Crises at Every Level of Service
Using Social Work Theory for the Facilitation of Friendships RICH FURMAN Social Work Program, University of Washington, Tacoma, Washington, USA KATHRYN COLLINS School of Social Work, University of Maryland, Baltimore, Maryland, USA MICHELLE D. GARNER Social Work Program, University of Washington, Tacoma, Washington, USA KAREN LEE MONTANARO W. G. Hefner VA Medical Center, Salisbury, North Carolina, USA GWEN WEBER School of Social Work, University of Nebraska at Omaha, Nebraska, USA Positive friendships are essential to human development and resilience. In spite of the importance of friendships, few social work models have been developed to help clients establish or maintain friendships. This article explores how clinical theories of social work, and their associated practice interventions, can guide social workers in helping their clients improve their friendship relationships.
KEYWORDS friendship, social work practice, social support, theory, relationships INTRODUCTION Social work practice emphasizes the interaction between people and their social environments (Devore & Schlesinger, 1991; Payne, 1991; Sheafor, 17 Received March 11, 2005; accepted May 29, 2006 Please address correspondence to Rich Furman, Social Work Program, University of Washington, 1900 Commerce St., Tacoma, WA 98402-3100 USA. E-mail: rcfurman@u.
washington.edu Smith College Studies In Social Work, 79:17–33, 2009 Copyright # Taylor & Francis Group, LLC ISSN: 0037-7317 print / 1553-0426 online DOI: 10.1080/00377310802634582 Horejsi, & Horejsi, 1997). Social workers help people adapt to and alter their social context to better maximize their personal strengths, meet their personal and collective needs, and minimize or alter their limitations (Saleebey, 2001; Weick, Rapp, Sullivan, & Kishardt, 1989). Indeed, even more insight-oriented clinicians utilize systems-oriented interventions to bring about intrapsychic changes (Teyber, 2000).
Perhaps what separates social workers most from other helping professions is our expertise at helping people create more meaningful social contexts (Germain & Gitterman, 1996). For example, social workers help families improve their individual and collective functioning, as well as engage in advocacy work to change social policies and improve institutions designed to meet familial needs (Carter & McGoldrick, 1999; Janzen & Harris, 1997). Social workers help people develop relationships in the context of small groups as a means of improving their overall social functioning (Henry, 1992; Toseland & Rivas, 2005; Zastrow, 2001), implement interven- tions at the community level to ameliorate personal and community problems, and prevent future incidents of social distress (Homan, 1999; Netting, Kettner, & McMurtry, 1998; Weil & Gamble, 1995). Social supports can provide material aid (tangible things), emotional support, instrumental support (such as services), and a sense of belongingness (Walsh, 2008).
Although social workers have developed effective interventions to help families, groups, and communities, a significant social relationship has often been neglected in the social work literature: friendship. This is lamentable, as friendships can be some of the most enduring and supportive relation- ships in our lives.
Friendships are essential to human development (Clark & Ayers, 1991; Hartup, 1979, 1983, 1989; Hutter, 2001; Linden, 2003) and contribute to a sense of depth and wholeness for individuals as they move through the life cycle (Burk, 1996). Studies have demonstrated the relationship between friendship and quality of life (Bradburn, 1969; Phillips & Fisher, 1981).
Because these relationships are essential to healthy human functioning, social workers would be well served to learn how to help clients develop meaningful and lasting friendships. Further, higher levels of education and being White are positively correlated to the number of individuals people have to confide in and discuss important topics (McPherson, Smith-Lovin, & Brashears, 2006). As a result, friendship facilitation emerges as a more important clinical target for the marginalized populations of clients with whom social workers often work. This article seeks to help social workers meet this objective in two ways. First, we explore the concept of friendship and its importance to human development and health. By doing so, we provide a rationale for why social workers should consider friendships an important practice domain. Second, we discuss the principles of facilitation of friendship that are drawn from several clinical social work theories that can guide social workers in helping clients improve their friendships.
18R. Furman et al. THE IMPORTANCE OF FRIENDSHIPS The need to belong seems to be a fundamental human drive. Although attachment theorists traditionally have explored the importance of parental attachment to infants (Ainsworth, 1989), current research in this area has focused on the central importance of attachment, connectedness, and bonding for adults (Baumeister & Leary, 1995). For some, friendships have become primary vehicles for adult attachment and bonding. As society has undergone rapid transformation over the last 200 years, kinship and community relationships and structures have undergone radical transforma- tions (Postman, 1992). Changes in the very nature of these bonds and the geographic mobility of the population in the United States have often altered the capacity of families to meet individual psychosocial needs. Economic resources that have historically been set aside for social services have increasingly been allocated to other priorities, such as defense and homeland security. Further, it seems that on a national basis, social networks are shrinking. A marked shift in demographic data suggest that more than one half of the respondents from the 2004 General Social Survey indicate that they have no nonkin confidant with whom to discuss important topics, whereas one fourth indicate they have no one (kin or otherwise) with whom to have such discussions (McPherson et al., 2006). Given this reality, it is essential that social workers find ways to help clients develop and connect with friends rather than relying primarily on professional relationships.
