Psychoanalytic Social Work

Practice, Foundations, Methods

Michael Gunter, George Bruns, Harriet Hasenclever

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429918063
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book represents the first systematic account of the theory and practice of psychoanalytical social work. For students and those entering the field of social work who are interested in psychoanalytical social work it offers an overview of the diverse fields of practice of psychoanalytical social work and combines this with a description of its history, relation to other areas of social work and relevant psychoanalytical theories. The authors are convinced for this reason that both for students on degree courses as also for social workers and social education workers in further training the book offers an important contribution and fills a gap in this field. Equally, it addresses practising social workers, social educationalists, psychiatrists or psychotherapists offering comprehensive insight into this particular form of social work for those working in centres for counselling or early intervention or in social paediatrics.

CHAPTER ONE

Social work and psychoanalytic social work

The term “psychoanalytic social work” links two disciplines of an apparently contradictory nature. “Psychoanalytic” refers to a methodical, reflective procedure for uncovering unconscious impulses, connections, and meanings in which the analyst refrains from active or direct interventions in the life of an analysand. So this method confines itself to helping analysands to recognise and understand the unconscious factors influencing their inner life and social interactions. This enables them to make decisions and act in ways that are more mature, independent, and less predominantly fashioned by the unconscious. Psychoanalysis is concerned with a person’s unconscious inner world and with the confrontation of this inner world with external reality.

As it is usually understood, social work, by contrast, very much involves “stepping in” to regulate and help in the external world. It seeks to influence external reality at least as regards the crippling, external, and above all material situation of people who have landed in distress. The combination of psychoanalysis and social work is rare in Germany. There may well be many social workers and social pedagogues who are inspired by psychoanalytic ideas but an organisation of social work that takes psychoanalytic principles into consideration only exists in very few places. One example of organising social work on a psychoanalytic foundation is found in the Association for Psychoanalytic Social Work in Rottenburg and Tübingen, whose work is described in detail in Chapter Fifteen of this book.

Before embarking on an examination of what psychoanalytic social work is we feel it makes sense to give a brief outline of the spectrum of social work.

Social work—areas, developments, trends

There is a fair degree of haziness about the term social work and no consensus on its definition so we would like to preface further thoughts with a few comments on the original conceptions and on the development the term has taken. This includes its latest redefinition, recently marked in Germany by the renaming of Sozialarbeit as Soziale Arbeit (a little linguistic shift which is hard, or even perhaps impossible, to translate into English) as the field of practice of a postulated science of social work (Sozialarbeitswissenschaft).

With Soziale Arbeit two main areas are covered, namely social work as it has developed from “a history of care for adults” (Schilling, 2005, pp. 17 ff.) and social pedagogy which has arisen from “a history of care for young people” (Schilling, 2005, pp. 59 ff.)

Discussions in academic circles see the current position of social work as much affected by the fact that the decades in which national resources were channelled into the social sector in a continuously growing quantity are obviously now over (cf., e.g., Butterwegge, 2005; Krüger & Zimmermann, 2005; Sorg, 2005). So what was an astonishing expansion in staffing in the area of social work is presumably a phenomenon of the past. There was a tenfold increase in the Federal Republic from 24,800 welfare workers in 1950 to 235,000 social workers and social pedagogues in 2003 (Amthor, 2005, p. 45).

Nolens volens, whether we welcome this or not, in view of the straitened finances of the present day, suggestions are being made on how to make the best out of limited means. Spatschek (2005) for instance speaks of a “professional modernisation” which would consist in making programmes available to clients encouraging activity—following, for instance, the Scandinavian path from “welfare to workfare". The social work of today, according to these ideas, needs to concern itself with the consequences of modernisation and will necessarily bear some postmodern traits. It is bound to suffer from ambivalence over whether to help or not to help, whether to support Lebensweltorientierung—orientation to the client’s environment, or to economise, and whether to foster individual responsibility or to emphasise societal cohesion.

One solution is seen in systemic case management (Kleve, 2005). Another, in a rather different approach, is the propagation of the idea of working in the client’s real-life social network which aims to mobilise the latent resources to be found there (Kruse, 2005). An example of this is eco-mapping or genogram work that traces forgotten social and family relationships which can be reactivated (Budde & Früchtel, 2005). And a further suggestion is to combine individual casework with orientation to other networks (Klawe, 2005).

