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THE PRACTICE OF PSYCHOANALYSIS:A SPECIALTY OF CLINICAL SOCIAL WORK
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Psychoanalysis is defined as the psychotherapeutic application, by trained analysts, of psychoanalytic theory in order to ameliorate disorders that interfere with the analysand’s satisfactory functioning. It is conducted with frequency and intensity, and seeks to bring unconscious mental elements and processes into the analysand’s awareness, where they may be explored and understood.
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THE PRACTICE OF PSYCHOANALYSIS:
A SPECIALTY OF CLINICAL SOCIAL WORK
A Position Statement of
The American Board of Examiners in Clinical Social Work
Published January, 2004
© ABECSW 2004, all rights reserved
ABE, Shetland Park, 27 Congress Street, Suite 211, Salem, MA 01970
Executive Summary
The American Board of Examiners in Clinical Social Work has published a position
statement that is intended to be definitive and comprehensive in its treatment of
Psychoanalysis as a specialty within the overall practice of Clinical Social Work. With
more than 180,000 practitioners in virtually every city and county of every state, clinical
social workers make up the nation’s largest group of providers of mental-emotional
healthcare services.
The statement offers a new interpretation of what constitutes the advanced practice of
psychoanalysis in the clinical social work profession. In highly detailed groupings of
professional knowledge and skills, it identifies the specific characteristics of practice by
which a clinical social worker psychoanalyst may be recognized for competence.
These characteristics (summarized in section V of the statement), and other relevant
considerations addressed in the statement, serve as the source material for a new credential
in the specialized practice of Psychoanalysis, in conjunction with the general-practice
certification of Board Certified Diplomate in Clinical Social Work.
The statement also addresses the pertinent psychoanalytic literature in the following
areas:
• its salient features as a method of treatment,
• its history and contemporary standing, and
• its nature as a specialty of clinical social work
• principles of intervention
• research
• cultural competencies
• major theories of psychoanalysis
• issues affecting the analyst and analysands.
In an effort to be as accurate and inclusive as possible, the statement’s authors
submitted it in various drafts to leading practitioners and academics, who responded in
detail. Many of their comments were incorporated into the final version, which is fully
annotated as to sources and references, and is intended to meet high levels of scholarly and
empirical scrutiny. A bibliography is included.
Purpose of Psychoanalysis
In clinical social work, psychoanalysis is conducted by an experienced and skilled
clinical social worker who treats those experiencing disturbances in affect, thought, and
behavior. Analysts draw on a well-defined knowledge base derived from research,
theoretical constructs, applied practice methodologies, and a highly developed set of
specialized practice skills and activities.
Nature of Psychoanalysis
Psychoanalysis is defined as the psychotherapeutic application, by trained analysts,
of psychoanalytic theory in order to ameliorate disorders that interfere with the
analysand’s satisfactory functioning. It is conducted with frequency and intensity, and
seeks to bring unconscious mental elements and processes into the analysand’s awareness,
where they may be explored and understood.
Generally, psychoanalysis is conducted with the analysand lying on a couch and
talking to an analyst who is out of the analysand’s line of sight. The unconscious material
that has been brought into awareness is addressed by the analyst and analysand through
various techniques, including exploration, clarification, confrontation, and interpretation.
Approaches to Psychoanalysis
Although once informed by a unifying theory in the work of Sigmund Freud,
psychoanalysis has evolved over the years and now has many models and encompasses a
wide variety of theoretical approaches. Section IV of the position statement identifies the
organizing principles of the four paradigms that dominate psychoanalytic theory: Drive
Theory, Object Relations Theory, Ego Psychology, and Self Psychology. Theories of
human motivation, the nature of anxiety, and the causes of psychopathology, are
considered, as are Jungian, Kleinian, and Lacanian schools.
