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Clinical concepts are useful to the social work practitioner insofar as they account for and explain clinical data and guide the practitioner to do what is needed. This book argues that a constructivist paradigm has greater explanatory power than the adaptive point of view.
Central to the constructivist position is the concept that the construction of meaning is not inherent in either the person or in the known object or situation. Knowledge is basically a relationship between subject and object. Meaning is defined in “… four separable but interrelated functions for the individual, namely, communication, organization, evaluation, and participation in a human community” (p. 25).
Twelve chapters comprise four discrete sections. Section One highlights meaning and causation in clinical social work theory and its applications to the interpersonal and the intrapsychic, to identity and the self, and to culture as a shared meaning system. Section Two explicates some processes of the self such as internalization, regulation, diagnostic patterns in the self, and therapeutic use of the self. Section Three focuses on the content of identity by discussing the role of narratives, the uses of history, and the constructing of a concordance. This means that a client demonstrates the creation of meaning in partnership with a practitioner “… who diagnoses the capacity of the client's self to create meaning and then provides a relationship that will maximize that capacity” (p. 169). Section Four revisits the role of the professional relationship and stresses that the creation of meaning is the main therapeutic ingredient.