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Falling Through the Cracks

Falling Through the Cracks: Psychodynamic Practice with Vulnerable and Oppressed Populations

Copyright Date: 2012
Pages: 448
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  • Book Info
    Falling Through the Cracks
    Book Description:

    Psychodynamic theory and practice are often misunderstood as appropriate only for the worried well or for those whose problems are minimal or routine. Nothing could be further from the truth. This book shows how psychodynamically informed, clinically based social care is essential to working with individuals whose problems are both psychological and social.

    Each chapter addresses populations struggling with structural inequities, such as racism, classism, and discrimination based on immigrant status, language differences, disability, and sexual orientation. The authors explain how to provide psychodynamically informed assessment and practice when working with those suffering from mental illness, addiction, homelessness, and cognitive, visual, or auditory impairments, as well as people in prisons, in orphanages, and on child welfare. The volume supports the idea that becoming aware of ourselves helps us understand ourselves: a key approach for helping clients contain and name their feelings, deal with desire and conflict, achieve self-regulation and self-esteem, and alter attachment styles toward greater agency and empowerment. Yet autonomy and empowerment are not birthrights; they are capacities that must be fostered under optimal clinical conditions.

    This collection uses concepts derived from drive theory, ego psychology, object relations, trauma theory, attachment theory, self psychology, relational theories, and intersubjectivity in clinical work with vulnerable and oppressed populations. Contributors are experienced practitioners whose work with vulnerable populations has enabled them to elicit and find common humanity with their clients. The authors consistently convey respect for the considerable strength and resilience of the populations with whom they work. Emphasizing both the inner and social structural lives of client and clinician and their interacting social identities, this anthology uniquely realizes the complexity of clinical practice with diverse populations.

    eISBN: 978-0-231-52181-9
    Subjects: Sociology, Psychology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-viii)
  3. Acknowledgments
    (pp. ix-xiv)
  4. 1 Why We Need a Biopsychosocial Perspective with Vulnerable, Oppressed, and At-Risk Clients
    (pp. 1-39)

    This book is about practicing psychodynamically with those who are vulnerable, at risk, and oppressed. Whether one is working with clients in a prison or a homeless shelter, with a person who is chronically mentally ill, or with mothers who suffer from addictions or who are pregnant and parenting and living in poverty or who give their children up to orphanages, we maintain that an exploration of their inner lives is invaluable. When we work with someone who has been oppressed on the basis of sexual orientation, ability, language, culture, or race, we must also be able to enter into...

  5. 2 Making It Thinkable: A Psychodynamic Approach to the Psychosocial Problems of Prisons and Prisoners
    (pp. 40-74)

    On my first day as a second-year master’s in social work intern on an acute psychiatric treatment unit of a California state prison, I was told at the gate that if I were to be taken hostage, the state would not negotiate for my release. Despite my fear, I agreed to this caveat and was reassured by the correctional officer that hostage situations hardly ever happened. I stepped through the gate, which promptly shut behind me, and tried to wrap my mind around the fact that I was now locked in a building with three thousand people, many of whom...

  6. 3 “We’re Cool, You and Me”: A Relational Approach to Clinical Social Work in the City: Psychodynamic Psychotherapy Within a Homeless Shelter for Formerly Incarcerated Women and Their Children
    (pp. 75-106)

    The chairs were set in the shape of a horseshoe, and the majority were occupied by the women who were residents of the building. Nine additional chairs had been placed along the front of the room, cutting through the curve in a straight line. In these chairs sat the building staff, I among them. We consisted of the agency director, two caseworkers, two housing specialists, three child care workers, and me—the individual and family therapist. It was my first full house meeting, and I was eager to meet the residents as a group. After many years working in the...

