Abstracts of theses: Smith college School for social work 1945

Abstract

This paper examines various psychoanalytic conceptions of trauma, including ideas associated with classical psychoanalytic theory, object‐relations theory, self‐psychology and continuous construction theory. Clinical issues germane to the psychotherapy of children are then discussed and a clinical vignette presented. The vignette focuses upon the psychotherapy of a 10‐year‐old boy, with particular attention given to the narrative discourse that evolved in the course of the boy's therapy. The evolution of the child's narrative is illustrated through the use of transcribed material derived from different phases of the boy's treatment.     

Criteria for Admission to Detoxification Treatment

This paper examines the formal triage process used by an alcohol/drug detoxification center to determine a client's need for treatment. The analysis tests various types of client characteristics for their influence on admission decisions. In accord with the policy of the agency and the medical model of addiction, symptoms of acute physiological withdrawal should determine whether a client is admitted for treatment during the triage period. Societal reaction theory presents an alternative perspective suggesting that a person's history of substance abuse and socio-demographic characteristics will influence the likelihood of admission into a treatment program. Results offer support for both a medical model and societal reaction approach in that physiological withdrawal symptoms, history of abuse characteristics, and socio-demographic makeup each independently influence staff's assessment of the need for treatment.     

A Control-Mastery View of Case Consultation

Case consultation is an important part of deepening a clinician's therapeutic skills. However, consultation is not theory neutral: Each theory of therapy guides consultants according to their particular theoretical orientation. Control-mastery theory assumes that clients come into therapy desiring to solve their problems and have a tentative unconscious plan for working in therapy. These assumptions have been supported by 40 years of research data. Although control-mastery theory is written in everyday language without jargon, it takes considerable time to learn to apply the theory because each plan formulation is case specific. Consultation relies on the examination of detailed process notes, within and across sessions, as well as the therapist's affective reactions to the client. Initially, it can help the therapist formulate the client's unconscious plan and determine the types of interventions that will be most helpful. Consultation is also useful during ongoing therapy to help the therapist maintain (or regain) the focus on the client's unconscious plan, especially when it is derailed by transference enactments.     

THE PREPARATORY INTERVIEW

An educational approach to preparing clients for group is a widely held concept delineated throughout the literature and research studies on group work practice. The author is suggesting an important additional component as part of any preparation model, focusing on the client's perceptions, expectations, fantasies and concerns about what it means to be a member of an organized group. This client focused process can have a positive impact on each individual's experience within the group as well as accelerating the formation of group cohesion. This is illustrated in forming groups for children of Holocaust survivors.     

Middle Adulthood and the Theories of Erikson,Gould and Vaillant

Human personality formation and development are being increasingly viewed as products of life span events and episodes. This is especially true of the psychoanalytically oriented theories of Erikson, Gould, and Vaillant. This article discusses these theories as they relate to the gay man. It is the author's contention that while these theories hold special promise for understanding and aiding gay men in mid-life development they have not been adequately applied to this population. This article discusses the strengths and weaknesses of such an application and examines research and intervention potential inherent in these theories.     

The slippery slope of constructivism

While constructivism as both a philosophy and a clinical practice is being embraced by many individual and family practitioners, it remains controversial. This paper examines the difficulties one encounters in trying to balance the client's “relative truths” with those around them, including that of the therapist. Through the use of clinical vignettes, the authors demonstrate the difficulties inherent in dealing with ambiguities in the clinical situation, balancing the client's perspective, with that of a predominant culture or biological “fact,” and considering the issue of the client's “veracity.” Particular attention is paid to the difficulties involved in work with trauma survivors, whose own recollections of events may be ambiguous. Finally, the authors discuss the implications that constructivism holds for research and social action and advocacy. In sum, the authors recognize significant promise in the constructivist perspective, but caution clinicians to consider the inherent difficulties in a theory that relies on the relativity of truth.     

The Complexity of Evidence-Based Practice: A Case Study

In this article, the author addresses areas of complexity within evidence-based social work practice that she has encountered in her work with clients. The author offers an in-depth case study from her practice that involves the assessment and treatment of a client with a complicated diagnostic presentation. Clinical choices are discussed using a biopsychosocial framework that highlights the importance of attending to the client's specific needs as the author select interventions based on the best available research.     

