Balancing responsibility, boundaries and time: social workers’ experiences in service user meetings – a multi-method study based on Interpersonal Process Recall

ABSTRACT

The article focuses on social workers’ reflections on their own professional practice in conversations with vulnerable service users in the Norwegian Labour and Welfare Administration (Nav). Drawing on Interpersonal Process Recall (IPR), a video-based method, together with a focus group interview, the study explores the experiences and reflections of five social workers of in-situ encounters with service users. A key finding is that the social workers, who worked in two different offices within the work and activation field, perceived their professional practice as highly complex, negotiated, and ambiguous. The social workers nevertheless displayed a multitude of knowledge and competences, expressed through practical synthesis in the conversations. The article argues that more attention should be paid to ethical aspects of professional knowledge, such as when balancing contradictory considerations towards national workfare policies and vulnerable service users, and how to set the limits for their own professional responsibility in the work towards the service users. Furthermore, the article also directs the attention to another area of professional knowledge, as it explores time as an embedded and ubiquitous aspect of, and condition for, professional knowledge to unfold.

KEYWORDS:

• Professional knowledge
• reflection
• vulnerable users
• interpersonal process recall

Introduction

Front line workers in social services are tasked with safeguarding both governmental policy goals of work and activation and the service users’ interests (Lipsky 2010). Several studies (e.g. Astvik, Melin, and Allvin 2014; Djuve and Kavli 2015; Hansen and Natland 2017; Håvold 2018; Kjørstad 2005; Lundberg 2018; Røysum 2017; Terum and Jessen 2015) have shown how front line workers often experience a complex work situation with many and sometimes conflicting tasks. Furthermore, several studies of encounters between service users and counsellors in the Norwegian Labour and Welfare Administration (Nav) (e.g. Djuve and Kavli 2015; Hansen and Natland 2017; Terum and Jessen 2015; Øvrelid 2018) challenge dichotomous understandings of social work in Nav as either care- or rule-oriented. Terum and Jessen (2015) found that counsellors with a bachelor’s degree in social work reported a more flexible and user-influenced practice compared to colleagues with different professional backgrounds. However, there are few empirical investigations into these qualified social workers’ practices in service meetings.

A recent work on participation, interprofessional collaboration and positioning in multi-agency meetings in social welfare has analysed audio- and video-recordings of interactions in actual client situations (Juhila et al. 2021). Through empirical examples from diverse social welfare frontline practices, they demonstrate how interprofessional collaboration and service user participation are interactionally achieved, and thus display the contingent nature of interaction in multi-agency meetings. These studies prove the value of detailed examination of interaction in meetings, offering insight to processes and happenings as they occur. However, detailed accounts of how conversations in one-on-one meetings between social workers and service users actually take place has to the best of our knowledge received little attention in the Norwegian context. There have thus been calls for more video-assisted analysis in Nav (Riis-Johansen et al. 2018), as well as more research into the relationship between counsellors’ educational background and their approaches and practices (Hansen and Natland 2017). Our study therefore aims to contribute to a deeper understanding of in-situ practice, by employing video-assisted interviews in the study of qualified social workers in Nav. Qualified social workers in Nav work within both state and municipal services, especially with counselling, casework and coordinating services. Within the work and activation field, the aim is to qualify users for the labour market through tailored measures and comprehensive follow-up.

Relationship building is a frequently used concept in social work literature and practice. In a recent study of encounters between service users and counsellors in Nav, we found that the development of good relations is the most crucial factor for the users (Solheim et al. 2020). Taking as its starting point that the social workers’ interaction with the users is restricted by the limitations of the work structure (Lipsky 2010) and that the development of good relations is central to well-functioning social work (Solheim et al. 2020), this study intends to explore additional aspects of the professional experience. Leaving the overriding and extensive discussion on knowledge in social work aside, the study explores qualified social workers’ on-the-spot use of knowledge in conversations with vulnerable service users. This is done by combining the video-assisted method Interpersonal Process Recall (IPR) with a following focus group interview. The aim is herewith to deepen our understanding of how the social workers themselves experience and reflect on their practice.

