Psychoanalytic Theory for Social Work Practice

Thinking Under Fire

Marion Bower, Marion Bower

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781134304677
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Written by practicing social workers and social work educators, this text analyzes modern psychoanalytic and psychosocial approaches to social work and relates them to current practices and values. Focusing on working with children and families, the text covers salient issues in social work practice including risk assessment, dealing with parents with drug and alcohol problems, supervision and management of emotional stress.

Throughout the book there is an emphasis on the realities of frontline practice, and looking at what can realistically be achieved. It also addresses the research evidence for this approach. With psychoanalytic and psychosocial approaches becoming increasingly popular, this text will be a welcome addition for professionals, students and social work educators.

Part 1

A framework for practice

1

Psychoanalytic theories for social work practice

Marion Bower

This is the first British book for nearly thirty years to be exclusively devoted to the use of psychoanalytic theories in social work practice. After thirty years of neglect or hostility why does social work need psychoanalysis now?

One of the uniquely valuable aspects of social work is the balance it holds between understanding and working with the internal and external realities of client’s lives. This balance of course is an ideal and in reality workers may move between internal and external considerations, and between action and reflection. However on the larger scale the profession has undergone two major swings in the list fifty years. Initially there was a move towards psychoanalytic theory; however these ideas were never given time to be adequately integrated with the complexities of social work practice. From the 1970s onwards social work has been dominated by a sociological perspective which has stressed external factors, poverty, deprivation, trauma and racism coupled with a stress on the values of the profession. Unfortunately this has not been balanced with a psychological model which takes into account the internal world and the interaction of external and internal realities.

Currently it seems to me that there is a hole in the middle of social work where a comprehensive, coherent model of human personality and emotional development should be. The introduction of attachment theory has been helpful, particularly in childcare social work, and as a research tool. However as its name suggests it covers a very specific area of human experience. Psychoanalysis covers a wider area of human experience; it also has well-researched interventions in the areas of human behaviour which concern social work. Psychoanalytic theory provides a model of how external adversity impacts on the individual or family and becomes part of their internal world. These of course are rational reasons for adopting psychoanalytic theory which I shall return to below. However it is in the area of emotion and irrationality that the loss of psychoanalytic theory has been particularly damaging to social work.

Although emotional disturbance and the power of the unconscious internal world have been pushed to the edges of social work training, they are central aspects of our client’s lives and make their presence powerfully felt in the relationships between clients and workers. Some clients are grateful for our help; however many are hostile, suspicious, critical or unco-operative. Most social workers have known clients who reject or spoil potentially helpful interventions or services, or who repeatedly put themselves in damaging or dangerous positions despite attempts to stop them or offer alternatives. This sort of behaviour is often rationalised although the rationalisations are rarely entirely convincing. Clients bring us into even closer contact with their internal world through their emotional impact on the worker. This can be gross and overt, or subtle and insidious. Workers may feel confused, fragmented, inadequate, despairing or enraged. The impact on the worker may go beyond feelings, and workers may find themselves behaving in ways which are not typical of them, for example being punitive or indulgent.

These experiences are taken for granted yet they are part of what we mean when we talk about being ‘bombarded’ by the work. One of the most satisfying aspects of teaching psychoanalytic theory to experienced social workers is the interest and excitement that workers feel when they discover that there is a theory which explains these emotional experiences and shows how they can be harnessed as a professional tool. I have written elsewhere (Bower 2003) on the importance of a theory which is congruent with the realities of practice to enable social workers to process their experiences with clients. I think that the absence of theory which makes sense of disturbing aspects of the work is a major contributor to stress in social work.

The loss of psychoanalytic theory from social work has opened up a gulf between what is taught and the realities of encounters with clients. However, if psychoanalytic theory is to be reintegrated into social work it has to take account of the realities of current social work practice. Therapeutic social work will remain a specialist option, but all contact with clients has therapeutic potential. Many workers will have a series of brief encounters with clients as part of an assessment or case management role; others will have opportunities for longer-term work. Whatever the situation there will be a need to understand the relationship with the client and what aspects of the relationship can help bring about change or even help a client make use of a service.

It is important to emphasise that the reintegration of a psychoanalytic perspective into social work is not a superior alternative to a sociological/structural perspective. Psychoanalytic theory provides additional evidence of the importance of external and environmental factors in peoples’ lives. It is not possible to explore or work with the inner world without a proper structure for the work. The first priority for a homeless refugee is housing; therapy is not a substitute for adequate parental care. Holding two different perspectives is professionally stressful. Social work prides itself on working with and respecting difference, if these different views can be held together in a creative balance internally it will strengthen us professionally.

