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Social Work 10-1-2004 Psychodynamic Perspectives on Relationship : Implications of New Findings From Human Attachment and the Neurosciences for Social Work Education

In this article, the historical significance of the therapeutic relationship in social casework theory and practice is discussed and elaborated on in relation to contemporary psychodynamic theories and constructs, such as the therapeutic alliance, the holding relationship, and selfobject theory. The significant contributions of investigators in such diverse fields as infant attachment, neurobiology, and feminist theory are then discussed in relation to these psychoanalytic ideas. Based in part upon recent research being conducted in such fields, a more central role is proposed for psychodynamic conceptions of relationship in the education of social work clinicians. FAMILIES IN SOCIETY | Volume 85, No. 4 550 Historical Perspectives in Social Work and Psychodynamic Theory Although relationship has long been emphasized in the social casework literature, it was originally conceived in a nondynamic way. Mary Richmond (1899), writing over 100 years ago, noted that friendly visiting means intimate and continuous knowledge of and sympathy with a poor family’s joys, sorrows, opinions, feelings, and entire outlook upon life. The visitor that has this is unlikely to blunder about relief or any detail; without it he is almost certain, in any charitable relations with members of the family, to blunder seriously. (p. 180) In this early view, one that is framed in the language of the charity organization movement, relationship is not thought of as a dynamic, interactive process, but as something akin to a friendship. As a matter of fact, it wasn’t until 1930 that the term “relationship” was finally adopted as a way of characterizing the encounter between the worker and client (Biestek, 1957; Robinson, 1930). Although other terms such as empathy and rapport were subsequently introduced to enhance this early characterization, these conceptions of relationship lacked dimension. When, in the late 1920s, the psychoanalytic concept of transference was first used in the social casework lexicon, thereby adding considerable complexity to the simple formula originally provided by Richmond, it may have furnished additional impetus to efforts to define the nature of the casework relationship.1 In the late 1950s, Felix Biestek introduced his now-classic volume, The Casework Relationship (1957). In this book, he outlined seven principles of relationship distilled from a comprehensive analysis of the extant casework literature. These consisted of individualization, purposeful expression of feelings, controlled emotional environment, acceptance, nonjudgmental attitude, client self-determination, and confidentiality (Biestek, 1957). One might argue that these principles are in basic synchrony not only with important psychoanalytic concepts emerging in the mid 1950s regarding nontransferential aspects of the analytic relationship, but that they also presage the work of Carl Rogers and his colleagues on the “facilitative conditions”2 for effective psychotherapy. Biestek’s emphasis on a professional relationship emphasizing the creation of an interpersonal climate in which clients are encouraged to express their feelings openly, and workers respond with nonjudgmental acceptance, also calls to mind the object-relations notion of the “holding environment.” Though originally used to describe the facilitative maternal environment through which the good enough mother is able to offer her infant emotional security, which ultimately affords him or her protection against the inevitable failures in maternal attentiveness or empathy, this concept also possesses a unique currency in the casework treatment situation. In the broad context of social services, holding may be defined to include the provision of material goods, such as food, housing, or financial assistance; the provision of family preservation programs or respite care; or even the removal of children who have been subject to abuse or neglect (Applegate & Bonovitz, 1995). In the clinical milieu, the good enough parent is, of course, the therapist, the holding metaphorical rather than literal. What elements, however, are associated with such therapeutic holding? Foremost among these would be the creation of a safe emotional environment, in which the client can feel relative comfort and security in disclosing the details of her personal life. Oftentimes, such a safe environment is possible only through therapeutic containment, whereby elements of the client’s rudimentary identity, as well as rage, violent projections or fantasies, and other internally arising dangers are absorbed and therapeutically metabolized by the clinician (Bion, 1962, Klein, 1974; Meissner, 1996; Ogden, 1982). The therapeutic effect of such containment is to assure the client that the therapist cannot be destroyed and that she or he is a good container for such dangerous thoughts, wishes, or impulses, thus furnishing the client with a “safe context for emotional discharge” (Meissner, 1996, p. 20). The safety of the therapeutic environment may also be enhanced or managed through various external structures (e.g., institutional rules or psychotropic medications) that function to diminish frightening thoughts or impulses. The therapist’s genuine interest in and concern for the client, her ability to listen attentively to the client’s story as it unfolds, and reasonable efforts to remain affectively attuned and empathically Social work practice arose from a tradition in which the idea of alliance and alliance building is almost inextricable from conceptions of treatment. 1 An even greater motive was the gradual movement toward professionalization within social work, which required greater conceptual clarity as well as the substitution of a new scientific terminology for the experience-near language of casework pioneers such as Mary Richmond. 2 Empathy, positive regard, and congruence constituted the original facilitative conditions identified in Rogers’ seminal research (Rogers, 1957), although this list was later amended to include nonpossessive warmth and genuineness (Truax