Use of knowledge in social work practice

Social work as an academic discipline is transdisciplinary and has a heterogenous knowledge base. As a practice-based profession it is processual and socially constructed by the theories that inform practice and the different actors involved (Payne 2014). Both as an academic discipline and in practice, social work has struggled to articulate its knowledge base (Finne, Ekeland, and Malmberg-Heimonen 2020; Fossestøl 2019; Gray and Schubert 2013; Trevithick 2008, 2012). Some studies have suggested that the conventional Western knowledge paradigm, privileging theoretical, propositional knowledge, is insufficient for understanding knowledge in social work (e.g. Fossestøl 2019; Trevithick 2008, 2012). More dynamic notions are needed, and diverse understandings of practical and tacit knowledge have been important to understand knowledge in social work and to develop reflective professional practices through critical reflection (e.g. Adams, Dominelli, and Payne 2009; Øien and Solheim 2015; Payne 2014; Schön 1987; Sodhi and Cohen 2012; Trevithick 2008, 2012).

Empirical studies of social work practice find that social workers refer to several sources of knowledge, and that practice and relational knowledge – personal work experience, colleagues, clients and supervisors – seems to be valued more than theoretical knowledge (Finne, Ekeland, and Malmberg-Heimonen 2020; Heggen 2008; Iversen and Heggen 2016). The problem of articulating and justifying social work as knowledge in practice is highlighted in both Røysum’s (2017) and Fossestøl’s (2019) studies. They found that the qualified social workers in Nav only in a limited sense managed to articulate what specific kind of knowledge, reflections and considerations underlay their actions in specific situations. However, social workers defined themselves as distinct from non-social workers through the application of core concepts such as ‘thinking holistically’ or pursuing an integrated approach; the ability to think in general terms, taking all sides into consideration and resisting being locked into a narrow knowledge base (Fossestøl 2019; Røysum 2017).

Despite the articulation of their professional ethical perspectives as ‘social work’, an ambivalent self-understanding concerning ethics and knowledge was identified (Fossestøl 2019). Ethical values and positions are especially challenging in the contradictory position as gatekeeper implementing national workfare policies, while at the same time ensuring protection of vulnerable service users (Kjørstad 2005; Saario et al. 2018). The concept of ‘ethics work’, developed by Banks (2016), describes the efforts of people to embed ethical issues (such as reasoning, work on emotion, identity roles and responsibility) into their work practices, further explored by Saario et al. (2018) as jointly constructed and enacted in real-life interactions in service user meetings.

One way to conceptualize a heterogeneous professional knowledge base is offered by Grimen (2008). He portrays the relation between theoretical and practical knowledge as a continuum containing complex interplay and tension. The concept practical synthesis denotes the integration of the different elements in the knowledge base. This synthesis is expressed in the professionals’ actions – according to demands emerging in practice (Gilje 2017; Grimen 2008). Different parts of knowledge are thus combined because they together constitute a meaningful integrated professional practice (Grimen 2008).

Time perspectives in social work practice

Time, or the lack thereof, is another salient issue for those doing social work. In a study of time perceptions in the Swedish social services, Olsson and Sundh (2019) found that the social workers had a general experience of lack of time. Similarly, Nissen (2019) and Beer, Phillips, and Quinn (2020) identified lack of time combined with heavy workloads as a common concern and a source of stress for social workers.

Rosengren (2006) offers an explanation for such frequently expressed and experienced shortage of time in modern society and life: the coexistence of dual competing time perceptions. Several studies of time at workplaces and in professional contexts have used anthropological understandings to explore such dual concepts: Time, understood as cultural constructs, range from task-oriented time (cyclic, experienced and distinguished by iterative processes) to clock-oriented time (abstract, linear and quantified) (Johansen 2001). A similar opposition between cyclic and linear time discourses at workplaces is from polychronic (more flexible preferences, characterized by multiple activities being carried out simultaneously), to monochronic (the preference to do activities one by one) (Hall 1989; Kaufman‐Scarborough & Lindquist, 1999).

Returning to social work, time is essential in several ways: both in the processual work (Payne 2014) and in several of the basic competences, such as the perseverance needed in the relational building (Solheim et al. 2020). Similarly, in reflection-in-action (Schön 1987), the thinking in action entails figuring out what is the best action at a particular moment in time, and reflection as a process can only happen across time. Tsang (2008) argues that despite its importance for both professionals and service users, the element of time has been neglected in studies of practice wisdom. Tsang does not enter the discussion of dual competing time concepts, but rather refers to another alternative discourse of time, namely the ancient Greek concepts of time. He argues for the relevance of kairos – qualitative time – in social work practice, as a concept that embodies a paradoxical use of knowledges and experiences (Tsang 2008). While Tsang calls for greater attention to the time element in practical reasoning, he also points to the lack of social work research that examines the concept of time. This is offered by Juhila, Günther, and Raitakari (2015), when exploring how discourses of time are produced and negotiated in professional client interaction within mental health services. Similar to previous research, they find that different, and partly competing discourses of time are present.

