ACTIVE APPROACH IN THE PRACTICE OF SOCIAL CASEWORK D R . ( M I S S ) G...
ACTIVE APPROACH IN THE PRACTICE OF SOCIAL
D R . ( M I S S ) G . R . B A N E R J E E
In the following article, the author discusses the potentialities of the active approach
in the practice of social casework and poses a question whether the social workers should
be afraid of creating dependency in the client or the latter should be made to face the
reality. In the writer's opinion, it is the worker who should provide opportunities to the
client to express his repressed feelings, to clarify his thinking, and to encourage him to give
his opinion on the solution.
Dr. G. R. Banerjee is the Head of the Department of Medical and Psychiatric Social
Work, Tata Institute of Social Sciences, Bombay.
In the course of the last thirty years a lot rights and integrity of the individual. Social
of changes have taken place in the practice of
workers felt that they had no right to decide
social casework. T h e r e have emerged several for the client what was best for him. He h a d
important trends in this area in the West, to decide about it himself. Also the steady
one of them being the recognition of the growth of the scientific knowledge regarding
importance of helping the client to help h u m a n behaviour, particularly, the import-
himself. In earlier years the emphasis of the ance of emotional motivation further
social worker was on 'doing things for the reinforced the need for self-direction. As a
client.' If he was poor, relief was sought for result, in the field of practice of social case
him or if he was sick, he was removed to work, there emerged a period of passivity, as
the hospital for better medical care. M u c h against the previous phase of activity. Social
of the help t h a t was given was generally workers became afraid of 'creating depen-
characterised by an autocratic approach. T h e dency' in the client and some of them tried
autocratic attitude of the helper was reflected to push back the client, if he showed any
not only in the tone of the interview but very
sign of leaning on the worker.
often also in that the worker planned the
In the practice of social casework in India,
solution and imposed it upon the client. In however, the importance of active approach
short, social workers tried to do something cannot be denied. It may be due to our
the client which they thought was best cultural pattern; for centuries we have learnt
for him. Gradually, they came to realise that to value the words of our elders, for example,
very often the treatment plans which seemed the head of the family or the village headman
good failed, because, somehow or other, they or an elderly person in the neighbourhood.
'could not enlist the real co-operation of the We are used to being told by our seniors what
person they tried to help! In course of time it
is right and what is wrong or what one should
dawned upon them that the client's own or should not do, rather than going about
conception of his difficulty, his own plans for in the indirect way of asking, 'What do you
himself and his own wish for any change were
think is the best course'? or W h a t do you
important factors in treatments Instead of think should be done'? ''The active method
working for the client, it was felt necessary can be growth producing too, provided an
with the client.
approach is made in the right spirit and
This swing may be attributed partly to the atmosphere. When it does not imply threat
growth of the democratic idea regarding the or punishment but a sympathetic guidance,
ACTIVE A P P R O A C H IN T H E PRACTICE OF SOCIAL C A S E W O R K
the client can derive a lot of benefit out of it. to go to a hospital. H o m e medicines had been
If social case worker is going to be looked tried, but there was no improvement in the
upon as a person who, on account of her patient's condition.
training and experience, has something to
It was decided that a friend should talk to
offer, then it is expected, at least, amongst Shanta's relatives about the Family Welfare
certain communities or social groups to which
Agency and also that a worker be sent to make
a majority of the clients of social case workers arrangement about the treatment of the
belong that she should be able to advise them patient.
about the best course of action. A certain
section of our population is not used to demo-
On August 10, the worker visited Shanta's
cracy and it confuses them when a democratic residence. It was gathered that Shanta had
approach is taken.
developed a fear for hospitalisation ever since
her last operation. Shanta was married much
Owing to certain circumstances which are against the wishes of her husband's family.
dependent on the personality of the client, They wanted a bride from a well-to-do family.
an active approach is indispensable. This Shanta's husband was her neighbour for about
may be illustrated by the approach of two six months, and he married her when her
workers in handling the case of Mrs. Shanta B.
