Narrative in Social Work Practice: The Power and Possibility of Story

By Columbia University Press

Narrative in Social Work Practice features first-person accounts from social workers who have successfully integrated narrative theory and approaches into their practice. Contributors describe innovative and effective interventions with a wide range of individuals, families, and groups facing a variety of life challenges. One author discusses the family crisis that ensues when a promising teenage girl suddenly takes to her bed for several years; another brings narrative practice to a Bronx trauma center; and another finds that poetry writing can enrich the lives of people living with dementia. In some chapters, practitioners turn narrative techniques inward and use them as vehicles of self-discovery. Settings range from hospitals and clinics to a graduate school and a case management agency. Many chapters illustrate the deep relationship between private troubles and public issues.

Throughout, Narrative in Social Work Practice showcases the flexibility and appeal of narrative methods and demonstrates how they can be empowering and fulfilling for clients and social workers alike. It also highlights how the differential use of narrative techniques can fulfill the required core competencies of the social work profession in creative and surprising ways.

• Language: English
• Publisher: Columbia University Press
• Release date: May 30, 2017
• ISBN: 9780231544726

Book preview

Introduction

MANY WAYS OF KNOWING

▶     ANN BURACK-WEISS

A historic and defining feature of social work is the profession’s focus on individual well-being in a social context and the well-being of society. Fundamental to social work is attention to the environmental forces that create, contribute to, and address problems in living.

National Association of Social Workers, Code of Ethics

The boundaries of our profession are wide and deep. We are concerned about the nature of our society, about social justice, and social programs. We are concerned about human associations, about communities, neighborhoods, organizations, and families. We are concerned about the life stories and the inner experiences of the people we serve and about the meaning to them of their experiences. No one way of knowing can explore this vast and varied territory.

Ann Hartman, Many Ways of Knowing

We not only operate within a narrative environment, but are part of the narrative environment of others. This dual positioning lays on us, I believe, an ethical obligation to take care. When we are invited onto the holy ground of other people’s lives/stories, then it is important to remove our hobnail boots.

Clive Baldwin, Living Narratively

Most of the chapters in this collection begin with one epigraph. This introduction has three—the better to underscore the challenge of the social work profession’s broad mission of service, to reflect the equally broad base of knowledge needed to fulfill that mission, and to indicate the unique contribution of narrative to the endeavor.

SOCIAL WORK IS MULTISTORIED

The story begins with the client. Today’s clients tell many of the same stories that were told by clients in the early days of the profession, more than a century ago. Food, clothing, and shelter are still hard to come by. Physical and mental illness abound. Drugs and alcohol continue as potent scourges of individuals and families. The care needs of young and old remain underaddressed. Families and communities continue to struggle to find common cause amid difference. And beneath it all, the toll of living in a world that often feels inhospitable to one’s deepest needs seems to have always been with us.

The story is heard by a social worker, who brings her own stories into the room. The social worker’s stories contain the idiosyncratic circumstances of her life, the home and community from which she comes, and the subsequent life experiences that shape her views. They also include avocational interests, such as music, art, history, poetry, and science. All of these inevitably affect her co-construction of the story (the ways in which she retells the story in the written and oral venues open to her).

Then there are the origin stories that are learned at schools of social work, the legacy of the great social work theorists of the past—with thinkers in allied disciplines and professions—who have made major contributions to the body of knowledge, skills, and values on which the profession draws.

Finally, there are the stories of the practice settings in which social workers are employed—deeming which elements of the client story are relevant to agency mission. These select pieces of data tell funders and regulators what they want to know, presented in a digital form that obliterates all else from the telling (including the worker’s role in the process). A reductive tendency—of which digitalization is both a cause and an effect—is not unique to social work. It is reflective of society’s stories, the dominant narratives known as public opinion—society’s views on who clients are, what they need, and how best to provide for them.

The ensuing narrative affects how social workers listen to their clients, what they listen for, how they think about what they hear, and how they retell client stories in case charts, professional conferences, and advocacy efforts. Most of all, they affect what happens next—in the client’s life and in the larger society.

WHOSE STORY IS IT ANYWAY?

The history of social work in the United States can, in fact, be told through the profession’s response to client stories.

In the early years of the twentieth century, when friendly visitors (volunteers from the middle and upper classes) visited the homes of the poor, they brought with them lay attitudes and judgments and sought to substitute their own stories for those of their clients. In so doing, these visitors imparted the prevailing societal consensus on the importance of hard work, sober living, and moral rectitude as a remedy for all manner of personal and social ills.

