Washington Baltimore Center for Psychoanalysis

Beyond the COuch

Becoming a Psychoanalytic Social Worker

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By Joel Kanter, MSW, LCSW-C

Emerging from my MSW program as a neophyte social worker, my aspiration was to become a psychoanalytic psychotherapist largely indistinguishable from my colleagues in other disciplines.  Well aware of the professional hegemony which privileges the psychoanalyst over the psychotherapist and the psychotherapist over the social worker, I enrolled in the Washington School of Psychiatry’s Advanced Psychotherapy Program which, in the late 70’s, was the only local program training social workers in psychoanalytic therapy.  

While I continued my training at the Washington School, my salaried job was in a community support program working with individuals recently discharged from psychiatric hospitals.  In this role, besides functioning as a psychotherapist with very troubled individuals, I also directed a small day treatment center, provided what we now call “case management” and collaborated with families.  

Stimulated by the Baltimore-Washington community’s longtime interest in treating such troubled patients, I began to explore how psychoanalytically-informed interventions could be developed with such individuals outside the consulting room in “casework”, group work, and family consultation.

Yet, internally, my professional identity was bifurcated between functioning some days as a psychotherapist and others as a social worker. This started to change as I read more of Donald Woods Winnicott’s writings and began to discover remarks which embraced social work interventions. In one such comment on treating psychotic patients, he said the analyst must step outside his role at appropriate moments and himself becomes a social worker. Reading his classic 1960 paper “The Theory of the Parent Infant Relationship” where he first elaborated on the concept of holding, he ended a later version of the paper with one of his rare footnotes, directing readers to his wife Clare’s elaboration of the concept of holding in casework.  

In the pre-internet era, it took three years to locate Clare WInnicott’s 1964 monograph “Child Care and Social Work” but when I did, I began to appreciate how psychoanalytic social work could address difficult human problems that could not be addressed with conventional analytic interventions.

Clare’s ideas about this emerged from her wartime collaboration with Donald, her future husband, as they collaborated during the war consulting with five group homes for over 80 evacuated children with special needs in the Oxfordshire area. 

In a later paper written after her analysis with Melanie Klein and completion of her analytic training at the British Institute, Clare observed that:

The psychotherapist starts from the inside and is concerned with inner conflicts which hamper social development. He or she remains, usually until the very end of treatment, a subjective figure in the child’s world. The effectiveness of treatment depends on the degree of subjectivity that can be maintained. The social worker, on the other hand, starts off as a real person concerned with the external events and people in the child’s life. In the course of her work with him she will attempt to bridge the gap between the external world and his feelings about it and in so doing she will enter his inner world too. As a person who can move from one world to another the social worker can have a special value all her own for the child, and a special kind of relationship to him which is quite different in kind from the value and relationship that a psychotherapist has. (The social worker) can never become entirely the subjective object which the psychotherapist becomes. She is bound to external reality because she is part and parcel of the child’s real world, and often is responsible for maintaining that world. The social worker with children is therefore in a strategic position in their lives because she is in touch with a total situation representing a totality of experience. 

My practice experience with very troubled adults also required me to “move from one world to another” seeing clients in their homes, with family members, on psychiatric wards, in homeless shelters and community programs, and even in jails. In several instances, this involved me organizing funeral services for the client’s parent.  

Reflecting on Clare Winnicott’s characterization of the social worker’s role, I began to identify this function as being a transitional participant. Unlike her husband’s concept of the inanimate transitional object, Clare Winnicott’s transitional participant is not a passive recipient of the child’s or adult’s projections; the social worker actively positions him or herself in the client’s life, making direct contact with an array of significant others. For example, in clinical practice with a child of divorce, I may be the only person the child observes communicating directly with both parents as well as with siblings, teachers, and significant others.

Undoubtedly, the privacy of the consulting room enables one special sort of relationship to emerge between therapist and client. As a psychoanalytic social worker, I’ve learned that functioning as a transitional participant can offer a quite different special relationship as the separate threads of clients’ lives are gathered while moving between their disparate worlds. This phenomenon is not confined to professional relationships; siblings and longtime friends also embody our lived experiences, and the internalization of such relationships is a cornerstone of a cohesive self. 

References: 

Kanter, J. (1980). Facilitating a Therapeutic Milieu in the Families of Schizophrenics (w. A. Lin). Psychiatry,  43(2):106-119.

Kanter, J. (1984). Resocialization in Schizophrenia: Renegotiating the Latency Era.  International Review  of Psycho-Analysis, 11:43-59, 1984.

Kanter, J. (1989). Clinical Case Management: Definition, Principles, Components.  Hospital and Community Psychiatry, 40(4):361-368.

Kanter, J. (1990). Community-Based Management of Psychotic Clients: The Contributions of D.W. and  Clare Winnicott. Clinical Social Work Journal, 18(1):23-41.

Kanter, J. (2013) The Trauma of Dislocation and the Transitional Participant. GoodEnoughCaring.com.

Winnicott, C. (1963).  Face to Face with Children. In Kanter, J. (Ed.), (2004). Face to Face with Children: The Life and Work of Clare Winnicott.  London: Karnac.

Winnicott, C. (1964). Child Care and Social Work, Codicote.

Winnicott, D.W. (1960). The Theory of the Parent Infant Relationship, in Maturational Processes and the Facilitating Environment. International Universities Press. 

Winnicott, D.W. (1963). The mentally ill in your caseload, in Maturational Processes and the Facilitating Environment. International Universities Press. 

Winnicott, D.W. and Britton, C. (1944), The Problem of Homeless Children. In Kanter, J. (Ed.), (2004). Face to Face with Children: The Life and Work of Clare Winnicott.  London: Karnac.

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