father requested him to do so. He was good
who was suffering from tuberculosis of the to Shanta as long as she was psysically well.
bone and was afraid of hospitalisation and Later, he did not pay much attention to her,
surgical operation. T h e case is given below: and began to return home very late in the
: The case of Shanta was night.
referred to the Family Welfare Agency on
August 8, 1950, by a friend of the client, with
So far as Shanta's ailment was concerned,
a view to removing the fear of a surgical she was taking treatment from a Hakim,
operation from Shanta's mind and to prepar-
she found no improvement. When the worker
ing her to take treatment for her diseased introduced the topic of going to a hospital,
Shanta said that she would give 'Hakim's
treatment a fair chance. T h e worker left the
Social situation, as stated by the friend, was house, stating that she would be interested in
her welfare and she should let her know when-
Shanta is 19 years old. Her family consists ever she was prepared to take the hospital
of her parents who are mill workers, her treatment.
widowed sister, and her husband who works
Between August 10, and 30, 1950, the
as a peon in a private firm. About five years worker kept in touch with Shanta by occa-
ago, Shanta had fractured her right ankle. She sionally visiting her at her residence. On
was operated upon in the K. E. M. Hospital, August 30, Shanta developed an unbearable
and later, her foot was plastered for six pain in the leg and decided to go to the
months. After that she was all right for one hospital the following day. The worker told
year and got married. Within a year of her her that she would be in the hospital and meet
marriage, she was delivered of a premature her there. Shanta did not turn up.
baby which died later. At the time of delivery,
which took place about four months back, her
On the following day, when the worker
right leg was swollen and, within a few days, visited Shanta, she was told that Shanta's
watery discharges and mild pain started. Soon father had come across a homoeopath who had
after she had severe pain, but she did not want
promised to cure her in two months' time.
D R . ( M I S S ) G . R . B A N E R J E E
She was further informed that the patient had
she had come from Family Welfare Agency
started taking his medicine and that her pain
and would be glad to help them in the matter
of Shanta's treatment. T h e family talked
about Shanta's costly treatment. T h e worker
During the course of her visits, she learnt sympathised with them and said that she was
that Shanta suffered from pain. Whenever the sorry to hear that they had to spend so much.
topic of sending her to the hospital for She suggested that Shanta be taken to the
treatment was opened, it was agreed to take K.E.M. Hospital.
her there, but, under one pretext or the other,
the idea was turned down.
T h e mother said that she could not say
exactly when she would be free. Moreover, a
On the advice of a Hakim,
Shanta was sent Hakim
had promised to cure her. The worker
to her native village for about two months, talked about the efficiency of hospital treat-
and later, she was sent on a pilgrimage to ment and stated that she could take Shanta
Nasik. T h e time passed and there was no to the hospital and if the parents were free
improvement in Shanta's condition.
they could come along, too.
On July 8, 1951, the worker learnt that
After putting forward several excuses, the
according to the arrangement made pre-
mother expressed her fear that her leg would
viously, Shanta h a d not been removed to the be cut off in the hospital and that her
hospital, because the pain h a d slightly (Shanta's) husband would refuse to accept
decreased after being treated with herbs.
her as his wife. T h e worker had a long talk
On August 10, the worker visited the with the mother and Shanta. She tried to
patient and was informed that Shanta would point out that, with a swollen leg Shanta was
be taken to the hospital as there was no an invalid and after the operation, she would
improvement in her condition. On August 25,
be in a much better position to help her
Shanta's mother told the worker that the husband or earn her own living. T h e worker
patient had been taken to the hospital and a explained also how an artificial limb could be
date had been fixed for admission. She added
provided. It was arranged that she would
that S h a n t a could not be taken to the hospital come after a week on a Sunday morning, when
owing to the death of a neighbour.
all the members of the family could be present
and they all could talk things over.
