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Advanced Clinical Social Work Practice

Advanced Clinical Social Work Practice: Relational Principles and Techniques

Eda G. Goldstein
Dennis Miehls
Shoshana Ringel
Copyright Date: 2009
Pages: 264
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  • Book Info
    Advanced Clinical Social Work Practice
    Book Description:

    Advanced Clinical Social Work Practice traces the development of relational ideas from their origin in object relations and self psychology to their evolution in current relational, intersubjectivity, and attachment theory. Relational treatment emphasizes openness and collaboration between client and therapist, mutual impact, the client's subjectivity, and the therapist's empathy, genuineness, and use of the self in therapeutic interaction. The approach treats the relationship and dialogue between client and therapist as crucial to the change process and shows how the therapeutic relationship can be used to help clients and therapists bridge differences, examine similarities, overcome impasses, and manage enactments.

    The relational emphasis on the subjective experience of both client and therapist is beautifully illustrated throughout this book as the authors draw from their clinical work with clients from diverse backgrounds, including gay and lesbian clients, immigrants, and clients of color. They demonstrate how relational principles and techniques can be applied to multiple problems in social work practice-for example, life crises and transitions, physical and sexual abuse, mental disorders, drug addiction, and the loss of a loved one. The authors also discuss the integration of relational constructs in short-term treatment and with families and groups.

    This volume opens with a historical perspective on the role of relational thinking in social work and the evolution of relational theory. It presents an overview of the key concepts in relational theory and its application throughout the treatment process with diverse clients and in different practice modalities. The book concludes with a discussion of the challenges in learning and teaching new theoretical and practice paradigms, particularly in creating a more mutual exchange in the classroom and during supervision.

    eISBN: 978-0-231-52044-7
    Subjects: Sociology

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
    (pp. vii-x)
    (pp. xi-xx)

    This book is about relational theories and their application to clinical social work practice. After tracing the relational thrust of social work practice throughout the profession’s history, it will review the writings of major psychoanalytic theorists who have contributed to the relational perspective. Following a description of the key developmental concepts that comprise relational theory today, the book will consider and illustrate the main components of treatment based on relational ideas. It will show their utility in work with a wide range of clients, including those from diverse cultural backgrounds. It also will consider the use of relational theory in...

    (pp. 1-17)

    Social work practice has reflected relational thinking throughout the profession’s history and, despite variations in emphasis, has been organized around two main principles. First, social work practice has been grounded on the belief that human behavior develops and can only be understood in the context of interpersonal relationships and social and cultural conditions. Thus, a key feature of social work assessment is its person-in-situation perspective. Second, almost all social work practice models, with the exception of the cognitive-behavioral approach, place importance on the client–worker relationship in the therapeutic process (Turner 1996).

    As the social work professional evolved, the originators...

    (pp. 18-36)

    As described previously, there is a rich historical tradition and compatibility of relational thinking with social work values and practice that has spanned many decades. Relational ideas themselves have expanded and changed over time and have gone through different phases. Although early relational theorists moved away from the “drive-structural model” of classical Freudian theory (Greenberg and Mitchell 1983), their formulations initially still adhered to what has been termed a “one-person” psychology that views development as an “individual” activity that is aided by the presence of a caregiving other. A second group of more contemporary theorists have put forth concepts that...

    (pp. 37-53)

    In contrast to the “one-person” relational theories that were discussed in chapter 2, the more contemporary “two-person” intersubjective theories that characterize phase 2 of relational thinking place central importance on the mutual and interactional process that occurs between infants and caretakers during development. These theories have contributed significantly to new understanding and innovative approaches to the therapeutic process. Chapter 4 will describe the most important of the developmental concepts that comprise this phase in relational thinking, whereas this chapter discusses their treatment implications. Contemporary relational treatment puts a great deal of emphasis on the clinician’s subjective feelings, thoughts, and reactions,...

    (pp. 54-78)

    Chapters 2 and 3 show that early relational thinking tended to focus on what the baby brings to the world and on how the caretaking environment nurtures and influences individual development, whereas later contributions emphasized mutuality and interaction in the relationship between the self and others. The ideas put forth by the full range of relational theorists are not fully integrated so that there is not a unitary relational developmental theory. Drawing on both theoretical streams, this chapter describes what we consider to be major developmental relational concepts. It also will draw on recent research findings that provide some empirical...

