The Politics of “Twoness”: Policy, Clinical Judgment, Relationship, and Evidence-Based Practice

Abstract

North Carolina has designated its mental health policy as “evidence-based practice” (EBP). The role given to the social worker in this policy is an example of one approach to relationship identified by Carol Gilligan (1993) and Jessica Benjamin (2004), which the latter termed “complementary twoness.” From this position the social worker's clinical judgment is seen to be potentially harmful to the client and thus must be mediated by a more objective means. An alternative position exists in which the relationship between the clinician and client can be understood to be of vital importance. Rather than attempting to mediate this relationship because of the inherent danger, thirdness calls upon us to elevate this relationship and the clinical judgment that is the result of the connection. In this article the authors deconstruct the current social work practice of EBP and policy guidelines in the light of the very nature of therapeutic relationship and latest research on neuroscience.

Keywords:

• evidence-based practice
• intersubjectivity
• mental health treatment
• clinical judgment
• thirdness
• mental health policy

Notes

1. Medicaid is a means-tested program in the United States for health and mental health care. The program is administered by individual states. Funds come from both the state and Federal government.

2. The authors recognize that there are circumstances in which the clinician must “do to” the client; for example, when there is an imminent threat of harm to self or other. We contend that these circumstances are limited and carry the burden of justification.