Between August 25, and the November 1,
the worker paid several visits to Shanta's
On November 22, the worker visited
residence and was informed that Shanta could
Shanta's family again. Everybody was there
not be taken to the hospital, because on the except Shanta's husband. In the course of the
first occasion her father could not get leave discussion, Shanta expressed anxiety that in
from work, on the second occasion, Shanta the K.E.M. Hospital, students might operate
h a d a mild diarrhoea, and on the third upon her. The worker said that students might
occasion, her husband h a d refused permission be present at the time of operation, but only
to remove her to the hospital.
a qualified surgeon would operate upon her.
It was finally suggested by the worker that she
On the day of the last visit, the worker might visit the hospital at least once and then
informed Shanta's family that some other she could make up her mind. Perhaps, it was
worker would visit them as she was leaving.
the fear of the amputation that bothered her.
On November 15, the new worker visited Before leaving, the worker talked to Shanta
the family and introduced herself saying that at length and pointed out that it was natural
ACTIVE A P P R O A C H IN T H E PRACTICE OF SOCIAL C A S E W O R K
for anyone to be afraid, and it was her own
On November 27, the worker visited Shanta
fear that h a d prevented her from taking a a n d found her more cheerful than before.
bold step. T h e worker said, "unless we try to She readily talked to her about the hospital
overcome it, we would go on putting forth treatment and said that it m a d e her sick
excuses. Why not we both of us go to the to see the patients in a bad state, and
hospital and consult the senior surgeon there?
would never like to go to the hospital.
We can talk tilings over with him. There is T h e worker sympathised with her and
no h a r m in taking his advice. Later, you will assured her that many went there because
be free to decide whether this treatment will they were sure of being cured there.
be better than those you had had before." Shanta remarked that many got worse, too.
Shanta replied, "I guess you are right. I T h e worker said that she was right, but as
myself did not want to go to the hospital after
they did not get cured elsewhere, they went
my first experience at the hospital. This time there and got cured. T h e worker reminded
I will surely go if you accompany m e . "
her about the case they had seen in the
On the following day, the worker met hospital—O.P.D.—an amputee with an arti-
Shanta who asked whether she could go after ficial limb. Shanta wanted to know more
two days as there was a festival the following about artificial limbs and they talked at length
day. T h e worker assured her that she could be
about it. It was finally decided that Shanta
back for the festival after making all the would get herself admitted on the fixed day
arrangements at the hospital, and that nobody
and worker would come to her place in the
would keep her there against her wishes. It was
for her to see the doctor and later on decide
On December 1, Shanta was admitted to the
whether she would like to take the treatment hospital and her leg was amputated. The
worker visited her often during the period of
T h e worker h a d already talked to the hospitalisation. Later on, an artificial limb was
surgeon about the patient. She had also provided by the hospital on a part payment by
requested him to examine Shanta. When the patient, and the worker advised her to
Shanta was brought to the hospital, the use the limb properly. T h e case was followed
surgeon examined her and told her that, as up by the worker, till Shanta could make use
the disease had advanced, no drug treatment of the limb properly and adjust hereslf to her
could help her. H e , however, assured her that home environment. H e r husband began to
if her leg was amputated below the knee, the take interest in her.
disease could be arrested. He explained to the
It is clear from this case that the second
mother that it was a case of the tuberculosis worker's active approach helped the client to
of the bone. An X-Ray was taken. He wanted
face the problem rather than run away
to admit her immediately. Shanta looked at from it. The worker realised the innate fear
the worker and kept quiet for a few minutes. of the client, stood by her throughout and
T h e n she nodded her head in assent. At this tried gradually to pull her out of it. She gave
stage the worker told the doctor that the the client insight into her problem. The strong
patient had expressed a desire to remain at and stable relationship formed by her helped
home for celebrating a festival for two days. the client to depend on her to tide over the
T h e doctor agreed to her suggestion and difficult period.
checked that the next vacancy in the ward
would be caused after six days and Shanta
A question might be raised here whether the
could be admitted then.
