Conditions for helping relations in specialized personal social services – a client perspective on the influence of organizational struc-ture

ABSTRACT

This article highlights organizational structure as a factor influencing conditions for helping relations. It is based on a survey study and an interview study, both directed at parents in families that have parallel contacts in different parts of Swedish personal social services (PSS). The aim is to describe and analyse conditions for helping relations when clients with complex needs encounter specialized PSS.

Low system trust, people processing dimensions of work, and an organizational and a professional emphasis on formal organizational structures and boundaries were found to constitute unfavourable conditions. Conversely, an occurrence of individual trust, people sustaining and people changing dimensions of work, as well as informal organization and individual social workers’ boundary spanning efforts, constituted favourable conditions. The article concludes that greater understanding of how clients are affected by contextual service conditions can give some pointers towards how to generally improve services for vulnerable and disadvantaged populations.

KEYWORDS:

• Helping relations
• social services
• organizational structure
• specialization
• client perspective

Introduction

Extensive research shows that the relationship between social worker and client may have a profound impact on the client in several respects. The quality of this relationship has proven to be critically important to the outcomes of specific treatment interventions (Gockel, Russell, and Harris 2008; Hubble et al. 2010; Marsh et al. 2012; Sæbjørnsen and Willumsen 2017). However, the client-social worker relationship may also have a more immediate emotional and supportive dimension for people in difficult and vulnerable life situations (Beresford, Croft, and Adshead 2008; Denhov 2007; Sowerby 2010; Sæbjørnsen and Willumsen 2017).

In this article, the general term helping relations is used for client-social worker relationships that in some respects make a positive difference for the client (Carlsson 2005; Denhov 2007). There is relatively good understanding of the hallmarks of relationships that are helping from a client perspective, although most studies have been conducted in the field of mental health and psychotherapy, and have focused on interactions between individuals; usually a client/patient and a professional in a specific therapeutic setting. There are fewer studies of how surrounding contextual factors (e.g. the physical setting, organizational culture, rules and regulations, leadership, workload, and interpersonal staff relationships) inevitably condition the encounter between client and staff (Hasenfeld 2010; Johansson 2007; Lipsky 2010). Likewise, there are few studies of helping relations in a social service context which take into account the particular duality of help and control/confrontation that characterizes encounters between clients and social workers (Hansen and Natland 2017; Platt 2008).

The aim of this article is to describe and analyse conditions for helping relations when clients with complex needs encounter organizationally specialized personal social services (PSS). The main research question is: From a client perspective, what are the favourable and unfavourable conditions for helping relations in the organizationally specialized PSS context?

Building on an example from a Swedish context, the article is based on a qualitative survey study and an interview study, both directed at parents in families that have parallel contacts with several parts of the PSS. The article highlights organizational structure as a factor influencing conditions for helping relations, specifically focusing on the situation when clients with complex needs encounter personal social services (PSS) marked by organizational specialization. Swedish PSS are clearly characterized by specialization (Lundgren et al. 2009), where various parts of the organization are responsible for different target groups within defined problem areas (such as child care, substance abuse, and monetary benefits) and specific tasks (such as counselling, assessment, support, and treatment). Clients whose needs are complex and touch upon several of these aspects thus need to interact in parallel with a number of different social workers within separate areas of responsibility.

Complex needs

Just like the closely related term multi-problem, the term complex needs refers to adversities that are distinct in terms of gravity, scope, and persistence (Marsh et al. 2012; Sanders 2011; Sousa and Rodrigues 2009; Tausendfreund et al. 2016). It also implies a situation where multiple social problems or adversities (such as poverty, unemployment, substance abuse, criminality, mental/physical illness or disability, and difficulties providing children with adequate care and protection) exist simultaneously and interlock in various ways (Sousa and Eusébio 2007; Spratt 2011). We want to emphasize from the outset that any discussion of clients’ ‘complex needs’ entails a risk of one-sided objectification and stigmatization. However, we have chosen to use the term in order to encompass the relevant target group and to apply the common language in the social work research literature.

Organizational specialization in Swedish PSS

In a large majority of Swedish municipal PSS organizations, problem areas such as child care, substance abuse, and monetary benefits are managed in separate units. This division is usually referred to as problem-based specialization (Lundgren et al. 2009). Problem-based specialization is often combined with function-based specialization, where the functions that exercise public authority (assessment and decision-making) in each problem area are distinguished from support or treatment functions and assigned to separate units (Perlinski 2010).

