The Social Work Psychoanalyst's Casebook

Clinical Voices in Honor of Jean Sanville

Joyce Edward, Elaine Rose, Joyce Edward, Elaine Rose

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781134896219
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

The Social Work Psychoanalyst's Casebook begins with an interview with Dr. Sanville, who reflects on her evolution as a social work analyst, theoretician, writer, teacher, and leader. These reminiscences are followed by accounts of nine analytic treatments, each of which offers an unusual window into what actually transpired between analyst and analysand during the treatment hours. These case studies concern particularly troubled, often traumatized patients-the very "hard to reach" or "difficult to treat" clients with whom social workers have long been familiar. They include a reanalysis by the same analyst of a patient whose first therapy ended in a stalemate; an account of transference and countertransference phenomena during termination; a report on the analysis of a young woman who experienced both chronic and stress-related trauma; and an account of the special issues involved in the treatment of an aging woman. Most of the case studies reflect the influence of Dr. Sanville, whose work has long evinced the therapeutic imagination and disciplined creativity to which all the contributors aspire.

Tthe contributors to this volume offer the salutary reminder that analytic work is built on a relationship of respect and empathy and that treatment success follows from the therapist's willingness to accommodate the unique needs of individual patients. In honoring Jean Sanville, The Social Work Psychoanalyst's Casebook speaks to the robustness of a multidisciplinary approach to psychopathology that transcends the bounds of any single profession-an approach in which contemporary psychoanalysis is enlarged by the insights and emphases of social work just as social work is enriched by the clinical wisdom of psychoanalysis.

Chapter 1

Playing in Time and Space

An Interview with Jean Sanville

Interviewers: The Editors

Would you start by telling us how you were originally drawn to social work?

The simplest answer would be that I became a social worker as a route to becoming a psychoanalyst, but of course there is a longer answer. While still in high school, I found on my father’s bookshelf Karl Menninger’s The Human Mind. Being a bit worried about my own at the time, I read it cover to cover and was really turned on by psychoanalysis as he portrayed it. It looked as though the route would be through medical school, which did not appeal to me. But I was transfixed by some paragraphs that described a budding new profession, psychiatric social work. Menninger was declaring that it was no longer possible even to think of evaluating personalities broken by their efforts to adapt to their environments without considering the nature of the environmental factors. He advocated psychiatry’s turning to “young women” who would be especially trained to evaluate those factors. Moreover, he maintained, training in psychoanalytic principles would also “reanimate social work.”

I knew only one social worker, a friend of my mother’s from Goucher. Like most social workers of that era, she worked in a public agency offering services to the poor, and, in the course of telling me many stories about her cases, she declared that there were two prerequisites to being a social worker: “strong legs and a stout heart.” I did not doubt that I possessed both. But I missed something: her stories dealt abundantly with factors outside the person, and I could not see her clients in my mind’s eye so well as I could Dr. Karl’s, for his stories included the insides of his patients’ minds. Dimly I began to glimpse some possible combination of the socioeconomic and the psychological.

I went off to college assuming that the best major for me would be psychology. Alas, it was the era of operant conditioning, and each course was more disappointing than the last. We ran rats in mazes with no knowledge of their psyches other than that they would behave in ways that got them the rewards. Frequenting the library, I discovered the works of Margaret Mead and was fascinated with her Coming of Age in Samoa and Growing Up in New Guinea. And there too was George Mead and his Philosophy of the Act and his Mind, Self and Society. They wrote of real people, in different environments and with minds as well as behaviors. So I changed my major to sociology and actually ended up with a double major, though with decided preferences for sociology and anthropology.

In my senior year, through my library explorations, I learned of the Smith College School for Social Work and its psychoanalytic orientation. The school had been founded just a few years after some social workers who had heard Freud when he visited Worcester decided that his theories were the underpinnings that social work needed. I was excited to discover that something of which I had dimly dreamed actually existed: a profession that attended both to psyche and to social surround. I applied and was granted a scholarship and went there immediately after graduating from the University of Colorado at Boulder.

My teachers of theory were mostly psychoanalysts from the East Coast cities, and they were male physicians. I was stimulated by them, but ambivalent, for they often talked as though they had powers of divining the innermost motives of us students, entirely women at that time. To some extent, the casework teachers, all women, emulated their methods and often engaged in blank-page approaches to interviews, with an air of owning secrets not to be freely imparted. What saved us students was, I think, the incessant communication among us about ourselves, about the faculty, and about what we were learning and how. And we “got even” every summer by enacting skits in which we played one or the other of them, joked about their ways, their ideas. About the latter, we made up songs that to this day can come back to me. In short, we survived—and thrived—giving a humorous perspective to what was an immersion experience during those three summers.

