Social workers as an action-oriented sociotherapist: an existential health discourse

ABSTRACT

The purpose of this paper is to reinvigorate sociotherapy by contextualizing its practice within a logotherapeutic and an existential health discourse. This approach is used to enhance meaningfulness in life within the framework of a sociotherapy, through mindfulness, and greenspace activities such as walking and gardening. This discourse has been largely inspired by: 1) sociotherapy’s capacity to facilitate existential health; 2) the international research community’s struggle for a broader concept of health; 3) World Health Organization’s concept of existential health; and, 4) Frankl’s assertion that people must be understood holistically as physical, psychological, social and spiritual beings. This paper approaches the social worker as sociotherapist (SWS) from an ecological and systemic perspective, the aim being to move the client from an egoistic to a mindful and ecological mind-set.

KEYWORDS:

• Sociotherapy
• social work
• existential health
• meaning of life
• logotherapy
• Foucauldian discourse analysis

Introduction

Health is a multidimensional concept that has been discussed in terms of four general dimensions in the health-related literature: physical, mental, social and existential (Nilsson, 2014). This paper focuses on the existential dimension, the meaning and purpose of life. This is one of the eight existential parameters identified by WHO as being essential to an individual’s overall health (World Health Organization [WHO], 2002). International health research has, in the last decade, shown an interest in the relationship between existential health and personal wellbeing. The focus of this paper on the existential dimension reflects this research interest (cf. O’Connell & Skevington, 2007; Rutz, 2006; Sawatzky et al., 2005).

Rutz (2004) notes that the emergence of a more holistic health model will not take place until the existential dimension becomes more established through medical sciences. Deriving and establishing definitions and theoretical models for an existential science of epidemiology is also a challenging task. This challenge therefore gives a more pragmatic explanation for the absence of existentialism. We, however, in this paper propose that the rediscovery of sociotherapy within social work practice can, through increasing personal resilience, self-transcendence, and the ability to cope with life stressors, provide clients with a sense of existential health and meaningfulness.

A vital aim of sociotherapy is to cultivate empathetic feelings of connectedness and compassion, these translating into caring interactions with others. This in turn leads to sustainable social relations (eco-relational; [cf., Lewis et al., 2019]), and a better future for both humanity and the natural world.

The aim of this paper is to reinvigorate sociotherapy by presenting a meaning-centered discourse that provides a context-bound examination of the effects of sociotherapy as an action-oriented, pedagogical discipline, and that can be used in counseling to help individuals, groups and societies in their search for meaning and purpose in life. We therefore, based on this, intend to highlight:

1. How sociotherapy, mindfulness, and green philosophy (i.e., walking and gardening) influence existential health.

2. How the meaning and purpose of life emerges as an important socio-cultural issue in SWS work with individuals, groups and society at large.

We begin with a brief discussion of methodology, and then present discussions on the incorporation of sociotherapy into social work, and on the concept of existential health. This is followed by a brief presentation of Frankl and meaning and purpose in life. The three next sections attempt to contextualize healthful life viewed from three systemic levels within sociotherapy: the individual level, the group level, and the societal level, sociotherapy’s focus often moving between these three levels of meaning discourse.

Method

This paper employs a text-based methodology approach, largely inspired by Foucauldian Discourse Analysis (FDA). FDA postulates the existence of a dialectical relationship between language and society, and between text and context (Burman & Parker, 1993). Language is however, according to Foucault (1972), both a social construct and a subject position anchored in the individual and in a collective intention and attitude of ethical, political and cultural value. We then therefore ask how the discursive formation of existential health, sociotherapy, mindfulness and green philosophy are formulated within social work.

