that the social worker cares for his or her clients and through our discussions of reciprocity of care we clarified that my interest was in examples where care was offered to each other. The interview questions also provided an opportunity for participants to describe their care for their client both to check this assumption and to bring that sensibility into the conversation. Participants were intrigued by the idea of talking about the experience of being cared for by the client and similarly assumed their own care toward their clients. The primary focus of the interview questions was to examine the experience of being cared for by a client. As was expected, the idea of care being reciprocal between social workers and clients was found on one hand by some participants to be a novel idea, and on the other hand some participants assumed it as a given. In sum, the definition of mutuality or reciprocity here means that the social worker cares for the client, and that the social worker believes that the 32 client cares for the social worker. The terms mutuality and reciprocity were also used to refer to the exchange of feelings or experiences other than care. The concept of care is cited in many contexts by participants. They speak of their care for clients, and the care they receive from clients. The care they receive from clients has two different meanings; one is more related to a sense of being cared about, liked, appreciated, even loved, and is a sentiment. The other relates to actions that demonstrate a willingness to look after, or do something for the social worker. Both of these interpretations of care from clients are similar to the way that the participants describe the kind of care they extend to clients. Participants did not distinguish between the two types of care and both types seemed to have a similar effect on the social workers. Cited below are several examples of the different ways social workers describe how clients have expressed care. The two types of care, while not differentiated by the participants, are worth distinguishing because of the significance receiving care from clients has in relation to common social work practice. It will make clear to the reader what care means to the participants in this study and provide a context for discussion. The following extracts of participants' stories provide the reader with illustrations of the social workers' experience of care and how they interpreted the client's actions as care, and set the context for the thematic findings. This first story illustrates the experience of a therapist being cared for, or looked after by a client. At the end of several years work with one couple, during the last session: The woman brought up a lot of negative feelings about me that I was just so surprised at and we were—said goodbye and then I went to my office and they were walking down the hall and the man turned and just, I felt like he had a sense of—he couldn't 33 say anything now, but he cared about me, it was just a moment of—just that I would have been impacted, and (the participant pauses and cries) just that he kind of recognized that, yeah... So it was just a very quiet moment of non-verbal, sense that he was, and I did, I sensed that both of them cared about me, and it was such a shock, and it was a hard way to end, it felt very unfinished, but you know I couldn 't control all that. But there was a moment of caring for what I might be going through that I felt was expressed from him. This next story also illustrates the type of care that signifies the client ' looking after' the social worker, in this case the legal guardian of a youth. The morning after a difficult night with the sixteen-year-old girl, the social worker discussed the youth's involvement with people l iving i n the house across from the client's group home. The social worker had heard stories about her involvement from group home staff and was concerned that these people were not safe associates for the youth. The youth did not want the social worker to intervene, and the social worker took time to try to reassure the teen that she did not want to embarrass her, but that it was her duty as an adult to take care of the youth. The social worker headed over to the house, while the youth continued to protest. Anyway, so I trudged across the street and I started going towards the steps, and she came flying out, and she went up the steps, and she stopped at the bottom—/ remember it was steps going up—and she said, no, no you can Y go up there, and I was saying why? I have to—why? And she then, she kind of—little tears run out her eyes, and she says, you can't—and she says, because they are in there, and they are going to get you. 34 The youth named the people living in the house whom the social worker recognized as people with a grudge towards her. These neighbours had been pumping this youth for information about her for weeks. And she—and I guess they were in there, and she knew they were just waiting for a chance when I would come up there, so anyway, so I just—then she told me the client's names, and she just said, they 're there, and I was just like—oh—my heart was just pounding so I was thinking, oh my god, imagine if I walked in on them, and any way, so we left and we ended up calling the police and the police went over I guess at that point, I was thinking, you know, she was, you know hard to the core and she would you know, spit venom when she talked to you, but when she knew at that particular point that it was me that the people [were after], she kind of you know, stepped in and told all the information. The following story illustrates the other type of care, a strong sentiment between the social worker and client. This social worker, a therapist, worked with a woman for several years dealing with the impact of long term sexual abuse. The social worker describes the depth of feeling that developed between them. And I think that in some ways [the relationship is] an evolution, as I said, I think in the initial stages there was none of that [overt expressions of care from the client], there was just working together, I was the therapist, and gradually, over the years, it became more of a—an emotional connection. And then after therapy was over, the relationship is really... on that level of mutual respect, mutual caring, she cares, I think, as much about me as I do about her... She still, and she has said to me and I 35 think it might have been that day when we had lunch, that she does have love for me, that she loves me. And I feel the same about her. Another story illustrates an everyday gesture from the client that has a subtle but important meaning to the social worker. Participants typically identified gestures like this, as well as personal inquiries and other civilities, as gestures of care from their clients. It was not that the gestures alone conveyed this care, however. Participants described specific people and instances where the social worker felt the client wasn't 'just going through the motions'. Something is coming to my mind that just happened recently, and it was as simple as a handshake that I got from a woman [a foster parent whose son the social worker was investigating]... we didn 't substantiate the allegation against her son, but she was still a little standoffish, but by the end of the conversation, you know, we got to the point where things were amicable, and I kind of get up to leave, and she stopped me, and took my hand, and gave me a—it was a firm, it was one of those good, firm handshakes—it wasn't just that she was going through the motions—and something was communicated to me through that—again, it was something small, but Ifelt like that handshake kind of said that it's okay? Between us, in a little way, strange way?... I mean for—I was quite... well, it has stood out for me that, that little handshake... and I—I guess you know I do have, you know, lean sense kind of like a physical, or emotional, or reaction, like a reaction, like I notice like whether it's that feeling in your chest, or, like a good feeling, though, like you know, a little bit of warmth, or you know, or you just, it whether it's kind of affirming that you know that they are appreciating the work that you are doing, or that what I'm doing isn't completely 36 pointless, like it is making a difference, or I am helping someone or giving comfort to someone. These four excerpts of stories above reflect participants' attribution of meaning to activities that take place in the context of their relationships with clients. The stories provided by all ten participants are the basis for the findings as outlined in the following section. Al l findings are based on the participants' interpretation of events, as it is the meaning that they attribute to events that affects their personal and professional development, or identity (Stets & Burke, 2003). The emergent themes are identified and an illustration of each theme is provided through the use of selected statements. To ease reading of the transcribed oral statements, I have eliminated repetitive words, have shortened statements, and edited awkward sentence structure. I have sorted the themes into the categories of community, interpersonal and personal. Some themes may fit in more than one category, and in fact each theme may be seen to reflect elements of each sphere of influence. Community This thematic category represents the influence of the community through the participants' experience and assessment of the environment in which they work. As the following themes and supporting extracts suggest, both the work environment and the broader culture relating to the internalization of social work professionalism, theory and practice imparted through training, professional codes of ethics and conduct, and exposure to other practitioners have significant influence on the way social workers relate to clients. These findings suggest that the participants are aware that their own practice of engaging in personal and mutual relationships with clients may be seen by some aspects of the 37 community as unprofessional. Further, the stories participants tell indicate that conforming to community expectations is important to them and that they seek environments where their approach is supported and encouraged. Like their attributions to the community (i.e. the social work profession and their colleagues), participants too have similar concerns about the appropriate level of intimacy between workers and clients, and their analysis of this issue considers both inappropriate emotional closeness and too much (or an impersonal) distance. The first theme illustrates the participants' sense of going against accepted practice, Subversion. Participants report an awareness of the subversive nature of engaging in mutual relationships with clients. The gaze of others, including ideals of professional practice acquired through training, and codes of ethics, is often not supportive of this mutuality. The participant quoted below describes her concerns as she notices the difference between her practice (and the topic of the interview) and her understanding of the expectations of the profession she learned in both undergraduate and graduate school. Other participants also described an awareness of the practice of mutuality as being counter to what they were taught or counter to how they understand the Board of Registration for Social Workers in British Columbia's policy (2002) on social worker and client relationships. An additional sign of this awareness that mutuality is a subversive act is that it is important to several participants that the anonymity of their experience and actions be maintained. They attribute this desire for protection from the direct gaze of the profession or their colleagues (and the interviewer) to their sense of potentially being seen as doing something wrong in light of professional limitations of their relationships with clients, even when they felt it was right with respect to the usefulness to the client. 38 I remember that ethics course, right—you do not take anything from anybody. But that you know, in accepting that [gift from a client], and so in doing this interview— it's, you 're almost a little standoffish because it's like, yes, I am conceding to the fact that I had this relationship with a client, so you are a little intimidated by the questions because you don't know where this is going to put you, you know, and in knowing that you are doing research that this will get printed, and it will be reflective of the student body, and maybe they are all going in disarrays because this is actually how we are practicing... Because again, you were taught that you don't do this, and mind you I don't necessarily believe that my client should go and buy me a something... but in doing the context of this interview, you know, you do it with the understanding that you are working against what you have been taught to a large extent, right? So, we need to—so that's sort of what is going on in the back of my head, right. What are the kind of questions is she going to ask me, how is she going to define reciprocal relationship, what does this mean in terms of my own practice, because when you leave here, I am going to start thinking about—which is natural— we are supposed to—I think this is healthy and we should be able to do things like this—but that's what it makes me think, so it inspires that sort of critical thinking. I think it's okay, I think it's totally okay, you know? This description highlights the participant's struggle to make sense of how to conform with professional expectations and her own assessment of appropriate behaviour in her relationships. She describes the gaze of the culture of the profession as it is embodied in the school and the potential readers of this study. Participants also described feeling this gaze in their workplace and among fellow workers. It should be noted that other participants were 39 not concerned with confidentiality or anonymity and described a confidence in their own experience that they felt would stand up to scrutiny. In addition to this broad context of the institution of social work, participants talked about their practice in relation to their workplace and governing policy. Influence of the workplace and public policy. Participants report that the culture of the institution within which they work, particularly the attitudes of supervisors and team members, plays an important role in whether they engage in more personal relationships with clients. Additionally, the culture of the times, including government policy, plays a role in the way in which participants engage with clients. When the culture of the team or institution does not openly encourage or accept reciprocity between workers and clients, participants report that they were less likely to engage in mutual relationships. The following quotes describe the attributions these social workers give to the workplace and policy. Even while participants state that they are philosophically comfortable with their decision to engage in mutual and personal relationships with clients, it is important that their peers and institutional practices support their practice. The first excerpt describes one social worker's comparative experiences in different agencies. I felt that the work environment has to support that caring relationship—that work environment has to support the notion that the caring relationship is a reciprocal relationship. And I think the culture of agencies either does that or doesn't do that. I am very fortunate now to work in an area of health care where that is supported. The following excerpt illustrates the influence of public policy on the worker's relationships with clients. 