These shifts in social relationships may influence the mental health of large numbers of people. Isolation and alienation often lead to social dislocation and depression in individuals (Mirowsky & Ross, 1989; Ollman, 1971). Some of those persons who possess extreme difficulties in establish- ing social bonds may have received psychiatric diagnoses of major depression, social phobia, anxiety disorders, or avoidant and/or schizoid personality traits that compromise their interpersonal relations. Fears of intimacy, an inability to trust and depend on others, and insecure attachments may permeate their relationships.
Researchers have found the lack of positive friendships correlated with developmental and psychosocial problems (Dunstan & Nieuwoudt, 1994), whereas sustaining friendships is correlated with various strengths and resilience (Norman, 2000.) Indeed, numerous studies have demonstrated the positive impact of social relationships on preventing psychosocial problems (Higgins, 1994; Rutter, 1979, 1987; Werner, 1987; Werner & Smith, 1992; Wolin & Wolin, 1993). For instance, Berndt and Keefe (1995) found a relationship between positive friendships, greater involvement in school, a sense of acceptance by peers, and positive self-esteem among the children studied. Children who have established and maintained friendships demonstrate better scholastic achievement as compared with their peers who lack friendships (Masten, 1994; Shure, & Spivak, 1980). Those adults Social Work Theory and Friendship Facilitation19 who lack close friendships may be vulnerable to feelings of dysphoria and loneliness (Elkins & Peterson, 1993; Williams & Solano, 1983). Crosnoe (2000) sums up the importance of friendship well when he observes, ‘‘friendships provide a forum for the learning and refining of socio/ emotional skills and enduring relationship templates’’ (p. 378).
Although the importance of friendship to psychosocial health has been largely neglected in the social work literature, other allied disciplines have ambitiously undertaken the study of friendships during the past 50 years. In his research and development of interpersonal theory, Sullivan (1953) explored the necessity of friendship for socialization. Bronfenbrenner (1979) posited that friendships were essential to human growth and development as essential aspects of human ecosystems. Recently Powdthavee (2008) has even used the 2005 British Household Panel Survey and shadow pricing techniques to put a price on the happiness derived from interacting with friends or family. For example, a frequency of ‘‘once or twice a month’’ is worth £35,000 sterling ($53, 233 USD) whereas ‘‘most days’’ is worth £63,833 ($97, 095 USD). The average actual annual income among respondents was only £9,800 pounds ($14, 908 USD); indicating a huge effect of socializing upon happiness (Powdthavee).
What precisely are friendships? From a definitional perspective, Furman, Collins, and Swanson (2003), observe that friendship is similar to love. Both concepts are difficult to define; yet one knows when he or she finds it, and when it is missing. Burk (1996) definesfriendshipas ‘‘a dynamic reciprocal relationship between two individuals’’ (p. 283), whereas Wiseman (1986) definesfriendshipas a voluntary relationship that exists primarily for personal satisfaction and enjoyment rather than the fulfillment of a particular task or goal. Berndt (2002) states that high levels of intimacy, prosocial behavior, self- esteem, support, and loyalty, combined with low levels of conflict, and rivalry dominance characterize high-quality relationships. Similarly, the author notes that friends ‘‘help and share with each other’’ (p. 7).
The nature and composition of friendships differs by gender. Rosen (1999) contends that friendships between men are less intimate as compared with men’s friendships with women or friendships between women. She proposed that patriarchy contributes to male competiveness, whereby men become less likely to risk ‘‘the loss of power that closeness with another might create’’ (Rosen, 1999, p. 129). Elkins and Peterson (1993) ascertained that men had lower ideal standards for male–male friendships and reported more satisfaction with their friendships with women than with men.
Friendships between women, in contrast, are generally designated as expressive and intimate (Caldwell & Peplau, 1982; Fox, Gibbs, & Auerbach, 1985). Women place great emphasis on self-disclosure, empathic under- standing, and connectedness in their friendships (Parker & deVries, Fox, Gibbs, & Auerbach, 1985; 1993). Davidson and Packard (1981) asked women to explain what aspects of their friendships were beneficial to them 20R. Furman et al. by contributing to personal growth, support, or change. Factors such as reciprocal expression of feelings, altruism, and communion were rated as highly therapeutic.
Despite these differences, men and women are about equally likely to have nonkin confidants (2004 data, McPherson et al., 2006) and to identify some of the same aspects as significant in their friendships. Parker and de Vries (1993) examined how people perceive friendships and what they valued most in those relationships. Men and women rated trust and authenticity as the most essential features present in their friendships.
Sapadin (1988) also found commonalities among the beliefs shared by men and women regarding friendship. Both genders reported that sharing and enjoying each other’s company are central factors in friendships. When studying the development of friendships, Hays (1985) found that men and women were equally as likely to establish solid friendships after starting college. Although women may undergo and report more intimacy with their friends, men are just as adept at forming new friendships, contrary to some popular gender stereotyping. Men and women also report a comparable amount of time spent with friends, and both place a certain amount of emphasis on intimate friendships (Caldwell & Peplau, 1982).