The ensuing professionalization of social work, which reached its apotheosis during the Progressive Era, was transformative, heralding a new way of listening and responding to client stories—one that replaced judgment with a search for better ways to help. Mary Richmond and her followers, seeking intellectual rigor as an antidote to lay attitudes, looked to the medical profession for guidance, adapting their model of diagnosis and treatment of the physical to the psychosocial. Client stories were no longer viewed as evidence of moral failings; rather, they prompted an attempt to understand the roots of the problems and to apply the best of social work knowledge to their resolution. Jane Addams ([1935] 2010) and her colleagues chose to live within a poor immigrant community in Chicago to personally experience the daily stressors of their neighbors’ lives. Client stories were used to develop a host of community programs as well as to spur advocacy efforts that received national and international recognition.

The Great Depression brought many more Americans into the social welfare arena—individuals who had no previous need to ask for help from others and who often felt a loss of pride in doing so. During this time, two social workers emerged who shared the vision of the individual well-being in a social context—as promulgated in the current mission statement of the profession.

Charlotte Towle (1945) wrote for the many untrained workers hired to administer the social programs of the New Deal. The title of her slim volume, Common Human Needs, carries its message: more unites clients and social workers than separates them. Client stories reveal that they have the same needs, desires, and emotions as those who listen to them. The worker’s understanding of a shared humanity as a prerequisite for the helping relationship has rarely been so eloquently expressed.

Bertha Reynolds (1934), whose work and thought began in the 1930s and spanned almost a half century thereafter, was a student of both psychoanalysis and Marxism—a breadth of knowledge and values that informed her understanding of the relationship between private troubles and public issues, a movement from case to cause that continues to this day.

By the 1940s, the psychoanalytic works of Sigmund Freud and Otto Rank had become widely known in the field of social work. Appreciation for unconscious motivations for behavior and recognition of the many childhood issues that persist into adulthood had an irresistible appeal to the profession—resulting in what was later known as the psychiatric deluge (Field 1980).

Two strands of thought then emerged: the diagnostic Hollis (1964) and Hamilton (1951) followed Freud, and the functional Taft and Robinson (Dore 1990) followed Rank. Both strands were expanded in the work of other theorists throughout the early 1960s. The client’s story now revealed many heretofore unrecognized layers of meaning, which required new approaches. Literature of the time reflects the foundation of each school and the vehemence with which each was argued. Many of the initial differences were subsumed by history, but many insights, including the emphasis on the power of the helping relationship, endure.

The 1960s were a time of societal revolution and, as always, social work both reflected and contributed to the zeitgeist. A powerful rejection of psychological approaches, a call to put the social back in social work, was invoked in the literature and in schools of social work as group work and community organization gained ascendance. The client’s story, once again, was being linked to the cause of achieving social and racial justice.

Client stories endure. Social work’s responses change—while in many ways remaining the same.

From the vantage point of the twenty-first century, one can see vestiges of each era discarded, others continuing to inform and edify. It is in this territory that narrative stakes its claim.

THE UNEXPECTED CONSEQUENCES OF TECHNOLOGY

We are now faced with a challenge unknown to previous generations of social work: the increasing mechanization of practice. Well into the late twentieth century it was possible to pick up a case record and receive an impression of the client, the worker, and the helping process. The reader could be aware of a co-construction—of the client’s story filtered through the worker’s consciousness—while simultaneously appreciating the unique essence and voice of the person whose name was on the cover.

The old method of recording was far from ideal. Overly long, often lacking specificity, and sometimes rendering unfounded judgments, it did not provide sufficient information for regulators and funders. Replacement by a digitalized form—consisting of check-off boxes and single written lines—rectified these problems while creating others. The form required the social worker to become a reverse alchemist, turning the gold of client stories into hard beads of computer-ready data. Needs in column A were matched to services in column B. It was now possible to read through an entire case record and receive no sense of the person whose life it purported to represent.

Social work form no longer followed the social work function. And, slowly, social work function began to follow the form. When the client’s sense of his past or hopes for his future have no place on a form, it may seem less important for a social worker to inquire about them. When the human connection between the client and a caring, skilled worker is no longer of interest to funders and administrators, it may seem less important to cultivate helping relationships. In fact, the role of the worker, the ways in which his or her professional use of self contributes to or detracts from an intervention’s usefulness, is often overlooked.

The change—and the backlash it engenders—is not unique to social work. It heralds a societal change, as teachers resist teaching to the test and social workers resist practicing to the form.