active approach of the worker would not
DR. ( M I S S ) G. R. BANERJEE
hamper the growth of the client and make her
family. Besides, it is not always possible for
dependent. Would it really help the client to men to forgo their wages to bring their women-
help herself? The active approach of the folk to the offices of the workers. Some women
second worker was really more growth accustomed to going out of their residence are
producing than the passive approach of the ill at ease, when they have to face somebody
first one. This active approach helped the at an 'office.' They are not used to an 'office'
client to face the problem. She was inclined idea. They feel shy or afraid to go there. In
to depend on the worker to go through the such situations, the case worker has to take an
ordeal and the worker gave her active support. active approach and visit the client at her
This would build up in the client ability or residence several times to remove this fear and
strength to face similar difficulties in future shyness in order to enable her to avail herself
herself or at least to ask for timely aid of the of the help. If the worker remains passive and
agency to deal with similar problems. Even leaves it to the client to come and meet her
though she could not face the problem all by when she feels the need, she may never turn
herself and had to seek the help of the Agency, up and the worker may have to close the case
this act would be a step ahead in the process by declaring the client as un-cooperative. A
of growth and enable the client to help herself. worker who has the fear of making her clients
dependent may try wrongly to refrain herself
Sometimes a fear lurks in the mind of case from visiting the client at her house. Thereby
workers that an active approach might lead she will be barring the growth process of the
to the use of authority. It should, however, client which otherwise could have been
be noted that authority also plays a positive brought about by an active approach. We have
role in the development of normal personality. to accept the client as he or she is and base
As authoritative or direct approach can be of our treatment plan accordingly.
help to emotionally disturbed persons under
many and varying circumstances, for example,
It has been the experience of the writer that
in relation to certain reactions of fear, in our country, clients, on the whole, welcome
confusion, shame, dependency or effort to the visits of the worker, i.e., a helping person
evade social responsibility. When clients are to their homes. Her visits make them feel that
not in a position to take a decision or an the agency and the worker are genuinely in-
initiative, it is helpful to give concrete advice terested in them and this feeling enthuses them
rather than leave them in that state to work with a strong desire to put forth their best
out their own problems. When the concrete efforts to make the treatment plan a success.
suggestions help these people to overcome
A social case worker in India is well aware
their problems to some extent, they can of the difficulties of conducting an interview
develop some strength to cope with their in a congested home where not only the
members of the family but also the neighbours
Particularly in India, an active approach crowd around her. She may not have the
plays an important role and the worker should privacy for an interview. So it is essential that
visit the client at her residence whenever the client should come to the office of the
possible. Specially women clients are not used agency. In some cases, before the client can
to visiting 'offices' of various agencies all by take that decision, the worker has to visit the
themselves. There are some women who do person at her residence to remove the social
not got out alone anywhere and so, do not visit
barrier which the client may feel and also to
the office of the agency worker, if they are not convey to her the feeling that the agency is
accompanied by the male members of their interested in her.
ACTIVE A P P R O A C H IN T H E PRACTICE OF SOCIAL C A S E W O R K
An active approach, if planned out properly
method, but to adapt one's approach, to the
a n d geared to suitable situations, will lead to need of the client and his personality. Unless
the growth of the client. An active approach the case worker is careful about her
does not amount to an autocratic approach. approaches, she may develop a dangerous
During interviews the worker should provide tendency to search for a need to fit her
an opportunity to the client to express his technique, rather than a willingness to search
partially repressed feelings, to clarify his for a technique or develop a technique for
thinking, to give his opinion on the solution every need she is treating. If she sticks on to
suggested by the worker.
her favourite approach, then it may amount
In the practice of social casework, there is to her saying that she can help only the person
a great need for flexibility of approach on the who makes use of a certain type of treatment
part of the worker. While workmg with a method, i.e. a person who has initiative and
person who seeks help to deal with his who needs little help. This may lead to the
problems, it is important to follow any one defeat of the very purpose of casework.