The Use of Social Support in Clinical Practice
Authors: Norbeck Jane S 
Published: April 2021

ABSTRACT

Several assumptions are presented that describe the underlying characteristics of social support networks and factors that influence the adequacy of the support that is available to individuals. Based on these assumptions, assessment of the adequacy of social support must address both person-specific and situation-specific factors. The special case of the chronically mentally ill population is developed and contrasted with other populations. Finally, a typology of deficiencies in social support is presented along with interventions that have proven useful for specific types of deficiencies.

Stories of hermits hold a special fascination because the individual appears to transcend the need for human contact. Yet typically, the history of the recluse points to a bitter rejection or betrayal leading to exile or self-imposed isolation. Also, the individual often is portrayed as extremely narrow or restricted, as in the case of the legendary Silas Marner, known for 15 years among the villagers as a miser who did nothing but bend his back for endless hours every day over his loom. Even Silas Marner had social needs, which were reawakened by a personal crisis when his life-long savings were stolen. Of course George Elliot had an artist's license to give the story a happy ending through the vehicle of a small abandoned child who appeared in Silas' cottage one evening and became the catalyst for his transformation into a fully integrated member of the village society. But in real life isolated individuals often are caught in an unending spiral of circumstances that perpetuate their aloneness.

People have differing needs for social interaction, and certainly there are life-long isolates who are happy, functioning individuals. However, as Bowlby (1973) has concluded, people of all ages are at their happiest and most effective when they are confident that there are trusted persons behind them who will come to their aid if difficulties arise. Some theorists in the social support field view supportive interactions in adulthood as analogous to attachment in infancy: just as the well-adjusted, attached infant is considered to have a secure base from which to explore, interact, and discover the world, Kahn and Antonucci (1980) propose that adults with strong, supportive relationships are able to cope better with the stresses of their environments. These theoretical arguments about the need for social interaction lead to the first of six assumptions that provide a framework for understnading social support.

A look at the pages of current journals in the health professions and in the social sciences confirms that research interest in social support is exploding. As with other new ideas, this period of expansion is being followed by a period of criticism, resulting in a final period of retrenchment, wherein the core ideas are refined, and more exact, though perhaps limited relationships are specified. Just as it would be a mistake to ignore this important variable, it is equally dangerous to see social support as a panacea. Some of the current popularizations of this concept gloss over key distinctions and promise unwarranted outcomes. Ultimately this unbridled enthusiasm will lead to disillusionment as the outcomes fail to match the expectations. However, sound approaches to incorporating social support into clinical practice also are being developed. The purpose of this paper is to present key assumptions and research findings that can guide clinicians in thinking realistically about social support, both in assessing their clients and in planning interventions.