Design, material and methods

Research design

The study has a multi-method approach, which takes Interpersonal Process Recall (IPR), a specific video-assisted research method, as its’ starting point, followed by a focus group interview with the five participating social workers.

IPR was initially developed as a skill training programme within therapy and counselling (Kagan et al. 1969). IPR as a research method is a semi-structured individual interview based on video-assisted recall, focusing on the participant’s experiences as they occurred during a recorded session (Elliott and Shapiro 1988; Larsen, Flesaker, and Stege 2008). In this study, IPR was chosen as it enabled the researcher to explore in-session interactions, both verbal and non-verbal, as well as experiences that would otherwise be inaccessible (cf. Larsen, Flesaker, and Stege 2008; Macaskie, Lees, and Freshwater 2015). The method further provided possibilities for first-hand clarification from the participating social workers and allowed mutual explorations and reflections between the social workers and the researcher. Despite an increasing use in studies outside the counselling and psychotherapy professions, the method is rarely used within social work (Larsen, Flesaker, and Stege 2008; Naleppa and Reid 1998).

Adding to the strength of video-assisted recall, a focus group was chosen to continue the reflections from the IPR sessions. The focus group allowed for a joint reflective conversation about the experiences from the encounters and from doing social work in Nav.

Sample

The selection of participants was based on a combination of strategic and convenience sampling. Participants were recruited after initial contact and agreement with Nav-leaders, first at the regional, followed by the local level. The inclusion criteria were a bachelor’s degree in social work and at least five years of experience in social work. Five female social workers aged 35 to 45 from two different Nav offices participated. All had diverse work experience with service users, ranging from ten to twenty years, and all had participated in professional supervision. At present, all five worked within work and activation programmes.

The five social workers each recruited one service user they were actively working with and whom the social workers trusted that could handle the videorecording of the conversation. The current study is part of a project studying professional practice in different social work fields, where an inclusion criterion is the service user to be in the age range 16–40, in order to make possible comparison of practice between practice fields. Three of the participating service users in the current study were in their early twenties, while two were aged 30–40. They all had diverse challenges, such as drug addiction, long-lasting psychiatric challenges, experienced child welfare interventions and lengthy phases of being on the margins of society.

The Norwegian Centre for Research Data (NSD) approved the research project. Names and personally identifiable information are anonymized, and the participants provided written consent. The service users were informed that their participation was voluntary and would not affect their present or future services negatively.

Data development

The data material consists of audio recordings and transcripts from the five IPR interviews and audio recordings, transcriptions, and field notes from the focus group interview. True to the IPR-method, the video recordings were support material and not to be analysed separately.

However, the five individual IPR interviews were each based on one video recorded conversation between the social worker and their recruited service user. As preparation for the subsequent interview, the researcher went through the recording and roughly transcribed it. At the beginning of the individual interviews, the social workers were introduced to a brief interview guide with a few fixed themes, such as working conditions, aims and expectations before the meeting and degree of service user participation. True to the IPR method, the interviews were mostly related to the video recordings and conducted as closely to them as possible (varying from one to ten days apart). The social workers were invited to stop the video at any point they found interesting, significant, or surprising, or where they wished to add something (cf. Macaskie, Lees, and Freshwater 2015). Addressing events as they occurred in the video recorded session, the social workers’ experiences of what happened and their motivation for doing what they did (focus, questions, and comments), were explored. As a result, further reflections on their professional practice were generated.

Prior to the focus group interview, transcriptions were made of the five individual IPR interview sessions, which allowed the researcher to address some preliminary themes. Due to the social workers´ professional secrecy, we could not delve into the details on the service users. Each participant retold what they experienced as most interesting and challenging from the IPR-session, while the researcher presented patterns, common experiences, and characteristics. The dialogue in the focus group thus emerged both as continuations of reflections from the IPR sessions and joint reflections on experiences of professional practice in Nav.