40 The Ministry [of Children and Families] was shifting a lot of their philosophy at the time, and so it was great just to be a part of that and to really feel like you were part of a family [with clients] because...we would do the Christmas party dinners, and we would do Thanksgiving, [with youth in the centre] and it would be all organized with a lot ofparticipation from both sides. So [it was] a good learning experience in how do we work together, as opposed to Fm the one that has the expert knowledge and you know, trying to put it on you? It was a lot of cohesiveness, working together, collaboration, so—that would have been the best thing [about that experience]. Finally, participants identified the need to conform with their supervisors' perspective even when the broader social policy or movement (here the social worker is referring to the Vancouver Resource Board's practices in the 1970's) suggests otherwise. I think you know, no matter how free or liberating the [cultural] environment may be, if you've got a boss who doesn't see it that way [allow for new ideas about relating to clients], you know, you had better tow the line. These excerpts illustrate these social workers' preference that their practice conform with institutional and peer expectations. One participant stated that this need to conform in the early part of his career was related to his practical need for paid work (as a social worker) and an unwillingness to put it at risk. This aspect of why social workers pay attention to and follow workplace and institutional practices seems obvious and quite reasonable, but was not typically addressed in the participants' own analysis of their experience. Another way in which the community influences the way in which participants make sense of how they choose to engage with clients is through the particular type of social work practice or different social work roles they are engaged in. Social roles are socially or 41 culturally defined and recreated through the individual's behaviour when playing that role (Stets & Burke, 2003; Valsiner, 2003). One way to make sense of these roles is through observations of others' behaviour and how it is similar or different from other roles, and this process is illustrated by participants in the following thematic finding. Differences in roles, differences in relationships. Participants believe that the field of work, or role of the social worker, plays a role in deterrnining the extent to which they (or others) develop mutuality in their relationships with clients. Participants' interpretations of how different roles dictate different relationships were not consistent with each other, but illustrate an interesting aspect of how they make sense of why their way of relating may be acceptable and still conform with the concept of professional boundaries. Some participants believe that other social work roles may require professional distance but that their own area of practice does not. For example, participants cited differences between working with seniors in residences and standard health care provision, or volunteering and social work. Common to this theme is that the workers saw their own role as allowing for a focus on relational practices and mutuality. For some this difference was attributed to the role itself and for others it was attributed not to a difference in role, but to their own development within a role. Here one participant describes his analysis of difference in roles. I think that the traditional role of social worker was like a professional counsellor and that's it. I think if you want to look at that kind of relationship you can kind of understand where the doctrine, and you know, having your boundaries very clear comes from, because I guess in a strictly counselling relationship, it's not about you, it's not about your issues, it's about your working with a person, helping them deal 42 with their issues. Most social work relationships are not like that. That's not the reality of practice in social work today. The social worker quoted below describes how she relates her social work role to another role, in this case someone who does what social workers do but is not a social worker. This experience has influenced the way she sees her own role as a social worker as a subsequent impediment to relationships with clients in that being a social worker appears to intimidate people. She has made sense of the possible limitations of her role through her experience of how people respond to her (or others) in light of the designation as professional. I remember probably about a year and a half ago in Vancouver here, I was doing some community development work and so I had met this girl who worked for the organization and she wasn't a social worker, but she was doing social work and that was a just a red light for me that said social workers are like everybody, like so many other people who are doing work in our communities and we just happen to have this title, and the title intimidates people. These examples illustrate the way in which participants have paid attention to their understanding of cultural values and norms embodied in roles, and how their own and others' interpretation of the roles influence their relationships with members of the community. The specific community interactions described in these three identified themes—culture, workplace and role—indicate the importance of the community in defining how individual social workers make sense of appropriate relationships with clients and to some extent guide their actions. 43 Other cultural or community locations include colleagues' practices and professionalism. Participants describe their experiences and analysis of these influences and compare them with their own philosophy. Both too much distance and too much closeness are seen to be problematic by participants and generate concern for the welfare of clients and social workers. These next four themes represent the participants' analysis of social work practice and professionalism. The practice of colleagues. Participants express both a concern for the practice of their social work (and other) colleagues regarding the way in which colleagues maintain emotional distance from their clients, or that social workers may cross traditional boundaries without sufficient reflection or supervision. The first excerpt below describes one social worker's observations of her colleagues' focus on technique (analysis) and that she feels a technical, emotionally distanced approach is problematic. You know, there are social workers—when Ifirst came out of my master's degree, there were social workers that I wouldn 't have sent my worst friend to, and they were totally analytical, they had fallen for the fact that in order to maintain a therapeutic relationship that meant you had to be some kind of wooden character that didn't display emotion, didn't display much feeling, you were in fact case manager—that says it all, and they had degrees, and they had somehow gone through life untouched, and that was about their life experience, because that's what you bring. The next excerpt reflects some participants' concerns for their colleagues' practice of blurring relationship boundaries. This participant believes that she utilizes skills and practices 44 that allow her to create and maintain appropriate boundaries with clients (which may include closeness), but has concerns about some of her colleagues' ability to do the same. I do, I think that there are [social workers] who are blurring those boundaries because they don't have self-awareness or supervision. And that worries me, it really worries me. Another participant speculated that some workers may be getting their own needs met through their relationships with clients. He states his concern that workers may at times not be professionally motivated in their engagement with clients, but that does not mean that the care and interest in helping others is not genuine. / think that a lot of professionals go into helping professions because when you care for other people, it can also help to mask some of your own issues, and makes it easier not to deal with your own issues. But that doesn't mean that you don't care. It means that you are caring, and have your issues, and maybe not doing what you do for the right reasons, but that doesn't stop you from caring. Other examples of concerns over colleagues' practice include a sense that some of their colleagues do not really care about their clients and or the worker simply needs paid work. These conclusions were drawn from witnessing what the participants believed to be colleagues' emotionally distanced relationships with clients and apparent lack of effort on behalf of clients. You know, unfortunately I see a number of situations where overwork, or indifference causes [social workers] not to extend themselves in any way, and I can't stand it... I mean I'm not putting in time between this and some other part of my life andfor some 45 people who are burned out, they are. They are putting in time until they retire, until the end of their shift, until their vacation, you know, that's not where I'm at. The previous themes illustrate cultural and institutional influences on the ways the participants think about their relationships. The following themes focus on the attributions participants made to the specific concept of professionalism. Participants identify several aspects of professionalism including emotional distance, burnout, and express a desire to examine and talk openly about social works' professional stance towards clients. Professionalism and emotional distance. Participants connect the concept of professionalism with maintaining an emotional distance from their clients. Along with other participants, this social worker identifies the desire to be seen as professional as a guiding force in the attempts of social workers to avoid engaging with their clients emotionally and recognizing the mutuality inherent in human relationships. Here he describes his experience of talking with colleagues about their emotional desensitization to common elements of their work in a cancer ward. And part of me felt that that [colleagues'] desensitization [to illness and death] happened because there are no opportunities to ever acknowledge their feelings. I mean that is supported by biomedicine. That is supported by our social constructs of what a professional relationship is, I mean and that's whatever profession you go into... You know when your patients die, you are going to have to grieve that—that doesn't happen, because the expectation is that, no, you don't feel as a professional, and no, you don't care. Several participants named this emotional distance as a 'wall' and connect this dictate of professionalism with burnout. In contrast to maintaining a wall of emotional distance and 46 separateness from their clients, participants spoke to their need to engage in emotionally intimate and reciprocal relationships in order to stay in the work. Professionalism and burnout. Participants hypothesize that the 'wall' of professional distance from clients leads to burnout, and that engaging in mutual relationships prevents burnout. The following quote illustrates how one worker has made these connections. / think if you want to look at the rates of burn out among social workers—does that have anything to do with the fact that you have to maintain this wall? I kind of think that it does. I kind of think that not maintaining that wall makes me an overall more of a healthy person and being able to integrate my work life and my personal life into who I am, and being comfortable with that... I really believe that in a field like mine, you put up that wall and you are in trouble, pretty soon. And in a lot of different ways, because your patients won't trust you and respect you and you are going to burn out. Further descriptions of the effects of emotional connection and reciprocity in relation to clients are described in themes identified in the interpersonal category following this community category. While burnout may be attributed to an individual's ability to cope, here participants have connected burnout to coping in the context of the community culture rather than the individual's skills, abilities or attitudes. The burnout effect is included in the community category because the concept of professionalism is arguably a community location—these individuals are making sense of and acting in response to the cultural norms of professionalism. 47 Given the subject of the interview and that participation in the study is voluntary, it is perhaps not surprising that participants stated a strong interest in bringing this topic into the open. At the end of each interview, participants were asked if they had anything they would like to add and the importance of this topic is the focus of many of their reflections. Importance to the profession. Participants report that talking about their experiences of receiving care from clients is new to them, and that they believe it is an important issue for social work. While many participants are conscious of their practice of openness to mutuality and receiving care from clients, others have not until now thought about their experiences in quite this way. Whether the social workers are clear about their practice of engaging in reciprocity or are only beginning to frame their practice this way, participants describe the newness and importance of talking about this approach openly. The following quote is an example of these reflections. Here, the social worker's description of relationships as subjective follows her reflections about the objectification of clients, something she identifies as an element of professionalism. She has connected a lack of reciprocity with objectivity and unequal power, and reciprocity with (inter)subjectivity. / think [the focus of this study] is a good topic. I think that this is a topic that we need to address as social workers... People work, are working with clients and it's not reciprocal, and it's a power-over thing, and workers are using their position with vulnerable populations—I don't think we do enough work with how to maintain these relationships as subjective in a healthy way, and that it goes back and forth. In summary, these themes reflect participants' ideas about their practice and openness to reciprocal relationships with clients as related to cultural or community ideals. The themes 48 describe how participants interpret the gaze of the community, integration of professional standards, and the subsequent influence on their actions and attitudes. It seems that while these social workers attribute some power to these community influences to limit their practice of embracing mutuality within their relationships with clients it does not prevent it from happening, but rather contributes to a sense of subversion of professional standards. Through their participation in the interviews and their stated interest, these social workers invite public conversation to explore the value and practice of mutuality. The following interpersonal categorization of themes captures the ideas and experiences of the participants that relate to their experience within their relationships with clients. Interpersonal The following themes identified from the narratives told by the participants reflect the meaning they made of their reciprocally caring relationships with clients. This interpersonal category captures the ideas participants related about past events between themselves and their clients and the influence of the interpretations participants give to the relationship as they described it at the time of the interview. The focus of the interview was to identify change that occurred as a result of engaging in reciprocally caring relationships and several participants described experiences from early in their career that they identified as formative, however some described recent experiences. The meaning they made of the experience of being cared for affects both the participants' sense of the specific relationship described and how they may generalize this experience to frame future relationships with clients (and others) and their future actions. I have organized these interpersonal themes into five sub-categories. The first group deals with the social workers' interpretations of their clients' behaviours, the second with 49 how a sense of mutuality or reciprocity happens and comes to be understood by both parties (from the perspective of the participant), and the third with how this mutuality influences the social workers' perspectives. The fourth section deals with descriptions of the qualities of the relationships and the fifth with perceived changes to the work as a result of the experience of mutuality. How do they know? During the interview, participants were asked to describe how they knew that the client cared for them, and this question yielded the following descriptions of overt and subtle gestures made by clients and what the gestures mean to the social workers. Social workers often noticed this care through physical or tangible symbolic actions. Awareness of care from overt gestures. Participants receive overt gestures of care from their clients including hugs, small gifts, invitations to special events, notes and letters. These gestures from clients may happen at any time in the relationship, but often occur near or after the end of their work, or around significant milestones and achievements during the course of their work together. The following excerpt captures one social worker's story about a client's expression of care toward her after the client completed treatment. / think of one particular example would be a First Nations' girl and I started working with her when she was about 15 years old, and had worked with her probably for about six months and then she eventually went off to a treatment centre. So this is the example—and when she returned from her time, her three months in treatment—she brought me back something that she had made. It was like rock, and she had engraved my name on it and I think I knew primarily from that sort of action that she 50 cared... that's how I would see that she cared and stuff. And she would write me poems and stuff like that. Some participants' stories describe both subtle and overt gestures from one client— both types of gestures may be made within each relationship. Both types of gestures seem equally