As practiced by a clinical social worker psychoanalyst, the different models all have
a core set of principles (developed by social work schools and organizations and by
regulatory bodies) for the analyst to follow: ethical and legal practice; a commitment to
advocate for improved human services programs and social policy; respect for culture and
diversity; and recognition of the analysand’s rights to privacy, confidentiality, informed
choice, and self-determination,
Psychoanalysis as a Specialty of Advanced Clinical Social Work
In clinical social work, psychoanalysis is a specialty area of practice that is pursued
through advanced training, years of experience, and mastery of a range of competencies
(identified in detail in the position statement). The clinical social worker’s training and
education begin in master’s program at a school of social work, and continue for at least
two years of post-graduate entry-level practice under clinical supervision. During these
years, the neophyte practitioner absorbs the theory and methodology of clinical social
work, and applies it to the treatment of clients. After this, clinical social workers may
engage in autonomous practice; however, if they choose to specialize in psychoanalysis,
they will re-enter a period of rigorous training and education which will last for a number
of years. In most instances, this process is undertaken through a psychoanalytic institute. It
is intended to produce deep, detailed expertise in psychoanalytic processes and their
emotional, psychological, cognitive, and behavioral aspects.
Once established as a psychoanalyst at the advanced level, the practitioner will
continue to receive supervision or consultation and will keep learning through continuing
education or certificate programs, reading current literature, attending professional
conferences, and self-observation and reflection on interactions and their outcomes. The
advanced practitioner will apply evidence-based best practices when possible, and will
practice legally and ethically. Ethical practice, among many other things, requires that the
practitioner who chooses to use psychoanalysis has a high degree of expertise in
psychoanalytic theory and practice, without which he/she should refer interested clients to
clinical social worker psychoanalysts who do have such expertise.
Competencies of the Advanced Clinical Supervisor
A proficient psychoanalyst should be practicing at an advanced level of competency.
The analyst understands theoretical concepts and how to apply them flexibly to practice,
and has practice wisdom gained from years of experience in this field. The analyst monitors
his/her own direct practice, pursues professional development, and knows when to seek
consultation and/or supervision. The analyst may also serve as mentor or consultant to
colleagues, and may model and teach what is needed for practice. In determining the
competence of the analyst, nothing is more telling than the level of competency in
professional knowledge and practice skills, which can be measured by detailed
characteristics of practice (listed in detail in position statement) as they are related to the
following terms:
!
!
Assessment and Diagnosis
!
!
Treatment Considerations
!
!
Intervention
!
!
Outcome Evaluation
!
!
Supervision, Consultation, Training, and Writing.
Table of Contents
Introduction
4
I.
Background of Clinical Social Work Psychoanalysis
5
A. Rationale as a Practice Specialty
5
B. Brief History of Clinical Social Work Psychoanalysis
6
C. Contemporary Context of Clinical Social Work Psychoanalysis
7
1.
Practice
Issues
7
2.
Education
and
Training
8
3. Clinical Social Workers’ Contributions to the Field
8
II.
Nature of Psychoanalysis as Practiced by Clinical Social Workers 9
A. Definition of Psychoanalysis as Practiced by Clinical Social Workers 9
B. Contemporary Research on Psychoanalysis
11
C. Cultural Competence in Psychoanalysis
11
D.
Ethics
and
Training
Standards
13
1.
Personal
Analysis
14
2.
Course
Work
15
3. Supervision
15
III. Principles of Therapeutic Intervention
15
A. Assessment and Diagnosis
15
B.
Psychoanalytic
Treatment
Considerations
16
C.
Special
Issues
17
1. Characteristics of Those Who Can Benefit from Analysis
17
2. The Place of Medication Consultation in Psychoanalytic Practice
18
3. The Place of Psychological Testing in Psychoanalytic Practice
18
4.
Child
Psychoanalysis
18
5. Limits
of
Confidentiality
19
IV. Major Psychoanalytic Theories/Perspectives Used by
Clinical Social Worker Psychoanalysts
19
A. Drive Theory
20
B. Object Relations Theory
21
C.
