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Psychodynamic social work: Standing on Freud's shoulders
There's something about the question "What's the matter?" that gets a person to loosen up, feel at ease, and release the flood that's been pent up for hours, days, even years. It's true for coworkers and family members, and, says William Borden, AM'83, PhD'88, it's certainly true for the mentally ill and other troubled members of society.

Borden, a senior lecturer in the School of Social Service Administration, recalls his days as a young psychoanalytically trained mental-health clinician in the late 1970s counseling clients with schizophrenia, bipolar disorder, and other severe mental illnesses. "We followed Freud's metaphor of the clinician as archaeologist, trying to uncover traumatic events and determine 'what really happened' as we explored clients' problems in living," he tells the 20-odd students gathered for the first of his two-course sequence Psychodynamic Theory and Practice. "But the emphasis on the past and interpretive work made it very hard for clients to talk about what's the matter now and deal with their most pressing concerns and worries."

It was a rigid template, says Borden, and one that's changed dramatically in the past two decades as social workers have begun to embrace a narrative approach, asking clients to tell their stories on their own terms. The students, mainly first-year master's candidates headed toward careers as social workers, listen intently to their instructor, last spring's recipient of the SSA Award for Excellence in Teaching. After two quarters of core courses, they've learned enough about their field's history and basic theories to recognize that rigid templates are a good way for social workers to start out on the wrong foot. But that doesn't necessarily mean they believe the psychodynamic approach will start them out on the right foot with their clients.

The air during the class's first session is heavy with ambivalence as students go around the room and explain why they chose to study psychodynamic thought and describe their current field placements. Many admit to enrolling not because they like or agree with the theory, but because they cannot escape the school of thought that was born on a certain Viennese divan 100 years ago. "I hate Freud and everything he stands for," announces a woman who works with children with developmental, cognitive, and behavioral problems. Several students say they enrolled because their field supervisors take a psychodynamic or "relational" perspective, and they want to understand what that means. One thin young man, who interns at a local high-school counseling center, confesses, "I'm still trying to figure out what psychodynamics is."

It is 9:30 on a late-March Wednesday morning in a sunny east-facing seminar room in the SSA building, a flat expanse of brick and floor-to-ceiling windows. Vertical blinds cast lines across Borden's round face as he listens, a paper coffee cup clutched to his chest, his shoulders hunched forward, his brow furrowed.

Borden nods his entire torso in empathy. "Boy, Freud is deeply problematic in our field, isn't he?" But what's more problematic, says Borden, is that most present-day views of psychodynamic theory-the students' included-are off the mark by a good two or three decades. Students are correct in assuming that psychodynamic methods rely on Freudian ideas, but their fears that they'll be learning to interpret the dreams of at-risk teens or explain Oedipal complexes to drug addicts are unfounded. "A lot has changed in this school of thought. We're not limited to clinical theory anymore."

Borden sets about explaining what, as the young man and others in the room want to know, psychodynamics is. Tales of his earliest days as a social worker reveal a lot about methods the students won't be learning. Questions about early development will be set aside to focus instead on the experience of clinicians as they practice psychosocial interventions in social-work settings. The students will learn to think of therapy as a "mutual, collaborative process between client and social worker," says Borden, and the therapist's comprehension and appreciation of the process will be viewed as an essential aspect of therapy that can influence its outcome.

Although psychoanalytic theory is the foundation of the course, the compassionate outlook of the social worker is at its heart. Issues such as culture, gender, and socioeconomic status are seen as intrinsically important in all phases of treatment. Borden explains that psychodynamic social workers recognize that human experience is "relational"-shaped by early (maybe Oedipal, but maybe not) relationships with our parents and guardians, but also by ongoing contact with family, friends, and other members of society-including social workers. As the course unfolds, he says, students will consider their own socioeconomic statuses, social experiences, and attitudes as they relate to their clinical work.