  7. 4 If I Feel Judged by You, I Will Not Trust You: Relational Practice with Addicted Mothers
    (pp. 107-140)

    One might say that my coauthor, Jennifer, and I (Shelley) met on a professional “blind date” in the winter of 2007. Colleagues had encouraged us to join forces given our collective passions for pediatrics and for the needs of women and children marginalized by the health care system. Both of us were seasoned clinicians. Jennifer was a veteran neonatal nurse, former school nurse, and family advocate; I have practiced clinical social work for over thirty years, working with children and families. Each of us was new to academia, and we both felt isolated in this unfamiliar professional realm.

    On that...

  8. 5 Making a Difference: Psychodynamic Views on Race and Racism
    (pp. 141-156)

    Racism makes a big difference and a powerful difference. And psychodynamic theories have much to say about how we make—and make sense of—differences. In this chapter I offer some of the ways psychodynamic theories deepen our understanding of racism as a form of “badness,” as a hated difference, that we all live out. As a nation, we have inherited a violent, degrading, and shameful history. The legacy of legal and institutional slavery and of European colonization has colored us all. The economic, political, social, and psychological implications of this history are enormously significant to who we are and...

  9. 6 Navigating the Perils of the Child Welfare System: Applying Attachment Theory in Child Protective Practice
    (pp. 157-179)

    The suffering of children who become involved in the child protective system is well documented and yet poorly understood. Millions of vulnerable children are referred to protective services, but insufficient attention is paid to the problematic attachments that have brought them into the system—a system that often imposes further disruptions in already tenuous connections between these children and their caretakers. Children who end up in the child protective system have often been raised in abusive homes plagued by patterns of disordered attachment, resulting in behavioral patterns and emotional problems that echo maltreatment by caretakers who themselves have often been...

  10. 7 Holding a Mother—Holding a Baby: Psychosocial Casework in a Clinic for Women with High-Risk Pregnancies
    (pp. 180-205)

    One day I received a call from one of my colleagues in which she excitedly told me about the birth of her granddaughter. The extended family had driven in from around the country to be with the new mother and coo and fuss over the baby. Playful competition ensued as relatives warmly bickered about who would get to hold the baby next. Later that day, I was told that one of our patients, the same age as my colleague’s daughter, had delivered her baby. She too was a first-time mother. But she had no one to even hold her hand...

  11. 8 Finding Common Ground: The Perils of Sameness and Difference in the Treatment of Lesbian, Gay, and Bisexual Clients
    (pp. 206-240)

    Until relatively recently, gender and sexuality were discussed in rather simple, straightforward terms. Men were men and behaved as men; women were not and did not. Men were sexually attracted to women and vice versa. Today we know that this was not always the case. Gender is a much more fluid entity than previously thought or admitted. And many, if not most, aspects of what are considered sex-appropriate gender presentations—the way we look and behave—are socially and culturally constructed and instilled in us from birth. Moreover, our gender identities as men or women tell us little about our...

  12. 9 Full of Feelings, Disabled, and Treatable: Working Psychodynamically with Special-Needs Adults
    (pp. 241-260)

    Is it possible to do psychodynamic psychotherapy with adults with special needs? This chapter describes special-needs adults, including those who are intellectually challenged or have autism, Asperger syndrome, or Down syndrome. It describes how psychodynamic psychotherapy can be an effective tool in treating special-needs adults. Since most literature about the treatment of this population describes only educative or behavioral approaches, I, along with Sinason (1992) and Ruth (2006), suggest the efficacy and benefits of psychodynamic psychotherapy in conjunction with the multitude of other services that might be needed.

    People with special needs deal with relationships and coping issues similar to...

  13. 10 Seeing Through the Eyes of the Blind: Psychodynamically Informed Work with Persons with Low Vision
    (pp. 261-297)

    It is often remarked that every crisis presents an opportunity for change. Such has been the case with the clinical author of this chapter, Catherine Orzolek-Kronner. As a therapist with low vision, I (Catherine) am often sought out to speak on behalf of the blind, visually impaired, or disabled population. I am frequently in the position of giving advice, suggestions, or a perspective based mostly on my own experience or limited personal or professional relationships with other people who are blind. While my contributions are often helpful, my perspective might have been “shortsighted.” After being asked to write this chapter,...