Principally, five separate areas of responsibility can be identified that usually correspond to separate units in the PSS organization. There are units for the exercise of public authority within the three problem-specialized areas of child care, substance abuse, and monetary benefits, and there are function-specialized units in the child care and substance abuse areas that are responsible for support and treatment. The administration of monetary benefits is characterized mainly by the exercise of public authority (Angelin 2009).

Previous research

The hallmarks of helping relations

Certain features recur in studies investigating the hallmarks of helping relations from a client perspective. Briefly, the central elements are that the professionals are perceived as empathetic, as expressing genuine and sincere caring, and as assuming an accepting and non-judgmental attitude in the encounter with the client (Denhov 2007; Gockel, Russell, and Harris 2008; Maiter, Palmer, and Manji 2006; McLeod 2010). Flexible social workers who go somewhat beyond formal role expectations and ‘walk an extra mile’ for the client are also appreciated (Beresford, Croft, and Adshead 2008; Knei-Paz 2009; Maiter, Palmer, and Manji 2006). The opportunity to regularly meet face to face and the continuity of the relationship over time are other significant aspects (Beresford, Croft, and Adshead 2008; Topor and Denhov 2012). Correspondingly, professionals in non-helpful relations are generally described as paternalistic, uncaring, pessimistic, and judgmental (Ljungberg, Denhov, and Topor 2016; Maiter, Palmer, and Manji 2006). Practical instrumental help, such as arranging transport, helping the client fill out applications, and making contact with other agencies, serves an important function alongside more talk-oriented support and treatment (Buckley, Carr, and Whelan 2011; Matos and Sousa 2004; Ribner and Knei-Paz 2002). Reciprocity in the client-social worker relationship has also been proven important, for example in the form of a ‘friendship’ that to some extent goes beyond strict formal frameworks (Beresford, Croft, and Adshead 2008; Buckley, Carr, and Whelan 2011; McLeod 2010). This can however be difficult to achieve, because clients – especially those with long-term and extensive contacts with social services – often have little faith in the organization’s intentions and potential to help (Angelin 2009; Dale 2004; Mirick 2012; Sanders 2011).

The influence of organizational structure

While much is known about the hallmarks of helping relations, few studies address how organizational structure can influence service conditions in general and conditions for helping relations in particular. However, formal organizational structures are first and foremost abstract frameworks for how work is supposed to be carried out (de Toni, Nonino, and Zulauf Sharicz 2010; Meyer and Rowan 1977), and so they illustrate aspects such as managerial levels and division of labour in the organization. Hence, there are difficulties involved in determining how the formal structure in fact influences service conditions, interpersonal encounters, and in turn, more or less directly, conditions for helping relations. Nevertheless, there are some studies that have taken this approach.

To begin with, specialization relies on the premise that clients’ needs can be standardized and differentiated in line with formal intra-organizational divisions of tasks and responsibilities (Johansson 2007; Järvinen and Mik-Meyer 2003; Lipsky 2010). This approach seems to be most appropriate when the client’s needs are specific and well differentiated (Grell, Ahmadi, and Blom 2013; Healy and Meagher 2007; Stevenson 2005). Contrariwise, a more holistic approach in combination with a looser organizational structure appears more beneficial when needs are complex (Austin, Lemon and Lear, 2005; Grell, Ahmadi, and Blom 2013; Seikkula, Arnkil, and Eriksson 2003). Specialization has, consequently, been shown to bring about a general fragmentation of service for clients with complex needs (Krumer-Nevo, Slonim-Nevo, and Hirshenzon-Segev 2006; Matos and Sousa 2004; Spratt 2011). Clients run the risk of being everybody’s and nobody’s case when multiple units and social workers are involved at the same time (Matos and Sousa 2004). In this situation, the lack of continuity, as well as lack of face-to-face and in-depth contact, can obstruct the development of helping relations (Beresford, Croft, and Adshead 2008; Ljungberg, Denhov, and Topor 2016; McLeod 2010; Winter 2009; Sousa and Eusébio 2007).

As a result of function-based specialization, particularly difficult conditions for helping relations occur in the context of the exercise of public authority, which is more characterized by formalization, control, and a distinct shift of power (Angelin 2009; Buckley, Carr, and Whelan 2011; Dale 2004; Hansen and Natland 2017; Platt 2008). On the other hand, studies from a Swedish context indicate that dedicated support and treatment units offer better conditions for helping relations between clients and staff (Blom 2004; Perlinski 2010).