Similarity and proximity also seem to be important aspects of establishing and maintaining friendships. Hays (1985) determined that the geographic distance between residences correlated negatively to the effective development of new friendships. He discovered that the farther apart people lived, the less likely they were to successfully form a friendship.
Nahemow and Lawton (1975) conducted a study at a public housing project in New York City with a diverse mix of residents of various ages and races and discovered that the closer people lived to each other, the more likely they were to be friends. In fact, when asked to identify who their friends were, more than 80% of the respondents first reported someone who lived in their building—often on the very same floor. Age and race were also strongly associated with friendship development. However, friends that were reported to be of different ages and races, always lived in the same building, so their proximity to each other seemed to mitigate those differences. Some became friends with residents of other buildings, but only if they were the same race and close in age. The authors subsequently concluded that people are likely to make friends with those that live geographically close to them and will reach out of their immediate space to make friends with others who share commonalities.
Verbrugge (1977) also reported a relationship between similarities and the likelihood of developing friendships. He found that friends tended to be similar on such factors as age, occupation, education, and political and religious preferences. Indeed, women and men declare sharing similar values with their friends and report that having congruent values was important to their friendship relationships (Davidson & Packard, 1981). Even Social Work Theory and Friendship Facilitation21 children tend to establish friendships with those that are similar to them in terms of sex, race, and academic achievement (Tuma & Hallinan, 1979).
Recent national data confirms that most people’s close confidants are among those similar to themselves (McPherson et al., 2006). FRIENDSHIP FACILITATION AS A PRACTICE APPROACH In spite of the importance of friendship, few helping professionals seem to have examined the actual processes and personal qualities involved in helping clients establish and maintain these relationships (Burk,1996). Although some might assume that these processes naturally happen, the prevalence of loneliness, which may affect as many as one in three adults (DeStephano, 1990), suggests that many might need therapeutic assistance in developing their friendships.
Although it is true that little has been written for professionals on helping clients improve their friendships, important work has been done in the area of friendship facilitation for children with disabilities (Oden & Asher, 1977; Schaffner & Buswell, 1992). Schaffner and Buswell (1992) stress the importance of helping provide social contexts through which children with disabilities can meet nondisabled children. They identified the concept of friendship facilitation as part of a broader strategy of including children with a disability into mainstream educational and social situations. They found three elements central to this process: finding opportunities, interpretation, and accommodation. Teachers and other providers often help facilitate opportu- nities for inclusion and social interaction where these children can establish interpersonal connections based upon their strengths and interests.
Interpretation stresses the need for providers to help children and those affiliated with them to focus on strengths and resources, thus highlighting the children’s capacities for social encounters and friendships. Accommodation emphasizes the need to structure the environment that children with the disability can maximize their strengths within that environment or social context. This project serves as an example of the potential of developing models and programs designed toward helping young clients develop friendships. Although such models are in the initial phase of development for children, little has been written about facilitating the friendships of adults.
Conceptual models need to be further developed and made available for direct practice with adults who seek friendships and additional social supports. The following section explores some of the ways that diverse clinical theories inform the development of practice models aimed to facilitate friendships. FACILITATION OF FRIENDSHIP AND CLINICAL SOCIAL WORK THEORIES As in any practice arena, social workers must first assess the nature of clients’ friendships prior to intervening in this important system. Even when specific 22R. Furman et al. clinical practice theories are employed, such an assessment must be ecological and holistic in nature. This assessment should pay attention to environmental and systemic factors, as well as psychosocial factors such as an individual’s level of functioning, inter- and intrapersonal capacities toward meaningful relationships, the meaning of friendships, as well as psychosocial skills. These factors are expanded upon throughout this section.
The social work literature rarely includes the assessment of friendships when identifying the social functioning of the individual. Cowger (1997) does include friendships in his strengths-based assessment model.
Understandings based on concepts from an ecological perspective, psychodynamic and interpersonal theory, and existential and cognitive theory offer unique areas for consideration when completing the compre- hensive psychosocial interpersonal assessment that focus on friendship.
In keeping with the profession of social work’s unique and historic dual focus on person-in-environment, this article advocates practices congruent with the ecological perspective. This perspective enables one to simulta- neously focus on person and environment and on their reciprocal relationship. According to Germain and Gitterman (1996) social work interventions that adhere to the ecological perspective recognize that causality in social work practice is reciprocal rather than linear in nature.
Beginning with the initial contact with a client, social work practitioners have the distinctive ability of assisting clients to understand, explore, and develop friendships with individuals within their social environment to promote health and well-being and to prevent and/or resolve psychosocial problems. For example, throughout the engagement and assessment process of working with individuals, families, groups, and communities, the concepts of friendships, interpersonal relationships, informal/formal net- works, and social support should be examined with the client. This process helps clients begin to realize that facilitating friendships draws upon the strengths that exist within themselves and in their homes, schools, neighborhoods, work environments, and larger communities. Social work- ers, already trained in utilizing the resources of family and community, are advised to increase their ability to help clients understand and employ friendships as a means of encouraging people to meet their needs.