Anyone who is interested in using psychoanalytic theory in their practice will also need to make the time and effort to really get to know it properly. In my experience a great deal of the teaching of psychoanalytic theory in social work is inaccurate, distorted or out of date. During the thirty years in which psychoanalysis and social work have been estranged there has been an explosive development in theory and practice applications. An increasing number of very disturbed patients seen in private and public psychoanalytic and psychotherapy practice have led to new developments in theory. Psychoanalytically informed workers in the public sector are now working with many of the same client groups as social workers. This includes adult and child victims of abuse, children in the care system, refugees, and clients with personality disorders, drug and alcohol problems. Some of this work is on an individual basis, but there is a growing development of work with families, groups and the sort of complex interventions we use in social work practice. Psychoanalytic theory is also being used to understand racism, attacks on welfare and other policy issues. There is a growing body of research on the effectiveness of psychotherapy and psychoanalytically informed interventions (see Chapter 2).

Some of this work is represented in the Journal of Social Work Practice; however the majority of it is in journals or texts not readily available or well known to social workers. One of the purposes of this book is to make some of this work available to social workers. More than half the chapters are written by social workers and all the authors work closely with mainstream social services. Some of the work will translate very directly into social work practice; other chapters provide a framework of understanding which will need to be adapted to the social work task. The chapter on using this book suggests possible applications of some of the ideas and practices discussed in the chapters.

The rest of this chapter summarises areas of Freud’s thinking which remain fundamental to the psychoanalytic approach. It also introduces key ideas and recent developments in modern British psychoanalytic thinking which are particularly relevant to social work. These ideas are developed further in other chapters in the book. I think that it is easier to understand ideas if they are placed in a context and something is known of how and why they developed so I shall start off with a bit of psychoanalytic family history.

Those who are familiar with modern British psychoanalytic theory will be aware that there is a concentration on the work of Melanie Klein and her followers and less on the modern Freudians, Winnicott and the Independent group. There are a number of reasons for this. Firstly, these are the ideas which I personally know best and find particularly helpful as a social worker. Secondly, by concentrating on a core set of ideas which reappear in each chapter, readers will gain a clearer understanding of the ideas and how they are used. Finally, I believe that there is a limit on how many theories or techniques of intervention anyone can really absorb. I think that professional development in social work involves an increasing depth of knowledge and understanding in key areas of knowledge, this forms a secure base from which further knowledge can be added.

Psychoanalytic theory, some history and context

For many people psychoanalysis means the ideas developed by Freud. This is true to the extent that psychoanalysis retains many of Freud’s key concepts, however the theory has developed rapidly. Freud himself was a constant innovator always willing to discard an idea if it did not fit with new evidence and experience. As a result he made some radical changes in his own theory and laid down the seeds for further new developments. From the beginning Freud was keen on practical applications of psychoanalysis outside the consulting room, from the earliest years of its development psychoanalysts worked with disturbed children, in psychiatric hospitals and provided the forerunner of modern child guidance clinics.

In this book I am mostly concentrating on the developments of Freud’s ideas by a group of very talented and innovatory psychoanalysts living in Britain since the Second World War. Some of the earliest members of the group, like Freud and his daughter Anna were refugees from Nazi persecution. However, Melanie Klein, who was the catalyst for a great deal of new development, came to England in 1927 as she found the British Psychoanalytic Society more receptive to some of the radical new ideas she was developing about children.

The Second World War provided a huge impetus to the practical application of psychoanalytic understanding. Wilfred Bion and other analysts worked with traumatised soldiers developing groupwork techniques and a therapeutic community to restore self respect. Anna Freud ran nurseries establishing the principle of family groups and key workers. A range of services was developed to meet the needs of children affected by evacuation, displacement and other disturbances. After the war psychoanalysts continued to be involved in innovatory practice with direct relevance to social work. James Robertson who started his career working for Anna Freud trained as a social worker and a psychoanalyst, and went on to make the films of young children which had a radical impact on how young children are cared for in hospitals and nurseries. He and his wife pioneered the use of foster care.

It is not widely known that John Bowlby, the founder of attachment theory, was a psychoanalyst whose work was supervised by Melanie Klein. Clearly Bowlby and Klein had major differences of opinion, however it is interesting that the modern version of attachment theory with its concepts of internal schemas and working models bears a considerable similarity to Klein’s concept of internal object relations. Clare and Donald Winnicott are psychoanalysts whose influence on childcare practice is well known; both were closely associated with Klein and introduced some of her ideas and others of their own into social work practice.

After the war British psychoanalysts increasingly worked with patients who were psychotic or suffered from borderline personality disorder. This work was stimulated and aided by Klein’s theoretical developments (described below). Experiences with this group of very disturbed patients also stimulated the development of new theories and techniques. Understanding this group of patients is very significant for social workers. Personality disorder is frequently linked to past histories of abuse and a large number of clients have these problems even if there is no formal diagnosis. Changes in psychiatric practice mean that many more patients with psychotic illness are caring for their children and understanding psychotic states of mind is a crucial professional tool. The Climbie case is an extreme and tragic example of the failure to recognise severe psychological disturbance in a parent or carer.

