Psychoanalytic Social Work: How to Do Things with Words and How to Say Things with Deeds

Abstract

This article reviews how psychoanalytic theory has described talking and action, especially talking in opposition to action. Starting with a paper of William “Bill” Meyer about psychoanalytic social work and using theories of the philosopher J. L. Austin and the psychoanalyst Thomas Ogden, the article questions an apparent dichotomy in psychoanalytic theory between speech and action. This apparent dichotomy has left reverberations for psychoanalytic social work that require further attention. Using a clinical vignette along with further contributions from the work of William “Bill” Meyer, the paper attempts to highlight and work through the tensions between interventions of word and interventions of deed and to develop a theory of “interpretive social work action.” The paper argues that the legacy of our theories may lead to unwitting exclusions within the field of psychoanalytic social work. It then addresses some implications for this field in general and for dynamically-informed clinicians in agency settings in particular.

Keywords:

• Psychoanalytic
• social work
• agency-based psychotherapy
• therapeutic change processes

Notes

1 I dedicate this paper to the memory of Bill Meyer, zikhrono levrakha, teacher, mentor, and friend.

2 The term tikkun olam, appearing more traditionally with the definite article as tikkun ha-olam literally means ‘repairing’ (from the Hebrew root t-k-n) the ‘world’ (from the Hebrew word olam). According to Gilbert Rosenthal (2005), the term is found in antiquity in the Babylonian Talmud, most frequently in tractate Gittin concerning the laws about marriage and divorce. There, as the phrase often refers to laws that are meant to protect the vulnerable, Rosenthal prefers “the improvement of society” as the best translation. Rosenthal notes that the term developed its more contemporary meaning when it appeared in kabbalistic texts like The Zohar. A famous understanding of tikkun ha-olam appears in the mystical writing of 16^th-century Rabbi Isaac Luria. These Lurianic ideas and their relationship to contemporary social work are summed up in a passage by Weinberg (2010): “In Jewish mysticism, there is a story that G-d attempted to fill a vessel (which represented order in the universe) with celestial light. The vessel shattered so that humans entered a broken world in which sparks of the divine were present. An essential responsibility is to use our own G-d-given radiance to gather up the broken bits through Tikkun Olam or repair of the world. Social work is one avenue for being involved in Tikkun Olam, and a fundamental component of that repair is to seek social justice.” (p. 134).

3 Freud wrote, “in his medical school a doctor receives a training which is more or less the opposite of what he would need as a preparation for psycho-analysis. His attention has been directed to objectively ascertainable facts of anatomy, physics and chemistry, on the correct appreciation and suitable influencing of which the success of medical treatment depends.” (Freud 1926, p. 230)

4 Flora Lazar (2022) has recently described this ongoing split. She says that the majority of University of Chicago’s Crown Family School of Social Work, students “pursue clinical work rather than careers more historically aligned with social work’s social justice roots. Indeed, this evolution from social work’s roots in fighting broad systemic oppression is so pronounced within the profession that scholars of the field’s history have referred to those clinicians as ‘apostates’ and ‘fallen angels’.” (p. 26). The history of social work training is a bit more complex. For example, Smith College School for Social Work began its training program in the summer of 1919 for the express purpose of treating soldiers returning from World War I who suffered from what was then referred to as shell shock and what would now be called combat‐related trauma or post-traumatic stress disorder. The school was first called The Training School of Psychiatric Social Work at Smith College.

5 Perhaps because of their own embarrassment, early psychoanalytic theorists focused on the intrapsychic to the exclusion of the socio-political context. Bigliani (2013) has observed that many early psychoanalysts were refugees who fled their countries, but not the shame both experienced and transmitted intergenerationally. A wish to forget the shame and humiliation they left behind resulted in an unconscious exclusion of external reality in order to ward off negative affects suffered in the past.