meaningful to the participants. The physical demonstrations seemed easy to recall and stories about the workers' experience began with a description of this type of gesture. Sometimes the more overt gesture provided the touchstone to recall other more subtle gestures that the social worker identified as caring. Awareness of care through subtle gestures. Some workers feel cared for as they pay attention to the nature of the relationship or feelings generated while they and the client spend time together. Participants report that they often become aware of the clients' care for them through subtle gestures (friendliness, personal inquiries, shared laughter, etc.) rather than overt gestures or declarations. The following three quotes illustrate how participants interpret their clients' actions, verbal expressions or way of engaging with the worker, and the feelings that arise in the worker in the context of their relationship. The first quote describes how a participant interprets the behaviours of the youth she works with: A lot of our kids—a lot of the clients we work with, they don't, you know, come out and say, I care about you, or I—you know, all that kind of stuff, but it's just, for them, it's a non-verbal way of saying it, by their actions. The second quote captures how participants describe feeling cared for by noticing the way in which they and the client are engaged, or the context of the exchange. This participant 51 interprets the ability to share humour or tease each other as an indication of a mutually caring relationship. I think that people show it through their—besides their being, talking about their own lives, just in non-verbals, and sometimes we can tease, or you know, joke a bit together, and so I can tell that there is—they are with me, and I am with them. The third quote illustrates how some participants know that they are cared for by their clients without identifying a particular action or concrete sign of care. There appears to be a certain quality of respect and value to the relationship itself. It wasn't anything tangible. But I knew that she valued me as a person. I felt it. She had respect for me and it was in a non-verbal way, it wasn't anything tangible. It never has been anything tangible. It's been that connection that is almost inexplicable, but ii built over time. These descriptions of gestures that the participants interpreted as caring take place within a context of the social worker's own openness to receiving that care. There was variation in the degree of comfort or openness to receiving that care at the time it occurred, and while for some the event they described represented a turning point or transformational moment in creating a confidence in holding a perspective that allowed for that openness, it seemed that some degree of comfort with this phenomenon was required to allow the gestures to hold this meaning. The following theme illustrates how when looking back, this social worker makes sense of clients' gestures from this perspective of openness. Clients' demonstrations of care independent of worker's openness. Participants remember instances of mutual caring between client and worker even when the worker was not open to or comfortable in receiving care from a client. This social 52 worker is amused by her own position (a lack of openness to mutuality) as she looks back at her early work with clients. At first I had more the family therapy, more traditional expert sort of model that I was a part of and so—but you know I remember some people being amazing, I remember they cared, even then (laughs).... You see, I think I was cared for by clients even in those other, in that other environment, but it was harder for me to be myself, and be enjoying of it, or really let it flourish. I think also when I [was more myself], people didn 't go, oh my god—the clients still, in fact I'm sure—that they had a better experience. That clients may care for workers even when the social worker is not open to receiving that care because of the influence of the community or theoretical model adopted by the social worker provides an illustration of how the relationship is co-created by both participants in the relationship, yet each individual has a contribution to make to the nature of the relationship. Even though the social worker is professionally responsible for providing appropriate boundaries, it appears that clients too have the ability to set, or at least offer, the terms of the relationship. Assumed reciprocity in the relationship. Several participants stated that they have always been aware of the mutuality inherent in their relationships with clients. These participants believe that the client also approaches the relationship with assumptions that it is a reciprocal relationship. Their understanding of their clients' care for them developed not only from interpreting their clients' gestures, but from the perspective they brought with them to the relationship. 53 / think that—I would feel that the vast majority of my clients care about me too. Like the vast majority of my clients think that it is a two-way relationship. So is it a point that I pick up on that this person cares about me? I don't know if there is a specific point where I pick up on that because I just, I guess my kind of naive way of thinking, just assume that both parties are going to look at it as a reciprocal relationship. While several participants stated that they brought this perspective into their work with clients, most identified their openness to mutuality as stemming from a process over time. Participants described the process of their own change and the change within each relationship. The following sub-category includes three themes which detail the participants' explanations of how a sense of mutuality developed within specific relationships. Participants describe how their relationships are dynamic, mutually negotiated, and variable. How does it happen? A dynamic relationship. Participants notice that each relationship with a client changes over time—the client also influences the amount of closeness between worker and client, the choice of activities undertaken between the client and worker, and when the relationship will change or end. Some participants only describe shifts that took place within their working relationship while others describe situations where the relationship moved from a focus on work together to a focus on their relationship outside work. This participant describes the process of an increased sense of mutual care and intimacy within the working relationship. Well I think the conversation... it takes sort of these minute steps towards greater and greater openness and receptivity and so when there is, when that starts, it's kind of 54 progressive, and so it's not like I would say that we crossed over a line towards caring or that I suppose sometimes that there is that more—a big leap. Participants described these changes as a somewhat complex process in that they had no clear or static rules for when a shift toward mutual intimacy would or could take place. This seemed to depend on their ongoing assessment of the client's behaviour and intention, and the workers' response. The chance that a more personal relationship would develop was dependent on both the worker and client. Sometimes this shift happened without either party talking about it and other times the shift was discussed explicitly. The following is an example of the way in which one social worker addresses this shift by talking about it with her clients. Transparency and negotiation. Participants report that they talked through the meaning of their relationship with clients, and that the meaning was mutually negotiated. Others relied on their feelings, non-verbal cues or less direct conversation to gauge the level of closeness in the relationship or negotiate change. The social worker quoted below describes how she negotiates a shift that is already taking place as indicated by the behaviour in which the worker and client are engaged. I don't intrude on people, I respond and so if they are interested, I'll respond, and then they get—you know, it just goes back and forth, that reciprocity. So, and also I talk about how things change with them, like, I've known you three years as your worker, and now, you know, we 're sort of in touch, and okay, let's get together for lunch, and you know, I sort of gradually loosen the professional limits and there isn 't everybody that I would make that transition with, but the people I have done it with 55 have wanted it, and I've been comfortable doing it, so Ifeel like I have more that I can give, and that we can both enjoy the relationship. This example illustrates the social worker's awareness of the reciprocal process involved in negotiating relationships. She is aware of her own choice regarding when she might engage in more personal relationships (not with everyone and only when she feels comfortable) and has assessed the clients' interest in a more personal relationship. The focus of this relationship is one of mutual enjoyment. Talking about the change in the relationship creates another opportunity, in addition to paying attention to each others' behaviour, to negotiate the nature of the relationship. Like this participant, other participants also reported that they do not engage in openly personal relationships with every client. Acceptance of variations in intimacy and mutuality. Participants report being comfortable with different levels of mutuality in relationships and do not expect or require reciprocity of care from clients. They expect that their relationships will vary from client to client and vary from moment to moment within each relationship. Participants connect the concept of variation in the relationships (some might be very intimate and close, others might not be) as one of the elements that allow for appropriate levels of intimacy with those clients and make the more intimate moments or relationships more enjoyable. In this first excerpt a social worker describes his focus on the client's need to be how they are and how he does not need clients to act in consideration of his or his colleagues' feelings. Because these are patients and families that are in such a difficult part in their life and have so much to deal with that I almost think like, that shouldn 't have to enter into it, like consideration of my feelings should not have to enter into it.... You know, 56 you can do whatever you need to do, or you can be however you need to be, and we '11 accept it and deal with it. And won't think badly of you for it. From the stories participants told, like this one, it appears that their relationships vary both between different clients and at times within each relationship. While this social worker does not expect clients to express care for him, he told several stories of how they often extend themselves to include him outside his professional role through personal inquiries and invitations to important family events (i.e. weddings and funerals). For him it is important that when a patient or their family reach out in these ways that he is open to accept that invitation. He expressed both gratitude and wonderment that people would invite him into relationship and find room to care for him when they are going through difficult times. I once had a sixteen year old girl [who] was palliative almost from the beginning, and she had seen a movie about a teenage girl with cancer, who was dying, who ended up marrying her boyfriend, and she decided she wanted to do that. So we got Make a Wish Foundation in to do that, and I was very close with her, and particularly close with her mother. And she ended up passing away and it was a funeral that I really felt I needed to go to, and she mentioned myself and quite a few others—the mother—mentioned myself and quite a few others staffpeople by name in the eulogy for this girl. So even at a time when it was totally not about us, and we wanted to be there for the family, and we, you know—the importance of that relationship even when the outcome was not successful, it's touching. I mean I got a Christmas card from that mother in December, I mean we talk still every now and again when she has issues that are going on for her. 57 The next social worker describes how the inconstant nature of intimate moments within each relationship makes it more valuable to her. Here she describes the variations in intimacy within a counselling setting: This [moment of intimacy with a client] is part of what I am alive for/is right now, and that is very precious for me to have those moments and it's not constant at all, it's part of probably what makes it more precious is that they aren't constant. Another social worker reflects on how allowing for variation in the openness of clients contributes to an acceptance of his own variable openness. He describes how this mutual openness occurs (or does not occur) because it needs to be that way for both parties in the relationship, rather than following a prescribed definition of an appropriate relationship. / guess I learned that my relationship with the people that I work with can be—it doesn't have to be open to a strict definition of what is correct and what is not, it can be what it needs to be. For myself, and for that person. Primarily, of course, that person before myself... You just have to be with people where they are, and it's allowed me—doing that has allowed me to be with myself wherever I am. The capacity for variability in relationships suggests a sophistication for managing the complexity within reciprocal relationships in the client-worker context. Participants described this variability and act of creating unique relationships as enjoyable and it heightened their appreciation of the opportunity to engage in relationships with clients. During the interviews, participants spoke directly to their understanding that engaging in relationships where they would respond in kind to clients' overtures (i.e. accepting an invitation), negotiate unique relationships with clients, or respond with different levels of intimacy with each client may not be seen as fitting with standard practice. Participants spoke 58 to the idea that all relationships with clients should be the same but in practice were not in agreement with this principle. The following section describes how participating social workers describe the process of learning how to engage in relationships with clients. How do the participants learn? Participants attribute their approach to relationships with clients to experiences early in their careers and report ongoing development or change through their practice. Participants who are in early stages (5 to 7 years in practice) of their careers describe how their current experiences are affecting the way they conceptualize relationships with clients. Senior practitioners typically reflected on their earlier experiences. The descriptions of ongoing development in their approach indicates that participants do not maintain a static or rigid method of practice, but rather pay attention to feedback and their confidence in their own judgement. While participants told many stories about the type of feedback they receive from clients and the improvements in the work, these are documented in the next section on the quality of reciprocal relationships. This section focuses on the process of learning rather than the specific content of what participants learned. Learning from positive and negative feedback. Participants report experimenting with more personal openness with clients as a means of making a difference to the client (trying something with the hope that it will be effective). Participants report paying close attention to what happens and the best interest of the client when they experiment with personal boundaries. Participants report having learned about appropriate closeness and reciprocity in relationships by occasionally making mistakes. The first excerpt illustrates the worker's process of noticing when his work with a client (a hospital patient) is not effective, he continues to pay attention and tries new approaches. 59 You know you are constantly sensitive to is this working or I'm getting silence or am I getting nowhere. So sometimes you don't get anywhere right away, it takes days or weeks to go, oh this isn't helping anybody. It's wasting my time and apparently not doing any good for anybody else. But eventually—hopefully quickly—you get it and you figure to try something a little bit different. This next excerpt describes how one experience of accepting care from clients and engaging in reciprocal relationships builds on the next. The social worker uses previous experience as a basis for new experiments and gains confidence in her method by paying attention to the results of her approach. So I think [clients had a better experience], the more I could kind of test—I could be a little bit more me, and be more just open to the relationship part, or a different type of relationship, then the more I got feedback that people were, it was more positive— and I would do it even more. Finally, several participants stated that their learning process included making mistakes where they felt the shift towards an openness in personal boundaries was detrimental to the client and occasionally to themselves. Making a mistake meant that the relationship was no longer an appropriate frame for productive work together. Participants reported that the results of these mistakes would lead to an end to the relationship or the worker and client shifted the boundaries towards a place more comfortable for the client and they continued the work together. This worker describes an example of this process where he had shared more personal information with the client than seemed useful or helpful to the client. 