One example of the unintended consequences of multiple narratives is clearly evidenced in the gerontological practice of today. Society’s concerns about the financial burdens of elder care are reflected in policies designed to alleviate the problem. These, in turn, result in funding initiatives, which in turn result in agency procedures, which in turn require that social workers limit data collection to care needs and service effectiveness. The result is a representation of older adults in which all that contributes to their individuality, their humanity, and their potential contribution to the well-being of society is eliminated.

MODERNISM AND POSTMODERNISM IN CONTEMPORARY SOCIAL WORK PRACTICE

Modernism dates to the eighteenth century (known as the Enlightenment), a time when logic, reason, and analytic rigor were seen as the route to knowledge about individuals and society, which included a belief that there is a singular truth about any situation, that progress toward that truth is linear and based on what has gone before. Elements of a modernist worldview have held sway over the helping professions—including social work—ever since (Lyotard 1979).

The current emphasis on evidence-based practice—in which the practitioner bases his or her approach on what research has determined was effective in the past—is a direct descendant of Social Diagnosis (Richmond 1917). And, as the social sciences of the mid-twentieth century turned away from descriptive studies in favor of rigorously designed quantitative research, social work followed suit.

Postmodernism is an explicit rejection of many of the precepts on which modernism is founded. The rejection was famously posed by C. Wright Mills (1959), in a book aptly titled The Sociological Imagination. He questioned the value of sociological studies of the time, quantitative studies and theoretical analyses that sought to identify one encompassing story (what he called grand narrative) to explain and order human behavior. His argument—for recognition of the reciprocal interaction of individuals and their worlds, an honoring of multiple voices and views—combined with other nascent movements of the time to form a powerful counterpoint that continues to be built upon by subsequent theorists.

Postmodernism accepts that there is much in life that is unknowable, and directs its efforts toward accepting and understanding ambiguity. It rejects a prescriptive set of rules, in favor of a process of discovery. Postmodernism accepts that an objective view of anyone or anything is not possible, that researchers and practitioners cannot help but view the work they do through a personal lens—a lens that shifts with mood and circumstances (see Orcutt 1990; Siporin 1985; and Weick 1987).

THE NARRATIVE PERSPECTIVE

Narrative is an overdetermined perspective in social work, its mid-twentieth-century roots embedded in the convergence of many strains of postmodern academic thought—all of which contributed to what has been described as the tricky and unsettling transition from modernity to postmodernity in social work (Irving and Young 2002, 19).

The contributions were as much a result of societal changes as of the work of academics. By the 1980s, it had become evident that personal narratives had the power to change the grand narratives of society. The expert opinion that had defined who women or African-Americans or gay people were and what they could achieve had crumbled in the preceding two decades. The media were filled with individual stories that demonstrated unrecognized potential, and public opinion followed. Revolutionary movements of the late twentieth century—increasing understanding and expanding rights of previously underappreciated and underserved populations—were a direct result of alternative narratives given voice.

In truth, the belief system now termed postmodern (that is, understanding that the client–worker relationship is an essential ingredient of the helping process, having respect for the individual story, and linking an individual story to larger social concerns) has been a part of social work thinking since its earliest days. What has changed is the unquestioned belief in the worker as expert—an overt recognition of client strengths and the client’s ability to act on his or her own behalf if given the opportunity to do so. Fook (2002, 14) succinctly states the case: The allowance for changing subjectivities and identities represents a little more of the complexity of human life, and the way in which living is mediated continuously by context. This may allow us to match our understanding of people’s lives more clearly with their own perceptions and experience.

As the years passed, social work theorists sought a broader, more encompassing perspective on social work practice, and textbooks followed suit. Narrative Means to Therapeutic Ends, by Michael White and David Epston (1990), was the earliest—and arguably the most influential—of emerging texts. Through several later editions, it has offered mental health professionals examples of how children, adults, and families who are experiencing problems with psychosocial functioning can benefit from composing alternative stories of themselves and their lives, stories that focus on strengths and potentials rather than on deficits and limitations.

In Reading Foucault for Social Work, Chambon and Epstein (1999) illustrate ways in which the philosophy of the French social theorist Michel Foucault challenges traditional views of practice. Foucault contrasts the multitudinous truths of life with previously unquestioned beliefs about such subjects as sexuality and surveillance, and alerts readers to the societal consequences of expert opinion. This provocative, original text on the nature of power continues to contribute valuable ideological insights.