Friendships promote self-learning and validation and give us the courage to face life’s challenges. Joe Abbot is a single, 49 year-old, Baptist, African American man referred by his employer for social work services to help him with his depression and anger. Joe is otherwise in good health and has worked for the county as a fireman for the last 20 years. Joe reports not having a significant other, and despite continually dating women, never having had a courting relationship that lasted longer than 6 months, at which Social Work Theory and Friendship Facilitation23 time he usually ends the relationship. After substantial work building rapport with his younger, White, male social worker, Joe admits to feeling isolated and lonely. When asked about his social relationships, and any sources of potential support, he described a family of origin history of substance abuse and conflict. One aunt, who has subsequently also passed away, got more involved with Joe in his teens and helped him stay clean, finish school, and enter his profession. She was the only one among his birth family with whom he maintained a relationship.
Joe’s remaining family is a source of stress, not support. When Joe’s clinical social worker asked him if he had friends who were supportive, he expressed surprise, claiming that no one had every asked about his friends in that manner before. The social worker explained that friendships were extremely important and that to some people they were even more valuable a resource than family. Joe related to this and stated that though this was true for him, he also had problems with his friendships. He tended to sabotage his relationships with other men as his friendships become more intimate. When the social worker asked if working on his friendships would be a potential subgoal that might help him with his anger and depression, he agreed that it would. Helping Joe to establish, deepen, and maintain friendships soon became a focus of therapy. Psychodynamic Theory Traditional, psychodynamic-based practice focuses upon the assessment of the early attachment and bonding experiences of individuals with their primary caretaker. However, adults possess the capacity to improve the ways in which they relate to friends and peers throughout the life span, although this process may be difficult for many, especially those who develop major mental illnesses characterized by a disturbance of interpersonal relationships.
Contemporary relationally based practice seeks to engage the client in a meaningful helping relationship that creates a corrective and reparative emotional experience for the client. The intention is to purposefully provide corrective experiences to alter relational patterns from early childhood, which without correction continue into adulthood and become core features of an individual’s life (Sullivan, 1953, 1970). According to Teyber (2000): the therapeutic process has metaphorically repeated the conflicted interaction that clients have not been able to resolve in other current relationships, and that they often have experienced in earlier formative relationships. (p. 17) Therapy is an experience where two people influence one another in meaningful ways (Moursund & Erskine, 2004). For example, the 24R. Furman et al. interpersonal therapeutic alliance creates dynamics of transference and countertransference. Within this framework, a social worker can utilize this therapeutic relationship to enhance a client’s ability to create friendships. For example, if an individual has difficulty trusting another in the therapeutic process (reflecting a transference theme), the client may begin to trust the therapist until conflict occurs within the therapeutic encounter as it does within other human relationships. Historically, a client may have experi- enced rejection or abandonment during childhood that then set the stage for a relationship template involving a wish for connection yet a fear of censure and rejection that he enacts regularly with all relationships, including friends.
Through modeling a willingness to work through the conflict, and continuing to hold the client in high regard, the therapist starts to be viewed as somewhat trustworthy. Yet hostility expressed toward the therapist may be reflective of the need for self-protection. As clients engage in the treatment process over time, they begin to understand that these adaptations are no longer especially effective nor necessary. Over time, in the context of the safe container of the therapeutic relationship, a client may safely struggle to address painful emotions and change old patterns, experience emotions more directly and practice new behavior.
Because even highly skilled and experienced clinicians can behave in a hostile, counterproductive manner with their clients after succumbing to inevitable countertransference enactments, clinicians need to develop the self-reflective capacity to understand how and why clients may trigger their own countertransferential emotional responses (Murphy & Dillon, 2003).
The relational dynamics in the treatment process offers clinicians the opportunity to use their own reactions as a means of understanding the client and intervening effectively (Arnd-Caddigan & Pozzuto, 2008; Aron, 1991; Mackey, 2008). Therefore, an important component of helping clients develop nurturing friendships is for clinicians to understand and come to terms with their own issues around friendships. The social worker must carefully monitor their own responses and be cognizant of personal projections. Successful professional use of self during sessions can help a client to repair, restore, or develop the capacity for intimate relationships and thereby enable them to discontinue destructive defense systems and experience new personal meaning in relationships (Mackey). Increased awareness related to the influences of early developmental attachment experiences, residual effects from previous interpersonal relationships or friendships, especially those harmful or fear evoking, and the vital role of defenses are important therapeutic areas to include when facilitating the individual’s capacity to develop meaningful friendships.