A second important question is that of the scientific-academic status of social work studies. It is true that with the Europe-wide changeover in all university courses to the bachelor’s and master’s model there are hopes of recognition for social work studies as a fully-fledged academic discipline. Greater social recognition of social work might at long last meet the wishes of the professionals in the field as they have so far generally seen their work ranked below its true value. There is, however, a prevailing uncertainty over its scientific and theoretical base—is it a practical science, a science of social action, a hermeneutical or a normative science? Anything seems imaginable (Birgmeier, 2005; Schlittmaier, 2005).

The research activities of a discipline give an indication of its current fields of interest and pointers to future fields of work. At a congress of the Deutsche Gesellschaft für Soziale Arbeit (German Association for Social Work) (DGS) sixty-eight research projects were presented in twenty-seven workshops (Engelke, Maier, Steinert, Borrmann, & Spatschek, 2007). Fourteen workshops, that is very nearly half of them, were concerned with topics generally requiring the setting up and shaping of a longer-term relationship with clients as opposed to one-off or isolated technical aid measures.

The topics of these workshops ranged from “The Life of Older Women” through “Violence and Prevention”, “Children in Nurseries”, “Foster Families and Upbringing in Children’s Homes”, and “School Social Work”, to the social-medical (severely ill patients, social psychiatry, addiction) and psychosocial themes (“Coping with Difficult Biographies”). This preponderance of relationship-based fields of activity points to what qualifications are required in the social work professions, namely those that train students to be able to take on long-term relationship work.

The question “Is there a theory or science of social work?” (Erler, 2007, pp. 115 ff.) is still debated. It is part of a debate on professionalisation which is connected with the progressive fragmentation of the fields of practice, the relatively brief history of the profession as such, the various different historical origins, and the many theoretical approaches balancing uncertainly between a critical and a conformist stance (cf., e.g., Bielefelder Arbeitsgruppe 8, pp. 147 ff.; Heite, 2008; May, 2008, pp. 69 ff.).

It is helpful in this general discussion to focus on the fields of practice of social work and the methods used there. Discussing the major fields of work, Chassé and von Wensierski (2004) talk first about work with children and young people, covering a wide spectrum from early intervention, nursery school, culture, school, and juvenile court work, to work in parenting and family support, care of old people, support of women and the women’s movement, and questions of disadvantage and poverty in the social state. They also describe a number of specialised areas: sexual counselling, social work in the health system, social psychiatry, drug addiction, and migration.

Galuske (1998) describes nineteen methods in social work, among which are social pedagogic counselling, multi-perspective case work, case management, mediation, reconstructive social pedagogy, family therapy, theme-centred interaction, empowerment, street work, orientation to environment, also known as person-in-environment-perspective, and supervision and planning of young people’s services. Here the range of methods covers a great variety of approaches, marked by distinct contrasts.

As regards work with the clients there seem to be two prevailing tendencies: 1. towards an indirect form of work with them in which they are regarded as part of a network which is given the task of finding a solution, and 2. towards keeping support as short-term as possible where the professional is regarded as merely providing the initial impulse for the client’s own activities and for those of his network. Both may easily be combined with the systemic thinking which has become widespread in social work over the last ten years. Sozialraumorientierung (Früchtel, Budde, & Cyprian, 2007)—orientation to environment—with its SONI formula (social structure, organisation, network, individual) seeks to combine the two, naming four strategic points for the application of social work intervention. Working with this approach, it is not a question of offering technical aid, for instance an aid plan orientated to “the ideal of a good citizen” (p. 18), neither is it about a “psychosocial diagnosis” (ibid). The aim is to make the most of opportunities and situations. The hope is that changes will arise from a “situation analysis”, intended to trace “situational potential” and lead to “situative efficacy” (p. 21). One outcome of the person-in-environment-perspective is intended to be the discovery and, if need be, the creation of contexts and contact structures (p. 25) out of which new situations and opportunities can emerge. The example given, as illustration, is of a guard dog which does not bark and so fails in its task. Its situational potential could be exploited with a warning sign: “Beware of silent dog!” (p. 22). Paradoxical intentions of this kind, however, presuppose the presence of reasonably well-functioning social and/or interpersonal systems if any systemic interventions are to become effective.