Method of analysis

The transcripts from the IPR interviews and focus group were analysed using systematic text condensation (STC); a qualitative, thematic, cross-case strategy following a stepwise approach that includes de-contextualizing, coding, synthesizing, and re-conceptualizing text data (Malterud 2012). The inductive analysis concentrated on the social workers´ recall and reflections upon occurrences from the recorded conversations and the reflective dialogues that followed in the focus group interview.

During the first step, the first and the fourth author read the six transcripts separately to form an overall impression, before agreeing on preliminary themes. In the second step, the first author identified meaning units concerning the social workers’ reflections and experiences, established code groups and sorted the meaning units. In the third step, the first author abstracted condensates from each code group and subgroup, before discussing these with the co-authors. In the fourth step, the condensates were re-conceptualized, creating synthesized descriptions of the social workers’ reflections on practice and challenges in the service user meetings.

The analysis yielded four main themes, which will be presented in the findings chapter: ‘Balancing an integrated approach within the Nav system’, ‘Tools, possibilities and limitations in the individual conversations’, ‘Ambiguous experiences of responsibility’ and ‘Time as a resource and consolation, shortage and threat’.

Methodology discussion

Developing reflectiveness and criticality in practice are ideals in social work, and self-reflection, through processes of self-analysis, self-evaluation, self-dialogue, and self-observation, is encouraged throughout the social work education (Adams, Dominelli, and Payne 2009; Yip 2006). The social workers were therefore well prepared to participate in a study emphasizing reflection and reflexivity. The complexity of the service users’ problems, vulnerabilities and states of transition displayed in the video-recorded sessions, coupled with the social workers’ vast experience and knowledge of and ability for reflection yielded thick descriptions.

Following the thematic approach, the data were analysed as a whole. As the IPR sessions and hence actual practical experience lay the foundation for the focus group, the findings from the two sources are not systematically differentiated. Additionally, all data were collected by the first author, who had no professional experience from the field of practice. Even though this influenced the research process and perspectives, the joint analysis with co-authors with vast, differentiated clinical experience, together with discussions with colleagues in the research field, is conducive to reliable findings. Researchers with practical experience and an educational background in social work considered the findings to be recognizable, supporting pragmatic validity (cf. Kvale et al. 2015).

Findings – complexities at work

The social workers had equivocal and nuanced perceptions of the complex practice in Nav. Hence, the four themes presented below serve analytical purposes, and the processes and understandings described must be viewed in conjunction with each other as deeply intertwined.

Balancing an integrated approach within the Nav system

All the participating service users were enrolled in statutory programmes that involved comprehensive follow-up from the social workers. The social workers explained that the workfare policy goals of work and activation outcomes guided their work with the users. Work or activation was to be a topic in all conversations, and paid employment should be the final goal. An experienced social worker stated: ‘I have worked in Nav a long time and, before that, in the social services, and I feel that the guidelines are stronger and more explicit [now] in this matter: Work first. Workfare policy’.

Despite the policy directions with increasing emphasis on workfare, the social workers rarely used predefined forms during the conversations. Nevertheless, documentation requirements could disturb the conversation as well as jeopardize the relation. In other conversations, policy goals and regulations could be regarded as a support if the social workers considered the users as not sufficiently active or involved. In such instances, the social workers emphasized the work and activation programmes’ limitations and the necessity of users making an effort to reach their goals.

All the social workers agreed that it was important that planning was based on the users’ experiences and assessments of their own situation. They all had experiences of being too ‘eager’ in the planning process: ‘It is their life, they ought to make the plan’. Appropriate measures at the right time, considered to be the mantra in Nav, required sufficient time for comprehensive mapping of the users’ situations. Rushing did not help, and forcing the users was considered ‘unethical’. If necessary, users could participate in programmes with a broader scope than employment, working with challenges related to sleep, physical health, establishing routines and attendance.

The connection between work life, living conditions, mental and physical health, economy, and family relations was fundamental to the social workers. They referred to this as an integrated approach, described as ‘picturing the entire challenge’. Together with the ability to encompass the ‘entire human being’, the integrated approach expressed competences and qualities that the social workers associated with their professional education and practice: ‘As social workers, we are concerned with the entirety, you know. You should be an employee, but also live, have economic means, children, and family. We have to bring the whole into the conversation’. This approach necessitated cooperation with other healthcare and social services. Available templates in Nav could then serve as a final check that all areas were covered. In such instances, the regulations were not regarded as limiting the relationships, but rather as supportive, both enabling the integrated approach and being part of it.