In conclusion, while the sparse existing research on the influence of organizational structure mainly adopts a professional and intra-organizational perspective on the subject, this article contributes to the body of knowledge by highlighting clients’ experiences in particular.

Conceptual framework

Human service technologies

The encounter between clients with complex needs and social workers in a specialized organizational context, as in this Swedish example, occurs under partially divergent conditions depending on which issue or aspect of the client’s life situation is in focus. This can be illustrated using Hasenfeld’s (1983) influential typology of human service technologies.

In this typology, the function-specialized assessment and decision-making in the areas of child care, substance abuse, and monetary benefits have distinct features of people processing (where people’s needs are assessed, categorized, and classified). The exercise of public authority, when it comes to child care and substance abuse, stands out somewhat, as these units may be involved in the client’s life both voluntarily and involuntarily. This potential skewing of power in the client-social worker relationship is ultimately manifested in the profession’s option to resort to legal compulsion. The work with monetary benefits also has features of people sustaining (various forms of support to uphold welfare), as its purpose is to ensure a reasonable standard of living for clients. Finally, the units responsible for support and treatment are also characterized by people sustaining, but above all by a people changing technology (focusing on support and treatment interventions).

The matter of trust

Trust is a critical dimension of interpersonal relationships, including client-social worker relationships (Jessen 2010). Trust in social work is a layered concept, but in the broad sense can be defined as ‘… one’s willingness to be vulnerable to others on the basis of one’s positive expectations of the other’s intention and competence’ (Behnia 2008, 1427). However, a distinction between individual trust and system trust may be justified. While individual trust is developed over time and concerns the interpersonal level, system trust refers to more immediate and general perceptions of social systems and institutions (Jessen 2010; Luhmann 2005).

In this context, it should be noted that asymmetrical power relationships between clients (or service users, patients, etc.) and staff in human service organizations like PSS are a significant barrier to trust (Järvinen and Mik-Meyer 2003; Lipsky 2010). This power imbalance is manifest in various ways, including the organization’s legal mandate to make decisions that affect clients’ lives, and also comes into play when the professional’s expert knowledge and experience with a specific matter are set against the client’s personal, lay-oriented knowledge (Elm Larsen, Mortensen, and Frølund Thomsen 2002).

Informal organization and boundary spanning

As mentioned earlier, the term ‘organizational specialization’ refers to a formal structure which essentially indicates how work is supposed to be carried out. The actual client work, however, is just as likely to be shaped by an underlying and informal organization (de Toni, Nonino, and Zulauf Sharicz 2010; Meyer and Rowan 1977). As regards specialized organizational structures, for example, more spontaneous, temporary arenas for exchange of information, support, and cooperation between actors may advance the work (Blom, Morén, and Perlinski 2011). These situations are distinguished by individual actors, or groups of actors – boundary spanners – who move across formal boundaries and link activities in organizationally separated systems (Simon 1997; Steadman 1992). This can be compared to boundary preservation, which is characterized by actors in a system who maintain formal structure and division of tasks (Nylén 2013).

Method and material

The empirical basis of this article is derived from a survey study aimed at clients with complex needs, which was conducted in three municipalities in central Sweden, and an interview study involving clients in two of these municipalities. The selected municipalities’ PSS organizations featured both problem-based and function-based specialization, and were thus representative of typically-organized Swedish PSS.

The overall aim of both studies was to study how clients with complex needs perceive and manage organizational conditions within specialized PSS. However, the present article focuses on the conditions for client-social worker relationships in the specialized context.

A reference group was formed during the planning stage of the study, consisting of representatives from two service user organizations, Criminals Return into Society (KRIS) and The National Association for Rights, Liberation, Health and Equal Treatment (RFHL), who provided opinions on the survey and interview questions, and reviewed and commented on the research findings.

The survey study

In a purposeful sampling approach (Patton 2002), a questionnaire was sent to parents (n = 381) in the three municipalities, whose families at the time had some kind of contact with both child care services and at least one of the other problem-specialized units (units for monetary benefits or substance abuse). The reference group’s comments on the preliminary questionnaire resulted in a reduction in the number of questions and some rephrasing of questions that were perceived as hard to understand. The final questionnaire consisted of 23 questions regarding how respondents perceived their encounters with the specialized PSS, four of them open-ended. This article is based only on the written answers (n = 103) to the four open questions, where the respondents were able to expand upon their views in their own words. These questions particularly focused on the way in which respondents considered parallel contacts with (1) different units, (2) different social workers, and (3) the collaboration between units/social workers, as well-functioning or not. In the fourth question, respondents were encouraged to write down anything they wanted to add about the social services, on the basis of their experiences.

