23 Mar 2015 05 May 2017
Social work involves working in profoundly emotional events in people's lives, its practice is demanding and challenging and perhaps one of its most unique qualities is the balance it holds between understanding and working with the internal and external realities of service users (Bower, 2005).
In 1935, Charlotte Towle, a pioneering social worker, deeply influenced the profession recognising that social workers needed to secure knowledge of human behaviour to understand service users. She distinguished between knowing people and knowing about people, suggesting the core of social work to be the interaction between the service user and the social worker (Towle, 1969). More recently, literature has expressed a continued relationship based approach to social work, which emphasises the importance of the social work relationship and the quality of the social work experience provided (Trevethick, 2003, Howe, 1998). Understanding how to best facilitate relationships and work with service users requires acquisition of knowledge from a range of disciplines, theories and skills (Strean, 1978, Hollis, 1964).
Trevithick (2000) discusses that the insight derived from psychoanalysis, the psychodynamic approach and its theories on the unconscious can assist the social worker in offering a framework for understanding complex human relationships. The approach has had a major impact on social work's development as theories on the unconscious have impacted on ways of working with service users (Pinkus et al, 1977)
The psychodynamic approach derives from Sigmund Freud's psychoanalysis, a method of inquiry, theory of mind and body of research. Contrary to the prevailing thought at the time, where the assumption of psychology was that human behaviour was rational and the key to understanding human behaviour was to focus upon human consciousness, Freud (1936) believed that human behaviour was irrational and much of our personality, motives and behaviour were unconscious. Central to Freud's theories was the idea that certain experiences during childhood that are too painful to remember and are unconsciously repressed. According to Freud, these repressed thoughts give rise to states of anxiety or depressions which can be expressed in physical symptoms (Freud, 1986).
In the 1920's social work practice shifted dramatically as they began working in hospitals and clinics, extending their exposure to psychiatric thinking (Goldstein, 1995). In a publication in 1940, Annette Garret became one of the first social work authors to comment on the impact of Freud's work on social work theory and practice, advocating for psychoanalytical ideas to be used by social workers (Brandell, 2004).
Freud and his colleagues came to realise that symptoms, such as depression, anxiety and other psychological disorders could be expressions of unconscious conflicting impulses and unresolved issues (BPS, 2007). They explored the idea of transference, the projection of unconscious feelings of unresolved issues from the service user onto the worker. The issues were connected to significant others in their past. The service user experiences the worker through this lens and sees the worker as if he or she is the person from their past. The unconscious remembers feelings from the past and projects them into the present. The feelings from service user to the worker are the transference and the workers feelings towards the service user are the counter transference. Freud noted that transference and counter-transference were experienced in the therapeutic relationship (Freud, 1986). This notion has implications for social work in that it allows the social worker to be aware of his/her unresolved issues that may impact on the working relationship with a service user and also allows the social worker to be mindful of hoe the service user is viewing the working relationship. Payne (1991) discusses how a social worker's unconscious feelings can be awakened while working with a service user who perhaps reminds him/her of an experience or time in his/her own life.
Freud's theories relating to the unconscious show that rational human choice may be overridden by our unconscious inner conflicts (Brandell, 2004) and can aid us in understanding human behaviour. The theories encourage social workers to have an open mind when working with distressed service users, enabling them to individualise the person in their environment, suggesting that each service user is unique in personal experience, strength and weakness (Strean, 1993). Transference and counter transference recognise that both service users and social workers are human beings and that to work effectively together involves acknowledging the emotions associated with all relationships (Trevithick, 2000).
Schon (1983), Fook and Gardner (2007), Thompson and Thompson, (2008) advocate the importance of being a reflective practitioner. I feel that the psychodynamic perspective can assist social workers in acquiring the self knowledge it takes to become reflective. Trevithick (2003) describes this self knowledge as being what we learn about ourselves over time, including practice wisdom, our ability to be honest with ourselves about strengths and qualities while at the same time accepting our limitations.
