Using Foucauldian Discourse Analysis in Tandem with in-Depth Interviews to Understand the Impact of Institutional Discourses of Power on the Decision-Making Processes of Social Workers

Background and Purpose: Despite the rhetoric of ‘choice’ surrounding the neoliberal discourse, many vulnerable populations seeking social services do not get to choose their social service provider and can have varying experiences depending on the type of agency they have access to. Sex workers, like other marginalized communities, often have their first contact with access to social services through health service. Although some existing research has found that the dominant discourse of sex work from social workers has been aligned with carceral logics, there has been little research exploring how social workers are affected by discourses of power in their decision-making.

This paper works to engage with this gap in literature by assessing the ideologies of power implicitly and explicitly implemented by the institution where social workers are employed and how these ideologies are expressed. This paper also uses interviews with social workers to add context to how institutional ideologiles perceptions social workers have of sex working clients and its effect on the services offered by social workers.

Methods: This study used a multi-method approach including in-depth interviews of 14 social workers working within a medical institution, as well as a Foucauldian Discourse Analysis (FDA) of the Employee Handbook of the institution they work under. FDA was used to uncover the ways the institution itself enacts a preferred ideology down to it’s employees through the discourse surrounding their employment within the institution. Key questions being engaged with through this process involved how the institution framed the relationship between the worker, the client, and the institution itself. The interview protocol presented narratives of potential clients, created with the guidance of a key informant to ensure appropriate representation.

Findings: FDA of the New Employee Handbook reflected the ways in which the institution promoted and embedded hierarchical structures within its workforce. Employees are designated as “at will”, establishing a dynamic that places their success as an employee dependent on how they conform to the policies and practices of the institution. Individuals seeking services at the institution are referred to both as “consumers” and “patients”, promoting their interactions as transactional rather than personal, and as medical subjects lacking bodily autonomy.

Interviews suggested that social workers' employment of characterological legimitizations, as well as resource gatekeeping and embracing punitive, carceral methods were prevalent in the decision-making process. Social workers also often discussed how institutional pressures affected their decision-making by guiding how they refer clients and the type of assessments they give. Themes surrounding the influence of prior experience were also discussed.

Conclusions and Implications: Medical social workers are often the first contact for individuals in need of social services. These findings highlight the particular disadvantages sex workers face through social service gatekeeping and the entanglement of institutional ideology and social work practice. Social workers can better engage with and earn the trust of marginalized communities by more critically engaging with the ways institutions promote discourses of hierarchy that impact how social workers ultimately make decisions about their clients' care.