Smith’s program has always been a “bloc” one; that is, between those summers in academia came nine months of field placement. My first was at Worcester State Hospital. Bernard Malamud and the psychiatrists were in charge, and we, the social workers, were their handmaidens. I lived with two other Smith students in the hospital, and our jobs entailed getting acquainted with patients who were deemed sufficiently well to go home on leave and to visit them subsequently to ascertain how well they were doing and what further help we might be to them. Here the “environmental” was clearly important. In those home visits, I realized the truth of needing “strong legs” and learned how complicated and difficult life could be for patients and their families; a “stout heart” did come in handy. But within this teaching hospital itself there was broad and deep learning to be had, particularly in the regular staffings of all patients and the discussions among all of us who had anything to do with them. The orientation then was mainly psychoanalytic but did not preclude attention to the part possibly played by the organic and by the sociocultural surround. There was ongoing research aimed at comprehending causative factors in schizophrenia. The library was excellent, and I read extensively in the analytic writings available.

My second year’s field work was in Family Service of Cincinnati, which was also strongly analytically oriented. There the social workers were in charge, and they brought in analysts to consult with us. We learned how to “take case histories” and to present them in staff meetings so that the analysts could be maximally helpful to us. I loved that setting, with its opportunity to work with persons in much better shape than those psychotic patients at Worcester and where social workers were the ones to have all direct contact with clients. We were the therapists and drew on psychodynamic theory in their treatment.

What was your pathway to becoming a social work psychoanalyst?

My first three positions were in family agencies. I started in Pittsburgh, where the attraction for me was that the agency was Rankian, a point of view scorned by the Freudians up at Smith, so I wanted to see for myself what it was. That year I concomitantly took a postgraduate course at the University of Pittsburgh, with Ruth Smalley as my teacher. She, who got her original training at Smith, enabled me to respect much of what the “functional” school had to offer. It differed, she thought, in its psychological base, operating not from a psychology of illness but from a psychology of growth, with an emphasis on the creative potential of the person. The client rather than the social worker was seen as the center of the relationship. The professional was to lend herself to the client’s growth purposes, rather than estimate the degree and kind of sickness he or she suffered. The Rankians explicitly defined the purpose of social work as social rather than individual. Smalley and her colleagues were critical of us in the “diagnostic school”; they claimed that we took too much responsibility for the cause and cure of social problems and ignored their complexities. Social work’s special contribution was the alleviation and prevention of social ills through participating in the forming of social policy, through the development and modification of social welfare programs, and though the use of its distinctive methods. I did quite a bit of debating with my teacher as to how real these differences were from what I had learned at Smith. I did not then foresee that the profession might eventually split, with one segment holding a philosophy somewhat akin to that of the Rankians, and the other, a clinical one, emphasizing the individual and the intrapsychic. I suspect that my year with Smalley rendered that split unlikely in my professional psyche!

After that year, I went to New York, where I accepted a position at the biggest “diagnostic” family agency in the country, the Community Service Society, on condition that they offer me psychoanalytic supervision in work with children. They did, and they gave me as supervisors Margaret Mahler and Marianne Kris, with Ernst Kris an occasional resource too. Mahler was then interested in autism and childhood schizophrenia, and I had child patients who qualified for such diagnoses. So I was getting closer to my dream.

My next move was to the West Coast, to a job with Los Angeles Family Service. Now I had a supervisor, Janet Nolan, who was also a graduate of Smith but who, unlike me, had had years of experience before undertaking graduate study. I also had an analyst as a regular consultant, Sam Futterman, still in Army uniform when he first began with us. In time, he moved on to be the Director of the then new Veteran’s Administration Mental Health Clinic and invited me to be a member of his staff. It was an offer I could not turn down, for nearly every analyst in town was serving there. We worked with patients with service-connected emotional disabilities, a lot of what we now call posttraumatic stress disorders. French and Alexander were prominent theorists in that period, and our whole staff experimented with implementing their “corrective emotional experience” and discovered both its possibilities and its limits. The clinic was a hotbed of analytic thinking. Enthusiasm and excitement were at a high pitch. Everyone from the top down was supervised; there were regular staff conferences; most of us were doing group as well as individual therapy.