Ego
Psychology
Theory
22
D.
Self
Psychology
Theory
24
E. Other Major Analytic Theories and Schools
25
2
V.
The Summaries: Professional Competencies of the
Clinical Social Worker Psychoanalyst
26
A.
Professional
Knowledge
27
B.
Practice
Skills
28
The Tables: Professional Competencies of the Clinical Social
Worker
Psychoanalyst
29
Table 1. Assessment and Diagnosis
29
Table 2. Treatment Considerations
30
Table 3. Intervention
31
Table 4. Outcome Evaluation
32
Table 5. Supervision, Consultation, Training and Writing
33
Reference List
34
Publisher’s Note with Acknowledgements
42
3
Introduction
This paper was produced by the American Board of Examiners in Clinical Social
Work (ABE), a certifying organization for the field of clinical social work. ABE’s mission
is to conduct national certification at the advanced level and to set uniform advanced
practice standards.
As a position statement on the advanced practice of psychoanalysis by clinical social
workers, this paper seeks to be comprehensive and definitive in describing the main
characteristics of clinical social work practice of psychoanalysis, and in identifying various
approaches used by clinical social workers in this specialty. It was developed because there
is no such document that aspires to describe and identify the characteristics and
approaches of this important area of practice. The American Board of Examiners, as a
standard-setting organization representing advanced clinical social work, is committed to
identifying the characteristics of advanced practice in various specialty areas. Beyond its
function as a position statement, the paper will serve as a source for developing standards
for an ABE certification to be offered to advanced practitioners in the specialty area of
psychoanalysis.
4
I. Background of Clinical Social Work Psychoanalysis
A. Rationale as a Practice Specialty
Psychoanalysis is an effective method of treatment for those who experience
disturbances in affect, thought, and behavior. The clinical social worker psychoanalyst
masters a specific knowledge-base and applies a highly developed set of specialized practice
skills and activities through which the analysand (client/patient) and analyst work together
toward helping the analysand (see section V., The Summaries: Professional Competencies
of the Clinical Social Worker Psychoanalyst).
The knowledge base for this specialty is derived from theoretical constructs, applied
practice methodologies, and findings from supervised practice and other areas that have
been the subjects of research. Mastery of the knowledge base and treatment skills for the
competent practice of psychoanalysis is achieved through a rigorous, extended program of
study and training. While psychoanalytic theory and certain psychoanalytic treatment
methods have informed other types of clinical social work practice, psychoanalysis remains
distinct as a treatment method. Its unique process and capabilities are neither replaced by
nor interchangeable with any other method.
A competent analyst is the product of rigorous training and education. The
hallmark of the competent analyst is a deep, detailed expertise in psychoanalytic processes
and their emotional, psychological, cognitive, and behavioral characteristics. The non-
specialist, who may have a general understanding of psychoanalytic processes, cannot
practice psychoanalysis ethically and effectively. With regard to techniques and treatment
methods, specialists are distinguished by the extensive experience and high levels of
practice proficiency that enable them to apply specific psychoanalytic techniques adeptly
and to consider many alternatives before emphasizing certain aspects of intervention as
being in the best interests of the analysand.
The practice of psychoanalysis is mastered only at the post-graduate level, primarily
through the training programs of psychoanalytic institutes. Education and training with a
less formal curriculum are found at some university-based graduate schools of social work,
and in workshops and seminars. The three pillars of analytic institute training are the
following: personal analysis of the candidate, didactic curriculum (including theory,
development, psychological health, psychopathology, and technique), and supervised
clinical work (The Psychoanalytic Consortium, 2002).
Clinical social workers must practice within the limits of their competence and must
be well-informed about the knowledge-base and about the diagnostic and treatment
approaches they employ. This form of practice requires that clinicians have a high degree
of expertise in psychoanalytic theory and practice. Lacking this, they should refer
interested clients to clinical social worker psychoanalysts who do have such expertise.