We have used the following six-step FDA model to answer this question, (cf. Brunton, Todorova, Carnegie, & Whittaker, 2018). The first step frames the concept of existential health within a discourse construction, so combining the thinking of Austrian logotherapist Viktor Frankl and the theories from the fields of sociotherapy, social work and green philosophy. The second step recognizes existential health as a concept that encompasses three levels of discourse: the individual level, the group level, and the societal level. The aim of the third (action-oriented) step is to facilitate a better understanding of these three levels of discourse within the text (i.e., the description of these levels and the kind of social practice they engender within SWS). The fourth (positioning) step determines the location (or function) of the sociotherapeutic social worker (SSW) in relation to the individual, the group, and society at large. The fifth (practice) step introduces different action-oriented means through which the individual, the group, and society at large can enhance existential meaningfulness, and a healthier life. Examples of this include mindfulness and green activities (i.e., walking and gardening). Finally, the sixth (subjectivity) step, based on the facts derived from the previous steps, examines the relationship between the three levels of discourse and the subjectivity. For example, how SWS can help individuals alleviate different forms of suffering through logotherapy, mindfulness and green activities.

Sociotherapy within social work practice

Sociotherapy reached its peak between the 1940s and the 1980s in countries such as the United Kingdom, Canada and the United States. It has, however, become an almost forgotten clinical discipline, only a few papers (e.g., Wilkins, 2012; Fischer, 2014; Karpunkina et al., 2016), books (e.g., Dekker, 2018) and anthologies (Mezzich et al. 2017), being published in recent years. Sociotherapy emerged within the field of sociology to challenge psychotherapy’s traditional intrapsychic diagnosis by providing an alternative – interpsychic and/or social diagnosis. Interpsychic diagnosis analyzes problems between individuals/groups. Social diagnosis analyzes the impact of broader societal ills (cf., Edelson, 1970; Probst, 2016). A primary aim of sociotherapy can be said to be the achievement of constructive behavioral change in social situations, and in interactions between individuals, groups, organizations and communities (Svan, 1984, p. 98). This is close to the aim of professional social work, which can be understood as,

Promot[ing] social change, problem-solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilizing theories of human behavior and social systems, social work intervenes at the points where people interact with their environments (i.e., person-in-environment approach). Principles of human rights and social justice are fundamental to social work (Todd, 2009).

Sociotherapy and social work have similar aims. They both also constantly interact with and move between the three systemic levels of discourses of the individual (micro), of the group (mezzo) and of society-at-large (macro; Newberry, 2012; Probst, 2016). Social work and sociotherapy therefore both aim to promote individual empowerment, free societal resources, and to contribute to human welfare (Turner, 2009; Fischer, 2014). Probst notes that “like all person-centered approaches to care, sociotherapy’s core principles include democracy, non-directivity, equality, a focus on reality, and an orientation to building a positive future” (Probst, 2016, p. 269). Existential health is discussed in the next section as a core discourse within the framework of SWS.

Conceptualizing existential health

The term “existential” is derived from the Latin, ex-sister, “to stand out” (Cohn, 2002, p. 66), and is a term that has been of great interest mainly to existential philosophers (e.g., Buber, Nietzsche & Heidegger), theologians (e.g., Kierkegaard & Tillich), and existential psychologists (e.g., Frankl & Yalom; Nilsson, 2018). “Health” is a term that has been defined based on narrow and broad scopes. The international field of health has, however, viewed health as being made up of four distinct dimensions: physical, mental, social, and existential. Merging these four dimensions into a totality, instead of addressing each individually, provides a much-needed holistic model of health that has the potential to explain how individuals can remain physically active, mentally alert, socially involved, and existentially aware throughout their entire lives. Frankl also asserts that individuals must be understood holistically in terms of these four dimensions (McFadden, Ingram, & Baldauf, 2000), an assertion also held by sociotherapy. This paper focuses only on the existential dimension, this focus highlighting the search for meaning and purpose in life. Combining the two terms into “existential health” therefore, and from a discursive perspective, leads to a view of humans as holistic beings who are in search of meaning and harmony in life.

