Psychodynamic Approach to Social work

Look into the depths of your own Click to edit Master subtitle style soul and learn first to know yourself, then you will understand why this illness was bound to come upon you and perhaps you will thenceforth avoid falling ill." -Sigmund Freud

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What historical, political, social influences impact or shape the approach

Freud influenced by German Physiologist Brucke who taking a leaf from Thermodynamics All organisms are energy systems governed by principles of energy conservation. Also influence by Darwin and Lamarck Jean Martin Charcot (neurologist) Vienna - Repression perceived limited role of women in the society (prostitutes or mothers) Vienna was the seat of licentiousness and sexuality in Europe. Largely catholic culture. 4/9/12 No means of birth control made expression of

What historical, political, social influences impact or shape social work responses to the Psychoanalysis?

Until 1919 (WW 1) claim to fame was Jane Adams (sociology), Mary Richmond (social diagnosis) said that there was not much to do after the diagnosis, hinted at what has now become the domain of social psychology. SWs were ecstatic after discovering PA psychiatric case workerref. Jessie Taft (1922)- mental hygiene in all training programs . Jerome Wakefield* called it as a derivative function () took as their primary method
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History - SW and PA

1930s Freud influence felt in USA. Talking cure could be applied by non-physicians hence attractive to SWs 1929: Porter R Lee & Dr. Marlone- first SW textbook based on Freudian Principles Pennsylvania School: Jessie Taft Otto Rank (force of change is Will +relationship central to the helping process) Move away from emphasis on social reform to renewed focus on individual achievement and responsibility for self (Bruno, 1957). 4/9/12

What does the approach contribute to knowledge?

It has influenced the listening, open, listening type of relationship Encourages seeking explanation and understanding of personality rather than action Interactionism Nature + nurture Recognizes the irrationality of human behavior and complexity of human motives SWs emphasis on feelings and unconscious factors
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What does the approach contribute to knowledge?

Later schools of social work- Case work or diagnostic, the functional school (Jessie Taft) , psychosocial school (Hollis), problem solving casework (Perlman) Bowlbys Attachment theory for Social work Howe(1995) (secure base) Erikson Stages of Development - Adolescence Ego psychology Goldstein functions of the ego (12). SW is ego supportive while psychotherapy is seen as ego-modifying Bions group work (more in relation to 4/9/12

What does the approach contribute to knowledge?

Residential care

Planned environment therapy Milieu therapy (lewins Life space ) Therapeutic communities

Criticism from a SW perspective - Brought individual conflict to the center stage thus pushing socioeconomic issues and campaigns for social justice to the periphery (Of the concern of the profession). -Inadequate and delayed response of the 4/9/12

What does the approach have to do with the social work mission/mandate?

Direct Practice Alleviates suffering which could arise due to direct oppression or perceived oppression. Shifts the moral lens to a psychological one

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Phases

Drive ego- social cultural aspects (Erikson & Sullivan) cohesion and meaning ( self) Freud and his times drive theory, tripartite model (id, ego, superego), anxiety and neurosis, defense mechanisms, psychosexual stages of development, Object relations (2 person psychology) Klein , Pre - Oedipus to mother as object. Kernberg Ego psychology TFP with borderline and narcissistic PD clients Self psychology Psychodynamic brief therapies: 25 sessions, interpretations focus on present circumstances not on childhood experiences (Strupp & Binders Time Limited dynamic therapy , IPT, Luborskys supportive-expressive) Intersubjectivity, relational and influence on group work Neuropsychoanalysis or Developmental psychoanalysis (Schore): Self psychology and neuroscience..the search for mind, unconscious, right central 4/9/12 hemisphere in the study of attachments etc. (adverse influences on brain and

Contemporary approaches

SELF PSYCHOLOGY (self+ object)self is the core of the personality Shift from an intrapsychic to a relational unconscious and from a cognitive ego to an emotion-processing self). Dyadic aspects of unconscious communication Kohut: Individuals basic needs centered on empathic connection with others esp caregivers The focus is on persons subjective sense of cohesiveness and well-being rather than 4/9/12 objective functioning of various parts of the

Self (questions that Kohut asked)

How do early relational affective transactions with the social environment facilitate the emergence of self (development of the self ); How are these experiences internalized into maturing self-regulating structures (structuralization of the self ); How do early deficits of self-structure lead to later self-pathologies (psychopathogenesis); and How can a therapeutic relationship lead to a restoration of self (mechanism of 4/9/12 psychotherapeutic change).

