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Book Review: The Creation of Meaning in Clinical Social Work

Carolyn Saari examines the practice of clinical social work from the vantage point of constructed and shared meaning. She asserts that one’s sense of self and identity are best understood as concepts that underlie one’s sense of meaningfulness combined with a narrative construction of what was and what is possible. Reality is a construct, and identity is the story within which meaning is found. For clinical social work to be effective, Saari posits, the dinician must cultivate a shared meaning system with the client. Such a meaning system is one in which true dialogue occurs so that clients can better achieve their life potential. Saari notes Bruner’s (1987) work on modes of thinking. Bruner suggests that there are two basic modes of thought, the first causal and predictive and the second related to meaning and the narrative construction of what is possible. Noting that work with clients is based upon the past yet looks forward to the future, Saari seeks to examine the mode of thought that liberates clients from predictable quandaries and allows them to create other outcomes in the self-narrative. Her work blends the personal and the historical with the logic of narrative and embroiders the art of the clinical. Narrative knowing is being examined and explored by thinkers in various disciplines. Schank (1990) asserts that all human memory, indeed most thinking, is story based. It is here, in the human capacity to organize memories, ideas, and plans into a story, that changes can be introduced. Saari suggests that the evolving story of people’s lives can be redirected within the constructed narrative and a shared meaning system. Saari builds a case for her thesis about meaning in an orderly and systematic way. She takes the reader through a selective review of the history of psychoanalytic thought, which is replete with various theories of intrapsychic and interpersonal phenomena. In the realm of the interpersonal, she addresses the phenomenon of “affect attunement” and how it bears upon both the therapeutic relationship and shared meaning. Although she grounds her ideas in the works of others, her understanding of the phenomenon might well be strengthened by a review of the work of Condon (19781, who suggests that such attunement may represent part of our genetic heritage that is enhanced by learned behaviors. In her second chapter, Saari lists a minimum of four functions that meaning serves: communication, organization, evaluation, and confirmation of the self as a member of a human community. These functions permit a dialogue with others, a structure within which one’s life story is acted out, a sense of the appropriateness of emotions, and a shared sense of being one actor in a broadly cast play. In the third chapter, Saari discusses how one’s sense of self and identity are embedded in the social environment. The stories that people create about themselves in this environment are important to the state of their mental health. The possibility of creating a diverse number of potential responses, or plot twists, in response to the social environment allows for greater rather than fewer resources. In this sense, psychological health is enhanced by the ability to create multiple possibilities of and for meaning. Thus identity complexity, she asserts, allows persons creatively to shape their developing narrative or story-in essence, their future. The fourth chapter focuses upon the effects of culture. Saari suggests that culture is a shared meaning system. She also suggests that clinical social work should disregard the notion that psychological health is best served by developing one’s capacity to adapt to the culture or social environment. She notes that helping people adapt to a damnable environment does little for them or their future and that changes in environment alone do not always produce desired behaviors or mental states. She suggests that examining meaning systems is a more fruitful area for helping people. Changing social environments is, however, not to be neglected because such changes can support a more meaninghl life narrative. Such comments suggest that Saari is attentive to the needs for social and distributive justice in the culture in which meaning is imbedded.