Frontline managers' perceptions and justifications of behavioural conditionality

The debate on behavioural conditionality is characterised by abundant controversies. Frontline managers have a particularly important role in implementing these policies because their interpretation of the welfare policies regulates the frameworks of street-level bureaucrat's discretionary powers. A nationwide survey among frontline managers in the Norwegian Labour and Welfare Administration revealed that 86% of the managers expressed strong normative support towards welfare conditionality. With this as a backdrop, this paper develops a better understanding of managers' perceptions and justifications of the Norwegian type of behavioural conditionality. Analysis of focus group interview data showed that the managers adopted a broad definition of conditionality, meaning promotion of an overall (re)integration of the client into the society as opposed to the narrow definition focusing solely on labour market integration. Furthermore, the implementation of welfare conditionality primarily was perceived as mild and client sensitive. The managers mainly justified welfare conditionality in terms of care and paternalistic defences, arguing that requirement of work and activities are in the client's best interest, understood in terms of social democratic values.     

Third award: A follow‐up study of patients discharged as “improved” 1

In this study, the author researched his clinical practice in a community mental health center with six parental couples whose latency-aged children suffered from prevalent separation anxiety disorder symptoms. Through thematic analysis of the anamnestic process recordings of 53 parent sessions, the author's speculation on the effectiveness of the supportive psychodynamic psychotherapy techniques to psychodynamic clinical social work practice with parents was confirmed. Nine of thirteen supportive psychodynamically grounded therapy techniques were highlighted, whereas the clinical practice produced three more. The techniques permeated and shaped the author's clinical social work intervention, and a follow-up confirmed the reduction in mental health symptoms for the children and also increased parental satisfaction in response to the interventions.     

Client contribution in negotiations on employability – categories revised?

Eskelinen L, Olesen SP, Caswell D. Client contribution in negotiations on employability – categories revised? Int J Soc Welfare 2010: 19: 330–338 © 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. In this article, we explore how the institutional category ‘unemployed’ is specified in everyday practice when implementing an active employment policy. We illustrate the process of categorisation as an aspect of the in situ positioning and self‐representation of the client by examining one social worker–client talk: how the category unemployed is shaped and ‘translated’ when the client negotiates her situation with the social worker. Two types of category revisions are identified. First, the employability of the client, rather than her unemployment situation, is the issue under negotiation. Second, the client introduces new categories that are compatible with the demands of the employment system. She contributes by drawing on discursive resources related to the category of ‘active job seeker’ but does this with an own agenda of looking for a suitable job. The analysis elucidates the client's contribution to institutional practice and discusses constitutive and constituted elements of categorisation.     

Vygotsky,Wittgenstein, and sociocultural theory

This paper considers the use made of Vygotsky's work by many who take a sociocultural perspective and, in particular, by those who use his work to advance a particular view of second language acquisition and the ‘silent period’. It is argued that Vygotsky's account as represented in Thought and Language (Vygotsky, 1986 ) needs to be thought of as consisting of two distinct aspects: first, the observations he made (or claimed to have made) and, second, the theoretical account he proposed to explain them. It is shown that some of Vygotsky's observations are problematic but that, even if they are accepted, Vygotsky's theoretical account suffers from fundamental difficulties. Thus the support claimed from Vygotsky in accounts of second language acquisition is misplaced, first because of those difficulties and, second, because many who claim support from Vygotsky, do not need or even use his theory but instead focus their attention on his empirical observations and assume incorrectly that if their own empirical observations match Vygotsky's, then Vygotsky's theory can be accepted. Wittgenstein's later philosophy is shown to provide a perspective which dispels confusions about, and gives us a clearer insight into, the issues.     

An Overview of Men's Groups

Men's groups have existed for a variety of purposes, including consciousness-raising, support, education, counseling, and psychotherapy, for several years, but they have been described infrequently in the literature. This overview of men's groups presents a rationale for such groups in terms of changing perspectives on the masculine gender role. It also describes several applications for two specific types of men's groups, consciousness-raising and psychotherapy groups. The author discusses some of his own experiences as a leader in men's groups as well. The author states that the future of men's groups depends on an increased use of these groups and on more extensive reporting about them in the professional literature.     

Human Motivation in Question: Discussing Emotions,Motives, and Subjectivity from a Cultural‐Historical Standpoint

Vygotsky, at the end of his life, advanced a new representation of a psychological system that was ruled by a cognitive‐emotional unity, a theorization that remains inconclusive due to Vygotsky's early death. This article discusses the advances made by Vygotsky in the comprehension of human motivation through his concepts of sense and perezhivanie at the end of his work. Through these concepts, he further advanced the discussion of motivation, despite the fact that these concepts have only very recently been considered a relevant part of his legacy in both Russian and Western psychology. This paper discusses the departure from and the historical presentations of the concept of motive in the following two main approaches of Soviet psychology that were mistakenly equated in Western interpretations: Vygotsky's approach, mainly at the first as last moment of his work, and Leontiev's Activity Theory. Based on the final theoretical positions of Vygotsky and of other Soviet authors, and further developing this legacy, this article proposes a new definition of motivation as a specific quality of subjectively configured systems and defines motive as intrinsic to the functioning of all psychological function defines subjective functions as subjectively configured processes. This new proposal of human motivation within a new way of defining subjectivity defines new categories as subjective senses and subjective configurations on which the author bases a specific approach for advancing the topic of subjectivity and motivation within a cultural‐historical framework.     

