An Experience of ‘Not Knowing’ Challenges Existing Practice Models
By Carly Goldberg, MSW, LCSW
(Recently published in Social Work Today's E-Newsletter Web Exclusive)
She was dark, very dark. Petite and drowning in remnants of African garb layered with donated clothing from decades past. On her face was written a story that sadly reverberates around the globe. Rachel was an African woman infected with HIV. With her narrow back pressed up against the dimly lit office wall covered in local HIV/AIDS resources and pamphlets promoting safer sex practices, she was lost. Her eyes though, they stood out, all on their own. In the first few minutes of our meeting her eyes alone told me so much—the terror, the loss, the isolation, the trauma. The second Liberian civil war displaced not only Rachel’s body but her mind and spirit, too.
Via a refugee camp in Sierra Leone, Rachel arrived in Philadelphia just three months prior to our initial meeting. She came with her two children aged 4 and 8, her decreasing CD4 count, susceptibility to opportunistic infections, and her all-too-vivid memories of murder and rape. I, a white, privileged, American-born, licensed and master’s-trained social worker, was to acquaint her with the ways of safer sex practices and how she could reduce the spread of HIV infection. Her eyes drifted off and her gaze seemed noticeably fixed on memories of her not-so-distant past. Tears gently rolled down her face. Stumbling for words, like a fish out of water gasping for air, I choked. I choked on my discomfort, my lack of experience in working with refugee survivors of genocide and civil unrest, choked on my mother tongue, and choked on the knowledge and experience that I have come to rely on in my social work practice.
To meet the agency requirements for our initial meeting and complete a psychosocial assessment I feared may have resulted in further trauma given her fragile mental status. I was paralyzed by indecision. I did not know whether I should meet Rachel where she was at this very scary, difficult, and unfamiliar place for her (and me) or to continue with the assessment, risking further injury. I am sure in that moment my desperate attempt to search for the right words sounded just as, if not more, convoluted to her as it sounded to me. Clinically the only thing I felt I could do in that instance was to reassure her that she had great courage and strength coming to meet with me and that she was not alone. However, the “not knowing” and my uncertainty in that moment seemed like a curse and not at all the gift I would later recognize it to be.
Creating New Practice Models for a Changing World
As I move along in my clinical and academic work, this case continues to highlight for me the increasingly complex and dynamic world that we live in. Despite the arsenal of theories and techniques with which we are equipped upon graduating from our undergraduate or graduate programs and continuing education courses, we aren’t fully prepared to support women like Rachel. Her narratives, and those of women like her, are informed by world events such as the state of the economy and the drive for capital, political strife and reparations, and social and cultural expectations. Current practice models don’t sufficiently meet the needs of the people and communities in which social workers directly work. We need an analogous theory and practice that meets this 21st-century challenge for our clients and our profession.
As a clinician and doctoral student, I challenge the social work community, in particular our educators and clinicians, to demarginalize feminist theories, in particular postmodern and black feminist thought, to better serve the individuals, groups, and communities with which we work. The social work profession is no stranger to an integration of theories and thought from various disciplines and historically has been inspired by and borrowed from numerous theories that later translated into practice to best aid those in need, so I do not believe an integration of theory is an issue here.
To date, the social work profession as a whole has tread lightly in the area of feminist thought, while challenges for women from all socioeconomic, racial, and ethnic backgrounds in our local and global communities prevail. We do not live in a postfeminist era, though some would like to argue that we do. With the manifestation of the momentous growing global demands on women, social work has a unique responsibility to address both the personal and the political in practice and education. Perhaps one challenge is that there is not one cohesive feminist theory from which social workers can address all the needs of women with whom they work that would be accurate.
Beginning to incorporate a theoretical perspective such as critical race feminism stemming from critical race theory would at least start the dialogue of centralizing theories such as black feminist theory and postmodern feminist theory into our current social work pedagogy and practice. In doing so, I think this will not only raise consciousness for the women with whom we work but raise consciousness within our own profession to question whether the needs of the people we currently serve are being met.
As a social worker and activist, I am committed to addressing the unique needs of women’s health and women’s rights, both in terms of women as individuals and women in their sociopolitical world. In challenging the social work profession and myself to centralize theories such as black feminist and postmodern feminist theory in my practice, I am beginning to discover that a new model must emphasize and support women’s development through relationships and recognize that for the majority of social workers, there will certainly be an element of “not knowing” on a deep level about the multiple experiences of self that these women experience. However, providing a space that allows for the exploration and cultivation of self and multiple narratives is what’s most important for our profession and the women we work with, helping them recognize that they do have the power and the voice to negotiate their internal and external worlds.
Working with Rachel forced me outside of my personal and professional comfort zone and challenged me to put my clinical practice and theoretical underpinnings to the test. As a social worker and a woman, it seemed glaringly obvious in my work and within my professional and personal relationships that what is needed among the many opportunities and challenges posed in our society is an organization that allows for the exploration of a gendered self in relation to one’s world. I founded the Women’s Collaborative Circle in the spirit of the feminist consciousness-raising movement along with psychodynamic theories and social work core values. From many conversations with friends and colleagues, it appeared that women were in need of a space and a new model of self-care and preservation to allow for a full exploration of how a woman experiences herself in her gendered world and for multiple opportunities and modalities for development and growth.
After accompanying Rachel mostly in silence to a morning filled with visits to the obstetrician to discuss the risk of perinatal HIV transmission to her unborn child and the gynecologist to diagnose HPV and possible cervical cancer, the silence broke. While laying on the examination table with a specula protruding out of her vagina, left for what seemed an eternity for the resident to call her attending, tears of discomfort and utter fear flowed down her face. She quietly spoke, telling me about the African herbs she used as well as a hanger in a desperate attempt to abort her fetus. Then she became silent. We were able to sit together exposed with one another.
At the end of what was an excruciatingly long morning, she and I went to Quizno’s to get lunch before she returned to her demanding job working in a clothing factory, standing on her feet all day. As we walked down the street, I tripped. She laughed. It was the first time I had seen her smile.
As we approached the restaurant, I explained to her what type of food they served, as it was all unfamiliar. The 32-ounce pink lemonade was a big hit. As we went our separate ways that late morning, just being slightly more comfortable in our “not knowing” and open to the multiple opportunities for Rachel to share her narrative, it proved to be the beginning of what would be one of my most important social work relationships.
— Carly Goldberg, MSW, LCSW, is a doctoral candidate in the DSW program at the University of Pennsylvania School of Social Policy and Practice. She is the founder and executive director of the Women's Collaborative Circle (http://www.womenscollaborativecircle.org/), a feminist counseling and social action organization.
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