The response rate was only 13% (n = 50), which was not entirely surprising due to two factors. First, there is a general downward trend in the response rate to survey studies (Cock et al., 2009), and second, the study was directed at a target group that is notoriously difficult to reach, regardless of the chosen data collection method (Liamputtong 2007; Miller and Bell 2011). However, it is unfortunate that only 3 of 11 queried municipalities were willing to help by distributing the questionnaire. The main reasons given for refusing were lack of personnel and lack of time.

The interview study

The sampling process prior to the interview study turned out to be difficult to control and rather opportunity-dependent, although this is often inevitable in studies aimed at so-called hard-to-reach populations (Liamputtong 2007). The process can be primarily characterized as a convenience sampling with elements of snowball sampling (Patton 2002), with the members of the reference group acting as initial enablers. A query about participating in the study was distributed via their networks, and the same inclusion criteria were used as for the survey study.

A total of 15 persons were interviewed (10 women and 5 men, all between 23 and 53 years of age). The respondents’ life situations were characterized by rather severe needs and adversities, as well as long-term contacts with the PSS. Consequently, they can be said to represent critical and information-rich cases of clients with complex needs (Patton 2002).

The interviews were conducted at the place chosen by each respondent and lasted between one and two hours. All interviews were recorded and transcribed. A thematic interview guide which had previously been reviewed and approved by the reference group was used as a ‘checklist’ of central issues. However, two of the themes were particularly relevant for this article. The first concerned respondents’ experiences of an improved life situation as a result of social service contacts (what happened, who were involved, what were the decisive factors, etc.), and the other concerned respondents’ actual experiences of helping relations (in which context, what was mainly perceived as helping, what was the social workers approach, etc.).

Ethical and methodological considerations

Approval was granted by the regional ethical review board in Uppsala before study start (reference no. 2012/168). All respondents were informed in advance, orally and in writing, of the aims of the study and the fact that participation was anonymous and voluntary. Their written consent to participate was obtained thereafter. In order to ensure, as far as possible, that participation was genuinely voluntary, a form of renegotiation of consent (Miller and Bell 2011) occurred both during and after the interview; respondents were asked how they felt about the questions and the interview situation, and whether their decision to participate in the study was unchanged. All participants remained firm in their decision to complete the interview.

The underlying empirical material is based on two relatively small studies and has certain limitations, such as a narrow scope and low response rate in the postal survey, which prevents far-reaching conclusions and generalizations. Furthermore, combining two data collection methods in the same study is not without methodological problems, as different methods are likely to pick up different aspects of how people perceive a particular phenomenon (Patton 2002). It can be difficult to merge data generated using different methods to derive consistent and credible results (Silverman 2006). In this case, however, the merging of the survey and interview data was assessed as reasonable; first, because both empirical bases were of a similar nature, and second, because it allowed voices that are seldom heard in research to be heard. Essentially the same questions were asked in both studies, and the respondents were encouraged to expand upon their answers (albeit with shorter written answers in the survey and longer oral answers in the interviews).

Analysis

The analysis followed the principles of directed qualitative content analysis, namely an approach guided by theory and prior research on the subject under investigation (Hsieh and Shannon 2005). As a first step, the 15 transcribed interviews and the 103 written answers given to the open questions in the survey study were read through in order to identify the parts of the empirical material relevant to the article. All phrases that were found at the manifest (visible and obvious) level relating to organizational conditions and relationships with social workers were condensed; that is, shortened without losing their essential content (Graneheim and Lundman 2004). Next, the condensed phrases were grouped into two broad main categories: positive and negative experiences related to client-social worker relationships, respectively.

Moving towards a deeper analysis and understanding of the relationship between organizational conditions and the conditions for helping relations, the next stage involved a search for useful analytical concepts in earlier research and theory on the subject (Hsieh and Shannon 2005). Hence, the concepts of people processing, people sustaining, and people changing, like the conceptual pairs of system trust/individual trust, formal organization/informal organization, and boundary preservation/boundary spanning, contributed to identifying a number of themes regarding conditions that, from the client perspective, can facilitate or obstruct helping relations.

