Doing psychodynamic social work a basic introduction.doc

Doing Psychodynamic Social Work: A Basic IntroductionAndrew Cooper (Adapted from Wilson K, Lymbery M, Ruch G and Cooper A, Introduction to Social Work, Pearson Education, forthcoming 2008) IntroductionSocial work is a practical activity. This was the pronouncement of a government minister responsible for social work in 2004. She was not wrong, but we strongly believe she was only capturing a part of the whole truth about actually doing social work. In this paper we emphasise two other dimensions apart from doing which are (or should be) ever-present in how a social worker conducts herself or himself. These are thinking and being. The thinking component is partly about the importance of having a solid theoretical grasp of different social work methods, so that each step in your plan of activity is based on a clear understanding a theoretically informed formulation - of the service users situation to which you are responding in a particular way that reflects this formulation. The thinking component is also about reflecting, learning to step back both during and after each phase of activity or engagement and look at how the process and the relationship you are both involved in has changed, developed, deepened, or become problematic, tense, anxious. These reflections are all in the service of evaluating how you and the service user are getting on with the plans you should have made on the basis of your assessment (We say service user for the sake of simplicity, but of course there may be several service users involved, and quite possibly other colleagues as well). The being component may be less familiar to you in some ways, but it is no less important, and in fact once we have investigated it a little further it will probably seem obvious. Every time we meet, talk, engage, or develop even a superficial relationship with another person or with a group - each of us has adopted a particular, emotionally invested way of being in that relationship. We might compete with the other person or with the group members; we might be drawn to listen and empathise; sometimes we want to back off at once; some encounters seem to make us passive or withdrawn; or we become caught up in a feeling of elation and mischiefthe possibilities are endless. But, setting aside the fact that each of has a more or less stable personality (a fairly consistent tendency towards a range of ways of being) the important point is that there is no neutral, emotionally uninvolved way to be in a relationship. Something particular is always going on in terms of feelings, emotional responses, patterns of interaction, the ease or difficulty of the encounter; and over time there is always some kind of development, change, or evolution which is usually quite complex at the level of emotional engagement with other people. The being component of social work interventions is about reflecting on these processes, and coming to know about them through thinking about them. So, even if a piece of work seems to be all doing for example, an emergency visit because a severely disabled person living alone hasnt been contactable for several days these other levels of the engagement will be present; with the development of your skills, they become essential to carrying out the doing in the most sensitive, thoughtful, attuned, and purposeful way. For example, often we can be impelled in to action by other peoples anxiety, when a better course of action is to stop, think, reflect on the feelings that have already been mobilised in us, and only then decide what, if anything, to do. Frequently far more frequently than we often realise what someone in a state of anxiety finds truly helpful is not to rush into action, but to have their anxious state listened to, understood, so that they can be helped to think more clearly, as our case example of work with a young mother, Michaela, illustrates. There is a word for this way of responding to anxiety in relationships containment which is explored in more depth in the section below on psychodynamic ways of working. Case studySocial work practice with a young Romanian motherMichaela was a young single mother who came to England from Romania with her daughter to work. But she quickly found that it was hard to earn enough to pay rent, live and support her daughter. Christine was the duty social worker who saw her on her first visit to the office. Michaela poured out her distress, and Christine was able to sit and listen and empathise; but she also helped Michaela to understand some practical steps she could take to improve her financial situation, and she made a couple of initial phone calls on her behalf.When Michaela came to the office again she asked Christine to accompany her to the Housing Benefit Office. Christine thought about this for a moment, but said she didnt feel that would be so helpful and that maybe Michaela could tell her of her worries about going there herself. To her shock Michaela turned on Christine in fury, saying I thought you were going to be my friend, and stormed out of the office. Christine felt immediately overcome with distress herself, as well as guilty and had to stop herself from rushing out of the office into the street to try to get Michaela to return. Christine reflected on this episode, and began to see that maybe Michaela was even more vulnerable than she had appeared at the first meeting. She was a very competent person who spoke good English, but emotionally it seemed she had felt desperate, and developed an intense dependency on the idea of Christine as someone who could (and should) help her in the way she imagined. Christine also wondered if she felt guilty, possibly about the situation she had placed her daughter in as well as herself? Christine decided to visit Michaela at home. Michaela seemed immensely relieved to see Christine, apologised