5
B. Brief History of Clinical Social Work Psychoanalysis
Today, as in the past, many advanced clinical social workers—not only those who
specialize in psychoanalysis—draw on psychoanalytic theory in their efforts to understand
human motivation and behavior and to practice effectively.
In 1918, the first psychoanalytically oriented school of social work, Smith College
School for Social Work, was founded to teach students about Sigmund Freud’s ideas and
their application to practice, particularly in the treatment of WWI veterans’ “war
neuroses.” Freud’s appeal was great for many reasons, but greatest for his discovery of
how best to conduct the helping process itself: by listening, by honoring the client’s self-
expression, and by doing something with rather than to the client. These attitudes were
revolutionary at a time when clinicians typically sought to advise, persuade, and even
coerce their clients (Alexander & Selesnick, 1966). In these and other ways,
psychoanalysis, formerly seen as the province of psychiatrists, made such a profound
impact on social work that many practitioners were recognized by the title Psychiatric
Social Worker (note: the term “psychiatric social worker” was supplanted in the 1970s by
the term “clinical social worker,” since clinical social work is now practiced in a broad
array of settings).
In the 1940s and 1950s, several events occurred that were important to the
development of social work and psychoanalysis. Social work schools incorporated
psychoanalytic ideas into their curricula, based on the influence of the published work of
psychoanalytic social workers. Psychiatric social workers treated a wide array of clients,
including those in hitherto-neglected settings like family agencies and child-guidance clinics
(Feldman, 1982; Garrett, 1949, 1972; Hamilton, 1947, 1954; Hollis 1939, 1958).
Psychoanalytic training and certification programs arose in major cities throughout the
United States but generally excluded psychiatric social workers and other members of non-
medical disciplines. While some individual social workers were able to provide non-
certified psychoanalytic services, the institutes’ discriminatory policies generally prevented
clinical social workers from achieving recognition for the practice of psychoanalysis.
Informally, a few psychoanalysts did provide training and supervision to social
workers; and in 1948 social workers were first accepted at the psychoanalytic institutes of
the National Psychological Association for Psychoanalysis, and the Postgraduate Center for
Mental Health, both in New York. Other doors began to open and, by 1964 in New York
City alone, thirty such institutes accepted clinical social workers (Wallerstein, 1996).
Organizations such as the American Psychoanalytic Association gradually dropped their
prohibitions against admitting social workers.
In 1980, in New York, the first organization for clinical social worker
psychoanalysts was founded. It subsequently became a national organization and is known
today as the National Membership Committee on Psychoanalysis, affiliated with the
Clinical Social Work Federation, Inc. The Committee participates in The Psychoanalytic
6
Consortium with the American Academy of Psychoanalysis, the American Psychoanalytic
Association, and the American Psychological Association’s Division on Psychoanalysis
(Division 39). Clinical social workers have been accepted since 1988 as members of the
American Psychoanalytic Association, and are also accepted in its Fellowship Program and
in many institutes affiliated with that Association. Nationwide, clinical social workers
constitute a large number of students in many institutes (Perlman, 1995); and they serve as
presidents, deans, faculty, and curriculum chairs.
C. Contemporary Context of Clinical Social Work Psychoanalysis
1. Practice Issues
Clinical social worker psychoanalysts now form a relatively large part of the U.S.
psychoanalytic community. Employing a bio-psycho-social approach to mental-emotional
healthcare, these practitioners integrate their work as both clinical social workers and
psychoanalysts, and consult with clinical social workers in other practice areas to benefit
from their insights and to share psychoanalytic knowledge that can help their clients.
Today, clinical social worker psychoanalysts still apply many of Sigmund Freud’s
concepts, such as respectful listening, the importance of the unconscious and the irrational,
transference and counter-transference, the repetition compulsion, normal and pathological
mourning, masochism and sadism, the processes of identification, and defense mechanisms.
