Clin Soc Work J DOI 10.1007/s10615-007-0078-4
ORIGINAL PAPER
The Use of Self from a Relational Perspective Carol Ganzer
Ó Springer Science+Business Media, LLC 2007 Abstract This article explores the implications of a contemporary relational perspective on the use of self in social work practice. The author is responding to an article by Andrea Reupert, who interviewed social workers and reported they tended to see their concept of self as individualistic, autonomous, and only partially defined by others, even though social work practice focuses on personin-environment. In this article, the author expands the concept of self and argues that a contemporary view of the therapist’s self is one that is dialogic, contextualized, decentered, and multiple. Additionally, the author suggests that this relational perspective has implications for teaching and supervision. Several clinical vignettes are provided to illustrate the concepts under discussion. Keywords Use of self Multiple selves Supervision Relational theory The idea for this article began with a reading of Andrea Ruepert’s, Social Worker’s Use of Self, published in this issue of the Journal. The concept of use of self is a familiar one to clinicians. From our earliest training in the field, we learn that the relationship between clinician and patient fosters growth and promotes change. The personal characteristics of the therapist often enter into the therapeutic relationship as well, helping to shape and refine the process. These characteristics have been broadly defined (Woods & Hollis, 1990) as empathy for the patient, warmth and concern, acceptance, and a nonjudgmental approach. Additionally, the clinician, to the best of her ability, maintains objectivity, models attitudes and
behaviors, and develops self-awareness and self-monitoring, particularly of countertransference and its potential negative impact on the treatment. Andrea Reupert, in her qualitative study of use of self, asks her interviewees to consider how they describe their concept of self and how it impacts their clinical work. Although the study had a limited number of participants, the clinicians involved tended to see their concept of self as unique and individualistic, and only partially defined by the relational and environmental context of practice. To some extent, Reupert attributes this highly individualistic and autonomous sense of self to the Western tradition of rugged individualism as well as to the failure of clinicians to fully take into consideration the influence of social norms and values in self-definition She finds it concerning that these clinicians are reluctant to entertain the idea of the self as socially constructed and contextualized, particularly since historically social work training focused on a personin-environment framework, and the use of self in the social work literature is discussed within the therapeutic environment and not as autonomous or self-contained. It is my intention in this article to expand the concept of self and to argue that a contemporary view of self takes into consideration the notion that the self of the therapist, as well as the patient, is dialogic, contextualized, decentered, and multiple. I will draw on the work of several relational psychoanalytic theorists who have promoted this view of the self and illustrate this relational self through clinical vignettes.
The Relational Matrix C. Ganzer (&) 2824 N. Richmond ST, Chicago, IL 60618, USA e-mail:
[email protected]
The late Stephen Mitchell coined the term relational matrix to describe the way ‘‘psychological reality’’ operates
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within a matrix that contains both ‘‘intrapsychic and interpersonal realms’’ (1988, p. 9). Mitchell felt that earlier drive—and even object relations—theories tended to dichotomize the internal world of object relations and the external relational world of the patient into an either/or focus. He believed these realms ‘‘create, interpenetrate, and transform each other in a subtle and complex manner’’ (p. 9). What does this shift in focus mean in terms of a concept of self and how does it impact practice? Mitchell tells us that, in his view, self does not exist ‘‘in a psychologically meaningful sense, in isolation, outside a matrix of relations with others’’ (p. 33). In contrast to the individualistic self of the clinician defined by the participants in Reupert’s study, the relational self of the clinician, as well as the patient, is acquired through and defined in the context of relationships; and these relationships operate in social, cultural, and political contexts. Mitchell also contends that models of mind that place relationship as central to psychological growth, such as ego or self psychology, tend to privilege the self with concepts such as ‘‘selforganization, ego functions, homeostatic regulation of affects, developmental needs, a true or nuclear self, and so on’’ (p. 9). These models would align more closely to the findings of