Clients and case managers as neoliberal subjects? Shaping session tasks and everyday interactions with severely mentally ill (SMI) clients

ABSTRACT

This article explores how multiple contexts – professional knowledge (e.g. case management), institutional practices (e.g. New Public Management), and mental health policies and legislations (e.g. Mental Health Act) – under neoliberal governance (re)produce ways social workers interact with their clients in moment-to-moment interactions. It is part of a larger process and outcome research project on cross-cultural social work practice in outpatient community mental health settings in an urban Canadian city. Using transcripts of audio-taped sessions between social workers and clients with severe mental illness, and inspired by critical theories of language, knowledge and power, we illustrate how neoliberal themes (re)position clients and social workers in negotiating session tasks in everyday interactions, and how these interactions shape the clients and social workers as desirable and undesirable neoliberal subjects. These detailed studies in micro-interactions can be used as practice examples in considering how social workers can be critically reflective of our own micro practice and resist the governing neoliberal ideology in the macro level.

초록

본 논문은 신자유주의적 거버넌스 하에서 전문지식(예, 사례관리), 기관실무(예, 신공공관리), 정신건강 정책과 법률(예, 정신보건법) 등과 같은 다양한 맥락들이 어떻게 사회복지사와 클라이언트의 일상적 상호작용 방식을 (재)생산하는지를 탐색한다. 이 연구는 캐나다 한 도시의 지역정신건강센터들에서 수행된 다문화 사회복지실천의 과정과 결과에 관한 전체 연구프로젝트 중 일 부분에 해당된다. 사회복지사와 정신중증질환을 경험하고 있는 클라이언트 간 상담내용을 녹음하고 이를 언어, 지식 그리고 권력에 관한 비판이론으로 분석하였다. 이를 통해 신자유주의적 테마들이 어떻게 사회복지사와 클라이언트와의 일상적 상호작용 속에서 상담과제를 설정하는지, 그리고 이러한 상호작용들 속에서 어떻게 그들이 바람직한 혹은 바람직하지 않은 신자유주의의 주체로 결정되는지를 규명한다. 이러한 일상 언어의 미시적 상호작용에 관한 연구는 사회복지사가 자신의 실무에 영향을 미치는 신자유주의적 이데올로기를 어떻게 비판적으로 성찰하고 변화시키고자 노력할 수 있는지를 보여주는 실천사례로 활용될 수 있을 것이다.

KEYWORDS:

• Case management (CM)
• the severely mentally ill (SMI)
• critical discourse analysis (CDA)
• neoliberalism
• new public management (NPM)

주제어:

• 사례관리 (CM)
• 정신중증질환(SMI)
• 비판적 담화분석 (CDA)
• 신자유주의
• 신공공관리 (NPM)

Acknowledgments

The authors wish to acknowledge the research assistance from Sara Abura, Sophia Lam, Norangie Carballo-Garcia, Danielle Pearson, Tristan Gerrie, Diana Salih, and Bradyn Ko.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Eunjung Lee, PhD, is an Associate Professor at the Factor-Inwentash Faculty of Social Work at the University of Toronto in Canada. She is a psychotherapy process researcher focusing on cross-cultural clinical practice in community mental health. Her research also focuses on immigrant families, transnationalism, international education and clinical supervision and training.

A. Ka Tat Tsang, PhD, is Professor at the Factor-Inwentash Faculty of Social Work, University of Toronto. He has been developing a practice-research programme on cross-cultural psychotherapy since 1997. His current research focus is the development of a knowledge base for human service practice in a globalised context, with the key themes on diversity, global community and innovation in practice.

Marion Bogo, O.C., LL. D., MSW, is Professor at the Factor-Inwentash Faculty of Social Work, University of Toronto. Her scholarship and research focus on conceptualisation of holistic competence for professional practice and innovations in social work education and clinical social work supervision. She has developed and tested field education models and innovative approaches to assessment of student and practitioner competence.

Marjorie Johnstone, PhD, is Assistant Professor at the School of Social Work, Dalhousie University in Canada. Her research focuses on critical feminist perspectives, the history of Canadian social work, citizenship, immigration and globalisation.

Jessica Herschman, M.S.W., is a clinical social worker at the Child Development Institute in Toronto in Canada. Her research centres on clinical social work practice, social work education and training, and alliance and culture in mental health.

Notes

1. All identifying details are disguised and pseudonyms are used to protect the privacy and confidentiality of the participants.

2. Audio files were destroyed after complete transcription. Unfortunately, no notations were used in the transcripts in the original study. Thus, we analysed only verbal texts of interlocutors in the transcripts.

Additional information

Funding

This project is funded from the Social Sciences and Humanities Research Council of Canada, Standard Research Grant (PI: Tsang).