Freud

The development of psychoanalytic theory and practice was driven by two goals. One was to understand why and how people developed psychological symptoms and the other was how to help them become free of them. Freud’s goal was to help his patients fulfil their potential and become free to ‘love and to work’. Freud’s earliest work was done with hysterical patients who had dramatic and often crippling physical symptoms without there being any physical cause. Both Freud and his colleague Breuer discovered that by allowing their patients to talk freely the symptoms rapidly improved. Freud suggested that these symptoms were symbolic expressions of unconscious thoughts or feelings. These were unconscious because they contained unacceptable sexual or aggressive wishes or feelings linked to significant people in their lives. Bringing these feelings into the open removed the need for the symptom.

This process introduces a fundamental aspect of the psychoanalytic approach. The aim is not a ‘cure’ by the expert, but to give patients insight into aspects of themselves and what is going on in their mind, understanding the truth about ourselves is potentially liberating and allows us more control of aspects of our lives. Not surprisingly Freud found that his patients were not keen to know or believe unpleasant things about themselves and improvement was often slowed down by resistance. However Freud noticed that over time his patients developed a relationship to him which was clearly very similar to significant figures in their lives, particularly parents. These early relationships were ‘transferred’ onto the therapist. Initially he saw this as an irritating obstacle, later he realised that this was a powerful tool which enabled the patient’s past relationships to be explored in the current relationship with the therapist. Transference is one area where Freud’s ideas were developed by Klein. Freud thought that transference only happened in the context of an analysis, Klein discovered that it pervades all aspects of our ordinary lives, and this includes our relationships with clients.

Freud’s experiences with his patients led him to realise the importance of sexuality in early emotional development. This infantile sexuality is different to adult sexuality and becomes transformed in the course of emotional development. This ordinary developmental process can become disrupted. Initially Freud thought that this was caused by a sexual seduction of the child, later he came to believe that these stories of seduction were fantasies. Unfortunately, Freud threw the baby out with the bathwater and we now know that many children are sexually abused. However, awareness of childhood sexuality casts a new light on one of the disturbing aspects of abuse. Something which normally remains a fantasy for the child becomes a disturbing reality. One consequence of abuse can be extreme states of confusion and it is common when talking to victims of abuse to feel very uncertain about what is true and what is not.

From his own self-analysis Freud discovered the ‘Oedipus complex’. This is the child’s wish to possess or ‘marry’ the parent of the opposite sex and get rid of the rival of the same sex. For some reason this particular theory of Freud’s is dismissed as old fashioned or Eurocentric, although it is readily visible and often expressed by small children from many cultures. ‘Love triangles’ are a staple of stories and myths from many cultures. Criticisms of the Oedipus complex are often based on a rather literal misunderstanding. Freud suggested that young children have an innate knowledge of the ‘facts of life’. In all societies a sperm from a man and an egg from a woman have to come together to form a baby, an event from which by definition we are excluded. The experience of having to share the attention of someone who is deeply important to us is a narcissistic blow which different individuals and cultures manage in different ways. Defences against the awareness of Oedipal reality can involve the denial or distortion of the facts of life, including the differences between the generations, and this is inevitably an important aspect of the thinking of a child abuser.

Freud believed that the child’s fear of retribution for forbidden Oedipal wishes led to the resolution of the Oedipal complex by the internalisation of the parents and it is these internal figures who form the core of the ‘superego’ or conscience. The super-ego is not necessarily a mirror of the real parents. Freud noticed that people who seemed to have benign parents might have a harsh superego, suggesting that the external world is transformed in the process of internalisation. The concept of internal objects was taken much further by Klein. The word ‘object’ is used to describe an internal figure because it is the ‘object’ of an instinct. Freud’s model stresses the ...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Contents
• List of contributors
• Foreword Olive Stevenson
• References
• Preface Andrew Cooper
• How to use this book Marion Bower
• Acknowledgements
• Part 1 A framework for practice
• 1 Psychoanalytic theories for social work practice
• 2 Psychoanalytic research in the era of evidence-based practice
• 3 Racist states of mind: an attack on thinking and curiosity
• Part 2 Understanding and working with children and young people
• 4 Observation in social work practice
• 5 ‘Thinking in and out of the frame'; applying systemic ideas to social work with children
• 6 Individual brief psychotherapy with sexually abused girls and parallel support work with parents and carers Reflections from a clinical research study
• 7 Double deprivation
• 8 Psychoanalytic perspectives on emotional problems facing parents of children with learning disabilities
• Part 3 Parents, families and professional networks
• 9 The court, the couple and the consultant: Is there room for a third position?
• 10 Dangerous cocktails: drugs and alcohol within the family
• 11 Working with borderline personality disorder
• 12 Working with families who see help as the problem
• 13 Re-enactment as an unwitting professional response to family dynamics
• Part 4 Professional stresses and supports
• 14 Who cares for the carers? Work with refugees
• 15 The containing function of supervision in working with abuse
• Appendix 1 Helpful organisations
• Index