However, Freud's theories have their limitations in respect of social work practice. As Freud used non scientific methods in his research, it is difficult to prove or disprove his ideas. Freud did not have any concrete data, but undertook many individual assessments, mainly with older upper class women and for this reason, his work is considered sexist (Mitchel, 1974) and also euro and ethnocentric (Robinson 1995, Trevithick, 2000) as the studies on white populations. Fernando (1991) suggest that Freud saw other cultures as primitive in comparison to western white society implying a racist slant and Strean (1979) goes further to state that Freud had limited cultural assumptions and deviations from this cultural norm were considered abnormal and worthy of his treatment. However, in spite of this, Cameron (2006) points out that the psychodynamic approach has been taken up in many cultural contexts, most notably in Latin America, India and Japan.
In light of criticism, however, the psychoanalytical concepts put forward by Freud and developed by later analysts have enriched our knowledge of mental functioning and human relationships and informs the relationship aspect of social work. It not only assists in informing the social work/service user relationship but also the relationships that service users have had in the past, experience in the present and will have in the future. Social work is about working with people and the psychodynamic perspective brings an extra skill of awareness into the mix.
Freud began to understand, through this stage development theory for children, that the child's relationship to parental figures is the prototype for all subsequent relationships in the child's life (Freud, 1986). These can involve emotions such as rivalry, jealousy, guilt, love and hate. Freud felt that our sexuality began at a very young age and developed through various fixations. If each stage was not completed, we would develop an anxiety and late in life a defence mechanism to avoid that anxiety (Freud 1986). Freud developed the first stage development theory which acknowledges the issue of attachment between mother and child, a theory which later would be developed by other psychoanalysts and disciplines. The traumatic effects of prolonged separation between mother and infant are widely recognised today and this has led to radical changes in the management of children in hospital (BPS, 2007). Later followers of Freud, such as, Erik Eriksen and John Bowlby, came to realise, particularly through their work with children, that experiences of early infancy, though lost to the conscious mind in adulthood, nevertheless live on in the unconscious and continually affect and shape relationships and behaviour in everyday life (BPS, 2007).
Bowlby (1951) developed Freud's theory, agreeing with Freud's emphasis on the importance of the child's attachment to the mother as a basis for later emotional relationships. His attachment theory describes how our closest relationships begin in infancy and set the stage for subsequent development. When the relationships are secure, they promote self reliance, confident exploration of the environment and resiliency in dealing with life's stresses and crises. Lack of secure attachment can lead to emotional problems, difficulty relating to others and a vulnerability to psychological distress (Sable, 2004, Bowlby 1951).
Bowlby believed that a mother inherits a genetic urge to respond to her baby and there is a critical period after the baby is born during which the mother and baby form an attachment. One of the most controversial aspects of Bowlby's theory was the claim that babies have an innate tendency to become attached to their primary caregiver, usually the mother, and that this attachment is different from other attachments. Any disruption of this bond in this period can have serious long term consequences. This has been criticised by other theorists who state that the attachment does not have to lie with the mother, it can be with any care giver (Schaffer & Emerson, 1964).
Mary Ainsworth, a psychologist devised a laboratory experiment called the "Strange Situation" (Ainsworth, 1978) which showed that Bowlby's evolving ideas could be tested and given a research base. A baby was observed in a set of seven situations, with the mother, with the mother and a stranger, with just a stranger and on its own. The baby's reactions were observed (Ainsworth and Bell, 1970). Ainsworth found that psychological health is related to the positive quality of these attachment experienced, both present and past and the personal meaning attributed to them. Psychological distress is perceived as a distortion of the attachment systems and symptoms of anxiety, depression or anger reflect the internalisation of adverse affection experienced resulting in dysfunction (Sable, 2004). The behaviour of the parents towards the child, whether they are sympathetic and respond to the child's needs is important and according to Ainsworth, the more parents accept the child on the child's terms, the more securely attached the child is (Ainsworth and Bowlby, 1965).
In applying Bowlby's theory to social work, we can see how social workers can construct an understanding of service users' early lives and guide managing the relationship in the future (Sable, 2000). Bowlby (1982) proposed that children internalise the relational experiences with their primary care givers during their first year and develop internal working models, which help to predict and understand our environment. The bond that we create with our primary care giver shapes how we respond to others in later life (Bowlby, 1982). Studies from Ainsworth (1967) and Ainsworth et al (1978) support this theory. In social work with children, it is common to see a child's challenging and disruptive behaviour being understood as an attempt to test whether adults are reliable or consistent than previous ones (Payne, 2005). The psychodynamic approach offers an explanation for relationship behaviour in the service users we work with.