Abels and Abels (2001), Paquin (2009), and Freeman (2011) broadened the idea of narrative, showing applicability to a range of populations, settings, and problems, and often citing practice examples to buttress theory. However, it was not until Baldwin (2013) wrote Narrative Social Work: Theory and Application that the wide-ranging implications of ideas first set forth in Reading Foucault for Social Work were recognized. Baldwin examines narrative relevance to social work values and ethics and examines how a narrative understanding of the self is understood in social, cultural, and political contexts.

NARRATIVE IN ALLIED DISCIPLINES AND PROFESSIONS

The work of other professions and academic disciplines has greatly enhanced social work’s understanding of the narrative perspective.

Qualitative research, for years dismissed as anecdotal evidence by researchers wedded to quantitative methods, is now receiving overdue recognition. In Narrative Methods for the Human Sciences, Catherine Kohler Riessman (2008) draws from the fields of linguistics, anthropology, and sociology. Her translation of the insights of these disciplines into rigorous tools of narrative analysis—as well as her consideration of the ethical issues attendant to qualitative research—made a significant contribution to discourse in the field.

The field of narrative medicine has had an indelible effect on all the helping professions—none more so than social work. Many social workers (including several whose work is included in this book) are graduates of the program or of the workshops that spread the philosophy nationally and internationally.

Rita Charon, an internist and literary scholar, is the founder of the Program in Narrative Medicine at Columbia University and the groundbreaking author of its essential literature. Charon (2001) defines narrative competence as the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. In Narrative Medicine: Honoring the Stories of Illness, Charon (2006) expands on the concept. Her seminal work draws on the field of medical humanities but also reaches beyond it, providing concrete methods through which its goals can be achieved. Several of these narrative methods—among them, close reading and reflective writing, the parallel chart, co-construction, and witnessing—are exemplified in this collection.

THIS BOOK AND ITS AUTHORS

This collection can be called second generation in that it deviates from previous books on narrative social work in three ways.

First, it moves beyond the theory and practice examples of earlier books to take readers into the consciousness of the social worker/author who reflects on the origins and results of her narrative approach—trying to see the world through the eyes of an other while recognizing that her view will necessarily be clouded by the world as she sees it, retelling the tale while recognizing that the reader will bring her own worldview into its understanding, knowing that the elusive, multivalent story that emerges is but one possible thread of an important tapestry of meaning.

Second, the chapters suggest ways in which social work can achieve its mission of linking individual well-being to the well-being of society. Small changes in the present provide openings for larger changes in the future. Each cut into a one-size-fits-all approach, each attempt to pay closer attention to clients, to more fully use ourselves, and to explore new ideas about how to help advances the dialogue.

Finally, the chapters demonstrate nontraditional ways in which Council on Social Work Education competencies can be achieved. Each chapter of the book demonstrates one or more core competencies and practice behaviors as well as the narrative methods used to fulfill them.

Narrative in Social Work Practice spans populations and fields of practice. The narrative methods described and discussed extend from the personal to the global. Together they provide a cornucopia of strategies, suggesting that whoever she is, wherever in the system of services she may be placed, the social worker has the opportunity to use herself in new and creative ways.

REFERENCES

Abels, Paul, and Sonia L. Abels. 2001. Understanding Narrative Therapy: A Guidebook for the Social Worker. New York: Springer.

Addams, Jane. (1935) 2010. Twenty Years at Hull House. Reprint, New York: Signet Classics.

Baldwin, Clive. 2013. Living Narratively: From Theory to Experience (and Back Again). Narrative Works: Issues, Investigations and Interventions 3 (1): 98–117.

Chambon, Adrienne, and Laura Epstein, eds. 1999. Reading Foucault for Social Work. New York: Columbia University Press.

Charon, Rita. 2001. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA 286 (15): 1897–1902.

____. 2006. Narrative Medicine: Honoring the Stories of Illness. New York: Oxford University Press.

Dore, Martha M. 1990. Functional Theory: Its History and Influence on Contemporary Social Work Practice. Social Service Review 64 (3): 358–374.

Field, Martha Heineman. 1980. Social Casework and the ‘Psychiatric Deluge.’ Social Service Review 54 (4): 482–507.

Fook, Jan. 2002. Social Work: Critical Theory and Practice. London: Sage.

Freeman, Edith M. 2011. Narrative Approaches in Social Work Practice: A Life Span, Culturally Centered, Strengths Perspective. Springfield, IL: Charles Thomas.