Reupert’s study, which place the therapist outside of the patient’s relational world, providing ego strength, self-structure, or self object functions. Consequently, self-awareness, as described in Reupert’s study, would be paramount for the clinician to both understand and interpret the patient’s transferences and projections and to be vigilant about countertransference and the potential for enactments. In a relational approach self-awareness would develop through interaction with the patient and be cocreated with the patient in and through the environment. The clinicians in Reupert’s study leave us with the sense that they value their personal characteristics, their selfawareness, and their use of self as instruments or tools to effect change; and while they view the therapeutic alliance as a necessary component of treatment, it is secondary to their use of self derived from their own self-understanding and intrinsic to their own development. This use of self may involve how one implements a technique, or what one self discloses, or how one handles humor, all factors that emanate from the therapist and that place her on the periphery or outside the patient’s world. For Mitchell the therapeutic encounter is between two persons, therapist and patient, which levels the playing field and gives each participant somewhat equal status. The therapist no longer functions as knowing expert who provides interpretation and fosters insight, but rather is a participant in creating and constructing new transferential meanings. The clinician enters into and is embedded in the patient’s relational world through enactments that repeat old ways of being for the patient. In order for treatment to get underway, the
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therapist enters the patient’s relational world or perhaps ‘‘discovers’’ herself ‘‘within it’’ and is ‘‘in some sense charmed by the patient’s entreaties, shaped by the patient’s projections, antagonized and frustrated by the patient’s defenses’’ (1988, p. 295). According to Mitchell, the therapist finds herself in ‘‘one of the patient’s predesignated categories and is experienced by the patient in that way’’ (p. 295). Rather than remaining an autonomous, individualistic, and objective observer in the patient’s drama, the therapist takes on various roles and ‘‘attributes’’ of figures in the patient’s intrapsychic and interpersonal matrix, and together therapist and patient rework the patient’s narrative and rewrite the patient’s story, changing the patient’s perception of the figures to ‘‘allow greater intimacy and more possibilities for varied experienced and relatedness’’ (p. 296). For the therapist, the struggle is toward a new way of experiencing himself and the patient ... to find an authentic voice in which to speak to the patient, a voice more fully one’s own, less shaped by the configurations and limited options of the [patient’s] relational matrix, in so doing to offer the [patient] a chance to broaden and expand that matrix. (p. 295) In other words, through the mutual influence of therapist and patient, embedded in the relational matrix, new meanings are constructed, and new ways of being emerge for the patient.
Multiple Selves Another important contemporary view of self that has evolved from relational theory is the idea that there is not one cohesive, identifiable, or unitary self that we can locate. Rather, as Bromberg has argued, the self is viewed as ‘‘decentered, and the mind as a configuration of shifting, nonlinear, discontinuous states of consciousness in an ongoing dialectic’’ (1998, p. 173). These states are ‘‘linked to each other, to the external world, and to the past, present, and future’’ (p. 168). It is through this linking that we connect aspects of our personal history and experience to give us the illusion of cohesiveness. In treatment then, the clinician moves from a focus on the repressed or unconscious contents of the patient’s intrapsychic world to incorporate and reflect on the enactments of the intersubjective world of the clinician and patient. The self that we encounter may be various selves that the patient experiences as old ways of being with another. The perceptions evoked by enactments do not cohere with the patient’s past experiences but shift as the patient, together with the clinician, plays out various scenarios from the past. What
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has been dissociated or excluded enters the awareness of the patient and clinician and the possibility occurs for new narratives to be coconstructed. The self in this framework becomes a participant in a drama that is played out through the transference-countertransference transactions and reflected upon by both parties, which allows for multiple realities to emerge and discordant perceptions to be discarded so that the various self states can be linked into cohesive reality and integrated into the patient’s lived experience and form the basis for a new self-narrative.