Preliminary research findings were also presented to the reference group, who considered the findings essentially relevant and accurate. The reference group especially emphasized findings regarding negative conditions for helping relations related to the issue of trust/mistrust and power imbalances. However, the group also commented on the positive role that individual social workers can still play in a system generally perceived as threatening and non-helping.

Findings

Negative experiences and perceptions of PSS in general were found in the majority of the empirical material, and the barriers to helping relations were emphasized more than the opportunities. However, the conceptual framework made it possible to differentiate and conceptualize both favourable and unfavourable conditions for helping relations in the organizationally specialized context, as summarized in Table 1 and further elaborated below.

Table 1. Unfavourable and favourable conditions for helping relations from the perspective of clients

Unfavourable conditions	Favourable conditions
Low system trust People-processing aspects Formal organization Boundary preservation	Occurrence of individual trust People-sustaining & people changing aspects Informal organization Boundary spanning

Unfavourable conditions for helping relations

In social work, the question of trust is essential in a way that goes far beyond the consequences of organizational specialization, and thus beyond the limits of the study reported here. However, as trust is also a central dimension of the client-social worker relationship, it should be noted that there was a clear lack of trust in the participants’ descriptions of their experiences with PSS in general: ‘They [PSS] have no respect for people’ (survey respondent/SR 46). ‘I’ve never felt safe in my dealings with them; I’ve been anxious before every meeting’ (SR28). ‘I have to add that it is probably IN SPITE OF having had contact with PSS that my situation has improved’ (SR43). ‘They’re suspicious of you and they let you down over and over again’ (interviewed person/IP 10). This mainly concerned low system trust (Luhmann 2005). A brighter picture was outlined regarding trust in the relationship with certain individual social workers, which we will return to below.

In terms of the organizational specialization more specifically, function-based specialization proved to generate especially unfavourable conditions for helping relations in the units responsible for the people-processing aspects of work. In encounters with staff who exercised public authority in the areas of child care, substance abuse, and monetary benefits, clients feared they would not be understood and would be denied the type of help they had requested. They also feared being forced to participate in measures they did not ask for, with the worst-case scenario involving coercive actions such as removing children from the home or compulsory care for substance abuse: ‘It [contact with child care services in the exercise of public authority] is like walking into a brick wall’ (IP2). ‘When you do want treatment [for substance abuse], you don’t get it, and when you don’t want it they throw it at you’ (IP3). ‘It was a disaster, in my opinion [the unit for monetary benefits]. They didn’t treat you well and had a very bad attitude’ (IP14).

The units responsible for people processing were particularly strongly linked to power asymmetry and control, as well as formalization of the client-social worker relationship: ‘You get that feeling. That it’s part of the uniform: look, we’re the ones with the final say here’ (IP3). ‘No relationship with them is necessary [staff who process applications for monetary benefits], they’re just following their little rule book’ (IP1). This reflects how social worker tasks aimed at assessment, control, and decision-making about further help and service in themselves involve certain barriers to trust and in turn unfavourable conditions for helping relations (Johansson 2007; Järvinen and Mik-Meyer 2003)

However, the empirical material also clearly showed that the formal organization itself created various types of barriers, especially the multitude of contacts required for clients whose needs were of a more complex type. Adversities in the same family linked to financial hardships, substance abuse, and child care issues could give rise to parallel contacts with at least three or four different units and their respective staff. Contacts with ten or more social workers at once were far from unusual. One of the interviewees succinctly illustrated the experience of being everybody’s and nobody’s case (Matos and Sousa 2004) and the barriers to helping relations under these conditions: ‘The child care unit helps my kids, the monetary benefit unit focuses on my money and the substance abuse unit on the addiction – but who focuses on me?’ (IP15).

Instead of the continuity that has proven to be critically important to helping relations (Ljungberg, Denhov, and Topor 2016), the specialized organization exacerbated the fragmentation and discontinuity. In a specialized organization characterized by boundary preservation, clients need to form several parallel relationships with different social workers, each of whom works within their formal and limited area of responsibility. None of these can be said to be formally responsible for developing an in-depth, close and continuous relationship: ‘I wish I had had that one person who holds on to me for that one extra second and says: “I’m here to help you”’ (IP9).