  14. 11 What Did You Say? Clinical Practice with Deaf and Hard-of-Hearing Populations
    (pp. 298-318)

    Being deaf means being part of a marginalized group. It is a marginalization that results from social prejudices and misunderstandings, as well as the inaccessibility of resources and communication barriers. Through a medical model, deafness is considered a disability and loss, requiring rehabilitation and medical procedures to restore or compensate for diminished hearing. By contrast, a cultural perspective focuses on deafness as a cultural and social identity. People who are culturally deaf share a culture that has its own values, norms, and language, ASL, or American Sign Language, the primary form of communication within the deaf community.

    Approximately 10 percent...

  15. 12 Social Care with the Severely Mentally Ill: Psychodynamic Perspectives
    (pp. 319-346)

    A day in the life with Jean and Kevin, in the twelfth year of our working together:

    I receive a phone call from Jean’s eighty-five-year-old father. Jean has gotten a notice from her apartment complex asking that she and Jose, her partner, vacate the premises in two weeks. Her father is meeting with the manager that afternoon and wants me to attend. Fortunately, I am able to arrange this. In the meeting, I ask for the specifics of the management company’s concerns. I expect the worst: public alcohol consumption, property damage, and so on. But the concerns are modest: Jean...

  16. 13 The Return from War: Templates for Trauma and Resilience
    (pp. 347-371)

    As I write this chapter, the movie The Hurt Locker has just won the Oscar for Best Picture. It is a movie about an Army man whose job it is to defuse explosive devices. He daily faces death to protect both his comrades and civilians in the Iraq war. When he returns home to his wife and child he finds himself confronted with the intrapsychic conflict of how to adjust to peace. Unable to reconcile peace with war, he re-ups and returns to the war zone.

    The wars in Afghanistan, Operation Enduring Freedom (OEF), and in Iraq, Operation Iraqi Freedom...

  17. 14 Alien to This Country: Treatment Considerations with Immigrant Bilingual Patients
    (pp. 372-396)

    Bicultural and bilingual psychotherapy has always been a central component of my clinical work. I started conducting therapy shortly after emigrating from Greece to the United States. Therefore, my experience as an immigrant has become central to how I came to understand psychotherapy.

    Although I had lived in European countries, such as the United Kingdom and the Netherlands, in the past, coming to the United States was a profoundly exciting but also traumatic experience for me, one full of loss and confusion. In Europe, because of the lack of borders, I experienced immigration more as citizen mobility. However, in the...

  18. 15 When a State Becomes a Parent: Orphanages in a Post-totalitarian Culture: Attachment Theory Perspective
    (pp. 397-418)

    Bulgaria is a country “in transition.” This is a common description for countries from Eastern Europe and the former Soviet Union—all of which are postsocialist societies moving toward democracy. The process of transition for Bulgaria started in 1989 with the fall of the Berlin Wall and the shift from a centrally planned to a free-market economy. This short description, however, does not capture the profoundly turbulent societal changes that followed, one of which has been the transition from a welfare system that was totalitarian to one that reflects democratic values.

    In this chapter, I present some of the challenges...

  19. Conclusion
    (pp. 419-422)

    We hope that as our readers conclude this book they will have a greater understanding of how every clinical encounter contains within it intersections of power and privilege, class and race, culture and religion, sexual preference, ability, history, and politics. These interwoven aspects of identity emerge in our relationships with our clients, and they need to be recognized, interrogated, understood, and made manifest when we work with those who are marginalized and oppressed. To do so requires a great deal of self-awareness on the part of the clinician, whose work it is to help clients become more aware as well....

  20. Contributors
    (pp. 423-426)
  21. Index
    (pp. 427-440)