6 The Greek prefix epi- means ‘upon’ or ‘in addition to’ and so epigenetic refers to environmental factors that impact gene expression. Epigenetics studies how “various genetic traits might be turned on or off, and cells might read genes in different ways, due to different environments and experiences. In other words the genes we inherit do not change, but how they might be expressed does” (Music, 2017, p. 109). On the subject of epigenetic transmission, Graham Music has written, “If the mother’s state of mind is highly anxious then stress hormones cross the placenta and affect the unborn baby. Genetic inheritances alongside prenatal influences can lead some babies to be labile and hard to soothe, and others more robust and calm.” (2017, p. 3)

7 We know that agency-based social workers attend to more case management than just disability determinations. As Cushman has written, in community mental health settings, clinicians “are often the only ones holding their clients within a huge, unwieldy, and complicated structure and, as a result, are asked to fulfill multiple roles, including advocacy work and other case management-like tasks (Cushman, 2014, p. 67).

8 William Faulkner (1951/2011) Requiem for a Nun. Knopf Doubleday Publishing Group (2011, p. 73)

9 Breuer writes, “She aptly described this procedure, speaking seriously, as a ‘talking cure’, while she referred to it jokingly as ‘chimney-sweeping’ and that ‘the verbal utterance of her hallucinations calmed her…” (1893, p. 30)

10 She was even honored in 1954 in West Germany with a commemorative postage stamp.

11 I thank Dr. Harold Kudler for drawing my attention to a relevant paper by Kandel. Eric Kandel (1979) has identified a tension in psychiatry between the more “hard-nosed” biologically-minded and the more “soft-nosed” psychologically-minded. Yet cellular studies show us that biology and the brain and psychology and the environment are intertwined. Kandel writes “when I speak to someone and he or she listens to me, we not only make eye contact and voice contact but the action of the neuronal machinery in my brain is having a direct and, I hope, longlasting effect on the neuronal machinery in his or her brain, and vice versa. Indeed, I would argue that it is only insofar as our words produce changes in each other’s brains that psychotherapeutic interventions produce changes in patients’ minds. From this perspective the biologic and psychologic approaches are joined.” (1979, p. 1037) The hard-nosed approach and the soft-nosed approach are thus only apparently in opposition or tension, according to Kandel.

12 I myself often felt paranoid and helpless in my countertransference with Carin. In addition, I sometimes felt helpless within the agency and social service systems for many reasons, including the size of my caseload and the fact that provisions of help seemed to me to be too connected to proving one’s disability.

13 “I once said: ‘there is no such thing as an infant’ meaning, of course, that wherever one finds an infant one finds maternal care, and without maternal care there would be no infant.” (Winnicott, 1960, p. 587)

14 Certain babies suffer more than severe failures in containment in early life. They experience themselves as the recipients of parental projections. Patients with this history will feel at risk of being psychically invaded by others and may view others as “projection-rejecting objects.” I think their hope for emotional communication in relation to an available and receptive interlocutor is impacted as well. For more on the dynamics of projection-rejection see Gianna Williams, 1997).

15 For a slightly different way of conceptualizing no-show appointments, see Kwintner 2011.

16 Bill Meyer designed an introductory course in theory and technique at what was then called Psychoanalytic Psychotherapy Study Center of North Carolina and what is now part of Psychoanalytic Education Center of the Carolinas. He and Harold Kudler taught this class together for many years.

17 Enrique Pichon-Rivière was a groundbreaking Argentinian psychiatrist and psychoanalyst who wrote in Spanish in the middle of the 20^th century. His work has not been widely read among English-speaking practitioners, but fortunately English translations of his papers were published in 2017 (Losso et al., 2017). Pichon’s thinking is quite relevant for the psychoanalytic social worker and the social worker psychoanalyst because his ideas never isolate the intrapsychic from the interpersonal nor from the social. According to Pichon, individuals are born into and constituted by social bonds. His theories could provide a solid foundation for a social psychoanalysis, to be included in the education of the psychoanalytic social worker of the future.

18 ‘But that can’t be true,’ one of us objected, ‘it contradicts the Young-Helmholtz theory.’ He did not reply ‘So much the worse for the theory, clinical facts come first’ or words to that effect; but he did say something which made a great impression on us: ‘La théorie, c’est bon, mais ça n’empêche pas d’exister.