for her outburst and explained that at that moment she had just felt quite panic-stricken and unable to cope. She had already been to the housing office and it had gone OK. Christine explored Michaelas feelings and situation further, and it did emerge that she felt hugely worried and guilty about her daughters future as well as her own. This case study illustrates how doing, reflecting and being in social work are intertwined, and how the value of not rushing into action can be empowering Michaelas panic is intense but fleeting, and she recovers her own competence very quickly. Had Christine agreed to go to Housing benefit, or rushed after Michaela, this might have been undermined rather than recovered. But this required a capacity in Christine to think on her feet about intense and complex feelings that arose in the encounter, and an ability not to get too drawn in too quickly. Then she does act by going to see Michaela, and this re-establishes a proper partnership in the work. These interconnected components must, as we shall illustrate, inform whichever of the methods you select for working with a particular case or situation. However, in order to be able to think, do and be, you need also to have a strong theoretical grasp of the approaches; we shall introduce you to the essentials, and at the end of the chapter give you suggestions for reading to take you knowledge and understanding further.Psychodynamic interventionsIntroductionIn the history of social work there are probably more myths about psychodynamic practice, and more strong opinions both for and against this method, than there are in relation to any other approach to practice, perhaps in part at least because it was seen by radical social workers in the middle decades of the last century as ignoring societal inequalities and the impoverished circumstances of most service users. To some extent this merely reflects how our society and culture divides strongly for or against anything to do with psychoanalysis. The word psychodynamic is an adjective meaning based on or deriving from psychoanalytic theory and practice, and we use this adjective in preference to talking about psychoanalytic social work. In the earlier chapters about the history and development of social work we saw how in Britain in the 1970s and 1980s there was almost a civil war in social work, with radical political social workers often taking psychodynamic social work as their main enemy (as we explored in chapter x, on history in the first section). But it has often been noted that key ideas based in psychoanalysis are now part of everyones everyday thinking and language, as we illustrated in hg and d chapter in discussing the popular use of the term defence mechanism. So, although psychoanalytic practice and theory is still hotly contested, in some respects it remains the most successful and influential psychological perspective of our times. Because it has been influential and successful, there is a vast literature about psychoanalysis and its various related practices such as psychoanalytic psychotherapy and psychodynamic counselling. There is a more limited range of writing about psychodynamic social work, and we will refer to many of these texts as well as giving you pointers should you wish to look a bit deeper into psychoanalysis. However our main aim will be to offer an accessible account of this approach that tries not to reproduce any of the myths and misconceptions that abound. In this section we will cover the main concepts you need to understand in order to practice simply and effectively using psychodynamic principles. We then discuss the stages, or the process, which a typical psychodynamic piece of work entails and explore how to use yourself your feelings, responses and observations of your own reactions - as a central tool in doing this kind of work. We conclude the section by reviewing some of the important current research into the effectiveness of psychodynamic workGetting started thinking about emotional experienceThe best way to begin thinking about psychodynamic practice is with your own experiences on placement, at work, or in your own life. Psychodynamic theory proposes that people and relationships are made up of at least two layers of experience and functioning, a conscious one and an unconscious one. The idea of the unconscious can seem mysterious and even frightening, but its manifestations are in fact ordinary and everyday. Some years ago one of us was teaching a group of qualifying social workers about psychodynamic work when a student said You seem to be saying that these processes that relate to the unconscious are just there whether we like it or not. So we cant help encountering them in our work. This seems exactly right, but in order to be convinced of the truth of such a statement, it is probably necessary to open yourself to examining your own experience. Some social work training courses now require students to undertake a short, usually 10 or 12 week observation of a baby or young child in an ordinary setting, either at home or in a day nursery. The observer is not asked to do anything, but just sit and take in what seems to be happening for the baby and then afterwards write up a detailed account of this. However, many observers find that this task stirs up very strong feelings and important memories and realisations in themselves. Watching a distressed baby who has been left alone by her caretaker for even three minutes a perfectly normal everyday occurrence - without doing anything to intervene or comfort the baby, can put anybody in touch with very powerful feelings of their own. For example, feelings of (and vivid thoughts about) our own emotional neediness, distress about times when weve been abandoned by a loved person who we depended upon, anger with people we feel have mistreated us can suddenly come to the surface. This is unconscious