Bowlby's attachment theory and the concept of resilience has also been used in social work with children to achieve positive outcomes for looked after children where care provided to looked after children aims to provide a secure base, self esteem and self efficacy (Gilligan, 1998). The policy document, Caring for children away from home (DoH, 1998) explains that children in the care system will often have had a long history of family problems and an emotionally turbulent life, leaving their personal development damaged and their capacity for basic trust in people severely compromised. This document highlights that social workers will have to work with service users who display patterns of insecure attachments. The ability for carers to provide secure attachment and emotional warmth is part of policy guidance in the Framework for the Assessment of Children in Need and their families (DoH, 2000). Bowlby's attachment theory allows social workers to make the link between emotional development, behaviour and the quality of relationships with their carers (Trevithick, 2000). Howe (2000) states that attachment theory can guide and inform social work interventions with children. It can act as a framework of theory and patterns of thinking.
Bowlby's attachment theory can also help social worker's make sense of the way in which service users engage with services. Most social workers have worked with service users who say that they would like support but cannot make use of the services on offer. This difficulty can indicate experience of distress in early childhood and can be understood in terms of their history of attachment bonds (Howe, 1999). Some service users seek to exert control in the relationship with a social worker, perhaps refusing support or making unrealistic demands. Social workers could view this as the service user being difficult or alternatively with consideration to attachment theory this could be understood in terms of the service users previous experience of rejection from their carers which has left them cautious of accepting help (Trevithick, 2000).
In critical analysis of attachment theory, Schofield and Beek (2006) explain that although attachment theory can offer assistance, service users lives need to be considered uniquely, drawing on their wider environment, education, experiences of racism and economic background. For example, attachment to carers is central to working with looked after children but must be understood within a range of other factors (Schofield and Beek, 2006).
It can also be argued that attachment theory does not incorporate enough consideration of issues of oppression that result from differences of race, gender, culture, sexuality and social-economic factors (Milner and O'Byrne, 2002). In a society where due to globalisation, colonisation, immigration and asylum seekers, families are having to travel great distances to secure attachments, Bowlby's eurocentric theories do not go far in explaining cultures or social work from a black perspective (Robinson, 1995).
This highlights again that psychodynamic thought should not be used in isolation. Human nature is such that no one theory can account for the infinite range of difference amongst individuals. For example, difference in learning abilities and other problems in development such as autism can be mistaken for attachment disorders if examined in isolation (Rugters et al, 2004)
The central ideas of the theory used today are that the quality of close relationships (or attachments) has a bearing on personality, emotional and social development not only in childhood but across the lifespan (Howe, 2001).
In conclusion, it is evident that there are weaknesses to a psychodynamic approach in social work. Theories of the unconscious can partly explain human behaviour but it fails to take into account environmental, social, economic factors and issues of culture and race. It is also deterministic in its approach and does not leave much room for agency and change. However, there is not just one body of knowledge used in social work practice. Social work knowledge is derived from different approaches but what they all have in common is that they do not originate from or are specific to social work itself, recognising that social work theory is a political and social process (Payne, 1997). Briggs (2005) states that the overall the contribution of psychodynamic research is to bring in another point of view which enhances the reflective psychosocial space in which social work takes places. Psychodynamic insights can in part assist the social worker in the difficult and complex human situations in which they are involved.
As a core component of social work, the ability to respond to people's emotional needs, to their impulse for emotional development and to the difficulties they experience in forming or maintaining relationships, the psychodynamic perspective can assist in giving us another point of view.
In terms of recent policy, high profile investigations since 2000 have highlighted the importance of effective relationship building in social work ( Laming, 2003 and Laming, 2009) These cases have caused nationwide concern beyond the professions and services involved, causing a frenzy of media comment and public debate, putting the social work profession under the microscope. Social workers need good observation and analytical skills in order to be able to understand the nature of the relationship between a parent and child, to understand signs of noncompliance, to work alongside a family, and to come to safe and evidence-based judgements about the best course of action (Laming, 2009).
As social work continues to be very much under society's microscope, it is essential that it encompasses a body of knowledge from a wide variety of disciplines, always remaining open to new theory and knowledge while considering perspectives from other professions.
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