    (pp. 79-105)

    The relational theories and developmental concepts discussed in chapter 4 have significant implications for assessment and intervention in clinical social work. Assessment goes beyond understanding the nature of a client’s presenting problem or clinical diagnosis. In social work practice, assessment is biopsychosocial in nature and more holistic. It includes both current interpersonal and environmental and past developmental and cultural factors that have bearing on a client’s problems, personality, motivation, and strengths. Although it is important for clinicians to develop an initial, tentative understanding of clients and the likely causes of their difficulties right from the beginning of treatment, assessment is...

    (pp. 106-130)

    Relational theory views all human behavior as a product of the interaction between individuals and others. Incorporating this perspective into the clinical situation necessitates major changes in the way we envision how clinician and client work together in all phases of the treatment process. Although relational thinking reflects an identifiable core of treatment principles, there are two somewhat different emphases along a continuum of interventions. The early relational theorists emphasized clinicians’ holding functions, empathic attunement to the client, and the elimination of countertransference attitudes that might interfere with their empathy with clients. They focused on understanding the nature of clients’...

    (pp. 131-147)

    Beginning with Freud, psychoanalytic clinicians recognized that both clients and clinicians bring conflicts and relational patterns based on early childhood experiences to the therapeutic relationship. Traditional psychoanalytic theory viewed transference as emanating from the client and countertransference as beginning with the clinician. Relational theorists have expanded our understanding of these two concepts. They have alerted us to the presence of two major types of transference, the selfobject transferences and the repetitive transferences. Each type of transference raises somewhat different issues and calls for different responses from the clinician. Likewise, they view countertransference reactions and their management differently (Hanna 1998). Because...

    (pp. 148-163)

    Relational theories offer a broad perspective from which to consider race, ethnicity, culture, and other diversity factors that are intertwined with personal and interpersonal dynamics. The relational model’s emphasis on the client’s and clinician’s subjectivities and the coconstruction of new relational patterns based on a mutually created therapeutic space add new dimensions to clinical social work practice with vulnerable and oppressed populations. This chapter addresses how the diverse subjectivities of both client and therapist influence one another; how race, ethnicity, culture, and other diversity considerations shape the shared therapeutic space; and finally, how the nature of therapeutic action looks in...

    (pp. 164-179)

    Economic conditions and the ever-increasing influence of managed health care led many therapists and theoreticians to look for abbreviated models of psychotherapy. The very nature of clinical social work practice often necessitates brief contact with clients. For example, social workers who conduct clinical work in hospital, medical, and mental health settings often only see clients when they are in-patients in the system. As length of stays tends to be short, there is increasing need for social workers to utilize models of brief intervention.

    Safran (2002:171) comments that “brief psychotherapy has its origins in Ferenczi and Rank’s (1924) pioneering attempt to...

    (pp. 180-192)

    This chapter explores the influence of relational theory on “multiple-person” modalities, including couple, family, and group. Wachtel (2008) makes the point that family therapists have not historically made a great distinction between one- or two-person psychologies. He suggests that this differentiation had less meaning for family therapists as these clinicians always directly observed the influence of individuals on one another so that the focus was always interpersonal or relational. Thus, working within the multiperson modality naturally lends itself to relational thinking, and Wachtel suggests that relational theory has been influential in these modalities in that the relational “therapist inevitably becomes...

    (pp. 193-204)

    This chapter discusses how the principles of relational theories affect both teaching and learning in the classroom and supervision. It explores the perspectives of the student and supervisee when classroom instructors or supervisors incorporate relational constructs into their teaching strategies. It describes the process in which students engage when they begin to think “relationally” about their clinical work. The shift to relational thinking often challenges some of students’ and trainees’ preconceived ideas and stereotypes about clinical social work practice as well as the ways in which they may have been trained.

    Although students come to our graduate programs in social...

    (pp. 205-208)

    As we put the finishing touches on this book, we think we have accomplished the number of goals that we had at the outset of the project. An important goal for us was to articulate how relational theory is specifically practiced by social workers in social work settings. To underscore the compatibility of relational theory and social work practice, we once again remind our readers that social worak is truly relational at its core in both practice and theory. As noted in the introduction, social workers have historically been relational practitioners since the inception of the profession. As we review...

    (pp. 209-226)
  18. INDEX
    (pp. 227-244)