INTERSUBJECTIVITY
Winnicot, Orange, Stolorow & Atwood 3 person psych also multiperson

Context fundamental to understanding Organizing principles: emotional conclusions a person has drawn from lifelong experience of the emotional environment esp connections with early caregivers (mutuality) Therapists sustained empathic inquiry and emotional availability is crucial to the process Dialogue, relational impasse and ruptures, 4/9/12 working throughchange persons ways of

Relational theory (Mitchell)

Related to interpersonal theory, self psychology and object-relations (Bowlby, Winnicot). Influenced deeply by feminism, postmodernism (truth is plural and seen in perspective) View mind as fundamentally dyadic and interactive and it seeks contact and engagement with others Psychological reality best viewed within a relational matrix also includes intrapsychic Sense of selfhood and identity emerges from this relational matrix as does meaning (not a priori) Goal of therapy is to change the way in which the 4/9/12 clients relational world is structured. Client

Principles

An emphasis on the centrality of intrapsychic and unconscious conflicts, and their relation to development. Defenses as developing in internal psychic structures in order to avoid unpleasant consequences of conflict. Root causes of most problems are painful, frightening or unsupportive experiences in childhood. A view that internal representations of experiences are organized around 4/9/12 interpersonal relations.

Techniques and outcomes

Hypnosis Free association Dream Interpretation (royal road to unconscious) Interpretations of symbols Transference Countertransference Resistance Interpretations(defenses)
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Valid re:
Workability Dodo bird verdict

http:// www.mentalhealthpros.com/mhp/pdf/Dodo-bird-meta-a

Effectiveness A large multicenter study of adult patients with a history of early childhood trauma reports that psychotherapy is an essential element of the treatment of such cases and indeed is superior to pharmacotherapy as an effective intervention (Nemeroff et al., 2003). http:// www.pnas.org/content/100/24/14293.full.pdf 4/9/12

Completeness

Philosophy

Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as empirically supported and evidence based. In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.(Shedler, 2010)

Grounded in

Theory Experience Practice context

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Applicability

To understand relationships with self, world, others. SWs provide that secure base for exploration, assist them in the process, past n present patterns. Therefore useful in Direct practice with Individuals, Couples (narcisstically vulnerable couples) and Families Group Work: contemporary theories fit well with group work - Bereavement groups Most symptom groups esp. neurosis, character flaws (hyper- fastidiousness, hyperseductiveness) now PTSD, trauma Most age groups from children (contributed to
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Controversies

Infantile sexuality Development of female sexuality including stating women have weaker superegos (The great question that has never been answered, and which I have not yet been able to answer, despite my thirty years of research into the feminine soul, is What does a woman want? Freud) Homophobic Anti- church (Psychoanalysis is out, under a therapeutic disguise, to do away entirely with 4/9/12 the moral faculty in man D.H. Lawrence)

criticism

Does it ignore the social, economic, political context? Self psych: Cross cultural validity- in Some Asian cultures the goal is to transcend the Self. Also the American culture is seen as promoting consumerism as the self is seen as self contained and dominant construction is the empty self (Cushman), so is the focus on self psychology in the society lead to existential emptiness? Aspects of female identity besides motherhood? So does it support mother 4/9/12

Empirical debate: refer Westen, D. (1999) The scientific status of unconscious processes: Is Freud really dead? Journal of American Psychoanalytic Association Are the techniques useful, which population, which symptoms, what kind of therapy vs. It works and relationship is the basis Efficacy dependent on quality of therapist (training) and relationship

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Future influences

Moving from causal to the non-linear dynamic theory (chaos theory or complexity theory) for explanation Anthropological data on non-western cultures on Child rearing Childrens ability for resilience and protective factors that prevent psychopathology Kuhns (1970) Interdisciplinary Matrix is the way ahead?
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References

Malcom Payne Modern Social work Theory Contemporary psychoanalysis in Americaedited by Arnold M. Cooper Relational Concepts in Psychoanalysis Mitchell Theoretical perspectives for direct social work Coady and Lehmann Guide to psychoanalytic Development theories- Palombo, Bendicsen & Koch Empowerment tradition in American Social work Simon 4/9/12

References

http:// nvpp.nl/JonathanShedlerStudy20100202.pdf

Link to Shedlers article on effectiveness of psychodynamic therapy

Critical view of the study http://www.psychotherapybrownbag.com/psychothera / Inside Out and Outside In: Psychodynamic Clinical Theory and Psychopathology in Contemporary Multicultural Contexts Berzoff, Flanagan and Hertz (2011) 4/9/12