In more than just a few cases, however, there is no longer any functioning system available to clients, either of family or of friendship or even of a professional-governmental kind. Little Kevin from Bremen (Mäurer, 2006) is a case in point: he and his drug-addicted stepfather were well known to the social services but he did not receive help from the social services or from the neighbourhood or from any family circle that might have saved him from lethal abuse by his stepfather.

On the relation between social work and therapy

A number of factors have led to an increasing use of methods adapted from therapy in social work and social pedagogy: one, as mentioned above, is the number of clients who lack any kind of social resource; a second, as Galuske (2007, p. 132) points out, is the 1970s critique of methods in social work; and a third, we feel, is the expansion of the areas of social work practice since the 1970s when a turn to psychosocial thinking emerged following the establishment of a new Medical Licensure Act (Approbationsordnung) which covered the syllabus and qualifications for doctors of medicine. This was also the period when social therapeutic institutions were planned as an alternative to prison sentences and when socio-psychiatric ideas and structures became prevalent.

However, with the adoption of therapeutic methods, social work is in danger of losing touch with the everyday world and the social environment of its clients, for therapy is always carried out in a special space set apart from everyday life. The classic field of social work is giving aid to people in need as a result of outward circumstances whereas the focus of therapy is people’s inner state of need, their suffering through their mental and emotional disorders, and in simply being who they are.

Galuske is not wrong to emphasise the differences between social work and therapy (pp. 136 ff.).

On the one hand you have the great complexity of social work orientation to the client’s everyday world and environment; on the other, the centring of therapy on specific areas such as perception, communication, emotion, and self-control; or again on the one hand there is the direct action taken by social pedagogue and social worker in the client’s everyday concerns, and on the other the quiet of therapeutic “action” in a situation apart from the everyday; in the one field there are the social work interventions targeted to current visible, tangible everyday problems, and in the other the far-from-everyday interventions of therapy tied to a specific setting.

And there is the contrast between the clients of social work with everyday problems and interests in receiving social support and tending on the whole to belong to the lower classes, as opposed to patients in therapy with mental and emotional problems and a tendency to belong to the middle classes. In actual fact, in practice, many patients who are also clients of social aid systems benefit greatly from therapy so that we cannot agree to this last distinction which seems to wish to reserve access to therapy largely to the middle classes. Galuske is right that it makes sense to differentiate between social work and therapy—although above all in work with children and adolescents it is hard to see where the line between social pedagogic interventions, measures to foster development, and therapeutic interventions can be drawn (cf. Chapter Five). A further crucial difference can be added to those identified by Galuske, namely that the suffering which is the precondition for therapy is inner mental-emotional disorder, whereas the source of the suffering which is the precondition for social work is the outward circumstance of privation.

While it is true that both can be present, requiring effort from both systems of support, yet material want alone will seldom produce mental-emotional illness except in the case of traumatic experiences. On the other hand mental-emotional illness can well bring on serious material distress. In this case, too, both social work and therapeutic effort are required. In our view the perception of social work as shown in Galuske’s analysis restricts it too much to material living conditions. There is a long-established and recognised connection between pauperism (in the sense of institutionalised poverty, poverty over a person’s whole life and in some cases over generations) and mental-emotional illness. Mental-emotional suffering, as we see it, is one of the important areas of concern for social work.

As already mentioned in the examination of research topics, the methods and areas of practice which are increasingly coming to the fore are those which demand work on and with the relationship to the clients. This is reflected in the corresponding publications. Schaub (2007) describes theories, methods, and areas of practice of clinical social work, Denner (2008) social work with children with mental-emotional disorders, Kuhles (2007) social pedagogical “ways out of isolation” for autistic children and adolescents. Ortmann and Röh (2008), too, have edited a collection of essays on clinical social work, Lützenkirchen (2008) writes on social work concerned with depression in old age, Speck (2007) on school social work.