The Therapist’s Participation While we have come a long way from the idea of the therapist as a blank screen promoting abstinence, anonymity, and neutrality in practice, nonetheless, we still rely on the therapist’s technical expertise and effective interventions. This tendency speaks to the role of self as instrument or tool and assumes that the therapist has some degree of knowledge of what the patient may need. Over 20 years ago, Hoffman (1983) wrote an article that has had a significant impact on contemporary views of the therapist’s participation in treatment. Hoffman argues that the therapist participates in the coconstruction of transference and that this participation is inevitable, whether or not she recognizes it. This coconstruction of meaning that involves the thoughts, feelings, and behaviors of the therapist, as well as the patient, has a part in shaping how the patient’s experience unfolds in the treatment. As with Mitchell’s model, both therapist and patient are caught up in enactments of old ways of being. These enactments are part and parcel of the treatment and form the basis of therapeutic action. Use of self in this configuration requires that the therapist not only tolerate ambiguity and uncertainly but also immerse herself in it; for it is by entering the patient’s world and experiencing it that the therapist can work with the patient to emerge from it. This process often involves an inquisitive and curious stance on the part of the clinician and the self disclosure of the countertransference. It is by the therapist and patient working through and reflecting on enactments that involve therapist’s and patient’s transference and countertransference transactions that a space is created for new patterns of interaction to develop. The therapist’s use of self then becomes an interactive, subjective, and empathic means of furthering therapeutic action and portending a positive outcome to the treatment. Let us explore some of these ideas in the context of a treatment case.
The case of Ana This case is a treatment that has been ongoing for nearly 5 years, and this brief vignette is drawn from a larger case
study (Ganzer, 2006). I have presented this case with Ana’s permission, for she believes her experience will benefit others in similar situations. Ana is a woman in her early 30 s who was arrested, charged, and convicted of abusing her 4-year old daughter, Aida. She served several years in prison and was on probation for 2 years. Ana was referred to me in connection with her child welfare case and her desire to be reunited with her children. She presented as frightened, hostile, and distrusting with her own history of abuse and neglect. Initially, she would come to my office only with another individual, usually one of her relatives. I was uncertain about my ability to work with Ana, as her case file indicated that she had made threats against other workers and had been physically aggressive toward child welfare staff and court officials. At the time I began treatment with her, there was an Order of Protection forbidding her to have any contact with her children. After the first few sessions, Ana seemed more relaxed and less tense. She stated that she appreciated the fact that I did not accuse her of the abuse of her daughter but was willing to hear her story. After 3 months she no longer brought a relative with her to sessions. Over time, Ana and I addressed her deep-seated anger issues, and she began to show changes in her behavior toward others. Ana, who had only given me her phone number, became comfortable enough to share it with her caseworker, whom she began to trust as well. After a year Ana’s frequent outbursts of anger diminished. The court and the therapists involved with the family all concurred that Ana had made good progress. As a result of this and her improved control of her impulses, Ana was given limited supervised visitation with her children; and after 2 years, the children were returned home to her husband. Ana continued to live with friends and slowly began to have unsupervised time with her children. Ana made slow but steady progress toward reunification with her family. After 2 years of work, she was given overnight visits. The Monday morning after the second weekend visit between Ana and her children, I received a phone call from her caseworker. Ana had called the caseworker frantic that a detective was on his way to her home to arrest her for hitting Aida. The next day I learned that Ana had been arrested and charged with assault. She pled guilty to the charge and was given 3 years of probation, and her children were returned to the child welfare system. After her return to treatment, Ana began to disclose in greater detail her own history of physical abuse. With this history in mind, I would now like to explore aspects of this treatment from a relational point of view. Neil Altman, in his writing on community practice, makes the point that a clinician working with a disenfranchised population may take on various roles in the transference such as ‘‘rescuer, victim, abuser, and