For some clients, the development of an effective helping relationship may inspire them to develop new friendships. Having experienced a relationship that is safe and supportive, they may contemplate the possibility of new friendships for perhaps the first time. They may begin to wonder Social Work Theory and Friendship Facilitation25 about the roles that friendship will play in their lives, how friendships might enrich their lives, and what meaning such relationships can have. After several weeks of working together, and prompted by the therapist’s suggestion that Joe ask one of his coworkers to watch a game with him, Joe and his therapist began to explore Joe’s fear of being vulnerable in his friendships with men. He said that expressing his feelings, or asking for help and support, made him feel weak. He said that he worried that other men would perceive him as inferior or too feminine—both of these things he perceived as interfering with his job and reputation and clearly did not fit with his self-image. He reported that people always let him down. He said that at this point he doubted whether he would ever be able to trust men or women, and that indeed neither was probably trustworthy. Utilizing the working relationship that they had established, Joe’s worker pointed out that Joe had indeed trusted his social worker with a great deal of personal information. He asked if Joe was worried that he would betray him. Joe became defensive and hostile and reported that their relationship was different, and that indeed the social worker may betray him. Joe even suggested that the manner in which he was challenging Joe at the moment was a sign of betrayal. Joe’s social worker reflected Joe’s feelings of mistrust, fear, and anger and asked if these feelings were indeed what he was experiencing. Joe affirmed that these were his feelings, and the two sat in silence for some time. The social worker then informed Joe that no matter what he felt, that he would still be there to support Joe. Joe clearly was uncomfortable with the intensity of his emotions in response to this statement. After a few more minutes of silence, Joe’s worker asked if these were similar feelings he felt in his friendships, when he was worried about being disappointed. Joe affirmed that they were. The two were subsequently able to process this encounter and utilize it to help Joe understand more fully his role in friendships. Existential Theory Existential theory focuses practitioners on the meaning and importance of relationships to clients’ lives. The theory can be used to assist clients in identifying their own values (Krill, 1969, 1986) and sense of mission (van Deurzen -Smith, 1997) and to help clients achieve these self-directed aims (Willis, 1994). By assessing and asking challenging and thought-provoking questions, clients are pressed, or encouraged, to examine the significance of their experiences and relationships in their lives. Such inquiry may also inspire them to pursue their friendships with clearer meaning and relevance for their life. The following questions assist clients to explore issues related specific to their friendships.
26R. Furman et al. 1. What can we learn about you by (from) the way you treat your friends?
2. How close would you like to be with a best friend?
3. In what ways do your friendships enrich your life?
4. What does your friendship with (name) tell you about yourself as a person?
5. How do your friendships help you be a better person?
6. What do you fear in becoming closer to your friends?
7. What would happen if you told your friends everything you felt you needed to say?
8. What is your fantasy of a perfect friendship and what would it include? Questions such as this can be used to help clients think about the roles they hope friends may play in their lives. Such questions can help facilitate self-determination regarding the development of social relationships and can stimulate motivation to create a friendship system. Perhaps for the first time in years, clients may begin to see the development of social relationships as a conscious choice. Yet once they begin to see their own desires and possibilities, they must honestly appraise their own strengths and deficits in this domain.
Over time, Joe began to see his friendships as a source of support and growth. He soon observed that he was able to choose his friendships, and he was entitled to spend time with people who would bring out the best in him. He began to set limits with old friends who were dismissive and unsupportive, or who engaged in behaviors akin to those that Joe was attempting to stop doing himself. Joe began to see his time as valuable and developed an appreciation of the finite amount of time we were given. His therapist supported Joe in making difficult choices around his friendships and supported Joe as an autonomous, self- determining man. Joe began to view friendships as a source of meaning and value in his life. He moved from worrying about how his friends could help him, to being increasingly concerned with how he can support his friends. Cognitive-Behavioral Theory and Practice In this regard, the social worker and client can work together to assess the cognitive frameworks that influence perceptions and thinking regarding friendships. The central notion in cognitive therapy is that the manner in which clients perceive their life situations and challenges is the most significant cause of emotion and behavior. Cognitive therapists hope that their clients will be able to carry newly learned skills and thinking patterns with them throughout the rest of their lives (Beck, 1995). Self-defeating ideas are identified and altered with newly acquired thinking patterns and behavioral skills. The assumptions ascribed to another and the potential for the enduring quality of a relationship greatly influences the individual’s Social Work Theory and Friendship Facilitation27 ability to establish and maintain a friendship. The client’s personal views or perceptions of another may inhibit a friendship. Self-defeating messages such as ‘‘nobody wants to hear from me,’’ ‘‘no one cares about me,’’ ‘‘there are no others who have my interests,’’ ‘‘You can’t trust anyone,’’ or ‘‘I don’t need anyone’’ are a few of examples of this type thinking. Cognitive therapy techniques can be used to encourage new ideas, views, and thinking patterns that will promote the development of friendships. Relationship experiences with therapists serve to change false self perceptions and perceptions regarding others.
Rational Emotive Behavioral Therapy (REBT) addresses four primary irrational beliefs: low frustration tolerance, awfulizing, demandingness, and global evaluation of work (Dryden & DiGiuseppe, 1990; Ellis, 1994). These beliefs may inhibit friendship development as well as maintaining and deepening of friendships. For example, when experiencing conflict with a friend, a client may awfulize the conflict, making more of the conflict than really exists, leading to fear or increased anxiety and to future avoidance behavior. In REBT, demandingness is viewed as the source of most anger and many relational problems. Clients who possess cognitions characterized by demandingness believe that others should behave as they wish them too.