Work in and through relationships forms an important part of the various approaches in the publications mentioned and is clearly, as in Schaub’s writing, informed partly by psychoanalytic concepts but, in addition, there are also a number of publications which are explicitly concerned with the relation between psychoanalysis and social work. May (2008) devoted a chapter to psychoanalytic social work in his book on current theoretical social work discourses. He did not however mention any of the many publications from the members of the Association for Psychoanalytic Social Work in Tübingen, nor Stemmer-Lück’s book (2004) on “Spaces for Relationships in Social Work” which is exclusively concerned with the relationship between psychoanalysis and social work and the possibility of using psychoanalytic theories in social work. One special issue of the journal Kinderanalyse entitled “Psychoanalytic Social Work” (no. 1/14:2006) outlines the subject of psychoanalytic social work in a series of contributions (August Aichhorn, 2006; Thomas Aichhorn, 2006; Bruns, 2006; Feuling, 2006; Gunter 2006a). We see all these publications as pointing to a growing need in social work for an approach such as those which psychoanalysis and its perceptions can offer to the problems that emerge in work with clients, an approach needing and using the relationship with the client. Psychoanalytic social work is an application of psychoanalysis in the social area and this is one of the three major areas of its application alongside the clinical and the cultural. Its application is appropriate when in addition to an external situation of destitution or neediness there is a serious mental-emotional or interactional disorder, in other words in a doubly problem-laden combination of outer and inner need which cannot be overcome with the use of technical-instrumental forms of aid alone. It can be performed by all professions in the psychosocial field—social workers, social pedagogues, psychologists, doctors, teachers, nurses, and others. Psychoanalytic social work combines instrumental help with the deliberate use of the relationship to the client. Using the relationship refers to being aware of latent and unconscious elements in the relationship, regarding them as non-verbal statements about the client and the intersubjective combination. Using also refers to taking these into consideration in the planning of help to be offered. At the visible level, relationship is seen as meaning the committed character of a contact, communication, and understanding. At a latent and partly unconscious level, relationship means giving the other person significance.

To allow oneself to be involved in this way in a relationship is no easy thing, for we often sense intuitively very early on in a contact whether the relationship with this person is going to be fairly easy or whether it is likely to become complicated, burdensome, and taxing.

We often have a spontaneous defensive reaction to a relationship that could become complicated and demanding with the result that we avoid entering the relationship altogether. This can easily happen particularly with patients or clients who suffer from narcissistic disorders because they almost always have a pathological manner of shaping relationships. Some therapy concepts in the psychosocial area, such as the therapeutic chain in social psychiatry, have developed from therapists’ unconscious wish to protect themselves from taxing relationships (Bruns, 1998). In the therapeutic chain as soon as patients have developed a relationship for a certain time and are feeling better they are moved on to the next station in the chain. In this way the difficult and burdensome aspects of the relationship are not worked on. This practice, like a number of others, represents a form of institutionalised defence against relationship.

The element of setting up and using a relationship in work with clients makes it clear that psychoanalytic social work is hardly likely to be attempted if only brief, one-off contacts with clients take place. It requires a setting in which help or support is offered for a medium or longer period of time. Two examples follow.

The long-term care of an adolescent

Bob is a member of the group in a group home run by the association Verein für Psychoanalytische Sozialarbeit in Rott...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• FOREWORD
• INTRODUCTION
• CHAPTER ONE Social work and psychoanalytic social work
• CHAPTER TWO On the history of social work and psychoanalytic social work
• CHAPTER THREE Psychoanalytic theories, methods, and concepts
• CHAPTER FOUR Areas in which psychoanalytic social work is applied
• CHAPTER FIVE Psychoanalytic social work in the wider context of social and therapeutic assistance: points of contact and differences
• CHAPTER SIX Psychoanalytic social work and mediation
• CHAPTER SEVEN Psychoanalytic social work in day nurseries (day care centres), early education, and early intervention
• CHAPTER EIGHT Social work in real space and work on inner processes and structures
• CHAPTER NINE Setting and adjustment of the framework to the needs of the client
• CHAPTER TEN Transference—countertransference—“scene”—the enactive domain
• CHAPTER ELEVEN Cooperation relations in psychoanalytic social work (interagency working)
• CHAPTER TWELVE Cooperation relations with the institutions carrying the costs of social work
• CHAPTER THIRTEEN Supervision
• CHAPTER FOURTEEN Quality and qualifications
• CHAPTER FIFTEEN Psychoanalytic social work in practice at the Verein für Psychoanalytische Sozialarbeit Rottenburg/Tübingen
• GLOSSARY
• REFERENCES
• INDEX