Holding Multiple Perspectives in Mind: The Dialectics of Contemporary Clinical Practice

Abstract

In this paper, we explore the dialectical nature of psychoanalytic social work practice and the benefits - theoretical and clinical - of doing so. We posit being mindful of the dialectic 1) aides us in our effort to identify and speak to differing themes, each of which is understood to be a piece of glass in the mosaic that is the totality of the client’s experience as a human being, 2) enhances our awareness of what might be going on in the clinical moment, particularly the shared ­experience between client and clinician, and 3) facilitates holding multiple perspectives in mind. On the other hand, non-­acknowledgement of the dialectical nature of our theories and interventions seems linked with moments of clinical impasse and fuels the false dichotomies that often confront psychoanalytic social workers, individually and collectively. Appreciation of the dialectic can help us overcome these challenges and enables us to conceptualize our work as a process of becoming, which we see as highly relevant to clinical work with pressing contemporary issues such as trauma, diversity, and the theme of access. We demonstrate these claims through two vignettes, one explicitly clinical and the other an example of contextual factors affecting practice, to show how dialectical thinking allows for a deepening of things both inside and outside the consulting room.

Keywords:

• Dialectic
• clinical impasse
• false dichotomies
• evidence based practice