60 It's a fine balance. It's—of what you tell people. There were situations with clients where I went, I shouldn't have said that, I shouldn't have gone there, that was a mistake. Another worker described a situation from a time earlier in her career when she invited a client (who was in dire straits) to stay in her house while she was away with her family. While this response met the immediate needs of the client and the client did stay in her house, this shift in boundaries proved to be inappropriate for the therapeutic work and the relationship ended. This worker expresses regret over the loss of appropriate conditions for therapy with this client and cites it as an important learning experience: [The client] got into a situation where she was financially devastated, had no money, and this may not have been the right thing to do, but we had—we were going away, and she lived in our house when we were away for a few months, actually, and now that I look back on it, I'm not sure that I would have done that again. And it was with complete agreement of my family, but I—I'm not sure that it was a good thing to do. There weren 't any consequences per se, but I'm not sure that that was wise. You know she was in dire need, we had an empty house, it seemed like a good idea at the time. And now that I look back on it I'm not sure that it was good... Because I think after that it was hard to—I think our therapeutic relationship ended... And so there was a blurring there, which Iwouldn 't—I never did again. That was about 15 years ago, and I never did that again. The learning process described by participants is consistent throughout their stories. While mindful of the professional model for relationships, participants describe ongoing development of their perspective and relationship skills (assessment, action, re-assessment) 61 based on their own experiences in relationships over time. As described in the community section above, participants reported an awareness of the subversive nature of these kinds of relationships, but many, particularly those who are senior practitioners, spoke to their confidence in their choice. Confidence in one's personal judgement. Participants report a sense of confidence in their choice to engage in personal relationships based on their experience of what is helpful in their relationships with clients and their personal judgement as well as their professional socialization or training to determine their approach. The following explanation given by one social worker captures the confidence expressed by several participants. She adds that in addition to the learning process described above, her ability to follow her intuition provides her with assurance that her approach is helpful. It's interesting to go on this sort of retrospective, introspective journey [through this interview process]. You know I think at my point, in my stage in my life and my career [30 years of practice], I'm confident that what I am doing and have done has been really positive. I wasn't always confident, especially in the early years. You 're not sure, well yeah. I think that—oh I had theory and I had all of that, but I think mostly I think I had the capacity to really listen to myself, my intuition, my intuitive self in working with people, and it has served me well. It has served me well. These stories of participants' learning process indicate a self-reflective and dynamic process in the development of practice methodology. While in theory social workers should not cross boundaries as outlined in policy or professional guidelines it appears that an openness to experimentation and willingness to follow their own judgment provides these 62 social workers with a context for learning how to create useful relationships with their clients. In other words, while the profession and community culture provide rather static guidelines for relationships with clients, it appears thai some practitioners do not rely on these alone to determine their practice. Participants report paying great attention to the quality of their relationships with clients as a basis for determining appropriate levels of intimacy and mutuality. The following section describes these qualities. What happens to the quality of the relationship? During the interviews, once participants told a story of (at least one) experience of receiving care from a client (such as those described at the beginning of this findings section), they were asked to describe what, if anything, was different between themselves and the client after that exchange. The reported differences in the quality of the relationship are consistent between participants. While not all participants described every one of the qualities outlined below, there was considerable overlap and none of the stories contradicted these experiences. These qualities typically describe the nature of each specific relationship in which the social worker is engaged, although some workers generalize their experiences to most relationships with clients once they experienced a shift in their perspective to embrace mutuality and intimacy. The qualitative experience of these relationships reinforce the participants' choice to continue to be open to mutuality. Sense of equality. Openness to and the experience of receiving care from clients tends to lead participants to what feels like more equality between them. This is evidenced by a sense of not knowing (giving up the expert stance), deep respect for the experiences of the client, a willingness to slow down, comfort in silence together, shared laughter, and sharing personal 63 information. The theme of increased equality represented in this first excerpt was noticeably prevalent through all participants' stories. While this social worker recognizes that theoretically social workers are equal as human beings to their clients, her experiences of being herself and appreciating the contributions the clients make to her life brings that sensibility into everyday lived experience. So not just as the aspirational culture of thinking that it's a good idea to be equal to people—instead, as I became more receptive and saw my part in the relationship and didn't see myself as better than, and in fact often felt the opposite—quite honouring of people's experience. In addition to an increased sense of equality, participants described other qualities of these more mutual relationships as illustrated in the following three excerpts. The next excerpt describes how the participant connects the practice of engaging in mutuality with not acting like an expert, being herself, and not seeing clients (and now employees) as different from herself. [To] not just have to come from a knowing place nearly so much, it's so freeing, you know—to be able to have more mutuality in relationship and be more free to just express myself and that's, I think that's quite a big difference, and not to see clients as different, or now that I have this environment, not to see employees as different. The social worker quoted below sees shared humour as a sign of shared humanity and connected to mutuality. She illustrates the potential complexity of relationships with clients in child protection situations by describing the contrast between the possibility for shared laughter and fun even while working to address the client's abusive or neglectful behaviour. 64 I mean part of [mutuality] is being able to laugh with your clients, too. I think that humour is really underrated, and sort of having fun with people, I mean it seems sort of weird talking about you know, from a child protection point of view—even in child protection situations, you know there can be humour, and you know, enjoyment, and you know in terms of—especially if it's a long-term relationship with a family. I mean those aspects come into it—it isn't all, you know, bruises and drunk, home alone, beaten up, it's—that's not all it's about. Further change in the relationship identified by participants is a change of pace in the work. Several participants noticed that they are more willing to slow down. This slowing down was connected to matching the client's pace rather than meeting the demands of their workload. Participants also reflected that slowing down tends to support the process for the client's desired change. When this social worker noticed the positive results of slowing down, she was encouraged to stay with the process. / think that when there is more mutuality, the conversation can kind of slow down a bit and stay more in the present with more reflection, around what's going on in the person's life... then this conversation is starting to perhaps make a difference, and so, and so you can take some more time. Another element following an increased sense of and practice of mutuality noticed by participants is a sense of connectedness between themselves and their clients. Reciprocity in the exchange of personal information is one method that leads to the creation of an environment where clients may be more likely to open themselves to the worker. 65 Sense of connectedness. Participants notice that clients will be more open about how they are and share more personal information with them when they (the workers) are more open with the clients. Participants talked about sharing personal information with clients when clients express interest in their personal lives and when that interest feels like an expression of care toward the worker. The following excerpts detail both the process of choosing to be more open and the social workers' reflections on the quality of connectedness within the relationship. The first excerpt follows from the social workers' description of his practice of sharing personal information, or giving of himself. I became a better social worker through [being open to mutuality]—absolutely. I learned, you know what—this is not about being tight-assed, this is not about being a bureaucrat—this is about being a human being, and it's one human being talking to another human being. I've got a function, and you know, maybe I have the power, and I have the decision-making, I've got the authority, but you know what, it's about relationship. It's about caring, it's about how do I support you to get somewhere?... I became a better social worker because the more I gave of myself, the more people—it seems to me that people were more able to—I was going to be able to break through barriers. The second excerpt echoes this experience of connectedness and provides a more detailed description of what it feels like to the worker. This worker is not reflecting on the sharing of information specifically but rather a more general sensibility of mutuality in the relationship. 66 Well I think [the relationship] has a richness and depth that probably if you are professionally detached, you don't have. I think that there is a connection, a more intimate connection that happens and I think that our families recognize it. And I think that if there is a sense of you being on the same side, that you are working together, that there's sort of more being in unison and in sync together, and I think that people—that the fear reduces, there is a general feeling of acceptance. I think that it is more comfortable.... I think that it is easier to work with families when you've had a closer connection. I think that they—that they are more responsive, and I think that things just go better. The social workers quoted in both excerpts believe that as a result of being more connected the work is impacted positively. Additional descriptions of benefits to the work are described in the last section in this category of interpersonal themes. Congruency with personal values. Participants make a connection between their choice to be open to mutuality and modelling ways of relating to others for the client's benefit. Several participants reported that one of the purposes of their choice to engage in mutuality is to model or provide a lived experience of a positive relationship. When the client joins in creating a sense of mutuality and reciprocity, the workers report feeling an increased sense of respect for them. Workers express a hope that the client would take that experience with them into their other relationships. Modeling is framed here as a quality of respectful reciprocity that apparently fits with many of the participants' values. [When people demonstrate care], I think that I have a different sort of respect for them. Because they understand the importance of human relationships with each 67 other. And that our relationship becomes an example of this. I think that that's one thing. I think that to some extent, that I would like to think that it prepares them for other types of relationships in the fact that maybe I've demystified my experience of working with them in the role of helper and also that it—I would just like to think that it's taught them something about a relationship with somebody else and that relationships can be good, and here's an example of a healthy relationship that goes back and forth. So I hope that it to some extent acts as a template for them, as an example, and that they would—will, and I hope that they continue to build relationships, healthy, that are healthy like that, and that relationships aren't only about them giving, giving, giving, and the other person taking or me giving, the other person taking. I hope that that's what it is. While participants describe this modelling practice as a benefit to their clients, they also described how this approach to relationships affects their non-professional relationships. The practice of mutuality and openness is brought into their generalized approach to relating to others. This phenomenon illustrates well the apparent inseparability of some aspects of personal and professional relationships as well as how social workers' relationships with clients contributes to their own personal development. Participants readily connect these qualities described above to changes in their ability to work with clients which enhance the achievement of social work goals with their clients. The relatedness of the quality of the relationship to the effect on the work appears to be close and again consistent throughout the participants' stories. The following section in the interpersonal category of findings describes the impact of mutuality and the quality of relationships on the work. 68 What happens to the work? The qualities stemming from an acknowledged mutuality as described above have various effects on the social workers' work with clients. These effects are outlined in this section and include a willingness to follow the clients' lead, an increased commitment to the client, an acceptance of the outcome of the work and relationship, a sense of effectiveness in the work, uncertainty or discomfort on the part of the worker to put the relationship at risk, and a reduction in conflict between the worker and client. Following the client's lead and responding to the clients 'preferred approach. Participants report that when they are engaged in more mutual relationships they are more likely to follow the client's lead as the client determines what they want from the worker. This worker describes how her experiences of working with a client with whom the relationship developed a clear sense of mutuality influences her approach to the work. Her own expertise developed through training supports, rather than leads, her work. The clients' experience has become the lead or focus for her assessment of how to be helpful. And I learned a lot about my practice through her because you learn, you learn what works and what doesn't work, so she was just good because she really taught me what works... it is meaningful for me because I learned so much from her. You know, and that's what made that good, because it was reciprocal, in many ways, and I think that when it comes to reciprocity, I think that that is how it is supposed to work, we need to learn from our clients, we can't go in there and go well—Fve done this B.S. W. and Fve done some training on this depression or this addictions stuff, but that I don't know it all, and that [clients] are the best teachers—you know there is nothing really that can be captured in a classroom setting as opposed to when you get 69 out there, and then they tell you what's really going on and how they are reacting to their realities. Another