Frankl and meaning and purpose in life

We draw on Frankl’s existential psychology whilst viewing sociotherapy as a person-centered practice that begins by recognizing the client’s need to belong (Wilkins, 2012). This, however, raises the issue of meaning. Frankl (1979), from his experiences in Auschwitz and his encounters throughout his career with many individuals, concluded that the primary motivating factor in human life is not the pursuit of power and enjoyment, but the search for meaning. Frankl (1979) furthermore notes in Man’s search for meaning. An introduction to logotherapy., that meaning in life can be derived by means of the “optimistic triad”: 1) creativity (what we give to a task); 2) experience (our experience of things and/or other people), and attitude (the stand we take toward our fate/distress; Frankl, 1979). We will, in the next section, highlight practices in the client’s search for meaning.

Finding meaning and purpose in life: individual level

Mindfulness with its roots in Buddhism (known as sati) is a multifaced concept. In this paper mindfulness should be understood as: a particular type of social practice which leads the practitioners to an ethically-minded awareness, intentionally situated in the here-and-now (Nilsson & Kazemi, 2016, p. 190). The target of mindfulness and social work is focused on both mindfulness interventions and the development of mindfulness within the practitioners (Hick, 2009). In this regard, Western practitioners of mindfulness not only meditate and perform body scanning and yoga for therapeutic purposes, but also use these techniques to manage stress, to cure specific illnesses or to construct their selves. Mindfulness training can therefore, through improving their self-image, life-skills and health, help individuals discover meaning (Nilsson, 2018; Wilson, 2014). Mindfulness can therefore play an important role in one’s search for real, authentic happiness. Positive psychology, which includes the coaching, motivational, and mindfulness industries, claims to provide individuals with a practical roadmap to the life they always dreamed of (Linley & Jospeh, 2004; Lyubomirsky, 2007). Lyubomirsky (2007) writes:

In a nutshell, the foundation of happiness can be found in how you behave, what you think, and what goals you set every day of your life. ‘There is no happiness without action.’ If feelings of passivity and futility overcome you whenever you face up to your happiness set point or to your circumstances, you must know that a genuine and abiding happiness is indeed within your reach, lying within the 40 per cent of the happiness pie chart that’s yours to guide. (p. 68)

Kabat-Zinn (2013) states that mindfulness practice can lead to being less caught up in destructive emotions, mindfulness training predisposing us to greater emotional intelligence and balance, and ultimately greater happiness. These descriptions, which are geared toward non-spiritual settings so “hiding” the Buddhist connection, seem to be working right now. Mindfulness, however, beyond these “formal” practices (i.e., meditation, body scanning and yoga), also encapsulates an attitude to one’s experiences and actions in day-to-day life, this being more precisely termed “informal” mindfulness.

Kabat-Zinn write: “The heart of the practice in MBSR (Mindfulness-Based Stress Reduction) lies in what we call informal meditation practice, i.e., mindfulness in everyday life. The true meditation practice is when life itself becomes the practice” (Kabat-Zinn, 2013, p. 240). Schmidt (2004) pointed out that mindfulness in day-to-day life simply means “to be present” in all one’s activities (p. 9). This understanding of mindfulness entails the notion that mindfulness is a way of “being” as opposed to a way of “doing.” Mindfulness, as expressed in our daily lives, may therefore entail less-formal discourses such as the green space activities of walking and gardening, activities/discourses that are associated with a sense of belonging to the natural landscape (cf. Lumber, Richardson, & Sheffield, 2018). Green activities can, when placed in the terminology of sociotherapy, be understood to be a means that can be used when working with a client to utilize nature as a healing modality (i.e., man-nature relationship). This, of course, requires the SWS to have access to green spaces near their office (many social workers are situated in urban environments). The SWS, by setting the session’s agenda (e.g., how far to walk, what time to return, what topics to discuss) and by monitoring the level of privacy (e.g., assuring that client-SWS conversations are not overheard), can help put clients in touch with the restorative and neutral environment of the natural world, including all the human benefits and advantages that this relationship entails (cf., Rust, 2009). The SWS and the client can therefore together dialogically explore the client’s quest for meaning by means of “green walking meditation” (i.e., walk and talk therapy; Brazier, 2018; Wilkins, 2012). Vietnamese Zen master Hahn (2015) has written about walking meditation as a way of finding peace and serenity:

Meditative walking involves walking in a slow and relaxed manner while smiling a little. When we practice in this way we feel deep peace and the steps we take are the safest in the world. All sorrows and worries fall away as peace and joy fill our hearts. Everyone can practice this. A little time and a willingness to be lucky is all it takes. (p. 30)

Clients can practice (green) walking meditation at any pace, from ultraslow to very brisk. A very important understanding, however, is to practice (green) walking meditation with full attention to breathing and insertions of the feet, as Kessen (2009) points out. We will, in the next section, highlight the group-oriented search for meaning and purpose in life.

Finding meaning and purpose in life: group level

Meaningfulness can also be found within the social context of the group (cf. Dekker, 2018). Frankl (1979) has noted that the feeling of being an included and accepted member of a group is of great importance to the individual’s sense of meaning and value in life. Frankl also describes, in Group Therapeutic Experiences in a Concentration Camp (Frankl, 1954), his observations and experiences at Auschwitz, Dachau, and Theresienstadt concentration camps of meaningfulness, which relates to how motivated individuals are in their commitment to and investment in their group. Being part of a group can, according to Frankl (1954), lead to a “meaningfulness-positive” outcome, Kwee (2012) remarking that “[m]eaning is socially, not privately, constructed actively by members of the community who develop ways of speaking to serve their needs as a group” (p. 264). Fry and Debats (2010) add that an individual’s sense of meaning suffers when they lose their group identity, remarks that are reflected in sociotherapy.

Group belongingness assumes that we have, however, learned to be present in the here and now, to rest in our body and breathe without dwelling on external performance, or without actively attempting to resolve problems and conflicts. Clients can be taught sociotherapeutical techniques that help them to remain present in the moment, and to breathe and rest in the body without indulging the mind’s modes of thinking, feeling, and desiring. This can help them to gradually attain a state of inner serenity, from which sociotherapy counseling can begin.

Social change, problem solving in human relationships, and the empowerment and liberation of individuals/clients can be promoted by integrating mindfulness as a group practice within sociotherapy. This is quite similar to the social discourse of Buddha some 2,500 years ago or of Freire in the 1970s. Social activism is, regardless of historical and cultural conditions, a demanding and significant task in society (Freire, 1970). Viewing mindfulness through such a lens can therefore provide individuals and groups with a sense of meaning and health (cf., Nilsson, 2014, 2016). Mindfulness within sociotherapy can therefore be described as being a socially engaged discourse that focuses on social change and empowerment. The better understanding of this through highlighting sociotherapy as a green movement that strives for social engagement and ecological balance in the world is discussed in the next section.

Finding meaning and purpose in life: societal level

SWS can, through encouraging clients to become involved in social and green community projects, provide them with meaning (cf., Wilkins, 2012). A more challenging discourse would, however, be more action-oriented projects (i.e., micro relations of power project) such as the MettaDana project in Thailand, the Hawaii Insight Center (cf., Nilsson & Kazemi, 2015), and the Jungto (Pure Land; Sukhvat) Society in Korea.¹ The Jungto Society is a Buddhist community, founded in 1988, that is committed to cultivating Buddhist ideals and to working for social change. The Society is critical of capitalist values, which are considered to create greed, conflicts, and environmental degradation. It instead promotes a green economy by emphasizing a socially and environmentally sustainable alternate lifestyle. The Jungto Society encourages people to eat less, consume less, and sleep less, so that they have more resources for assisting people in need and for preserving the environment (Park, 2010). The Society works to alleviate problems such as illiteracy, disease and famine among the poorest peoples of the world (Park, 2010), which dovetails well with Freire’s (1970) notion of a pedagogy of the oppressed.

