social work: Standing on Freud's shoulders
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.
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."
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.
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."
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.
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."
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
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.
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.
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."
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
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."
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."
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."
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."
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?"
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.
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.
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."
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.