The duty to care and the need to split

This paper arises out of psychoanalytically oriented consultancy to teams of staff in the helping professions where there is a statutory 'duty to care'. It takes as its premise the seemingly paradoxical hypothesis that workers may need to split off part of their emotional experience in order to preserve their own mental health and provide reliable services to their clients. I argue that while a professional 'duty to care' requires us to be emotionally 'in touch', the demands of our clients together with the demands of the institutional response to the 'duty to care' cause us to split off parts of our awareness. I also argue that provided the splitting does not become extreme we are doing no more or less than the rest of society. In other words, there is a degree of 'normal splitting' which numbs our awareness of danger and destructiveness and seeks to protect us from too much anxiety and pain. Yet if professional workers are charged with the responsibility of assessing risk and acting accordingly for the protection of all concerned they need ways of being 'in touch' (re-integrating the splits) for some or enough of the time. Finally, I will describe ways of being 'in touch', illustrating the difficulty and the pain of re-integrating the splits and some of the insights that can arise out of this work with examples from my consultancy work.     

A CHILD PSYCHOTHERAPIST IN PRIMARY MENTAL HEALTH

This paper outlines the author's application of psychodynamic thinking and approaches to brief therapeutic work with children, adolescents and their families in community mental health settings. It is the author's belief that systemic and narrative therapy insights and techniques combine well with psychoanalysis in the assessment and treatment of many concerns felt and expressed by parents and young people. The therapist's tasks are to listen empathically to clients who are in distress and to explore the clients' beliefs about the origins of their problems, as well as their previously attempted solutions. In proceeding at the family's pace, opportunities arise for facilitating more effective ways of resolving conflict. Clients are often more free than they realise to change their interpretation of their experience, and this has important consequences for the maintenance and solution of problems. Brief therapy seeks to remind clients of their strengths and resources and to share ways to encourage clients to resume effective ways of learning about themselves.     

Training fieldwork supervisors of social work students at a South European University: evaluation of the effectiveness of a relational psychodynamic model

This case-study adopts a mixed research methodology in order to evaluate the process and the effectiveness of a psychodynamically informed training seminar for field supervisors of undergraduate social work students, at a South European University. At the beginning of the seminar, an anonymous questionnaire gathered information on the supervisors’ demographics, preferred supervision style and expectations from the training. The training consisted of four sessions involving analysis of (1) student process-recorded interviews with clients, (2) the relationships formed between the student, the supervisor and the field practice manager, (3) brief virtual scenarios (vignettes) of field practice problems and (4) a videotaped supervision session. At the end of the training process, a follow-up questionnaire researched the satisfaction of supervisors with the training, their confidence to conduct supervision, and their satisfaction with the instructor's teaching. Overall, the training has been satisfactory for the trainees and increased their competence to supervise.     

Conversations with Suwanrang: The Treatment Relationship in Cultural Context

Due to the changing cultural composition of the U.S., social workers are increasingly working with clients from different cultures. As a result of globalization, our schools of social work are training international students who return home to work in their native countries and take with them our theories and models of practice. It is essential that, as a profession, we address questions about the relevance of our models to work with clients from different cultures. This paper will use theoretical concepts from anthropology and data from field research with Suwanrang, a social worker in Northern Thailand to address these issues. The implications of the debate between universalist, relativist, and cultural pluralist perspectives within anthropology for psychodynamic, developmental models and social work treatment will be explored. The paper will focus on the ways the treatment relationship is shaped by and varies with culture     

The story of Lucy: lessons learned,lessons taught

ABSTRACT

This article provides an extended case example highlighting the value of a supportive approach to practice, in addition to the importance of holding a psychodynamic developmental frame of reference. Concepts of repetition compulsion, the holding environment, and object constancy are applied to the clinical material. The case is underscored for its value as a teaching tool.     

Using psychodynamic interventions to engage in trauma-informed practice

In recent years, trauma-informed practice has received increased attention in the social work literature. Although the adoption of trauma-informed practice is necessary for preparing social workers to practice effectively with clients, these frameworks do not necessarily provide social workers with the specific skills for doing so. Therefore, we argue that using interventions grounded in contemporary psychodynamic theory can help transform them into trauma-informed practitioners. Psychodynamic psychotherapy interventions, especially from object relations and self psychology, align with many of the principles of trauma-informed practice (e.g. establishing an atmosphere of safety and acceptance, relying upon relational collaboration). We begin by discussing trauma-informed practice and then discuss how the use of psychodynamic psychotherapy interventions (holding environment, containment, and selfobject transferences) can facilitate the application of trauma-informed principles. We conclude with a case illustration of how to incorporate psychodynamic interventions into trauma-informed practice.     

Constructing a Place for Religion and Spirituality in Psychodynamic Practice

A focus on spirituality has become in vogue for the media as well as for professional conferences, journals, and schools of social work. Likewise, our clients are struggling with how to integrate religion and/or spirituality with their therapy. The premise of this paper is that we have a role in assisting our clients with this integration and to consider some of the current postmodern approaches. However, in attempting such an integration it is important to retain certain parameters and guidelines that have been helpful to our clinical work. This paper will examine how to make room for religion and spirituality in psychodynamic psychotherapy and the ways in which constructivism can be helpful in this process. The influences of psychodynamic theories and postmodernism shape the discussion in the following areas: definition of terms, self-awareness, deconstruction of clients' narrative, assessment of strengths and vulnerabilities, and reconstruction of a useful narrative.     

Theoretical Support and Other Considerations in Using Simulated Clients to Educate Social Workers

This article builds on literature from many helping disciplines supporting the use of simulated clients (sometimes referred to as standardized patients) in training professional students, explaining why the use of simulated clients is more effective in developing clinical skills as compared with student-to-student role-plays. Psychodynamic and Bowen intergenerational family theory, critical to the development of social work knowledge, is used to support the use of simulated clients to portray clients with challenging and complex lives. Risks and benefits of using simulated clients is discussed, along with recommendations to educational programs regarding ways to effectively use this experiential learning method.     

Using Psychodynamic, Cognitive-Behavioral, and Solution-Focused Questioning to Co-Construct a New Narrative

The narrative and social construction metaphors are used as the conceptual frame for the clinical work with a client who felt trapped in an emotionally abusive relationship. To help the client deconstruct a problem-saturated narrative, questions were asked which drew from psychodynamic, cognitive-behavioral, and solution-focused models. The rationale for the use and timing of deconstructive questions from the various models is discussed. The problem-saturated story during the time of intake is presented, as is the change process that led to a more solution-focused narrative. An effective short-term treatment was created through the use of interventions drawn from multiple clinical models. Effectiveness was judged by client's improved emotional state, and the ability of the client to imagine and pursue identified solutions.