worker connected an increased sense of mutuality with the client's shift from passivity in receiving hospital care to setting the tone of the relationship. He described how his older patients let him know (both directly and in unspoken ways) when they prefer him to express his confidence in their ability to deal with their situation rather than be overly concerned and solicitous. [The elders] are the ones who are to be respected. So that's it's about re-establishing that. So when they come here and they are so ill—that's been reversed. They 're down and I'm up... [At some point in the person's recovery] the message is sometimes spoken and unspoken [that my] style or approach of extreme concern becomes less welcome. In other words, you don't have to worry about me, you know I'm okay. Sometimes that is actually said. Typically that's a subtext that isn't stated. And you get that message by body language, by facial expression I know when I'm being too concerned and too worried, and they are looking at me thinking oh you don't think I've got it together when you say oh I know you've been down for a endoscopy, that must have been really difficult for you how are you doing with that now? So when you get a response, no, that's fine, nothing, what do you mean must have been difficult for me? You know that they don't want you to be that concerned to express that and that what they want is the assurance that they can take that in great stride and they would like you to play along with that. Both these examples cited above reflect a willingness on the part of the social worker to pay attention to and follow the direction the client gives them whether in terms of utilizing 70 the clients' expertise or the way in which the clients prefer the social worker to relate to them. Commitment to the client. Participants report feeling more committed to clients and their work when they engage in reciprocal relationships (more open to receiving and acknowledging the care they receive from clients). Participants identified this as a commitment to specific clients as well as a generalized commitment to people and to social work. This first excerpt below describes the worker's acceptance of the difference between a professionally prescribed commitment and her actual experience of developing that commitment. Here she draws on her experience with one particular youth. For me, how I—yeah, it's almost like a different feeling, and I know that you are supposed to, as a social worker, and as someone in the caring profession you are always supposed to be you know, giving your all to every one of your clients, treat everyone the same, do all that stuff, but you know what, when you feel an emotional connection with someone or you actually have this feeling like, she likes me, she really likes me, you know, that sort of a thing, it's a different feeling, like—it's you know you find yourself thinking more about their actions, and their reactions, and you know, and when there's times when you say, well you know maybe she should spend a couple of nights in jail, maybe she should rot in there, but then you 're thinking, no, I'll go up and get her—you know? (Laughs.) Because you know, knowing someone cares about you gives you, I don't know if it's more of a reason to keep caring, or it makes you want to keep caring, or, it's one of those innate things, I don't know. Hard to describe. It's a good feeling though (laughs). 71 This story illustrates how the sense of personal connection and level of mutuality affects the way in which the worker is engaged in the work with a client. The following excerpt describes a similar conclusion reached by another worker. He indicates that the experiences of receiving care from clients provides a balance to his experience of the difficult challenges facing social work, particularly the way in which social work interventions are not consistently effective. It deepened my caring for people and it deepened my commitment to keep working at what I do. Because there were many times it was like geez, I don't want to do this job any longer, it's a pain in the ass. I keep making mistakes, things don't work out the way I want, you know. It appears that experiences of mutuality are rewarding to these workers and the reward in turn brings the worker closer to a genuine commitment to people, which is an element of ideal social work practice. It is also apparent that for some social workers and some clients this commitment extends beyond the formal social work relationship as described above. While mutuality may lead to an increased sense of commitment, it also appears to provide a positive basis for letting go. Acceptance of change in the relationship. When participants engage in reciprocal relationships, they report feeling able to let go of the relationship more easily when it ends (whether through death or end of contracted work together). They are satisfied with their part in the relationship and the contribution it has made to the client. Participants describe a sense of assurance that their work is effective, or as useful as it can be whether or not all goals are met. This phenomenon is related to a participant's comment noted earlier, where social workers are not always able to see clear 72 and positive results for their work, or that factors relating to the difficulties facing the client are beyond the worker's control or ability to solve. In the case cited below, this worker experiences a 50 percent death rate in his work on a cancer ward. / think because—Ifind that it [mutuality] has enriched the relationships that I have with patients and families and that makes it easier for me to deal with whatever happens to them, whatever the outcome, whether their treatment is successful or not and I find that my relationship with the patient, with the family makes a difference in how I can deal with it, you know, when they die, for example. This worker identified this positive outcome of mutuality as contradictory to what he feels many workers predict. A sense of closeness and connectedness to clients does not appear to make the lack of success (in terms of a complete resolution of the difficulty) harder but rather easier to deal with. The work is powerful. Participants report that when the relationship embraces mutuality the worker becomes more relaxed and more effective. In addition to holding qualities as described above, such as an increased sense of equality, more shared humour, and a sense of connectedness, participants attribute an added effect of relaxation and a resulting increase in the effectiveness of the work to this change. A therapist describes this change: It just becomes more relaxed. More, I guess just the flow is easy. For example if I was sick or couldn't make a session, or something, I knew it wouldn't be a problem. Just sort of, I guess more relaxed would be the word that, you know, once you have that, then your connectedness is even stronger, and I think the work together becomes even more powerful. 73 The participant illustrates this sense of relaxation with a story describing the way in which she and her client accommodate each other's needs. When her office was unsuitable to meet in she and the client met in a coffee shop. Other times the worker would pick her client up from the ferry in consideration of her client's age and difficulty getting around. These negotiations appear to consider the needs of both parties and the nature of the work. They imply a familiarity and casualness in the working relationship that contrasts with a more typical formal separation between the worker as a service provider and the client as a recipient of a service. When giving these examples, the participant connected this casualness with the sense of equality she feels is present in the relationship. Reciprocity—let's talk about that. I'll give you an example. My office is still in my home, [and one of my clients] travels from the Island to see me, and sometimes she doesn't have a lot of money. I charge her very little, if anything, and sometimes she just walks on the ferry and takes the bus and she's got health problems, it's not easy for her. She takes the bus and she comes to see me, and then I will drive her to the bus, because I know how hard that is for her. I'll just you known, put her in the car and drive her. Now yesterday, she came to see me and she brought her car and our appointment was for 11:15 and our—my house is on the market at the moment and the agent called and said, I'm bringing someone over at 11:30. So I met my client at the door and said, can't see you here. So we went to the White Spot, you know, and we had lunch together, and we talked. And you know, I'm okay with that. And we, it wasn't heavy-duty therapy, it was you know, it was more, again, it was support. But, so that's where the comfort is—/ think it's that if I considered myself to be better 74 than my clients, or more powerful, or not as equals, Iwouldn't have done that. And I am equal, they are equal to me no matter what, they are my equal. Uncertainty and discomfort. While most participants describe connectedness and a sense of mutuality as an advantage and a resource to the work, one worker predicts that connectedness may make it difficult to engage with a client in her role as an investigator. This worker told a story (cited in the introduction) about how after investigating a foster family, she felt that the foster parent made a gesture—a firm handshake—to her that indicated that their relationship is 'alright'. Now that this worker feels connected to the parent in this way, she is not sure if that connectedness will be a liability or a benefit to the work. In this case, the worker knows that she will have to investigate another allegation about this same family. Oh yeah, [having established a warm relationship] is making it much more difficult for me. Like I am dreading having to see her again [to investigate another allegation], as I'm thinking—I'm back again, and you know, everything that happened before is probably going to be, you know—// 's going to be the same or worse—so I don't know, I could either make it easier to go through this together, maybe she '11 trust me a little more, or the family will trust me a little more because we had a relatively positive outcome the last time, so maybe there won't be so much anxiety if they, you know—we 're going to continue working together. This participant has identified a risk related to her ability to do her work. In this case, the risk is that it will be more difficult for her even though she also sees the potential for a continued positive influence on the process of investigation and ongoing relationship with the family. The difficulty here appears to be a personal one, namely a dread in having to bring 75 the family into the process again and how it will affect their relationship. This story by itself does not provide enough information for a conclusion regarding what this means, but does indicate that mutual relationships may not be perceived as beneficial to the some aspects of social work, or that more information is required to fully understand how social workers manage this complexity in their roles. Reduction in conflict and potential for change. Participants report a reduction in conflict and an increased potential for change when their relationship with a client and family has a sense of mutuality and reciprocity. This worker describes the difference between using her power to legally enforce change and providing a positive relational context for the work with families. It's easier to make a relationship work, especially in child welfare, if you are not always in conflict and you are not, like, dragging them through the courts, and getting—ordering people to do things, if you can establish a relationship with them where there is some mutual trust, and some emotion, then, you know that change can happen as opposed to ordering them to this, and ordering them to do that--you know, where it's imposed on someone. Mutual trust is seen to be an asset for the worker's ability to contribute to positive change. The worker's ability to use legally sanctioned power to enforce behaviours and the capacity to contribute to change through their use of relational skills and willingness to engage in mutual relationships may add complexity to the choices available to social workers. This concludes the section on the interpersonal category of findings. The findings described above represent concepts that are connected to the meaning participants have given 76 to experiences that occur within, and are related to, the participants' relationships with clients. Participants describe this interpersonal location—their relationships with clients—as a dynamic opportunity to learn and to hone their practice. Personal The following thematic summaries comprise the personal category of findings. Like the interpersonal category, the themes and supporting participant quotes capture the meaning derived from the participants' relationships with clients. Valsiner's (2000) approach to developmental theory indicates that one's sense of identity is derived from one's experiences of oneself, and of oneself in relation to the community culture and through interactions with others. These experiences form the basis for the individual's sense of self or identity. In this case, I have assumed that statements related to a life philosophy reflect the personal qualities of the participants. The philosophical statements in this category are those where the philosophy appears to extend beyond a theory of their relationships with clients to a more generalized view of themselves in relation to others and the nature of existence. The themes below are examples of these reflections and the workers' subsequent sense of who they are. Identity The first two themes capture both the process of how the participants develop in relation to their clients and how the setting of the relationship provides opportunity for development. In addition to telling stories illustrating this phenomenon, participants spoke directly to an awareness of this process. Personal development. Participants notice that they learn a great deal that is applicable to their own lives from their relationships and work with clients and see their own development in relation to 77 their clients. Participants identify life skills, insight into specific human experiences, and an opportunity to move reflectively through their own developmental stages as they attend to their clients' process of development. The following participant identifies his interest in developing life skills for his future and his awareness of how his clients provide him with useful experience: Well this gets back to why I am working with seniors is one of my essential drives is completely selfish. And it's to figure out you know will I get there one day, how am I going to cope, how am going to manage? How is it going to be for me, what is the secret to living that long? To getting there and so that's one of the things that keeps me going to work and going to work with seniors is to keep on finding that out and asking that question. So that's what I get out of my work with this population and so similarly if I am able to be open to people I can't help but think that's a skill I will always need for my own mental health and social health and so that's something that I can never practice enough. Another worker describes how she finds herself working with groups and issues that reflect her own developmental stages: I seem to bring that with—whatever stage in life I was at—am at, I guess—I seem to bring that to the relationships and the work. Like I was wanting to work with families, and I had a young family and so I worked with and did family therapy with sexual abuse. [When] I was separating from my family and was in my early 20's, I worked with the women's movement and with the rape crisis centre—and you know I kind of like, did my developmental thing in my work. So that's been good for me. To be able 78 to express this, the things I had some energy around. I could bring it in, and it also contributed back to my stage in life. These descriptions of the process of development are not necessarily connected to experiences of reciprocity of care but rather are illustrations of the inseparability of personal and professional development through relationships. Both statements illustrate the personal nature of the workers' development through their work with clients. The context of relationships with clients is identified as a useful forum for creating new and unique relationships with people which in turn provides an opportunity for personal development. Unique relationships. Participants state that the experience of creating mutual relationships with clients is enjoyable because there are different expectations of each other (potentially more creative roles) than might be found in their roles within their family, circle of friends, or professional/work community. This social worker describes a relationship that although it happened when he was a volunteer (a friendly visitor), it continues to