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neglectful parent’’ (1995, p. 2). In retrospect, I find that I played out these roles with Ana and she brought various aspects of herself to me in the treatment. These roles were often enacted from the dissociated contents of our intrapsychic world and encountered through projective identifications that only later I identified and reflected upon either by myself or with Ana. In the early stages of treatment I found myself enacting the role of rescuer with Ana. She idealized me and felt that I was the only one who could help her. Aspects of my self that responded to Ana’s maternal transference to me allowed me to dissociate the more negative qualities of Ana’s behavior and to focus on her control of impulses and anger. The more grandiose aspects of my therapeutic personality allowed me to promote her rehabilitation to the court, while disregarding the darker moments when she would have angry outbursts. When I stated to a colleague that I saw the real Ana, she corrected me by saying that I saw one side of Ana, the good side, but disregarded the other side. So, much of my work with Ana was a response to her projective identifications with me as her rescuer and savior, and I entered her world and assumed these roles. In effect I was caught in playing out the old roles with Ana, roles that represented her relationship with her now-deceased father, and formerly abusive but now supportive mother. I was able to provide new experiences and a new way of being with her, and Ana was able to progress and make significant changes that were noted by others. I also found myself assuming the role of victim as I struggled with agency personnel who were not in favor of Ana’s reunification with her children as well as the court officials who found Ana to continue to be at risk of harming her children. It was not until Ana was arrested for a second time that other aspects of our various selves were played out. After I learned that Ana was released from jail, I found myself avoiding calling her to set up an appointment. I told myself that it was her responsibility to contact me, despite the fact that I had often called her in the past and that she had left me a frantic message on the day of her arrest. I did not visit her at the jail, although I could have done so; I gave myself the excuse that I was too busy to take off a few hours. I was slipping into the role of neglectful parent and soon found myself showing aspects of the abuser. When she finally called and resumed treatment, I found myself raising my voice in a session, demanding that she change her behaviors or I would not be able to work with her. Somewhere in the middle of my pronouncements, I realized that I was being less than empathic or nonjudgmental. I turned to Ana and apologized for losing my temper but also disclosed my disappointment and sadness over what had transpired in the past few weeks. Unlike others in her life, I did not abandon her but was able to discuss how my feelings were impeding our continued work. Ana then told
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me that she realized how difficult it was for me and that she was sorry that all my hard work with her was wasted. This was the first instance of Ana relating to me as a separate person and not an idealized projection. From that point on Ana was able to disclose more details of the physical and emotional abuse she experienced in her childhood, and our therapeutic work continued. How do we locate the use of self in this clinical vignette and what value does it have for therapeutic work? It was through enactments that I became embedded in Ana’s relational world, and these enactments were shaped by Ana’s ‘‘projections, antagonized and frustrated by [her] defenses’’ (Mitchell, 1988, p. 295). My entry into her world was not a carefully orchestrated set of interventions or conscious use of self, but rather I discovered myself in the enactments. I then was able to reflect upon my roles and either share my feelings with Ana or use them to work with her defenses. I did not experience myself as autonomous or objective but rather caught in enactments of old ways of being with Ana, at times the abandoning and abusive mother, at others times the rescuer, and yet at other times the victim. This participation was unwitting and unrecognized, but, as Hoffman asserts, inevitable. My thoughts, feelings, and behaviors, as well as Ana’s, helped to shape the direction that treatment took and allowed Ana to begin to have some empathy for me as a separate person, and we were able to resume treatment. This vignette further underscores that the therapeutic self is contextualized, decentered, and multiple as Bromberg argues and not cohesive or unitary. In my work with Ana various dissociated states and aspects of self came to the fore as Ana and I enacted past experiences and played old roles with which she was familiar. I offered new ways of being through continuing the treatment with her and disclosing my countertransference feelings of sadness and disappointment over her loss of impulse control. Through our ability to reflect on the various selves we presented to each other, Ana and I were able to repair our therapeutic relationship. Most recently Ana commented that she has been able to act out her anger less frequently but to verbalize it instead.
Use of Self in Training and Supervision In her concluding remarks, Reupert suggests that the training and supervision of clinicians should incorporate their personal qualities, as well as emphasis on theory and technique. She notes that the social workers interviewed bring more to their work than their professional knowledge and skill. Several of the clinicians in her study found that the way to best use self was to suppress the personal aspects of self in favor of professional knowledge and skill.