So much did I love working there that I was almost sorry when Frederick Hacker, looking for someone to serve as head of child therapy in his clinic, somehow found me. He well sensed that the one thing not pleasing to me in the VA job was that no children had managed to become veterans! A big factor in my move was that Beverly Hills would be nearer to my home, and I wanted more time to be with my own child. Moreover, the Hacker Psychiatric Clinic was an outgrowth of the Menninger Clinic in Topeka, and Karl Menninger was a regular visitor, so it did seem as though fate had somehow decreed this! After some initial reluctance, in 1947 I took the position and stayed there for over a decade. In that clinic too everyone was a supervisor and everyone had a supervisor. Psychoanalysis was in its heyday; the demand was great. I got to design my own playroom, and I saw all kinds of children–some of the sort that Mahler had taught me about, very disturbed, long-term cases; others who could be treated with relatively brief therapy. And I saw adults, too, usually in intensive treatment. The clinical experience was rich; but, in addition, when I was made Chair of the Hacker Foundation for Psychiatric Research and Education, we brought analysts from all over the world to lecture and do workshops with us, and from them I kept broadening and deepening my knowledge of psychoanalysis.

For the first time, I could afford to seek analysis for myself. One obstacle had been that there were as yet relatively few analysts around, and, with most, I had worked or sought supervision, or both, or sat at their feet in workshops, or had treated members of their families, or had socialized. So when Milton Wexler moved to Los Angeles from Menningers’, I became one of his first analysands. I was somehow pleased that he was not an M.D. but that he was so outstanding that the American Psychoanalytic had awarded him full membership. (Some of my analyst friends made cracks about this entering into my choice.) To this day, I feel it was a good choice, and I am grateful to him. As we ended that analysis, he facilitated my separation-individuation not only from him but from the “family” at the Hacker Clinic.

In 1958 I left the clinic and went into private practice. But it was to be nearly another 20 years before I became an analyst. And those were full years: teaching at UCLA, founding the California Society for Clinical Social Work, founding and playing Dean to the Institute for Clinical Social Work, getting my own doctorate from International College. Then, in 1978, I joined with a group of psychologists who, frustrated by the fact that the American Psychoanalytic continued to refuse other than M.D.’s for training, formed the Los Angeles Institute and Society for Psychoanalytic Studies, the first group on the west coast to accept non-medical candidates. We had all been powerfully involved in psychoanalysis and had obtained our own training the “bootleg way,” each along somewhat different pathways. We simply appointed ourselves the training analysts and proceeded to develop an excellent training program.

But for recognition on the broader scene some aggression was necessary. In 1988, when the American Psychological Association sued the American for its policy of not admitting other than M.D.’s to training, I, as then President of LAISPS, was requested to testify in a fancy law office in downtown Los Angeles. I was cross-examined all day by an attorney for the American as to how I and others had been disadvantaged by the American’s exclusionary policies. As is now known, the case was ultimately settled out of court, and we were at last free to apply for membership in the International Psychoanalytical Association. That involved many site visits from the IPA. They examined our files, including the CV’s of us training analysts and the kinds of records we kept on candidates. They interviewed us individually too and met with all other members and students. They watched us in supervisory sessions and in our teaching. And, according to their own rules, they first awarded us provisional membership and then, in 1995, at the 39th International Congress in San Francisco, LAISPS was made a full constituent member of the IPA.

In what ways do you see your social work training and experience having affected your practice of psychoanalysis?

As mentioned, from my reading of Karl Menninger at age 14, the two were from the beginning linked in my mind. Because of my choice of Smith, with its strong analytic orientation, social work was psychoanalytic social work. When Joyce Edward and I gave a subtitle, “A Psychoanalytic Social Work Approach,” to the book we edited together, one colleague wrote inquiring whether we were inventing a new profession. For me, it was never otherwise. Although the analysts who taught me, both in school and later in agencies, emphasized the intrapsychic, the teachers in casework classes and the social work supervisors in the agencies showed me how what is outside gets inside and vice versa. And, in case I had any doubts, my experience with patients and clients regularly demonstrated the interaction between internal and external. I am pleased to report that I never succumbed to the notions once prevalent in the mental health world that schizophrenogenic mothers caused childhood psychosis. I could see that what was in certain children exerted adverse effects on parents; insides could also affect outsides. When I moved into the realm of child therapy, there was no question but that either a colleague or I would need also to work with the parents of the child/patient.

There is reason to think that psychoanalysts over the years learned a lot from the social workers whom they supervised. Good social work theory has always been bio-psycho-social, and there is reason to believe that analytic theory is moving rapidly in that direction. At the conjoint meetings of the IPA House of Delegates and the Executive Council in Buenos Aires in 1998, it was seriously proposed that analytic training needs a “fourth leg,” education about the importance of the sociocultural surround in which people are born, grow up, and now function.

Who are the persons who have had the most influence on your outlook on life in general and on the ways you practice psychoanalysis?