Relational work was another foundational approach for the social workers. Displaying empathy, curiosity, and a genuine interest in helping and understanding were crucial, together with respect and a non-judgemental approach. Difficult topics were not brought up for discussion in the first conversations but raised gradually. The building of good relationships united the integrated approach and the goal-oriented work: ‘If we have good relations there is a good chance that we will reach his goal. He needs to feel that I’m genuinely interested in helping him. I think it’s a social worker matter’. Over the course of time, strengthened relations could work as a resource for exploring difficult subjects, such as drug addiction, more thoroughly: ‘When we know each other better you can explore matters further, trust each other, and dare to be more direct with the users’.

Tools, possibilities and limitations in the individual conversations

Exploration was one of the specific approaches identified during the IPR sessions. Others were open-ended questions, mapping, challenging, recapitulating, and delimiting. The social workers referred to these approaches as ‘tools’, and reflections on the use and benefits of these were continued in the dialogues in the focus group interview.

The social workers emphasized the importance of ‘tuning in’ to the user: by starting the conversations with open-ended questions, they tried to discover the users’ current state and needs. Exploring was also central to the mapping of the users´ situations: by encouraging the users to recount their experiences, the social workers tried to grasp the users’ perspective. One of the aims was to identify, together with the users, the change processes that the users were in, such as moving from unemployment to employment, or from substance use to non-use. Furthermore, focusing on the users´ resources, acknowledging their experiences and emphasizing positive developments were pivotal in building self-efficacy and in motivating the users to endure these processes. One example recounted in an IPR session was that of a young man who had experienced a leap forward in attendance in the Nav programme: ‘He had achieved an improvement, and I wanted him to say in his own words what he had done. How did he make it work? It was important to make him conscious that he had succeeded, and how, then hopefully he will do more of the positive stuff’.

While exploring, the social workers sometimes identified impediments to change. This demanded further exploration, and they additionally challenged the users to search for solutions. In most cases, solutions did not emerge immediately, but required work over time. The final important tool was recapitulation: by repeatedly summing up the main themes of the conversations, the social workers both checked the users´ understandings and strengthened their agreements. As such, they created a joint understanding, while keeping the momentum of the conversation. Being clear and specific was central to the important, but difficult limitation of the content in the conversations. Setting an agenda together with the user was necessary, but during the IPR sessions, several of the social workers criticized themselves for not being sufficiently specific with the users.

In the context of communicative tools and specific approaches, all the social workers mentioned their social work education as an important source of knowledge, in addition to post-qualifying education, supervision and practical experience. However, they often resisted pointing out single sources that guided their actions: ‘I think that’s valid for all conversations – you carry along experiences and knowledge, right? Then, after working for a while, it’s hard to differentiate what you really base your knowledge on. […] you use it subconsciously’.

Despite the broad knowledge base and the belief that they possessed a variety of ‘tools’, all the social workers had experiences of failing in conversations. To explore and concurrently be goal-oriented and obtain the required information was especially challenging in conversations where the users did not respond. In such instances, the social workers could feel powerless: ‘In a way, we are the only tool – we can’t hand out tablets or injections, or such. You know, conversation is kind of the knowledge we are supposed to do. And what do I do then, when I feel that I fail? Because I am the tool, the conversation is the tool, those measures are the tools. What to do then, when I don’t manage to utilize the conversation as a tool?’

Challenging conversations could also make the social workers feel irritated. On occasions, they displayed impatience towards the users when the users were passive or withheld information. However, the social workers mostly voiced disappointment about their own lack of professionalism when such instances occurred during the IPR sessions. Reflections concerning challenges and limitations emerged as topics in the IPR sessions and continued in the focus group. The social workers all felt they had little opportunity to reflect sufficiently on such ambivalences in their daily practice.

Ambiguous experiences of responsibility

All the social workers emphasized the users’ responsibility for themselves and described their own professional responsibility as limited to fulfiling their delegated tasks, such as applying for programmes and writing reports. If a user’s plan did not work, the social worker and the user had a joint responsibility to consider changing the course or making a new plan.

Though emphasizing the users’ own responsibility, the social workers felt an indirect responsibility if the users’ situations had not been clarified during the designated four years of the work and activation programme. At the same time, the social workers found differences between users: ‘It is harder when you have a lot of youngsters that may have gone through difficulties when growing up, that are vulnerable and really need help. The feelings are different, and the responsibility is greater’. As such, the social workers had mixed feelings about the apportionment of responsibility. In the focus group discussion, they displayed diverse understandings of professional responsibility, ranging from an experience of only being responsible for progression in the casework to feelings of great responsibility for the vulnerable users’ overall life situations.