Hamilton, Gordon. 1951. Theory and Practice of Social Case Work. 2nd ed. New York: Columbia University Press.

Hartman, Ann. 1990. Many Ways of Knowing: In Search of Subjugated Knowledge. Social Work 37: 483–484.

Hollis, Florence. 1964. Casework: A Psychosocial Therapy. New York: Random House.

Irving, Allan, and Tom Young. 2002. Paradigm for Pluralism: Mikhail Bakhtin and Social Work Practice. Social Work 47 (1): 19–29. doi:10.1093/sw/47.1.19.

Lyotard, Jean François. 1984. The Postmodern Condition: A Report on Knowledge. Minneapolis: University of Minnesota Press.

Mills, C. Wright. 1959. The Sociological Imagination. London: Oxford University Press.

Orcutt, Ben Avis. 1990. Science and Inquiry in Social Work Practice. New York: Columbia University Press.

Paquin, Gary W. 2009. Clinical Social Work: A Narrative Approach. Alexandria, VA: Council on Social Work Education.

Reynolds, Bertha. 1934. Between Client and Community: A Study of Responsibility in Social Casework. Smith College Studies in Social Work 5 (1).

Riessman, Catherine Kohler. 2008. Narrative Methods for the Human Sciences. Thousand Oaks, CA: Sage.

Richmond, Mary. 1917. Social Diagnosis. New York: Russell Sage Foundation.

Siporin, Max. 1985. Current Social Work Perspectives on Clinical Practice. Clinical Social Work Journal 13 (Fall): 198–217.

Towle, Charlotte. 1945. Common Human Needs. Reprint. Washington, DC: NASW Press, 1987.

Weick, Anne. 2005. Hidden Voices. Social Work 45 (5): 395–402.

White, Michael, and David Epston. 1990. Narrative Means to Therapeutic Ends. New York: Norton.

PART  |   I

Writing as Discovery and Healing

The circuitous route to self-knowledge is well expressed by the novelist Eudora Welty in One Writer’s Beginnings (1983, 102): It is our inward journey that leads us through time—forward or back, seldom in a straight line, most often spiraling. Each of us is moving, changing, with respect to others. As we discover, we remember; remembering, we discover.

Narrative approaches are particularly suited to that inward journey, the slow unfolding of meaning over time, and the way that meaning enriches practice.

Lynne Mijangos has recurring dreams of a gnome, which finally yield up their meaning. In a narrative that weaves back and forth between a first-year field experience and adult understanding of a memory from childhood, she shows how the very act of writing one’s story changes it: as unformulated experience rises to the surface, new insights emerge.

Lynn Sara Lawrence is stopped in her tracks by a painting seen on a museum wall. The chapter braids the close read of the painting with increasing levels of self-reflection. Writing as discovery takes on new meaning as the past gives up its secrets in real time. What was hidden in the painting provides the key to what was hidden from her.

Kristen Slesar tells of her work with children who have been abused—work that she loves but that hurts her. She describes a time when she sustained personal and psychic injuries in the process of restraining a child from doing harm to herself. The transformative effect of writing of this experience in a narrative medicine workshop brings healing.

COUNCIL ON SOCIAL WORK EDUCATION SOCIAL WORK COMPETENCIES

1. Demonstrate Ethical and Professional Behavior

The professional self begins as a personal self. Mijangos, Lawrence, and Slesar are midcareer professionals whose chapters exemplify continued professional development and engagement in career-long learning. Their chapters illustrate the ways in which writing fosters understanding of how personal experiences and affective reactions influence professional judgments and behavior. Each author learns something. Whether the self-discovery occurs before, during, or after their encounters with clients is less important than the result: an enhanced ability to use reflection and self-regulation to manage personal values and maintain professionalism in practice situations.

1

Stuck

AN INTERSECTION OF STORIES

▶     LYNNE BAMAT MIJANGOS

When we cannot find a way of telling our story, our story tells us—we dream these stories, we develop symptoms, or we find ourselves acting in ways we don’t understand.

Stephen Grosz, The Examined Life

A mother hears the short, sharp sound of her own heels against the waxed linoleum floor of a hospital corridor as she makes her way to the isolation room where her five-year-old daughter has been a patient for the past eight days. No communicable disease or infection has been identified and, since entering the hospital for fever and dehydration, the girl has not vomited again. She is pale, but she is eating and her temperature is normal. The doctor wrote her discharge order this morning.