To begin with, there were my parents. Because of the sociocultural surround and perhaps the time in history, I had not only a mother but a father who played as central a role as she from my infancy onward. I grew up in a small community in Pennsylvania where my father was the only physician. His office was just a walk down our backyard to the next street. So, except when he was off delivering babies or making home visits to sick patients, he was home for meals, and, when he was not with patients, I could often be with him. That was not only desirable but necessary, since my mother, who had been a teacher and school principal, was frequently herself busy with her own activities–on the local school board, on the boards of various colleges in nearby cities, or managing some properties that were hers. So I often accompanied him when he had to visit patients in the surrounding county area, and I was sometimes privileged to witness his conversations with them. I could see that his patients respected him, even loved him, and I suspected that healing ensued not only from the medicines prescribed, but from out of the special relationships he formed with them. He and I had lots of opportunities for talking, too, on those trips, and I think he communicated both love and respect for me, perhaps sometimes giving me credit I had not yet earned for an intelligence beyond my years.

But the result was that this important other who was my father imparted to me a confidence that came in handy in life, a confidence that, although I might not know, I could learn. Dr. Bovard loved learning. He read avidly, not only about medical matters, but about everything, and he enjoyed discussing what he was taking “inside.” He spoke often of the miraculous ways that bodies tend to heal themselves, and of his job being to facilitate that spontaneous mending. I came to believe that psyches too tend toward self-healing and that the job of a clinical social worker or a psychoanalyst is to foster that “reparative intent,” as Joel Shor and I later labeled it.

My mother too had a love of learning. From early on I heard stories of her courses at Goucher College and of her ongoing friendships with women she had known there. It was she who, on finding that social work was of interest to me, invited a former roommate to visit us and tell me about that field. Her own interests were very much in education, and her many teacher-friends came frequently to visit and to talk with her about their problems, sometimes with students, sometimes with the system. I heard many of those conversations and could see both her identifications with them out of her own experiences and her ability also to offer an “outside” view. In recent years, I have been impressed with the importance of a focus not only on empathy but on alterity and have guessed that I witnessed samples of that dialectic in her way of helping her friends. Mother too liked to read, and dinner table conversations often included exchanges about what stories were preoccupying one or another of us at the moment. So from both parents I inherited a love of learning and an inclination to turn to books for knowledge.

I would mention too my maternal grandmother, who had also been a teacher. I attribute a lot of my own playfulness to having identified with her way of being in the world. Her husband, my grandfather, was an earnest and strict man, and yet she never seemed to experience any constriction within herself on account of him. I remember no dissonance between them; indeed I knew that love and respect went in both directions. But, confident that grandfather could fend for himself for a month or so, grandmother also did her own thing, for example, packing up my cousin and me and taking us in the summers west to Colorado, where resided three of her Swedish sisters. She had a great capacity for pleasure, and it was because of those fun- filled experiences with her on those trips that I fell in love with the Rocky Mountains and chose to go to the University at Boulder.

My supervisors at Smith also had a profound influence and during both years I also had abundant opportunity for consultation with analytically oriented psychiatrists, such as William Thomas Barton, and with analysts, such as Lewis Hill. After graduation it was possible in those days to choose jobs on the basis of the quality and quantity of supervisors and consultants who would be available. The most influential of these persons were not those who tried to have me emulate their ways of working, but those who skillfully enabled me to develop my own ways, as Ruth Smalley certainly did, and later Sam Futterman, Eugene Mindlin, and Frederick Hacker. I found myself with professionals who had no trouble discovering and respecting my apparently innate allergy to dogma; they put forth little that I experienced as authoritarian. Because I was blessed with such sensitive helpers, I probably did come to practice in their ways!

You have treated both children and adults. How might doing so ha...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Acknowledgments
• Contents
• Contributors
• From the President of the NMCOP
• Publications of Jean Sanville
• Overture
• 1. Playing in Time and Space: An Interview with Jean Sanville
• 2. The Opening Phase of the Analysis of Mr. B: A Dramatic Transference Phenomenon
• 3. Nobody's Baby: A Psychoanalytic Creation Story
• 4. Consideration of Constructs That Organize Clinical Data: Analytic Play, Analytic Surface, Analytic Space
• 5. A Woman of Her Time (Or Was She?)
• 6. Trauma, Transference and Healing: A Case Presentation
• 7. The Unstoppered Heart: The Awakening of the Capacity to Love in a Person with a Schizoid Disorder of the Self
• 8. Vacation Breaks: Opportunities for Partings and Reunions
• 9. A Case of a Stalemate Reversed: A Second Chance
• 10. The Patient, The Analyst, The Termination Phase: Transference and Countertransference Considerations
• Coda
• Index