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Several others saw themselves as a creating a presence through a process that was highly intuitive. These views of self assume that the clinician can objectively know when and how to use the self and that she has the ability to identify, reflect upon, and objectively evaluate it. Reupert, in this issue (DOI: 10.1007/s10615-006-0062-4), references Yan and Wong (2005), who have identified problems with objective knowledge, and Kondrat (1999), who suggests that the training clinicians receive has also contributed to this objective stance. I have argued elsewhere (Ganzer & Ornstein, 1999, 2004) that although relational theory has influenced social work practice, supervision has lagged behind in embracing these ideas. How would processes such as those described in the study differ from supervision and education in a relational matrix? In the former, the autonomous, selfaware, professional self of the supervisor would tend to reinforce the hierarchy that is often inherent in a supervisory relationship with the supervisor being in a one up position and the therapist in a one down. In the early stages of a social worker’s career, she builds a professional self through seminars, practicums, and ongoing clinical supervision. The traditional view sees supervision as provided by an experienced supervisor who imparts knowledge to the supervisee and gives careful consideration to case material and suggests appropriate and useful interventions. Sometimes the supervisor may focus on the dynamics between the supervisee and the patient, but rarely is the focus on those between the supervisor and the supervisee. In turn, the supervisee gains knowledge and skill and acquires insight and awareness. In this approach knowledge, power, and authority are vested in the supervisor. A relationally oriented approach to supervision is less hierarchical and more one of mutual influence among all the parties: supervisor, supervisee, and patient. While the supervisor brings her knowledge and experience to bear on the case, the supervisee brings her knowledge and experience of the patient. Instruction then is replaced by dialogue and negotiation. In this model, power and authority are shared and knowledge about the patient is coconstructed. A relational model shifts the role of the supervisor from that of expert to participant, operating in a matrix that incorporates intrapsychic, interpersonal, environmental, and organizational aspects of all the parties. Let us turn to a brief vignette that illustrates a relational approach to supervision.
Self in Supervision Ellen, a young, bright, energetic therapist pursuing an advanced degree, had been a practicing clinician for several years and was at the dissertation stage in her career. As part of her program, she selected supervisors to whom
she would bring difficult cases. She came to me with a case that exasperated her and caused so much anxiety that she was certain she was not helping the patient. She described her patient, Moira, as anxious and consumed with worry. The worry was often about small things, such as daily activities, but more recently had been directed at fearing that something tragic would happen. Ellen, in turn, felt very anxious when she was with Moira, fearing that Moira would drop out of treatment because Ellen might say or do the wrong thing. Consequently, Ellen felt paralyzed and was waiting for the other shoe to drop. While the roles that supervisor and supervisee take on in supervision may not be as dramatic as the ones Altman (1995) thought characterized community practice, nevertheless, we do play out various dramas. At the time Ellen consulted with me, I was new to the faculty of the school where she was a student. She had been referred to me by another student with whom I had a successful supervisory relationship. Among the various roles I found myself playing were teacher, expert, and colleague; Ellen’s roles were those of student, supervisee, and colleague. The role that was less available to my consciousness had a more parental, authoritative cast to it, while the role to which she had less access was that of disappointing child. I entered Ellen’s relational matrix with the patient through an impasse in treatment. When Ellen and I reviewed her process recordings, I did not find anything to suggest she was making comments that might cause Moira to leave treatment. I could not account for the level of anxiety Ellen was experiencing, and I began to experience my own sense of anxiety as to whether I could give her the direction she seemed to ask for with her patient. I soon slipped into the role of expert. What I noticed was that Ellen was giving Moira detailed interpretations of her thoughts and actions or expanding on what Moira has been telling her to make connections. I began to look for ways that Ellen could intervene with her patient. Ellen, being a willing student, started to shape her comments according to my suggestions. Together we worked on ways that Ellen could provide more of a containing environment for her patient, but Ellen remained very anxious about the treatment. Neither of us could account for the excessive anxiety. Despite our efforts, Ellen’s anxiety did not abate nor did the anxiety of her patient, and I remained an uneasy supervisor afraid to disappoint my supervisee. As Ellen continued to worry that she was disappointing her patient and thought she might need to refer her to another therapist, I began to reflect on what might be going on in my relationship with Ellen and in the worlds that we shared. Why was I so anxious about my work with Ellen? Since I was a new supervisor for students at the school, I had anxiety of my own. Many of the students had completed a structured course of study and had in depth
