Discretion in Direct Practice: New Perspectives

Abstract

The study of clinical decision making in social work has focused on various areas over years, such as diagnosis, treatment planning, crisis intervention, and evidence-based practice. Major concerns over accountability and legal liability have recently caused study of clinical decision making to focus almost solely on ethical situations. Although important, these developments have, unfortunately, led to neglect of study of more common kinds of clinical judgment, despite fact that authors have indicated that major ethical decision making occupies only a small percentage of most practitioners' time (Vinzant & Crothers, 1998). Therefore, it would seem important to reexamine aspects of typical everyday decision making in direct practice. This article examines one such aspect, that of practitioner discretion, which has lately drawn attention in social work for its importance in certain types of clinical decision making (Torczyner, 1991; Vinzant & Crothers, 1998). DISCRETION IN SOCIAL WORK Discretion has been described as art of making opportune, strategic decisions while seeking solutions to common practical problems (Simon, 1988). According to Webster's Encyclopedic Unabridged Dictionary of English Language (1989), discretion can be defined as the power or right to decide or act according to one's own and also implies of judgment or choice. Such decision making has also been characterized as flexible experimental (Handler, 1986), intuitive, and responsive to client demands and needs (Stivers, 2001). For numerous examples of discretionary decision making, also featured in any number of social work texts, one easily available resource is work of Gibelman (2005). In making practical decisions, discretion (or prudence, to use traditional terminology) is often vitally important because it helps practitioners make decisions that are opportune, timely, and effective in often stressful social circumstances (Simon, 1988; Torczyner, 1991). The study of such decision making in social work practice originated in pioneering work of Mary Richmond (1917). Throughout 1920s and 1930s, other social work authors elaborated on her work and its implications (Follett, 1973). Although none of these authors specifically set out to analyze concept of discretion itself, their efforts contributed greatly to an improved understanding of ways in which this process is used in direct social work practice. In 1940s and 1950s, focus on insight-oriented approaches in social work helping relationship increased and deepened, and social work authors largely abandoned their efforts to better understand practitioner's use of discretion in practical decision-making efforts. The growing psychiatric emphasis of that time also reinforced such tendencies, which in turn led to a lack of attention to situational factors and practitioner's cognitive activity. However, starting in 1960s, following appearance of several works examining role and activities of community planner (Rabinovitz, 1970) and mental operations of practitioners (Schon, 1983), examination of practitioner involvement in everyday helping relationship issues gained renewed momentum in social work theory. Unfortunately, topic of practitioner discretion had by this time become viewed with suspicion and distaste by public administrators and some social scientists (Gummer, 1979), who viewed freedom of decision by professionals as lawless, unpredictable, and in need of rigorous control through accountability measures (Packer, 1968; Torczyner, 1991). Because of contentious legal climate engendered by such sentiments, topic of practitioner discretion again waned in clinical interest, and ethical aspects of practitioner decision making assumed dominant importance in practice theory (Reamer, 2001). REEXAMINING DISCRETION At present, growing influence on social work practice theory of other fields of practice enquiry, such as management, medicine, social sciences, and psychology, has once again helped to draw attention to direct practitioner's use of discretion in a wide variety of helping situations and problem-solving contexts (Keigher, 2001). …