The social workers often experienced ambivalence in the specific conversations, like when balancing the goal of employment with challenging family situations. Making decisions in difficult cases, the social workers felt the weight of responsibility: ‘I feel it in my bones at times, that I have a responsibility, and that my evaluations have great consequences for people’s lives. Especially in cases within substance use, or if people are without money. The electricity has been cut off – should we help them access? Is that the right decision?’

Another social worker described difficulties in setting boundaries with their personal life: ‘It’s hard. Leaving the cases when you finish work. Some manage through experience to draw the line, but I find it challenging. The responsibility lies heavy on me’. Responsibility was also an aspect when delimiting; the social workers had to steer the conversation towards the goal without rejecting the users’ experiences. This was especially challenging when the users themselves had problems with delimiting the topics, such as in a conversation with an unemployed young man with substance use issues: ‘It’s challenging: to have the patience to listen to him sliding into irrelevancies like problems with the shower, or very intimate things. I have to show that I listen, I don’t want him to feel rejected, at the same time I have to delimit him and try to teach him the time and place for everything’.

Time as a resource and consolation, shortage and threat

Throughout the IPR sessions and the focus group, the experience and presence of time emerged as an essential, but ambiguous, aspect of the professional practice.

In the conversations, time became a resource of its own. Exploring, challenging and building self-efficacy required work over time. Therefore, time became an inevitable part of the work. Aspects of time were also raised in the relational work. In cases where conversations and processes felt stagnant, the social workers found comfort in the knowledge that building relations often take years. As such, time worked as motivation in the work towards the users: ‘We have experienced cases that last for a long time. So, we try to focus on what they have done and managed. Step by step’. From this perspective, time takes its course rather than flies. Experience, described as professional knowledge achieved over time, was also considered an advantage in challenging conversations. ‘You can benefit from your experience with talking with numbers of people in vastly different situations’, one social worker said, ‘compared to being newly qualified and insecure’.

Even though time was an essential resource, it could also pose a challenge. The social workers described the first line service as fast paced, with too many users and a shortage of time for follow-up. The heavy caseload made the social workers feel that they had insufficient time to prepare for the conversations. In this respect, time was antithetical to the desire for integrated working, building relations, and seeing the entire human being.

Contrary to the perception of time as motivational, the impact of experience could also be ambiguous, leading the social workers to pursue their tasks in a less rigorous manner or lose faith in their own work: ‘Always believe in the users, it says in the textbooks. But then you have learned that it doesn’t always apply at all, you get a bit sceptical. And, eh, you bear the traces of all the cases with unfortunate outcomes, and then you lose some of the motivation and faith in it’. The decline in motivation was amplified by the lack of time to reflect on both the effects of working in prolonged processes and the consequences of not mastering the available tools. This led the social workers to call for professional supervision and time to reflect together with other social workers: ‘I need a boost, I need more time to talk about it, to continue and be motivated to endure the processes together with the users. You know, without hitting the wall’.

Additionally, non-fulfilment of tasks and subsequent delayed processes increased the feeling of individual responsibility towards the service users. In such instances, time shortages were felt as a stressor in their work, a scarce resource that was always running out.

Discussion

Balancing and negotiating – dynamic interaction with the system

The conversations with the users often focused on activation. Overall, the social workers accepted the workfare guidelines, although they sometimes felt that they interrupted the relation building and the integrated approaches they held in high regard as qualified social workers. The practice can thus be described as a complex balancing act between policy regulations and integrated approaches to the users’ challenges. However, this balance took place within the boundaries set by the Nav-system, and not in opposition to them. These findings are consistent with Hansen and Natland (2017), who through the notion working relationship argue that service providers manage to approach users in a person-centred way without compromising policy requirements. Our findings, however, reveal that the balancing also implies negotiating the limitations posed by the regulations. While Djuve and Kavli (2015) identify an ambivalence, and subsequent instances of ‘rule-bending’, in the implementation of activation policy measures, our findings indicate that the social workers typically acted dynamically and creatively when negotiating with the system. Thus, instead of perceiving the limitations as antagonistic to the integrated approaches, the social workers in our study often used elements in the Nav-system to support and enable their holistic and integrated thinking (c.f. Terum and Jessen 2015). The social workers ability to de-emphasize the activation measures during the conversation and adapt the approach to what is regarded as beneficial for the user is illustrative for how the integrated and dynamic approach is directive for their practice.