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knowledge of theory that I had learned autodidactically through my own reading. Also, many of my students had more years of clinical practice than I had. Was I really able to be an effective supervisor? Was I up to the task? Through this reflection, I realized that I was enacting Ellen’s anxiety in my relationship with her, and I found myself caught up and embedded in her world. Her anxiety had evoked mine, and her patient’s anxiety had evoked hers. In retrospect, I believe what was being projected between us was our unspoken fears of failure and disappointment in our relationship. I told Ellen that I was curious about her anxiety and her feeling that she was at an impasse with her patient and that I was at an impasse with the consultation. I wondered if anything in her own dynamics might have some bearing on the treatment. I knew that Ellen had a therapist with whom she discussed her issues, and I was not suggesting that we form a therapeutic relationship but rather that we look at what might be going on between us and between her and the patient. While I acknowledged that there was a parallel process involved in this supervision, I felt that more was being enacted and that it was important to open up a space for us to explore the transactions rather than my attempting to direct the course of the treatment. After a few more sessions, Ellen began to talk about the ways in which she and Moira were similar. Moira was a graduate student pursing a master’s degree that Ellen currently held. They both came from the same religious background, and their fathers attended the same medical school and practiced in similar areas of medicine. Both Ellen and Moira experienced their fathers as strict and demanding. Both women were required to demonstrate academic excellence and achieve at all cost. Ellen began to give me more information about her background, her difficult relationship with her father, her conflicts with her siblings, and her current feeling that in some ways she did not want to grow up. Moira’s problems, she felt, were so closely related to her own development and personal issues that she thought she might be confusing them with her own. I disclosed my own feelings of anxiety to Ellen as well as how I recognized that I had been playing the role of an authority figure, the one with the expert knowledge. Through our ongoing dialogue, Ellen and I came to realize that we both felt pressure to repair the situation and that both of us were grappling with issues of competence. Moira, as well, was concerned about her graduate studies and her competence in her internship. Ellen hoped to ‘‘fix’’ herself by reducing Moira’s anxiety, which to a great extent was Ellen’s own anxiety, while I was feeling pressure to ‘‘fix’’ the treatment. Once we came to this realization in our work together, my own anxiety about ‘‘fixing’’ Ellen’s case diminished, and Ellen’s patient settled into the treatment and began to move forward in
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working through her family issues and pursuing her career path in social work. Ellen, in turn, felt more competent as a therapist. The relational matrix in which Ellen, her patient, and I were embedded encompassed more than the treatment. It involved the parental and family constellations, the academic environments, and the social work careers in which each of us participated. The self each of us used in our various roles was contextualized by this matrix. While I was viewed as a supervisor with expertise, Ellen was actually more knowledgeable about her patient and her own participation in the treatment. From a relational viewpoint, Ellen and I coconstructed the meaning of all these variable as we looked for ways to link our perceptions and to understand how we experienced the anxiety in the supervision. The selves we used in our work consisted of aspects of our personal history, our professional lives, and our current roles as therapist and supervisor. What was in the foreground were the roles created by the academic environment where Ellen was required to consult on her case, and I was the chosen supervisor. What was dissociated was the intrapsychic and interpersonal residue from our personal histories. When Ellen and I explored her object relations and role in her family of origin, she was then able to identify the anxiety as coming from her struggle to achieve and her reaction to her critical, demanding father. She no longer projected her anxiety onto her patient, and the patient began to respond to the shift and found her sessions calming. When I recognized my desire to impart both theoretical ideas and clinical interventions, to show my expertise, I was able to begin a dialogue about the treatment rather than attempt to direct it. The personal struggles with competence and achievement, emanating from our early experiences, colored the way in which we worked together; and while it did not create conflict between us, it affected the course of the patient’s treatment. Once we identified and articulated the nature of the anxiety, the patient improved, and the supervision became one of mutual participation.
