Carol Ganzer

A Sea of Trouble: A Relational Approach to the Culturally Sensitive Treatment of a Severely Disturbed Client

In this article we will show how a relational approach provides a conceptual framework that shapes and informs culturally sensitive practice with a severely disturbed client. We argue that a relational approach facilitates therapeutic action through the intense focus on countertransference, the close attention to enactments, and the therapists authenticity and self-disclosure. Additionally, we emphasize that a therapeutic matrix that includes the cultural, racial, socioeconomic, and institutional factors, increases the likelihood clinicians will attend to what Perez-Foster calls their “dissociated and disavowed personal values.” We present a case that had a less than satisfactory outcome where the therapist found herself in a “sea of trouble.” The case illustrates how a relational approach enhanced the therapists understanding of the case and allowed her to continue to work with a difficult and challenging client. We conclude by suggesting that our conceptual understanding of this case exemplifies a necessary and appropriate focus for future social work research and practice.

Moral reasoning and Alzheimer's care: Exploring complex weavings through narrative

Abstract This article reports on selected results of an inquiry-guided study in which we used literature and autobiography to challenge current rationalist perspectives on the use of formal services by caregivers of Alzheimers sufferers. Starting with Gilligan s concepts of two basic forms of moral reasoning—justice versus care-based—we interpreted the moral reasoning about caregiving expressed in four novels: Diary of a Good Neighbor, Memory Board, Memento Mori, and The Other Side. Although we found Gilligans dichotomous framework not directly applicable, we did find ample evidence of the salience of moral reasoning to questions of who should care and on what basis. We also found that stories, as they are woven from threads of family history, social position and mores, as well as ideas about intimate love, religion, and autonomy, reveal the interconnectedness of so-called private choices to the social ideologies that constrain and shape these choices.

Dialectical Constructivism in Clinical Social Work: An Exploration of Irwin Hoffman's Approach to Treatment

We explore selected concepts of Irwin Hoffmans approach to treatment as delineated in Ritual and Spontaneity in the Psychoanalytic Process. These ideas are drawn against the backdrop of the current climate of evidence-based practice and the trend toward prescriptive approaches to treatment. We discuss and explore Hoffmans conceptualization of the dialectics of ritual and spontaneity and of being and mortality, his discussion of collaborative exploration, and his delineation of the concept of liminal moments. Although these ideas were originally developed in a psychoanalytic framework, we argue that they are equally applicable in social work practice. We present a case vignette to illustrate the effectiveness of Hoffmans approach with a client who was in a transitional living program for homeless individuals and who had a 30-year history of alcohol and drug addiction as well as chronic mental illness. Finally, we discuss some of the unsettling implications of Hoffmans ideas, especially in terms of a transformed understanding of the opportunities and challenges for the therapists participation in the therapeutic dyad. We view Hoffmans contribution as an organizing framework for developing and expanding clinical social work practice in the 21st century.

The Speech of the Suffering Soul

Abstract Drawing upon postmodern thinking on narratives and pathologies of the self, we read and commented on William Styrons autobiographical account of his own depression from four different perspectives as follows: culturally situated psychology, feminist-psychoanalytic theory, relational therapy, and cultural/moral constructivist. We explore how multiple readings of the narrative might open up new conceptual space for clinical practice, teaching, and research. Each author read and interpreted Styrons narrative from her own distinct perspective. Where relevant, we looked at such narrative characteristics as metaphor, emplotment, dramatic development, narrator position, and moral meanings. However, these aspects of narrative did not dominate the readings. The readings were so distinctive that they resisted synthesis or thematic analysis, and we offer them as transformative meditations.

[Ornstein & Ganzer] Response to Commentary on Relational Social Work: A Model for the Future

and Nelson’s (1985, 1986) works have not developed from a psychoanalytic tradition. Social work is free to draw upon these thinker’s constructs without fitting them to a psychoanalytic tradition. Equally, psychoanalytic relational notions, as well as relational constructs derived from other traditions, may inform social work practice beyond clinical interventions. In particular, Lakoff ( in Powell, 2003) has been focusing his work on what we in social work would call the “macro” arena. Relational social work could be informed by a number of different perspectives. If the term gains popularity it is possible that several relational social works will develop, as there are several relational psychoanalyses. Relational social work need not and should not be reduced to relational psychoanalysis.We appreciate this interesting and thought provoking response to our article.We are pleased that the commentators feel our article is a valuable and significant contribution to the profession of social work. However, we do not feel that their critique addresses the most important ideas and concepts that we emphasize in our article. The focus of our article is on showing how a relational redefinition of concepts of transference, contertransference, projective identification and enactment can enhance clinical social work. We present detailed clinical vignettes to illustrate how a social worker can effectively utilize these concepts in difficult practice situations.