Specific knowledge and practical synthesis

Even though the social workers in this study emphasized the integrated approaches, they also identified and articulated specific kinds of knowledge, reasons and skills that informed their actions in the recorded conversations. These findings contrasts previous studies, which found a lack of specificity when social workers were asked to articulate specific knowledge and considerations in practice (Fossestøl 2019; Røysum 2017). A possible explanation is that the IPR method allowed the participants to articulate their use of knowledge in relation to concrete actions and occurrences in actual encounters with users. The social workers identified a broad range of knowledge and competences, such as heterogeneous theoretical knowledge, communication skills and capacity- and relationship-building. Taken together, their practice and subsequent reflections revealed the multitude of sources of knowledge (c.f. Finne, Ekeland, and Malmberg-Heimonen 2020; Iversen and Heggen 2016; Payne 2014; Trevithick 2008, 2012). This points to an on-the-spot combination of theoretical and integrated, communicative embodied knowledge. This combining of different knowledge elements is a clear illustration of Grimen’s practical synthesis: the diverse elements are integrated and synthesized to accomplish specific tasks in the individual encounters (c.f. Gilje 2017; Grimen 2008). By understanding the knowledge used in the conversations as practical synthesis, we acknowledge that the diverse demands in practice determine the professionals’ use of the heterogeneous knowledge base, and not the other way around. Furthermore, both the similarities and diversities in the social workers’ practices fall into this understanding, as it is events in specific situations that guides the professionals’ use of knowledge.

The negotiation of responsibility as professional knowledge

Despite displaying a range of knowledge and skills in the conversations, the social workers could still feel powerless in practice. Similar ambivalences occurred in relation to ethics and the extent of responsibility, as when balancing between the limitations posed by the regulations in Nav and the integrated approaches emphasized by the social workers themselves. While being confronted with the dependency and vulnerability of the users’ lives, they also faced ethical considerations as gatekeepers, in line with what Kjørstad (2005), Lipsky (2010), and Saario et al. (2018) describe. Furthermore, our findings support that ‘ethics work’ is an embodied part of everyday social work practice (cf. Banks 2016), embedded in the communicative character of relational work – in our case between the social worker and the service users (cf. Saario et al. 2018).

The ethical considerations were particularly evident in the focus group discussions about the limits of the social workers’ responsibility. Responsibility was complicated by the importance that the social workers placed on pursuing an integrated approach towards the users: Just as the social workers’ desire to ‘picture the entirety’ complicated their efforts to structure the conversations, the same desire made it difficult to delimit their professional responsibility. A common feature of these concerns was the personalization of problems: The nature of social work within the organizational framework of Nav seems to blur the boundaries of the professionals’ responsibility, potentially transforming a host of different issues, including organizational deficiencies, as well as users’ personal problems, into concerns that the professionals perceive they have an individual responsibility for. This finding is consistent with that of Fossestøl (2019), who found that the social workers kept their professional ethical problems private, despite the understanding of ethics as a fundamental aspect of their professional self. Our study supports the call for a re-establishment of a broad understanding of social work knowledge where ‘ethics work’ is primary, and not subordinated to, knowledge (Fossestøl 2019; Trevithick 2008). The IPR sessions and the focus group provided an arena for the social workers to discuss ‘ethics work’ in practice, and furthermore revealed a need for permanent establishment of such arenas. Besides providing a better theoretical understanding of ethics as professional knowledge, mutual professional and ethical reflections might lead to both raised awareness on ethical issues and professional development in practice.

Time matters as professional knowledge in social work practice

One interesting finding was how meaning, use, and experience of time emerged as diverse and ambiguous among the social workers, but nevertheless inseparable from practice.

Time appeared as a concrete resource in the meetings, associated with the use of the specific tools identified by the social workers, and essential to the integrated approach and the gradual relationship-building. Therefore, time was not only fundamental in the relational work (cf. Solheim et al. 2020), but also a prerequisite in the gradual, purposeful process with the users towards work and activity.