The child's entry into the symbolic order: a developmental-societal interpretation of Jacques Lacan

Lacan's psychoanalytic insights, as found primarily in his 1964 seminar “The four fundamental concepts of psychoanalysis” are interpreted within a social-developmental framework. Using Piaget's theory of a structural transition from action logic to object logic I recast (1) Lacan's signifying function as a new competence emerging around age two and (2) the “Other” as the general content/context of this newness, namely the child's grasp of a societal-symbolic order. The child's entry into that order is described as inherently linked to sexuality, desire and the unconscious and as accompanied by feelings of alienation and separation. Insofar as the desire of the unconscious is toward the “Other” Lacan seems to support my claim of an endogenous origin of the societal order.     

Psychotherapy with Alcoholic Patients

Abstract

This paper demonstrates how use of the empathic mode in outpatient psychotherapy helped an alcoholic patient reduce his denial of the severity of his illness. Both the general psychoanalytic literature and, in particular, the self psychology literature concerning treatment of alcoholics is reviewed and evaluated. This paper also examines in depth how the empathic mode functions to promote selfobject transferences, which facilitate internalization processes that may lead to a reduction in the alcoholic patient's need to rigidly maintain his denial of the illness. The complexity of the relationship between alcoholism self-help groups and the professional psychotherapy community is also explored.     

To disclose or not to disclose: Political conflicts in the countertransference

Self‐disclosure is a frequent topic in the relational psychotherapy literature. However, there are few psychoanalytic writings or empirical studies that concern self‐disclosure in the context of cross‐cultural treatment; specifically treatment between Israeli therapists and Palestinian clients. This particular subject broadens the investigation of cross‐cultural treatment beyond race and color into the domain of religious and political differences between client and clinician. An Israeli‐American therapist's counter‐transference reflections around self‐disclosure and its impact on her Palestinian client will be the subject of investigation in the following paper.

Self‐disclosure has been increasingly examined in the relational literature over the past ten years in the context of the therapist's subjectivity within the therapeutic encounter (Aron, 1991; Renik, 1995). Few psychoanalytic writings, however, have focused on self‐disclosure as embedded within race and culture, and fewer still address the impact of religious and political differences between client and therapist, differences that, in the case of a Palestinian client and an Israeli therapist, reflect larger social and political conflicts. The transference‐countertransference dynamics around self‐disclosure and the way these shape the therapeutic encounter between a Palestinian client and an Israeli therapist will be the subject of investigation in this paper.     

Home-Based Practice with Older Adults

Abstract

Social work with older adults frequently occurs in the client's home. Although practitioners and the professional literature acknowledge the existence of differences between agency-based and home-based practice, little attention has been given to the way the home environment impacts on the intervention process. This exploratory study examined practitioner-identified events that impact on the intervention process in home-based practice. The events elicited two general categories, the context and the process of interventions. Factors subsumed under intervention context are situational and geographic factors, such as practitioner and client comfort, and differences in urban and rural environments. Examples of intervention process categories include setting up home visits, assessment, boundaries, common distractions, and termination in home-based practice.     

The Common Factors Model: Its Place in Clinical Practice and Research

The common factors model advances the view that client, relationship, and clinician factors account for a greater proportion of therapeutic change than do specific techniques or types of therapy. In this era of evidence-based practice, in which specific techniques are heavily emphasized, this updated review of the common factors model focuses attention on other components of therapeutic change, including the client's contribution, the therapeutic alliance, and clinician factors. The common factors model has recent and long-standing research support of several kinds. The model affirms many widely used therapeutic practices and has led to the development of several procedures to enhance therapeutic outcomes. This article explores the origins and development of the common factors model; its current research support; and its implications for practice, research, and education.     

The Concept of the Cultural-Historical Development of the Mind and its Prospects

Vygotsky's concept of the cultural and historical development of the mind, which he worked out together with his coworkers and students, never achieved finished form. It did, however, contain basic ideas that, when later systematically developed, opened paths toward knowledge about what Vygotsky considered to be the most important problem of psychology — knowledge of the human personality.