On his syllabus Borden has assembled a core group of "thinkers"-both theorists and practitioners testing theories in the field-who've forged the psychodynamic tradition from its Freudian roots, from its cold, scientific "-analysis," to its present-day, more open-ended "-dynamic." The semantic shift underscores the departure from the "grand theory" of the id, ego, and superego, divisions of the psyche which Freud depicted as functioning, says Borden, like "bodily organs regulating biological drives." Instead, students will learn to develop what Borden calls a "deep map" of a client's psyche, letting therapists "work on the surface" while understanding the "dynamic processes" at work within.

As they learn about psychodynamic thought, students will integrate it with other theories they encountered in the core courses. "I take a hopelessly comparative view of all these perspectives. I think we can learn from and use all of them in our work. Life as we know it and as our clients live it is messy. It's unfenced. Understanding different theories, where they overlap, how they complement and even contradict each other, this gives us different points of entry into a client's experience."

Turning to the chalkboard, Borden sets to work outlining the core ideas of psychodynamic theory: the unconscious, conflict and compromise, defense strategies, attachment, and personality structure. He'll return to these concepts repeatedly, he says, encouraging the students to think about them critically and in light of their own fieldwork.

"Okay. Unconscious mental processes," says the lecturer, reading the words he's just chalked up. "We can think of this as answering questions like, 'What is it that we want? What moves us to think and act the way we do?' Some theorists would say we want to be connected or related. Others think about motivators to establish confidence, to preserve the self or one's sense of oneself." Conflict, says Borden, arises when unconscious emotional and cognitive processes don't jibe. He gives the example of a former client whose fiancée had left him. The man still loved and missed her, and even though he knew he should, he couldn't move on. "Conflicted tendencies move us in opposing ways and cause dissonance. By virtue of being human, we have to negotiate conflict. How we do that, whether we're able to reach compromise, is very important."

An individual's response to conflict or distressing emotions is mediated by his or her defensive processes. "We can think of defenses as cognitive and behavioral strategies to regulate inner states and negotiation outer realities."

The concept of attachment is where psychodynamics departs from Freud entirely. "Freud would say the only reason to interact with other people is to regulate our biological drives. If we could regulate them on our own, we would have no need for relationships," says Borden. "We'll think of personality as a fluid thing. Early caretaking systems and ongoing social interactions play a role in the development of the personality, concepts of the self, and subsequent interpersonal functioning."

The psychoanalytic habit of "reductive interpretation" of a client's thoughts and dreams is not, Borden assures his class, on the syllabus. "We make interpretations to help the client understand the limits of our understanding." After all, he says, the goal of social workers' "therapeutic endeavor"-no matter which theory they use to achieve it-is to create a positive environment in which a client feels safe to move forward and work toward a sense of "health, well being, and the good life."

A 40-something man in the center of the room interrupts. "So where does this go? What is mental health? What is the ideal human condition? Do you have a few bullet points to offer?"

Again Borden gives a full-body nod. "Yeah, it's a lot, isn't it? These are big questions. Let's keep talking about them as we work through our readings." The student nods, but his barrage of questions underscores the challenge ahead for the entire class: making the leap from classroom theory to the real world, the mental-health clinic, the outreach center, the government agency. Later in the quarter, Borden says, they'll consider how to apply the theory in a clinical setting.

"Psychodynamic perspectives offer a framework for thinking about our work, whether you're involved in cognitive interventions, case management, monitoring medication, or group work. If we're able to think about how a client organizes his or her personality, if we're able to appreciate how a person presents himself or herself in different ways, if we can appreciate outside awarenesses and defensive processes, if we can think about a client's anticipated future and the importance of relational elements in their lives, then we are more likely to be effective.

"We have to understand what it's like for this person to be themselves as they are-psychodynamics helps us do this. I think you're going to find these ideas are of great practical importance."

Borden pauses to survey his students. "In my experience as a student, it was always hard to get Freud. If you struggle with these ideas, I understand. I've struggled too." It's a classic relational approach, and though the students can recognize that, none of them seems to mind.-S.A.S.

  JUNE 2001

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