When others do not meet their rigid expectations, anger and hurt are the result. Such cognitions must be reduced for a reciprocal, mutual adult friendship to ensue.
The development of communication skills is also an important aspect to cognitively based theories. Skills such as using ‘‘I’’ statements, affective expressive statements and developing empathy skills, making requests and increasing assertion skills, focusing on one topic at a time, clarifying underlying assumptions or intent, assertion tactics, decreasing fear and taking risks of personal self-disclosure are a few examples. For instance, when a conflict with a friend develops a letter-writing assignment offers a client the opportunity to practice and disclose personal views or feelings in a safe manner. The client may use such an assignment in therapy to work through faculty expectations or patterns, or it may be read to the friend with the added self-protection of writing, or serve to document the friendship experience being considered in treatment.
Of particular importance is the development of receptive skills to enhance the ability to receive the communication from others. These skills include active listening, confirming or disconfirming messages, paraphras- ing, seeking additional information, validation skills, and altering one’s nonverbal posture. Joe began to develop a close friendship with a former priest. Joe initially did not see himself as worthy of this friendship. Even though Joe had come far in his treatment, he began to sabotage this friendship. His social worker helped him identity the beliefs that were continuing to plague 28R. Furman et al. him: that was not worthy of support, that he would be hurt, that he would be rejected, and this rejection would be intolerable. Over the course of several sessions, Joe’s social worker helped him dispute these irrational beliefs. Joe was able to talk to his friend about his work in therapy, and how he was attempting to avoid listening to these beliefs which were straining the friendship. Joe demonstrated how far he had come when he was able to ask his friend for patience and hugged his friend in gratitude when his friend stated ‘‘that is what friends do brother, that is what friends do.’’ CONCLUSIONS Friendships are essential for healthy development. They play an important role in helping people create meaningful and fulfilling lives throughout the life cycle. Friends may help us in measurable and less-measurable but equally important ways, while allowing us to learn about ourselves and providing a sense of belonging. Through friendships, we become our best selves possible. In fact, friends reflect our own lives through their love and support. Although this article introduces the uses of clinical theories in helping clients develop and maintain their friendships, the authors hope that social workers and researchers will continue to explore the importance of friendships and will design interventions targeting this important social domain.
Frequently, the process of helping clients understand, explore, and develop friendships begins at the first meeting with the social worker. It is interesting that in just about every ‘‘pop culture’’ magazine the topic of ‘‘how to be or make a friend’’ is covered, yet social workers often forget the usefulness of exploring friendship skills within the interventions we provide to clients. Social workers instruct clients on how to network within their community to obtain appropriate services and resources but often do not help their clients find and establish intimate and supportive friendships outside of social service or health care systems. Social workers can institute role-modeling through employing the unique skills of engagement such as empathic listening, attending, and being genuine with clients. The ‘‘therapy office’’ is the microcosm of the broader society involving complex relationships. However, we caution the helping specialist to avoid confusing the professional boundaries of social support with friendship. Social workers realize that as helping professionals, it is not constructive to our clients to try to be their friends if we intend to maintain a supportive therapeutic partnership. Rather, we help to integrate skills of friendship through problem solving about how and where to find friendships, through role-play about how clients may engage potential friends or establish more Social Work Theory and Friendship Facilitation29 meaningful relationships with friends, and through teaching the skills that improve patterns of communicating.
This direction for clinical intervention is especially important as Americans become more socially isolated (McPherson et al., 2006) and as fewer social resources are allocated to treating psychosocial problems. In addition, the medicalization of emotional distress and the dominance of managed care further distance clients from reparative and healing relation- ships with health care professionals. This reality points to an even greater demand for social workers to find ways to increasingly help clients meet their needs through nurturing and sustaining friendships, as well as maintaining helpful relationships with professional providers. REFERENCES Ainsworth, M. D. (1989). Attachments beyond infancy.American Psychologist, 44(4), 709–716.
Arnd-Caddigan, M., & Pozzuto, R. (2008). Use of self in relational clinical social work.Clinical Social Work Journal,36, 235–243.
Aron, L. (1991). The patient’s experience of the analyst’s subjectivity.Psychoanalytic Dialogues,1(1), 29–51.
Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation.Psychological Bulletin,117(3), 497–529.
Beck, J. S. (1995).Cognitive therapy: Basics and beyond. New York: Guilford Press.
Berndt, T. J. (2002). Friendship quality and social development.Current Directions in Psychological Science,11(1), 7–11.
Berndt, T. J., & Keefe, K. (1995). Friends’ influence on adolescents’ adjustment to school.Merrill-Palmer Quarterly,45(1), 13–41.
Bradburn, N. M. (1969).The structure of psychological well-being. Chicago: Aldine.
Bronfenbrenner, U. (1979).The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University.
Burk, D. I. (1996). Understanding friendship and social interaction.Childhood Education,72(5), 125–147.
Caldwell, M. A., & Peplau, L. A. (1982). Sex differences in same-sex friendships.Sex Roles,8(7), 721–732.