Based on the notion of polychronic and monochronic time perceptions (Hall 1989; Kaufman‐Scarborough and Lindquist Jay 1999), it is reasonable to argue that dual, and sometimes competing, perceptions of time exist in Nav. While the linear, clock-related time (Johansen 2001) structures the work and activation programmes, the findings show that a predominant part of the actual work in the conversations was cyclic, processual, and task-oriented. The time-related stress experienced by the social workers can therefore partly be understood through Rosengren’s (2006) description of a temporal clash: they are captured in a double structuring of time, between an array of tasks and a ticking clock. However, while Olsson and Sundh (2019) identified a temporal clash between the social workers’ monochronic perspective of time and polychronic work tasks, this study indicates that a polychronic time perception is more appropriate to understandings of social work as processual and dynamic. This might help us to understand why time was also perceived as a consolation by the social workers; the iterative, task-oriented understanding, along with the knowledge that social work requires time, had given the social workers an experience of, and endurance with, long-lasting processes of change. Time in social work must therefore be understood beyond dual concepts: Our findings of individual ambivalence suggest that the social workers were neither monochronic nor polychronic, but rather that their time perception in practice was dynamic, complex, and contextual. These findings are partly contrary to those of Juhila, Günther, and Raitakari (2015), who identified a temporal clash as the professionals held on to a linear time discourse, while the mental health clients brought forward more cyclic time discourse of the mindful body.

However, suggesting that the social workers partly acted dynamically in relation to time is not to say that their perceived lack of time is not worth listening to. The findings show that lack of time impinged on motivation, the ability to fulfil casework in the desired manner, possibilities for preparation prior to meetings and reflection afterwards. The perceived shortage of time also led to less professional supervision and little joint reflection amongst colleagues.

Similarly to how the social workers kept ethical considerations private, they rarely thematized ambiguity related to time, but rather dealt with it individually. These findings support Tsang (2008), who argues that through paying more attention to qualitative time social work practice could embody a complex use of knowledge and experiences, and thus provide both better services and develop professionally. The findings also support Juhila, Günther, and Raitakari (2015) and their call for more research on the presence of different discourses of time in professional-client interaction. Thus – by discussing and articulating time as important to, and embedded in, the heterogenous professional knowledge base, the social workers could experience both raised awareness and professional development in practice. Ironically, such discussions demand the very thing that seems to be lacking, namely time.

Conclusion

Through a multi-method approach with a focus on the social workers’ recall and reflection, this study explores professional experiences in service user meetings. By taking actual conversations as starting points, the study enabled an exploration of on-the-spot use of professional knowledge. The use of video assisted recall enabled the social workers to identify and articulate their use of specific skills in concrete situations, in addition to more integrated, holistic approaches. Overall, the social workers’ use of knowledge can best be understood through the concept of practical synthesis; expressed in the professionals’ actions, guided by occurrences in the single conversations.

Furthermore, the study’s explorative approach demonstrates the social workers’ perceptions of the complexities in their daily professional practice as multifaceted, highly intertwined, and often contradictive. Despite contradictions, the social workers constantly balanced and negotiated their valued integrated approaches within the given limitations in Nav, and not in opposition to the system. However, the findings of how the social workers constantly made ethical considerations and negotiated the limits of their professional responsibility highlight the need to articulate ethical concerns as part of the professional knowledge, and not as personal or individual challenges. By understanding and discussing this ‘ethics work’ as professional knowledge, the social workers hopefully can be relieved of individual feelings of responsibility towards the users and rather develop professionally. The article also argues for a similar articulation on the notion of time in social work: Akin to how the traditional knowledge paradigm is claimed to be insufficient for understanding knowledge in social work, a linear time concept is inadequate for understanding the cyclic and iterative perceptions of time in the relation-oriented social work. This finding – the social workers’ experience of time as an ambiguous but ubiquitous aspect of practice – points to a need for further exploration of the embeddedness of the time element in social work practice.

Taken together: the discussion of the most obvious finding – professional social work practice as highly complex, often negotiated and seldom without ambiguousness – suggests that the social workers need more time for reflection, self-evaluation, and supervision. This would be consistent with a broad understanding of knowledge, ethics, and time in social work, and could contribute to further development and strengthening of professional knowledge in practice.

This study is limited to qualified social workers’ experiences; thus, the service users’ experiences are left unexplored. A natural progression of this work is therefore to explore and analyse users’ experiences and reflections, as well as the experiences in service user meetings of professionals with different educational backgrounds.

Disclosure statement

No potential conflict of interest was reported by the author(s).