Concluding Remarks As Reupert’s study confirms, the use of self has a profound and meaningful influence on social work practice and has been an essential component in clinical treatment. Like Reupert, I am curious as to why the clinicians she interviewed tended to see their use of self as so unique and individualized, particularly since the profession has stressed the importance of the relationship for positive outcomes in therapy and has maintained a focus on person-inenvironment. For one, the study sample is quite small, and that may affect the reported outcomes. Also, the clinicians
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interviewed are Australian. Relational theory, as I have discussed it, has its roots strongly placed in American soil and only recently has taken on an international flavor. But more important, I think, is that training and supervision of clinicians in social work has had a more hierarchical structure and a tendency to keep the boundaries between teaching and treating very tight. As illustrated in the second vignette, supervisor and supervisee were able to break through the therapeutic impasse once they were willing to explore their enacted roles and personal dynamics. Because enactments and countertransference are often initially unconscious and placed outside the patient’s narrative, they are more difficult to identify and articulate. We are more comfortable relying on theory and technique to guide us, and only occasionally do we have access to unexamined aspects of the treatment. I believe it is important to consider how we can incorporate a more contemporary relational approach to training and supervision in social work education and practice. I would encourage others in the field to present cases and write articles about their teaching and supervisory experiences. Because the social work curriculum is highly organized and specific, offering electives or an advanced training course on supervision would be helpful, particularly as many beginning clinicians find themselves in supervisory roles early in their careers. What I am suggesting in this article is that this contemporary view of self has value for social work practice, particularly clinical practice, training, and supervision. It places the therapist and/or supervisor within the relational matrix, where the subjective experiences of all the parties provide a venue for better understanding those experiences. This approach also acknowledges the inevitable participation of the therapist and accepts that the nature of enactments is often unconscious and dissociated. By maintaining a curious stance and having tolerance for ambiguity and uncertainty in the treatment, each participant can bring in
dissociated aspects of their experience. The elucidation of, and shared reflection on, these unconscious relational patterns allows for a space to be created to enact new patterns and for therapeutic action to be mobilized. Removing the therapist from an expert, objectified position allows for mutual influence of therapist and patient in the treatment and enhances respect for the patient. Finally, in supervision, the supervisor’s self-disclosure often normalizes the difficulties that students and practitioners encounter in their clinical work and promotes truly reflective practice. References Altman, N. (1995) The analyst in the inner city. Hillsdale, NJ: Analytic Press. Bromberg, P. M. (1998). Standing in the spaces: Essays on clinical process, trauma and dissociation. Hillsdale, NJ: Analytic Press. Ganzer, C. (2006). Psychoanalytic psychotherapy at the margins: The case of Ana Ortega, a Relational Perspective. Paper presented at a meeting of The Chicago Association for Psychoanalytic Psychology, October 7, 2006. Ganzer, C., & Ornstein, E. D. (1999). Beyond parallel process: Relational perspectives on field instruction. Clinical Social Work Journal, 27, 231–246. Ganzer, C., & Ornstein, E. D. (2004). Regression, self-disclosure, and the teach or treat dilemma: Implications of a relational approach for social work supervision. Clinical Social Work Journal, 32, 431–449. Hoffman, I. Z. (1983). The patient as interpreter of the analyst’s experience. Contemporary Psychoanalysis, 19, 389–422. Mitchell, S. (1998). Relational concepts in psychoanalysis: An integration. Cambridge, MA: Harvard University Press. Woods, M. E., & Hollis, F. (1990). Casework: A psychosocial therapy. New York: McGraw-Hill. Carol Ganzer, PhD, MSW, LCSW is on the faculty of the Institute for Clinical Social Work.She is a past president of the Chicago Association for Psychoanalytic Psychology and serves on the editorial board of Clinical Social Work Journal.She maintains an independent practice of psychotherapy and consultation in Chicago.
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