inform his experience of his relationships with clients. He appreciates the opportunity to create a relationship that is not historically or role defined. This relationship was one he developed as a volunteer who was assigned to visit a client (a senior) man. The worker noted that even though he was quite young, he felt he was taken seriously and this was a new experience. It was a relationship, with like no pressure, no expectation. I mean I just think a lot of relationships people have in their personal life come with a lot of baggage, and this was a relationship that came with absolutely no baggage. This was a relationship with a guy that appreciated the weekly visits. I also, likewise, appreciated making those visits. And we didn't have to define what our relationship is. 79 In this statement the worker is transparent about the usefulness of relationships with clients to his development as someone who can be taken seriously and whose companionship is enjoyed. In this case the worker does not attribute this to the mutuality itself as providing the context for development but rather the lack of prescribed role or predetermined definition of the roles the worker and client will take. This theme touches on previously described findings related to the importance of variability in the types of relationships social workers create with their clients. The following four themes speak to specific personal qualities that participants feel are reflected in or developed through their relationships with clients. When they notice that their clients care for them, participants feel seen and acknowledged as being who they want to be (someone who is helpful, capable, someone to be respected, someone who contributes to others' health or development, someone who is respectful and genuinely cares). Being seen as genuine. Participants spoke to the experience of reciprocal care with their clients as a sign of being seen as whole person, not just as someone acting out a role. The social worker quoted here reflects on the meaning she makes from her clients' gestures of care and how that informs her view of herself. I hope it says that lam sociable and thatfclients] sense from me that I'm a genuine person and I really do care, and I really do want to make a difference and I think that is what people get from me—I'm not a quitter, I'm not, I don't take the easy way out, you know, I stick with things, and stick with the clients with whom I work, even when things are really, really bad. I'm hoping that when clients show emotion, or show that they care, it means that they can see that, that there is, that I do want to help... that 80 it's not just me in a job that I get paid for day by day—saying that I care when really I don't. Because I think people can sense that. While this social worker sees elements of her character reflected back to her through her clients, the following themes capture how participants describe their development of characteristics through their practice of drawing on particular personal qualities, such as compassion, trustworthiness, and the capacity to be important to others. A gift of compassion. Participants report a connection between their reciprocal relationships and their capacity to be with suffering, and to understand and accept human experience. This worker describes how her sense of compassion flourished as she became open to the mutuality in relationships. / think that I have become more open to be touched by their lives as compared to being more professional or having categories ...and I have definitely have been more, well—that's a gift to be able to care for people and it makes me, not that it makes me a better person, but I get to have that experience even when they are awful experiences, I have the gift of compassion, being able to have compassion and them letting me in on their lives and me being able to be touched by it. Trustworthiness. Participants connect the experience of being trusted by their clients with being cared for and report that the experience of being trusted is extremely rewarding. These excerpts reflect the value participants place on being seen as trustworthy. 81 Well, it makes you feel—it's a goodfeeling because you are thinking, well you know, if someone cares about you, that means that there is a trust, there is a certain level of trust there. For the following participant, the context within which she is trusted by her clients (their vulnerability) adds to the depth of meaning it has for her to be trusted by her clients. The experience of being trusted appears to inform her own sense of who she is as well as her perspective on relationships with other people. People really do give you parts of their lives where they are the most vulnerable, and it's an immense trust, it's just immense trust, and how can you not feel honoured and humble and compassionate towards them and towards yourself as well, for all of our common human life. When asked what it is about their clients that the participants care about, many describe how they feel the person is special, how much they appreciate being let into their lives, and the high value they place on being given an opportunity to make a difference. This appreciation of the other appears to inform the worker about him- or herself as a valuable person. Capacity to be important to someone. Participants report great satisfaction from the opportunity to be important to their clients and that they feel fortunate to have had certain clients in their lives. The therapist quoted below describes one of her clients with whom she has an especially close, long-term relationship. Well, I think that she... she is incredibly creative, articulate, beautiful, talented, loving... what would be the word—motivated. She is everything you would ever want 82 in a client... we had a very creative kind of relationship, and a lot of it came from her. Ifound her to be very engaging... So I think from that point of view, Ifound it an incredibly rich experience. Yeah, yeah. She had a lot to draw on, a lot. And we just had a really good chemistry... It was very important that I be there for her and I think to some extent that's still important, in a very sort of ephemeral way, she knows I'm here, and if she ever needed me, that I'd be there for her... [That] gives me great satisfaction, great satisfaction... to know that—and again, I come back to what did I get out of it, I got a lot of satisfaction knowing that she is better off now than she was before we met. Participants typically described positive qualities about their clients, however one social worker admitted that it was difficult to like her client (one of the people with whom she describes having developed a sense of mutuality). She is clear that she feels her role in this young man's life has been and may continue to be important. He really wasn't an overly likeable person. (Laughs.) He—you know, he really wasn't—he was a difficult person to like ...I think that I cared for him in way in I would like to make things better for him... that I wanted to provide care for him—in the sense that no one else seemed to be doing that... But I took very seriously the, the legislation, that in our province states, because he was in care so much of the time, that if there is a child in care, then the worker must, or the agency must act as a wise and conscientious parent and that is in our Act. And I remember when Ifirst started with the agency, my supervisor would say, he always preached that—wise and conscientious parent—and I don't have children—and so, I've never been a parent, but I don't know why, but that really struck a cord with me, so I thought, well I have 83 to be his -wise and conscientious parent, and so when a decision would come up, I would, that phrase would—it often came into my mind, so I would have to think about, as a wise and conscientious parent, what would I do for my child? And so that, I think, helped me—that was I think, very significant thing in helping me to fight for services and placements and everything that he needed. More so than he was likeable because he really wasn't. ... [Now that he is no longer her client] he '11 kind of call, and connect with me, so it's not that we are, we 're not friends, and we don't have the client/worker relationship anymore but, there's kind of—like I get a sense of knowing between us that, that if he needs me, he can call, and he knows that I would help him out: And I know that I would, you know, try to help him out. Participants attribute the creation or reinforcement of their sense of their own personal qualities (genuineness, compassion, trustworthiness, and importance to others) to their experiences within their relationships with clients. These examples illustrate the process of development and the importance these relationships can have to participants' personal identity. It appears that participants also develop their personal philosophy through these relationships. Below are themes of a philosophical nature that participants describe as stemming from their experiences of reciprocal care between themselves and their clients. Philosophy A part of identity, a personal philosophy or the generalized meaning of our lives (identity and purpose), our relations with others and the broader community develops through our experiences. A personal philosophy in turn informs our perspective, or a lens through which we gaze into our experiences. The characteristic of the perspective is unique 84 to every individual. As described by the participants in the learning section above, the cycle of perception, meaning, and action is an ongoing process of development. The following themes reflecting the generalized meaning associated with participants' experiences of mutuality are significant in that a personal philosophy both allows for and creates limits for one's potential experiences. A philosophy develops over time and will typically not be embraced as the result of a singular experience but rather from the analysis of one's lifetime of experiences. The philosophy must be reinforced by current experiences or it will be altered to accommodate them. Alternatively, we will make sense of events through the lens of our perspective and in this way our experiences (the meaning we make of them) will fit with our perspective. Given the contingent yet durable nature of this development, one's personal philosophy is a particularly powerful force in determining one's experiences and resulting behaviour. These statements of personal philosophy were given as a response to the question of how their experiences of mutuality with clients affect them. Participants stated that they see people as capable and resilient, that they expect a richness in mutuality and connection in their personal relationships, and see themselves as capable of shaping their community both locally and globally. Even more generally, participants noted that these experiences of mutuality with clients reflect the essence of meaning in life. Appreciation for human strength and capacity. The experience of working closely with people informs participants about the strength and resilience of people (human beings), and this is inspiring and reassuring to them. This philosophy is consistent with the participants' choice to engage in reciprocal relationships with clients. While professional barriers to forming personal relationships may 85 indicate a belief that people who are clients need protection from potentially exploitive relationships, a belief in their capacity to look after themselves is congruent with faith in adopting an attitude of mutual negotiation of appropriate boundaries. The following two quotes illustrate the philosophy of human strength and capacity. While the quotes are quite similar, I have included both to reflect the participants' emphasis on this philosophy. The first social worker is reflecting on the meaning she makes of her experience working closely with people. It confirms for me the inner strength that people have. That if you can see beyond the surface, and you connect at that level, you get a lot of optimism about capacity, people's capacity to survive. Resilience, I wouldn't be in the field if I didn't believe that people can pretty much do anything. If they have the courage to do it and if they have the right kind of help. In this second quote, another social worker connects the perception of peoples' strengths with his openness to be close to his clients. While a lot of the patients I work with will end up dying within the first six months, you know a lot of them live, a lot of them move on with their lives and you get to see, you know, how people pull up their socks and really have to persevere through something like [having cancer] and you see amazing human strength. I think it is a wonderful experience for me, I really like my job... You get to see amazing strength in people at this kind of time in their life, and I mean, the only way you get to see that is if you open yourself to the relationship. Most social workers work with people who are struggling in some way and in this context it can be difficult to maintain a strengths perspective. This connection between 86 mutuality and a philosophy of strengths may provide guidance to supervisors and social work educators in how to develop or assist in the maintenance of that perspective. Creating meaningful relationships. Participants believe that they are more likely to engage in relationships that reflect their values (social justice, compassion, interdependency) outside the client-worker relationship as a result of having practiced respectful, mutual relationships with clients. One participant describes how his unwillingness to dehumanize people requires that he be critical of and attentive to the social and economic system rather than fall into blaming people for their struggles. So in that sense, when I talk about people being, seeing people as more human—is the more that you look at them as who are they are, and not looking at it from the system's—the organizations' [blaming] perspective, I can see them as much, much, much more human because they really are—humans are struggling With all kinds of challenges... We blame, blame the parents, blame the kid in care, as against looking at the structural, and the social, and the economic and the political [system]. Because it's easier to dehumanize—dehumanize the poor, dehumanize the person with mental illness, because if you humanize them, well, you have to start to evaluate your social structure. Further, he describes how his practice of seeing his clients as human is connected to the way in which he relates to other people in his community. You know, I can only think of hokey things like the fact that I'm nice to people, I think I'm nice to—you know, I don't know. I don't know, you know there are values that you believe in—just your basic values of what you give. And when people give to you, 87 how you give back to them, and so—you know it's like when you go into Shopper's Drug, or the butcher's, or whatever, and the person behind the counter says, heh, how are you doing? You know, what's up? And they, and then they engage with you and you engage with them and it's a give and take and it's a free exchange, and it's, and it's a caring, it is a caring kind of a thing, it's caring for your community and your community caring for you. The quote below illustrates one worker's commitment to meaningful relationships outside her role as a social worker. She attributes this attitude to her experiences of the reciprocity between herself and clients and how they [and others] contribute to her development. But even finishing my career, I'm still a person, I'm still going to have contact with people and I think that my hope is that whoever I come in contact with will benefit or be richer from that experience, and me too, and if not, then I don't want that relationship. So I think I've learned a lot about myself, about how I impact on people, how they impact on me, how to make choices, and that's going to continue whether I'm a practicing social worker or not. The participants quoted above describe how their practice with clients informs other relationships and their perspective outside their work. They attribute this development in their personal philosophy to their experiences with clients in their role as a social worker and their practice of acknowledging the mutuality in their relationships with clients. The following theme represents participants' personal philosophies about their role in the world. 