Mindfulness and sociotherapy can, it should be noted, be viewed as green movements, and therefore have the potential to contribute to justice, peace, and ecological balance in the world (cf., Moore, 2016; Macy, 1985; Dekker, 2018). Mindfulness and sociotherapy, as socially engaged practices, call for social engagement beyond the individual and the group, a social engagement practiced through asking existential questions about society’s sufferings (dukkha), and about betterment on a global scale. This in sociotherapy goes beyond a transformation of the individual (i.e., the egoistic approach) to a transformation of the world (i.e., the ecological approach). Such an attitudinal shift is therefore not possible without first changing the inner world of the client (Freire, 1970; Robertson, 2009), which in practice means helping clients to improve their existential awareness. Their lifestyle, their interactions with others, their daily financial choices, and their small, local actions. This can serve as an example to others of the building of a society that is based on interconnectedness, compassion, and care for others (Freire, 1970). These aims, the pursuit of existential health and of meaning and purpose in life, can therefore be facilitated by the introduction of mindfulness training within sociotherapy practice. Mindfulness is therefore not merely a secular counseling method for the management of pain and disease. It also is a means of meeting the mental, physical, social and spiritual needs of individuals that are struggling to find meaning in their lives, mindfulness training and the accompanying Buddhist discourse making this a superior means.

Many individuals in the West remain fully absorbed in materialistic, worldly pursuits throughout their lives, never really confronting the unsettling nature of the transient human condition within communal and/or societal settings. Living this sort of materialistic life can, however, generate what Frankl refers to as an existential vacuum (a life devoid of meaning; Frankl, 1954, 1962, 2011), Foucault (1996) describing this as individualizing fragmentation. SWS who take the existential dimension into consideration, can enable their clients to address the issue of meaning. Mindfulness and greenspace activities are in this important tools.

Summary

Many individuals in the West remain wholly absorbed, throughout their lives, in materialistic, worldly pursuits, never really confronting the unsettling nature of the transient human condition (i.e., egocentric mind). Mindfulness as a SWS tool carries the potential to be highly facilitative in increasing people’s sense of meaning and overall wellbeing. This view is shared by Sherman and Siporin who note that “[t]his aspect of mindfulness practice fits well within the increasing attention in the social work literature devoted to the subject of client spiritual needs and problems” (Sherman & Siporin, 2008, p. 261). The practice of nature-oriented activities such as walking and gardening can, furthermore, provide a sense of existential wellbeing, this providing purpose, value and direction in life, expressed through social interactions and marked by empathy and compassion. It is worth mentioning that gardening in terms of horticultural therapy can improve the quality of life, and wellbeing of those suffering from chronic illnesses, and how they conceive of themselves (cf., Söderbäck et al., 2004).

The practice of sociotherapy, as discussed in this paper, provides the client with a new perspective on the old person-in-environment discourse (for an overview, see: Weiss-Gal, 2008). Sociotherapy can therefore move the client from a linear, reductive to a more ecological, holistic approach to solving not only social problems, but also existential frustrations and other similar concerns (cf., Karpunkina et al. (2016). Sociotherapy, seen from this perspective, is grounded in a belief in the inherent transformational power of the human mind, in the power to transform an egoistic mind to a mindful mind, and a mindful mind to an ecological mind: mindfulness, existential psychology, action-oriented pedagogy and social work studies all considering the human mind to be a worthy and rewarding object of interest and attention.

Understanding how social workers as sociotherapists can help alleviate different forms of suffering through both mindfulness and green counseling, is also important. Mindfulness and green counseling have the potential to reduce the suffering of clients by enhancing human resilience and psychophysical wellbeing. It is therefore important to recognize mindfulness practices and green activities as social phenomena that are similar to sociotherapy, all three having the aim to free society’s resources, promote empowerment, and build a more sustainable society for the future.

Disclosure statement

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

Notes

1. Pure Land belongs to the school of Mahāyāna. Their teachings are focused on Amitābha Buddha and the three texts known as Three Pure Land Sutras. Pure Land are widespread and practice in China, Japan, Korea, Vietnam, and Tibet.