Carter, B., & McGoldrick, M. (1999).The expanded family life cycle: Individual, family and social perspectives(3rd ed.). Boston: Allyn & Bacon.
Clark, M. L., & Ayers, M. (1991). Friendship similarity during adolescence: Gender and racial patterns.Journal of Psychology,126(4), 393–405.
Cowger, C. (1997). Assessing clients strengths: Assessment for client empowerment.
In D. Saleebey (Ed.),The strengths perspective in social work(pp. 59–73). New York: Longman.
Crosnoe, R. (2000). Friendships in childhood and adolescence: The life course and new directions.Social Psychology Quarterly,63(4), 377–391.
30R. Furman et al. Davidson, S., & Packard, T. (1981). The therapeutic value of friendship between women.Psychology of Women Quarterly,5(3), 495–510.
DeStephano, C. (1990, March 11). Friendship and loneliness.Richmond Times- Dispatch, p. K1.
Devore, W., & Schlesinger, E. G. (1991).Ethic-sensitive social work practice. New York: Macmillan.
Dryden, W., & DiGiuseppe, R. (1990).A primer on rational-emotive therapy.
Champaign, IL: Research Press.
Dunstan, L. V., & Nieuwoudt, J. (1994). The relationship between indexes of friendship and biographical, personality, and behavioral variables.Journal of Genetic Psychology,155(3), 303–312.
Elkins, L. E., & Peterson, C. (1993). Gender differences in best friends.Sex Roles, 29(7/8), 497–508.
Ellis, A. (1994).The essence of rational emotive therapy. New York: Institute for Rational Emotive Therapy.
Fox, M., Gibbs, M., & Auerbach, D. (1985). Age and gender dimensions of friendship.Psychology of Women Quarterly,9, 489–502.
Furman, R., Collins, K., & Swanson, J. (2003). Social work practice innovations:
Helping clients understand, explore, and develop their friendships.Advances in Social Work,4(2), 116–129.
Germain, C. G., & Gitterman, A. (1996).The life model of social work practice:
Advances in theory and practice(2nd ed.). New York: Columbia University.
Hartup, W. W. (1979). Peer relations and growth of social competence. In M. W.
Kent & J. E. Rolf (Eds.),Primary prevention of psychopathology(Vol. 3, pp. 150– 170). Hanover, NH: University Press of New England.
Hartup, W. W. (1983). Peer relations. In P. H. Mussen (Ed.),Handbook of child psychology(4th ed., pp. 223–241). New York: Wiley.
Hartup, W. W. (1989). Social relationships and their developmental significance.
American Psychologist,44, 120–126.
Hays, R. B. (1985). A longitudinal study of friendship development.Journal of Personality and Social Psychology,48(4), 909–924.
Henry, S. (1992).Group skills in social work(2nd ed.). Pacific Grove, CA: Brooks/ Cole.
Higgins, G. O. (1994).Resistant adults: Overcoming a cruel past. San Francisco:
Jossey-Bass.
Homan, M. S. (1999).Promoting community change: Making it happen in the real world(2nd ed.). Pacific Grove, CA: Brooks/Cole.
Hutter, H. (2001). On friendship.Contemporary Sociology,30(6), 579–581.
Janzen, C., & Harris, O. (1997).Family treatment in social work(3rd ed.). Itasca, IL:
F. E. Peacock.
Krill, D. (1969, April). Existential psychotherapy and the problem of anomie.Social Work,14(3), 289–301.
Krill, D. (1986). Existential social work. In F. J. Turner (Ed.),Social work treatment (pp. 181–218). New York: Free Press.
Linden, G. W. (2003). Friendship. Journal of Individual Psychology,59(2), 156–166.
Mackey, R. A. (2008). Toward an integration of ideas about the self for the practice of clinical social work.Clinical Social Work Journal,36, 225–234. Social Work Theory and Friendship Facilitation31 Masten, A. S. (1994). Resilience in individual development: Successful adaptation despite risk and adversity. In M. C. Want & E. W. Gordon (Eds.),Educational resilience in inner city America: Challenges and prospects(pp. 74–91).
Hillsdale, NJ: Erlbaum.
McPherson, M., Smith-Lovin, L., & Brashears, M. E. (2006). Social isolation in America: Changes in core discussion networks over two decades.American Sociological Review,71, 353–375.
Mirowsky, J., & Ross, C. E. (1989).Social causes of psychological distress. New York:
Aldine de Gruyter.
Moursund, J. P., & Erskine, R. G. (2004).Integrative psychotherapy. Pacific Grove, CA: Brooks/Cole-Thomson Learning.
Murphy, B. C., & Dillon, C. (2003).Interviewing in action: Relationship, process, and change(2nd ed.). Pacific Grove, CA: Brooks/Cole.
Nahemow, L., & Lawton, M. P. (1975). Similarity and propinquity in friendship formation.Journal of Personality and Social Psychology,32(4), 205–213.
Netting, J. E., Kettner, P. M., & McMurtry, S. L. (1998).Social work macro practice.
New York: Longman.
Norman, E. (2000).Resiliency enhancement: Putting the strengths perspective into social work practice. New York: Columbia.