88 Personal efficacy to create change. Participants report a connection between their experience of reciprocal relationships with clients and their own optimism and sense of potential (including their own contribution) for local and global social justice. The first two participants allude to a difference between their philosophy and their sense of the typical community philosophy. It's about... creating—you know, I—my greatest wish is that we actually do live in not this uncaring dog-eat-dog world—which I think we do, but it's depressing to think—so you know I keep myself going by thinking, no, surely we live in a truly caring world... and then well... it's up to me. In the quote above, the social worker expresses not only that he derives hope from his work and relationships with clients, but he cites himself as an agent in creating the kind of world he wants to live in. The second quote below illustrates how this participant is informed and inspired by her work and relationships with clients. So it's affirming, in a world, that at times is not giving us that message, about man's capacity, to do good, in fact we are bombarded with man's capacity to do bad. The work that I've done, I think really affirms for me that people fundamentally, want to be... whole, and good, and decent. The philosophy of these two social workers is that there is possibility that the world is a caring place and that people want to be good to each other. The following excerpt further reflects this theme as the social worker describes how her own growing capacity for compassion moves her to consider how she will contribute to alleviating the suffering of people around the world. 89 / think that—one thing I've noticed is that I'm caring an awful lot for what's happening—and so this may grow, I don't know, Iwouldn't have predicted it, but I've noticed andlhadn 't until right now thought of the connection [to the experience of mutuality in relationships with clients], but I'm very, Ifeel a lot of compassion for what's going on in the world in a way that can make me quite touched and emotional and I think that if I hadn 't had the—these types of caring relationships with people that I've worked with, I might not have got that.... I have a sense of connection, or compassion or, something about being with the pain of people in the world that is larger than our—my life here, and so I don't know... whether it will go anywhere or if I just have an experience of it and... [I've] sometimes thought about what if I was to do work in, I don't know, the Red Cross... and I have sort of an emotional pull towards it, and so, not it per se, you know, but just something bigger, I don't know. [Going to work for the Red Cross] seems kind of impractical (laughs). It appears that for these workers, the practice of engaging in compassionate and mutual relationships with their clients results in a philosophy that continues to provide energy for and commitment to their work, and a sense of possibility in the usefulness of their contribution. For some participants, this philosophy is extended to the meaning of life. Meaning in life. These close, reciprocal relationships with clients provide meaning (in life) to participants. The following excerpt, the final word from participants in this thesis, is one worker's rendering of the meaning of existence. Well, it just, [being in these kind of relationships] just makes me part of the flow of the world, you know. I mean, there are people I care about and it enriches my life. 90 It's that energy exchange that—flow—and caring, that gives significance to the fact that you are here... It's just that is what makes us human is that exchange in life, it's that exchange of information, affection, and different ideas and arguments, about different ways of looking at things, the creative process, I mean that's the reward of being alive, otherwise, why would you bother, there's enough aggravation (laughs). The themes identified above are significant in that they embody fundamental social work values and perspectives. Given the difficulty of teaching values (Brummer & Richards, 1979), the connection between participants' experience of mutuality in their relationships and the subsequent development of their perspectives, these findings may provide guidance to the field. These implications and others will be further explored in the implications section. The following chapter outlines the insights derived from the analysis of these findings. 91 CHAPTER V Discussion The conceptual themes described above arise from an analysis of participants' stories of their experiences of reciprocally caring relationships with clients. Taken together, these themes provide insight into this phenomenon and practical guidance to social work theory and practice. The ideas articulated in this discussion of the findings are broad in that they address the nature or qualities of the experience of reciprocity in relationships (with a focus on reciprocal caring), the context of these experiences, and elements of a pattern in the processes related to the unfolding of the phenomenon. Congruent with contemporary constructivist grounded theory methodology, the emergent concepts provide the reader with insight into this phenomenon as it is experienced and made meaningful by the participants. The analysis and the discussion arising from their stories are derived through my interpretation of the stories and the conceptual themes. Agreement between cultural developmental theory and the processes described by participants provides additional grounding and a basis for confidence in the findings and subsequent theoretical implications. The propositions outlined below arise from these processes. Conflicting expectations Based on the stories told by participants, it is evident in this study that the community or institutional culture of professional social work has an influence on the actions and experiences of participants' relationships with clients. Further, there is conflict between the professional standards and expectations of the nature of participants' relationships with clients and actual practice. While participants attend to professional codes of conduct, they 92 interpret them and apply these codes differentially as they develop their practice. Participants are conscious of inconsistencies between some of their behaviours and their internalized expectations of professional conduct. As they examine their experiences with clients and the positive outcomes for both themselves and their clients, participants typically conclude that the concept of professional, non-personal relationships interferes with meaningful, ethical, and productive relationships with clients. In response to this conflict, participants suspend or hold in abeyance internalized elements of professional training and codes of ethics as they engage in openly mutual relationships with clients. This conflict can result in uncertainty or a sense of subversion for participants as they assess their own approach, as well as that of their colleagues, to relationships with clients and the nature of their work. These assessments are in turn connected to participants' concerns about social work's ethical and useful conduct with clients. There is a lack of internal consistency within the articulation of professional standards, codes of conduct, and the participants' practices. In determining their actions in relation to clients, participants tend to favour their own judgement over strict adherence to the professional culture. Care as a catalyst The findings suggest that the experience of receiving care from clients provides a catalyst for participants to notice and attend to the mutuality inherent in human relationships. This experience mitigates the dehumanizing aspects of professionalized social work practices and approaches to relationships. Aspects of the professionalized relationship dehumanize both client and worker through the limitation of expressions of individuality, vulnerability, needs, and competence in relationships. Attention to the whole person in their many interests 93 and roles in addition to the focus on the social work intervention leads to richer, more satisfying and effective practice. Personal and professional fulfillment The experiences of the participants indicate that in practice, personal and professional interests and roles are not distinctly separate from each other. Participants develop personally through their relationships with clients in their professional role, and their experiences with clients are carried into their life outside of work. Their personal experiences and interests also inform their professional role. Personal interests include a desire to act in ways that reflect (and inform) the ongoing development of their sense of identity including their personal values and philosophy. These interests are met through their role as a social worker. When their personal interests and professional roles are compatible, participants experience fulfillment and avoid burnout. Alternatively, the inability to openly express, explore and embrace this compatibility in the community context may lead to dissatisfaction and burnout. Idealized selflessness In addition to meeting personal interests and values, there is some indication that personal and professional interests are intertwined in relation to the desire or need for paid work. While the culture of social work typically idealizes selfless and impersonal motivations for working as a social worker, the findings indicate that the need for paid work may be one of the basic needs for people who work in the field and this need has some influence over the willingness of the worker to experiment or challenge conventional practice. At the same time workers state the importance of being seen (particularly by clients) as not working only for pay but rather as a reflection of their personal commitment to clients and social work goals. This phenomenon adds another layer of complexity to social work 94 practice. Again, the difference between the cultural expectations (selflessness) and the reality of the person working in social work (need for an income) may create dissonance for the worker and potentially for clients. It appears that participating social workers are aware that some clients understand the importance of income for the social worker. The social workers may feel a need to publicly deny this motivation in order to convey the sincerity of their commitment or meet the idealized professional culture. This unacknowledged reality and resulting lack of transparency within the field conflicts with ethical practice. Contribution to practice When these social workers are engaged in reciprocal relationships with clients, the characteristics of their personal development are congruent with social work values and goals. Their experience of caring for and being cared for by clients heightens or increases their: 1. Sense of equality and commonality in the human experience between themselves and their clients; 2. Commitment to the client; 3. Level of confidence in their ability to make a positive contribution to individuals and the community; and 4. Recognition of clients' strengths and support of client self-determination. The participants' relationships with clients are complex and the development of effective and meaningful relationships with clients draws on sophisticated relational skills and reflective practice. Participants' descriptions of how mutually caring relationships develop indicate a pattern in the formation of relationships with clients (elements of this pattern are identified below), but the method of engaging with clients and the nature of relationships is not reflective of a rigid standard of practice or technique. The level of closeness, mutuality and intimacy in relationships between clients and participants is 95 influenced by both parties to the relationship (not only the social worker) and varies according to: 1. environmental circumstances (institutional culture, historical moment and events); 2. the social workers' assessment of the best interest of the client and the effectiveness of the relationship; and 3. the unique dynamics of each relationship (including the developmental needs of both parties and their capacity to manage variability within the relationship). The social workers in this study hone their relational skills over time through their practice with clients. Their own emphasis on paying attention to what works for their clients is a strong force driving their commitment to learn and willingness to experiment. In telling stories of their experiences with individuals, it is evident that these social workers consider their practice effective and ethical in the context of each individual client as well as through a broader conceptualization of worker-client relationships. Added complexity Finally, the findings indicate that for some social workers, there may be anxiety about putting a relationship with a client at risk (through investigation or assessment) or their ability to perform their role when they have established some degree of mutuality within their connection with a client. Social workers may be inclined to maintain a distant relationship with clients in an attempt to remain objective or to reduce the potential for introducing this complexity into their work. The type of power and responsibility the state gives to some social workers or the power social workers may have (relative to the client in that environment) may be difficult to reconcile with elements of a relationship that speak to equality between the client and worker involved. The findings and the ideas presented in this discussion are ripe with potential for further exploration. Each aspect of the propositions named above invites further questions, 96 speculation and possibility for continued exploration of this phenomenon. While grounded theory methodology encourages the researcher to continue to explore new avenues as they become evident through the process of gathering data, analysis, the development of conceptual themes, the formulation of interrelated ideas I have articulated here reflects the scope of the research at this point in time. The following chapter will examine the implications of the findings for the field of social work theory and practice. 97 CHAPTER VI Implications The conflict between professional standards and actual practice identified in the findings indicates a major stumbling block for the social work profession which potentially prevents social work from achieving its goals. While the findings from this study indicate that some individual practitioners resolve this conflict through acts of subversion, social work theory and practice as well as the public face of social work suffers from the confusion inherent in aiming for the impossible task of non-personal relationships between clients and social workers. Additionally, it would appear that a professionalized approach to relationships betrays the humanity of both workers and their clients. The attempt to regulate social workers' behaviour with clients by focussing on proscriptions about what not to do (i.e. engage in personal or dual relationships) is an insufficient method for guiding a profession. Direction must come from theory that incorporates both the benefits and detrimental consequences of too close and too distant relationships. Social work must develop a more sophisticated understanding of relational practices, the cornerstone of the profession. The accommodation of a theoretical orientation that incorporates an understanding of mutuality of care and the interdependency of identity and development within all interpersonal relationships would provide a significant opportunity to the profession to demonstrate leadership and innovation in relational professions and practices. Several specific recommendations for consideration are listed below: 98 Mutuality Professional standards and expectations regarding social workers' relationships with clients should be re-evaluated and include an acknowledgement of the mutual nature of all relationships. Integration of the concept of bi-directionality in human development and the potential for mutually caring, intimate and meaningful relationships into social work practice would enhance the profession's capacity to contribute to change and provide leadership in the development of effective methods of practice. Specifically, 1. Professional expectations of social workers' relationships with clients should reflect their dynamic and variable nature rather than assume that static and standardized relationships are possible or preferred. 