From the client perspective, there was a sort of ‘squandering’ of the relations and the knowledge about the client’s needs built up within a specific unit: ‘It would have been a comfort if she [social worker in child care] had been there [in contacts with other units] as a personal support, since she had been right along with me in this process with the children’ (IP15). Repeated experiences of severed relations entail a risk that the sense of resignation and distrust the client is already feeling will deepen: ‘It feels like starting over from the beginning. Even if the new ones have my paperwork, they don’t know me. And I don’t know them’ (IP6). ‘You get used to it, but it makes you angry, too. Every time you’ve “bonded” and gotten to know someone, you get somebody new’ (IP12).

Favourable conditions for helping relations

Generally speaking, both studies gave evidence of significant distrust of the PSS as a system and social institution. Individual trust – that is, trust in individual social workers – did exist, but only to a limited extent: ‘They are responsive and helpful, both of them; I feel safe with them’ (SR13). ‘He really cared. It was like… I don’t know… is “humane” the right word?’ (IP5).

The empirical material also reflected how social workers in units with people-sustaining and people-changing functions were perceived as working under more equitable power relationships compared to those with a people-processing function. This emerged, for example, in comparisons between the exercise of public authority and assessment situations that preceded a treatment or support intervention: ‘Then you felt you meant something somehow, that you were worth something. It wasn’t the official authority thing any more’ (IP2). ‘I had a completely different relationship with them [treatment staff compared with assessment staff] because they visited me so often and we sat and had a coffee and a chat, you know’ (IP6).

When formal and administrative duties and any ‘uncomfortable’ decisions are handled by another place and by other social workers in the PSS organization, it seems easier for support and treatment staff to demonstrate the reciprocity and flexibility associated with helping relations in the literature (Beresford, Croft, and Adshead 2008; Topor and Denhov 2012).

As described above, the formal boundaries of organizational specialization between different types of problems and tasks emerged as a significant barrier to helping relations. In the rather rare cases where helping relations were experienced, the helping elements were usually the results of informal rather than formal organization, and they occurred because the social workers in these relationships had contributed to boundary spanning, which had been meaningful to the client in various ways.

While the formal organization and an emphasis on boundary preservation were shown to impair continuity in client-social worker relations, some individual social workers who had acted more independently and informally in relation to formal structures were sometimes able to maintain a certain measure of continuity. This was accomplished, for example, by talking about the client’s needs with the other units involved, and by proactively recommending appropriate interventions before the client applied for them.

Clients ascribed great value to these boundary spanners, who acted in matters that, in purely formal terms, were another unit’s area of responsibility: ‘Then I was actually able to go and talk to him even though he doesn’t really have anything to do with adults. So he’s really a driving spirit’ (IP3). ‘She [social worker in child care] helped me and got me in touch with the unit for monetary benefits and explained that the situation was rather urgent’ (IP9). ‘The contact person I’ve had the longest helped me explain to the others what kind of help I need’ (SR13).

The importance of continuity, in particular, was underlined in this respect: ‘I have a wonderful contact person now, but it took five years’ (SR25). ‘She knows more about my life than I do. She’s been with me so long, and I call her several times a week as soon as anything comes up’ (IP7). ‘She’s incredibly tough. But once you get to know her – she’s worked there forever – she’s fantastic. But it took a while before I figured her out’ (IP5).

Two types of boundary spanning were evident. The first was the spanning of formal boundaries within the PSS organization, which we have chosen to call organizational boundary spanning. The second involved spanning the boundaries of what would be expected of individual social workers based on their formal and professional roles, which we have chosen to call professional boundary spanning: ‘She jumped in the car and drove over to our place if necessary. Morning or evening, it didn’t matter, she came’ (IP4). ‘Yes, she kept up with me afterwards anyway [after the formal contact ended]. They helped me a lot with things a lot of people with my problems don’t know. Like how you apply for things, how to fill out a form. Things like that’ (IP 14).

These concluding quotations show how helping relations were also characterized by social workers informally meeting needs for which no unit or specific social worker within the PSS organization was formally responsible.

Discussion

Although this article is based on two relatively small studies from a specific Swedish context, we argue that it is reasonable to discuss the results in somewhat more generally applicable terms, as we intend to do here.

Even at the theoretical level, organizational specialization appears to be incompatible with complex needs. While specialization is based on setting rational boundaries for administrative categories and differentiating sub-aspects of clients’ life situations (Johansson 2007), complex needs as we know them are instead distinguished by the opposite; that is, a situation in which various adversities in the life course are intertwined in a manner that is difficult to comprehend and predict (Seikkula, Arnkil, and Eriksson 2003).