At the same time, these analysts make use of more recent psychoanalytically based
discoveries about the processes of development, especially pre-oedipal and female
development. Recently, the domain of psychoanalysis has been greatly enriched by the
findings of infant research, neurology, and gender studies (Richards & Tyson, 1996).
Analysts’ involvement in the mainstream of modern practice has led them to
grapple with managed care systems and with other challenges, including the need to
incorporate into treatment the new findings about biological aspects of bipolar disorders,
major depression, panic disorders, and obsessive-compulsive disorders, in which
medication may be required as an adjunct treatment. Clinical social worker psychoanalysts
have long been aware that physical illness and physical handicaps have an impact on
emotional and personality development. In recent years, they have better understood the
influence of organic and environmental factors on brain development and brain function.
Peri- and post-natal influences, temperamental differences, genetic and heritable factors,
cognitive and emotional deficits—each contributes to the maturing infant’s interaction with
the environment, and the environment responds differentially to the infant’s needs.
Analysts demonstrate a basic understanding of the effects of diet and environmental toxins
on children’s development. They possess an awareness of the limitations imposed by a
variety of physical, cognitive, and emotional handicaps.
Financial constraints (including lack of reimbursement under third-party insurance
7
Document Outline
- Introduction 4
- I. Background of Clinical Social Work Psychoanalysis 5
- Rationale as a Practice Specialty 5
- Contemporary Research on Psychoanalysis 11
- Assessment and Diagnosis 15
- Psychoanalytic Treatment Considerations 16
- Special Issues 17
- The Summaries: Professional Competencies of the
- Clinical Social Worker Psychoanalyst 26
- Introduction
- I. Background of Clinical Social Work Psychoanalysis
- A. Rationale as a Practice Specialty
- C. Contemporary Context of Clinical Social Work Psychoanalysis
- 1. Practice Issues
- 2. Education and Training
- 3. Clinical Social Workers? Contributions to the Field
- II. Nature of Psychoanalysis as Practiced by Clinical Social Workers
- A. Definition of Psychoanalysis as Practiced by Clinical Social Workers
- B. Contemporary Research on Psychoanalysis
- C. Cultural Competence in Psychoanalysis
- D. Ethics and Training Standards
- 1. Personal Analysis
- 2. Course Work
- 3. Supervision
- III. Principles of Therapeutic Intervention
- A. Assessment and Diagnosis
- B. Psychoanalytic Treatment Considerations
- C. Special Issues
- 1. Characteristics of Those Who Can Benefit from Analysis
- 2. The Place of Medication Consultation in Psychoanalytic Practice
- 3. The Place of Psychological Testing in Psychoanalytic Practice
- 4. Child Psychoanalysis
- 5. Limits of Confidentiality
- IV. Major Psychoanalytic Theories/Perspectives Used by Clinical Social Worker Psychoanalysts
- C. Ego Psychology Theory
- D. Self Psychology Theory
- E. Other Major Analytic Theories and Schools
- V. The Summaries: Professional Competencies of the Clinical Social Worker Psychoanalyst
- A. Professional Knowledge
- B. Practice Skills
- Table 1
- Professional Competencies of the Clinical Social Worker Psychoanalyst
- Assessment and Diagnosis
- Table 2
- Professional Competencies of the Clinical Social Worker Psychoanalyst
- Treatment Considerations
- Table 3
- Professional Competencies of the Clinical Social Worker Psychoanalyst
- Intervention
- Table 4
- Professional Competencies of the Clinical Social Worker Psychoanalyst
- Outcome Evaluation
- Table 5
- Professional Competencies of the Clinical Social Worker Psychoanalyst
- Supervision, Consultation, Training and Writing
- Reference List
- Jerrold R. Brandell, Ph.D., BCD
- David G. Phillips, DSW, BCD
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