experience becoming conscious. But it is not necessary to do a baby observation to access this kind of experience. An encounter with a service user who is stricken with grief or guilt about the death of a loved one will almost certainly evoke powerful emotional reactions in us and these reactions will not just be empathic or altruistic; we may find we become intensely emotionally preoccupied once again with experiences of loss that we thought were over and done with when in fact they are still alive in us, even if we arent aware of this most of the time. This then is the foundation of psychodynamic practice: openness to the emotional experience of other people, which leads on to the need to be open to our own emotional experience, which in turn leads on to the importance of us being able to hang on to the difference between our own experiences and those of other people. Most of us have no trouble with this most of the time we come away from an encounter saying something like, She was dreadfully upset, and cried for a hour, and afterwards I burst into tears myself because I was thinking about my friend who died last year. But there are important processes that go on between people, discussed below, which make it harder to know what is happening emotionally and whether it is us or them that feelings belong to. Some psychodynamic processes and conceptsFor now we will think back to the case study of Christine and Michaela in the opening sections of this chapter. This involved intense and rapid emotional exchanges that Christine somehow managed to handle to good effect. It is worth thinking, step by step, about what took place between them. First, Michaela comes to the office and asks for help and it seems to Christine that Michaela is able to listen to the practical advice she offers despite being very distressed. Christine has listened and taken in her distress, and for both of them this seemed a manageable if emotionally intense encounter. Consciously, all is going well and seems on course.But second, Michaela returns to the office and makes a request that Christine gently refuses. This elicits an intense outburst of rage from Michaela that takes Christine completely by surprise. Emotionally she is almost knocked off her feet. What has happened? In a way we can only reconstruct later what may have happened, when we learn that Michaela in fact went to the housing office straight afterwards and completed her tasks with them. Psychodynamic theory would suggest that two things have taken place. In the first place Michaela has projected an intense and unmanageable experience of frustration, despair, guilt and rage into Christine, who then becomes the one who feels incompetent, anxious, guilty and panicky. But importantly, she stops herself rushing after Michaela, and she succeeds in emotionally containing this experience. This gives her time to think about and reflect upon her emotional experience. So, third, it seems that perhaps Michaela has rid herself of a whole bundle of feelings which at that moment she found just unbearable. She was unable to contain and think about them, and found a solution that we have all used in our lives probably quite often she forced them onto someone else. For the time being, this makes Michaela feel more able to cope. Later Michaela admits to Christine that as she left the office she was full of hate and anger towards her for refusing to do what she had asked. In some way she had gone in there feeling bad, but left feeling good (or at least better) but having turned Christine bad in her own mind - and in fact Christine does actually now feel pretty bad herself. In psychodynamic theory the process of projection is closely tied to another one called splitting in which we project our bad thoughts and feelings into someone else, leaving us good and them bad. In this way we often create a view of the world split rather rigidly between the good and the bad. Thus, projection and splitting are examples of psychological defences against mental pain. They are used to preserve a sense of the goodness of the self but as we can see they also have a cost, for Christine certainly but perhaps also for Michaela. Then, fourth as Christine begins to think about her emotional experience, she works on the idea that maybe the feelings put into her by Michaela may give her information about Michaelas state of mind. In particular she wonders whether the guilt she felt might be a clue to something Michaela is struggling with, but has not been able to communicate about explicitly or consciously. This is speculation on Christines part, a kind of hypothesis that she must find a way to test. But if it is right, it is a very valuable clue she can follow up on. In psychodynamic language, this is Christine thinking about her counter-transference. You may be familiar with the psychodynamic concept of transference, a process in which one person transfers feelings and images from their own inner life onto someone else, who they then treat as if they were this figure from their own internal mental life. When you are the object of someone elses transference, it is often difficult to spot at first. The clue is often that you feel as though you have been systematically misrecognised in some way perhaps excessively loved and admired, or hated and despised by the other person. Examining what this experience is all about is the process of thinking about your counter-transference. It was a big step in psychoanalysis when therapists began to realise that maybe transference was not just a nuisance, but in many ways the centre of the therapeutic process, the means by which the unconscious could be known about in an immediate, live way if the recipient of the transference could identify and make sense of what had got into them. So fifth, when Christine visits Michaela again she finds her in a quite different state of mind. She is rat