Empirically, this field of tension between organizational principles and the nature of clients’ life situations and needs has also been noted internationally in studies. These show, overall, that clients with complex needs are at risk of being subjected to fragmentation of service (e.g. Blom 2004; Krumer-Nevo, Slonim-Nevo, and Hirshenzon-Segev 2006; Matos and Sousa 2004). In the studies presented here, the array of parallel PSS contacts constitutes a concrete example of such fragmentation, with a negative impact on the conditions for helping relations. The discontinuity in client-social worker relationships caused by the formal organizational structure stands out as particularly unfavourable. When it comes to meeting complex needs, specialized social service can hardly be said to be suitable for professional ‘extra milers’ who do that ‘little extra’ for clients. Instead, a more accurate metaphor seems to be an organization designed for relay runners who are supposed to ‘hand over the baton’ when needs and demands go beyond their own predetermined area of responsibility.

This somewhat grim picture of the consequences of organizational specialization is balanced by other findings from the two studies discussed here. When the client work that is actually performed is largely a result of informal organization (de Toni, Nonino, and Zulauf Sharicz 2010), there are also possibilities to modify shortcomings of the organization’s formal structure (Gulati and Puranam 2009). Furthermore, a certain amount of informality and flexibility that allows the crossing of formal boundaries, for example, has been shown to be of particular value when organizations must perform complex tasks (de Toni, Nonino, and Zulauf Sharicz 2010; Nylén 2013).

In the present article, this is illustrated in the offsetting of low system trust by individual trust, and the spanning of obstructive formal organizational boundaries by individual social workers. It is worth noting that the helping relations described by clients seemed dependent upon individual social workers’ familiarity with the system in which they worked. The same ability has also been identified as a core skill when it comes to boundary spanning in general (Steadman 1992). Hence, at least in complex cases, there seems to be reason for adding social workers’ system familiarity and boundary spanning skills to the present hallmarks of helping relations.

Previous research has paid attention to the importance individual social workers can have in clients lives when the relationship works well (e.g. Beresford, Croft, and Adshead 2008; Hansen and Natland 2017; Knei-Paz 2009; Munro 2001; Sæbjørnsen and Willumsen 2017). Furthermore, Hansen and Natland (2017) suggest that an ability to balance considerations of organizational and policy requirements with a person-centred approach to clients is essential in the doing of social work. Nonetheless, the presented findings regarding the benefits of social workers who informally cross both organizational and professional boundaries, in order to advocate for the client, entails certain dilemmas. It raises for instance questions concerning how far social workers’ professional autonomy actually should extend in relation to formal organizational structures, rules, and regulations. There is a potential risk of an all too unpredictable and chaotic work situation, but also a risk that a too far-reaching autonomy can imply a counterproductive disloyalty towards the employing organization. Another crucial issue concerns the potential downsides in terms of workload, stress, and burnout, which may be a negative consequence of a more ‘boundless’ social work. Questions like these are, however, hard to answer, since we know relatively little about the occurrence of informal organization and boundary spanning within social services in general and how it might play out, which indicates a need for further research.

It has also been shown that clients with complex needs must generally relate to several different types of issues, several different units with their respective staff, and several interventions of various natures. Heavy responsibility is laid upon the clients themselves to manage such fragmented situations and attempt to protect their own interests. Hence, clients must act as boundary spanners on their own behalf due to the organizational conditions and lack of assistance from professional actors. They thus need – as one definition of boundary spanning reads – to move across formal boundaries and link activities in organizationally separated systems (Steadman 1992).

In both social work research and practice, it is common to talk about complex clients and complex needs. There seems, however, to be a great deal to learn from flipping the perspective and focusing on complex organizations as well. Greater understanding of how clients are affected by the contextual service conditions that surround them, such as those caused by the organization of social work, can give some pointers towards better understanding and explanation of the outcomes of individual interventions.

If the conditions for helping relations are viewed primarily in terms of complex clients who, for example, are labelled as having a defensive behaviour or an avoidant attachment style, it is easy to overlook the other side of the story. In our opinion, we should also bear in mind that specialized social service organizations may appear just as complex from a client perspective. In line with this, it seems reasonable that social workers who strictly adhere to formal organizational structures can also be said to exhibit defensive behaviour, while the fragmentation of service caused by structural arrangements can be compared to a disorganized attachment style.

Disclosure statement

No potential conflict of interest was reported by the authors.