Oden, S., & Asher, S. R. (1977). Coaching children in social skills for friendship making.Child Development,48(4), 495–506.
Ollman, B. (1971).Alienation. New York: Cambridge University Press.
Parker, S. A., & de Vries, B. (1993). Patterns of friendship for women and men in same and cross-sex relationships.Journal of Social and Personal Relationships, 10, 617–626.
Payne, M. (1991).Modern social work theory. Chicago: Lyceum Books.
Phillips, S. L., & Fischer, C. S. (1981). Measuring social support networks in general populations. In B. P. Dohrenweld (Ed.),Stressful life events and their contexts (pp. 224–331). New York: Academic Press.
Postman, N. (1992).Technopoly: The surrender of culture to technology. New York:
Random House.
Powdthavee, N. (2008). Putting a price tag on friends, relatives and neighbors: Using surveys of life satisfaction to value social relationships.Journal of Socio- Economics,37, 1459–1480.
Rosen, E. J. (1999). Men in transition: The ‘‘new man.’’ In B. Carter & M. McGoldrick (Eds.),The expanded family life cycle: Individual, family and social perspective (3rd ed., pp. 124–140). Boston: Allyn & Bacon.
Rutter, M. (1979). Protective factors in children’s responses to stress and disadvantage. In M. W. Kent & J. Rolf (Eds.),Primary prevention of psychopathology, Vol.3: Social competence in children(pp. 49–74). Hanover, NH: University of New England.
Rutter, M. (1987). Psychosocial resilience and protective mechanisms.American Journal of Orthopsychiatry,57(3), 316–331.
Saleebey, D. (2001).The strengths perspective in social work practice(2nd ed.). New York: Longman.
Sapadin, L. A. (1988). Friendship and gender: Perspectives of professional men and women.Journal of Social and Personal Relationships,5, 387–403.
32R. Furman et al. Schaffner, C. B., & Buswell, B. E. (1992).Connecting students: A guide to thoughtful friendship facilitation for educators and families. Colorado Springs, CO: Peak Parents Center.
Sheafor, B. W., Horejsi, C. R., & Horejsi, G. A. (1997).Techniques and guidelines for social work practice(4th ed.). Boston: Allyn & Bacon.
Shure, M., & Spivak, G. (1980). Interpersonal problem solving as a mediator of behavioral adjustment in preschool and kindergarten children.Journal of Applied Developmental Psychology,1(1), 37–52.
Sullivan, H. S. (1953).The interpersonal theory of psychiatry. New York: Norton.
Sullivan, H. S. (1970).The psychiatric interview. New York: Norton.
Teyber, E. (2000).Interpersonal process in psychotherapy(4th ed.). Belmont, CA:
Brooks/Cole.
Toseland, R. W., & Rivas, R. F. (2005).An introduction to group work practice.
Boston: Allyn & Bacon.
Tuma, N. B., & Hallinan, M. T. (1979). The effects of sex, race, and achievement on schoolchildren’s friendships.Social Forces,57, 1265–1285.
van Deurzen-Smith, E. (1997).Everyday mysteries: Existential dimensions of psychology. London: Routledge.
Verbrugge, L. M. (1997).The structure of adult friendship choices.Social Forces,56 (2), 576–597.
Walsh, J. (2008). The psychosocial person: Relationships, stress and coping. In E. D.
Hutchison (ed.),Dimensions of human behavior person and environment(3rd ed., pp. 149–182). Thousand Oaks, CA: Sage.
Weick, A., Rapp, C. A., Sullivan, W. P., & Kishardt, W. E. (1989). A strengths perspective for social work practice.Social Work,89, 350–454.
Weil, M., & Gamble, D. N. (1995). Community practice models. InThe encyclopedia of social work(19th ed., Vol. 1, 577–593). Washington, DC: National Association of Social Workers.
Werner, E. E. (1987). Vulnerability and resiliency in children at risk for delinquency:
A longitudinal study from birth to young adulthood. In J. Burchard & S.
Burchard (Eds.),Prevention of delinquency behavior(pp. 16–43). Newbury Park, CA: Sage.
Werner, E. E., & Smith, R. S. (1992).Overcoming the odds: High risk children from birth to adulthood. Ithaca, NY: Cornell University Press.
Williams, J. G., & Solano, C. H. (1983). The social reality of feeling lonely: Friendship and reciprocation.Personality and Social Psychology Bulletin,9(2), 237–242.
Willis, R. J. (1994).Transcendence in relationship: Existentialism and psychotherapy.
Norwood, NJ: Ablex.
Wiseman, J. P. (1986). Friendship: Bonds and binds in voluntary relationships.
Journal of Social and Personal Relationships,3(2), 191–211.
Wolin, S. J., & Wolin, S. (1993).The resilient self: How survivors of troubled families rise above adversity. New York: Villard Books.
Zastrow, C. (2001).Social work with groups(5th ed.). Pacific Grove, CA: Brooks/ Cole. Social Work Theory and Friendship Facilitation33 Copyright of Smith College Studies in Social Work (Haworth) is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.