Here in the hospital corridor the mother passes a nurse’s aide, who comes out of the men’s ward pulling a stainless steel, squeaky-wheeled cart laden with breakfast trays. The smell of oatmeal and half-eaten eggs mingles with base notes of hospital antisepsis. These smells are more familiar than she would like, not only from visits this past week but also from eight days on the second-floor maternity ward six months earlier.

Full term, she had delivered a stillborn baby boy. The baby’s body was released for burial before she was discharged from the hospital. Only her husband stood with an undertaker in the March wind and pushed the metal marker, with the name John Robert and the year 1954, into snow-covered ground on the edge of the church cemetery.

Now, halfway down the hospital corridor, she hears, Mommy, Mommy!

Her daughter has memorized the sound of her footsteps this week as she approaches the isolation room during visiting hours. Mommy, Mommy, she calls again. I have good news. I get to go home today! The girl’s voice pulls her into the present. Daily her children’s voices pull her from muzzy, sad grey thoughts. She laughs and crosses the threshold to the five-year-old, who she calls her easy child, the girl who is easier to please and quicker to laugh than her four-year-old sister.

•         •         •

I was that easy child, who became an assistant mother (Deutsch 1945, 73) before I turned two. When I was sixteen months old—before I learned to talk—my sister Cathy was born and my mother’s father died suddenly of a heart attack. I learned to use good behavior, cheerfulness, and helpfulness to cushion adult soft spots, just as I would learn to protect newborn fontanels—the spot where temporal and parietal bones have not yet knit together and blood pulses just beneath the scalp.

From mother’s helper I grew to be teacher’s helper, and babysitter for a family with two girls who were born with spinal muscular atrophy, before I entered a hospital school of nursing. Hospitals were familiar places. Not only had I been hospitalized at five with fever of unknown origin but also I had shared a room with Cathy, several years later, when we had our tonsils removed. We waved to Mom in the window of her room on the maternity floor when two more siblings were born. We visited the children’s ward when our baby brother developed pneumonia and an allergic reaction to penicillin, read every Cherry Ames adventure, and became candy stripers before going off to nursing school.

I planned to be a pediatric nurse, but I quickly learned that hospitalized children want only their mothers. After graduation I donned my white cap with black velvet stripe and, armed with stethoscope, wristwatch, bandage scissors, and hypodermic needles, worked in an emergency department. It did not occur to me then that I was trying to turn my passive role as a patient into a nurse’s active role.

Three years later I left the hospital’s rotating shifts and physical demands to my husband, who was a surgical resident. I became a full-time mom until the youngest of our three children was in grade school. When I entertained thoughts of returning to work as a nurse, I remembered liking the pace and stimulation of work in urgent care but not liking the rapid turnover of patients. Their stories of illness or accident were only beginning to unfold when they were transferred, discharged, or died. Perhaps more importantly, I had been sensitized to loss. Since last working in the hospital, I had delivered a full-term, stillborn child. My mother had died of peritonitis five days after she was diagnosed with pancreatic cancer. The novel Ordinary People (Guest 1976) introduced me to the idea of working with people needing something other than medical or surgical intervention. My own grief work confirmed the usefulness of talk therapy. Tying tourniquets, dressing wounds, and giving tetanus shots was not the only way to help. Rather than read thermometers and sphygmomanometers, I would read theories of mind.

I entered a master’s program in social work with a concentration in families. The program requirement—that first-year students learn to provide concrete services and partner in community systems—sounded like what I had been doing as nurse, mother, and community volunteer for fifteen years. It seemed extraneous to my intended work as clinical social worker, talk therapist, and interpreter of dreams, but it was during my first field placement that I stumbled on the significance of a dream that began when I was five and still, occasionally, pestered me:

My mother and I are on our way to the corner grocery store.

A gnome, dressed in curly-toed shoes, striped stockings, and pointy cap, waits on the sidewalk. He tries to pinch me. My mother cannot see the gnome. I try to hide, wrapping myself in her skirt.

I wish readers could see the gnome, silent as the G in his name, but it is as difficult now as it was when I was five to relate dream-sensation. The inner eye of the dreamer … catches more than the tongue can tell (Kahn 1975, in Sanville 1991, 186).

•         •         •

Bethany had been treated in a local emergency room after her mother, Vivien, struck her with the cord of an electric iron, after hearing that her fifteen-year-old daughter was pregnant. A report was filed with Child Protective Services. The caseworker who followed up found mother and daughter sorry, scared, and in need of services. She referred them to the agency where I was a student making home visits