2. Social workers should reconceptualize their understanding of the power people in the client role have to affect individual social workers and the extent to which social work goals are realized. Clients are not only potential victims of inappropriate relationships or the fortunate recipients of positive relationships initiated and led by social workers. Clients also lead the relationship by providing invitations and setting boundaries regarding desired closeness and intimacy. Following the client's direction and/or engaging in transparent negotiation regarding the relationship expands the resources available to achieve common goals. Social workers must be properly prepared to respond to clients in this way. 3. Training and supervision should include support to hone social workers' relational skills and reflective practices. Within each relationship between social workers and clients there is a unique combination of the different developmental needs of each person and the interaction with each other produces an opportunity for both people to develop through this interpersonal relationship. Given the inevitability of development within all interpersonal relationships and the apparent benefits to clients and workers when the personal values of the social worker are congruent with the values of the profession, this phenomenon should be re-framed as a potentially positive process rather than an indication of dysfunction on the part of the worker or client. Satisfaction Burnout, disillusionment and retention are significant issues for the profession. While the social work profession has historically promoted the concept of practitioner objectivity and emotional distance, it appears that workers benefit when they are personally and 99 emotionally connected to their work. Social work would benefit from strengthening its focus on practitioners' personal motivations and satisfaction derived from the work. Humanizing rather than pathologizing relationships with clients that involve mutual care has the potential to significantly alter social work's approach. Embracing the potential for mutual care within the client-worker relationship may enhance the sense of equality between social workers and clients, and strengthen their commitment to individual clients and to social work practice. Ethical practice While the professionalization of social work practice and relationships is meant to provide standards for ethical behaviour, the findings of this study indicate that professionalization of human relationships may be unethical for both social workers and their clients. A rigid, standardized and non-personal approach to engaging with people while attempting to support their development belies a message of inequality and is ultimately patronizing and disrespectful. This standard, or one-way approach implies that people who are clients (in this moment) are incapable of determining or creating the kind of relationships they want or making a significant contribution to our life experience. In the professionalized context, we hesitate to embrace the meaningful impact their care, strengths and vulnerabilities have on our lives. On the other hand, understanding of this phenomenon improves the profession's ability to practice ethically. Open acknowledgement of this phenomenon invites discourse that will allow social work to refine guidelines for ethical practice. Ethical standards are more likely met when motivations, benefits, and vulnerabilities are made explicit to all parties involved rather than left to the individual social worker to struggle with in private. In social work, 100 these parties include social workers, clients, supervisors, and educational and professional institutions. Given this understanding of the mutuality inherent in human development, social work should develop greater sophistication in assessing beneficial and detrimental relationships with clients. The findings suggest the following specific refinements: 1. Ethical practice includes transparency with clients and supervisors by acknowledging that the social worker is personally engaged. Transparent negotiation increases accountability to each other as professionals and within social worker-client relationships. Transparency will better protect both client and worker from potentially harmful behaviours. 2. The concept of mutual care and an appreciation of the value in variations in intimacy between clients and workers provide a useful frame for self-reflection, collegial discussion, supervision and ultimately accountability regarding appropriate (not harmful) behaviour. 3. A greater understanding of the patterns in the learning process (how social workers develop an ethical and effective practice of mutuality with clients) will provide the profession with the ability to match the workers' style and stage of development with appropriate support and supervision. Recommendations for further study Each thematic finding could potentially be explored further to discover the nuance, related meanings, and interconnections between the themes. Likely, aspects of this phenomenon that I have not discovered or noticed through this process are waiting to be brought to light. I have identified several potential foci for future research that would build on the understanding developed from this study. 1. How does workers' focus on relationships with clients impact the institution in which they work? Is a focus on relationships with clients compatible with the interests of the institution? 2. Does the culture of professionalism have similar effects on people in other professions, or is it different? 101 3. How do (social work) clients make sense of dual-role relationships? How do all people make sense of dual-role relationships? How could this broader understanding of dual relationships be adapted to guide standards of conduct for social workers? 4. What is the difference between respectful, reciprocal relationships between social workers and clients and exploitive relationships? How does the social worker know when the reciprocity between her and her client is beneficial or detrimental to the client? What skills are utilized to assess the difference? How does the social worker determine the extent to which they will set boundaries in the relationship themselves or follow the client's lead? Is there a slippery slope from non-sexual dual relationships to sexual relationships? While the findings from this study give some indication of how the participants determine how to engage in ethical and appropriate relationships with clients, this process could be studied further. Inclusion of relationships where the worker and/or the client identifies the closeness between them as problematic would enhance our understanding and in turn refine our skills. 5. What are the experiences of clients who have had mutually caring relationships with social workers? What benefit does the client experience from offering care? What happens when that offer is accepted or rejected? While the findings from this study illuminate the social workers' experience, information about this phenomenon from the perspective of the client would be helpful to more fully understand the phenomenon. 6. Is there any connection between the worker's stage of professional development and their tendency to engage or not engage in reciprocal relationships with clients, or their ability to manage variability within and between their relationships with clients? What aspects of their development support their capacity (and willingness) to engage in reciprocal relationships? In this study, participating social workers described a shift in their practice over time. There is some indication that this shift is connected to their experience in the field and it would be helpful to understand more clearly the process of development specific to this phenomenon. 7. What happens to social workers when they remain distant and objective in their relationships, particularly in respect to their sense of identity, and personal and professional fulfillment? What impact does this have on their work and the way they see clients? Are there any significant differences between fields of practice (i.e. child protection work and therapy) in the tendency to maintain distance or tendency to develop closeness? If there are differences, what purpose do they serve? Limitations The findings and their application or generalization to social work as a whole is limited by the constructivist grounded theory methodology employed to examine and analyze this phenomenon. The findings illustrate only the experiences of the participants interviewed 102 and cannot be assumed to represent the experiences of others. However, the consistency and interrelationship of the patterns in the experiences as described by participants allow me to make the inferences and theoretical propositions as described in the discussion section of the thesis with some confidence. These propositions may provide a useful guide for further examination and testing of the patterns identified herein. The focus of the interviewer (myself) and the interview questions also limit the findings. The focus of the interviews was pre-determined (experiences of being cared for by clients, and the effect they had on the social worker) and while sub-questions were employed to follow up on ideas presented by participants I maintained a focus on this phenomenon and the main conceptual themes as they were articulated by participants. Further, while the purpose of sharing my story with potential participants was to create a comfortable environment for participants to talk about their experience it likely had some influence on what participants shared or omitted as they told their stories to me. These factors may limit the findings in that there may be aspects to this experience that were not captured in the interview process. 103 CHAPTER VII Conclusion The findings of this study indicate potentially radical implications for social work practice. Participating social workers describe significant differences between professional expectations of emotional distance, emphasis on objectivity and technique; and their experience of engaging in mutual relationships with clients. Conversely, their experiences indicate that their emphasis on their relationships with clients—embracing individuality, an emotional investment in their client, variability in relationships, and potential for mutuality— as the cornerstone of practice can be effective, ethical and meaningful. The stories told by participants indicate that the tension between the cultural interpretations of being a professional social worker and their personal investment in making a difference through their work with clients leads to subversive practice. The profession's desire to be seen as objective and impersonal as well as its effort to protect clients from the personal needs of any individual social worker potentially denies clients the experience of an authentic relationship with workers (and vice versa). Participants predict that workers will burnout if or when they follow these cultural expectations of professionalism. Alternatively, the participants' practices of engaging in mutual relationships * increases their commitment to clients, sense of equality, respect for clients, their own personal fulfillment, and their ability to join with clients in a way that promotes client self-determination. Participants cite aspects of professionalism as an obstacle to the achievement of these same outcomes. These findings indicate that institutional needs for professionalized workers (or some aspects of the cultural interpretation of being professional) may not be compatible with the goals of social work. 104 Further, participants' stories of how their relationships with clients affect their own development and their assessments of the impact of their relationships on their clients are congruent with developmental theory. The participants' experiences reveal that their relationships are indeed potential opportunities for development, both for themselves and their clients. In this way, mutuality in our relationships with clients is unavoidable. Social work would benefit from applying this lens to our practice. Perhaps as Bowers (1954) has suggested, social work should apply his imperative to the discipline. Social workers may draw on the subjective meaning they make of their work and lives to guide practice rather than emphasize objective, technical solutions to the challenges of living a fulfilled life—whether it is a client's life or their own. As social workers are called upon to place their faith in clients, they may have faith in themselves and the profession. This faith will be better placed if they are willing to see and accept themselves, and their part in the work. By consciously engaging in mutually caring relationships with clients, social workers have the potential to practice the very elements of living they typically wish for clients— respect, interdependency, individuality, personal development and fulfillment, care, and even love. 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Chicago: University of Illinois Press. 108 Appendix 1 Contextualizing Story Introduction I've written this story to give you some idea of my experience and thinking about this research question. I hope that it will both introduce me to you in some way and set the stage for our interview. My experience of social work and reciprocal care I chose to become a social worker because I wanted to do meaningful work. After working in various service industries for nearly a decade after high school, I wanted to do work that I would be eager to get up for in the morning. Social work has meaning for me because it is about working with people to create the kind of life, family, community, and society they want for themselves. For me, life is more about relationships than anything else, and relationships with others include caring about people I don't know but with whom I share a neighbourhood, community, country and world. At this time I have worked as a family support worker for nearly seven years, and it is not always as romantic as I have idealized above. It can be hard work connecting with and creating a relationship with people to find ways to make change, personal or otherwise. Caring about people has meant both suffering and joy. I have noticed that as I gain more experience in the role, I become more comfortable being in relationships with clients or members of the community that are defined by the quality, depth and differences in our connection rather than simply a definition of helper and helped; carer and cared-for. I have become more able to appreciate and accept the ways in which clients have cared for me, too. I've noticed that we don't talk about this much in our work, I think because the focus of care is supposed to be on the client. I think that intuitively we understand that change tends to happen in and through relationships, yet somehow for social workers they have been defined as one-way relationships of care. I have noticed that some different things happen when I am able to receive care from a client. It may be as simple as a genuine inquiry about how I am doing—and I reply authentically, not to take care of them but to convey something real about myself in the moment. I answer believing that they are capable of and interested in being in real relationships. Something changes when I notice myself being seen by them—an inquiry about my wellbeing, congratulations, a shared laugh about a foible of mine (as they have come to know me), and reassurance that whatever it is I forgot can wait for next time—and I am able to respond by accepting that care. I have noticed a shift in the quality of relationship and in how we relate to each other once there has been some expression or gesture of care between us. We are on common ground at that moment, and it is difficult to fall too far away from that place when we have 109 acknowledged each other in this way. Likely, after this expression has occurred once, it will occur many times again. As this reciprocal relationship continues, we are doing something together and will have to do the work to keep it together. After that point, it is not simply a social work role that is not being fulfilled; it is a personal one. I feel engaged and accountable, both personally and professionally. These experiences and resulting awareness of reciprocity has been a matter of transformation for me. Inner qualities have changed, and my work has changed. My perspective towards people seeking help and care has shifted to account for this knowing that they are also helpers and carers. And I too am someone who is helped through care. My embracing this care provides fulfillment that is not achieved by caring-for only. It feels more like how I want the world to be like—people caring for each other and acting on the basis of that care. That is a bit of my story, at least. I'm looking forward to our interview. Regards, Carla Alexander 110 Questions for Interviews Appendix 2 Research question: How does social workers' experience of reciprocity of care with clients transform social workers personally and professionally? Warm up question: Can you tell me briefly about the nature of your work with clients? In what setting or context do you work with people? What are some typical goals in your work with clients? Interview questions: 1. Can you tell me about a time when you were aware that a client cared about you, personally? How did you know? 2. What was your reaction to that awareness of their care for you? 3. What was it about your client that you cared about? 4. How was it different between you and your client after that experience? 5. What is the one different thing about the way you think about your relationships with clients since that experience? 6. What do you do differently since that experience? 7. How has this awareness of reciprocal caring between you and your client transformed you as a social worker? Personally? 8. How will this experience affect you in the future? 9. Is there anything you would like to add? I l l 


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