Eda G. Goldstein

Self-disclosure in treatment: What therapists do and don't talk about

In contrast to the traditional view that sees therapist self-disclosure as a form of countertransference acting-out that either makes the therapeutic process more difficult or subverts it completely, this paper will present a self psychological rationale for the selected use of therapist self-disclosure in treatment. It will discuss the nature of therapist self-disclosure, issues in its use, countertransference issues, and its evaluation.

What is clinical social work? looking back to move ahead

This paper traces the evolution of the concept of clinical social work and looks at where we are and where we are headed as clinical social workers. It reaffirms the view that clinical social workers intervene with clients presenting the full range of problems in a variety of facilities and in private practice and must draw on a broad knowledge base within a person-situation perspective and address the special needs of culturally diverse and oppressed populations. The paper also considers the move toward legal regulation, the role of private practice, the need for clinical doctoral education, the importance of new models for clinical research, and the significance of advocacy for a broad range of services to clients.

To Tell or Not to Tell: The Disclosure of Events in the Therapist's Life to the Patient

Happy or disturbing events may occur in a therapists life during the course of treatment that intrude on the therapeutic process whether or not their true nature is disclosed to the patient. Therapists are not immune from experiencing acute, chronic, and even terminal illnesses, divorce, remarriage, adopting a child, mourning the death of a parent or significant other, or major accomplishments. In many instances such events affect the treatment process by disrupting appointments, necessitating sudden absences, restricting a therapists emotional availability and physical stamina, or altering the therapists mood and affect. In other instances, patients may be aware of such events, at least unconsciously, because of subtle changes in the therapist. Drawing on self psychology and intersubjectivity this paper explores the reasons for therapist self-disclosure of these events based on an assessment of the patients developmental needs and the nature of the transference. It will discuss ways of making such disclosures therapeutic.

Psychoanalysis and Social Work: Historical Perspectives

Abstract This paper traces the close relationship between psychoanalysis and social work after Freudian theorys dramatic impact on social work practice in the 1920s. It shows how revisions and expansion of psychoanalytic theory beyond its traditional base influenced clinical work during later decades until the 1960s, when society turned its attention to macrosystems intervention and other theoretical frameworks and practice models. The paper considers the impact of this change in emphasis on clinicians, direct practice, and schools of social work. Although it describes the resurgence of direct practice that occurred in the 1970s and 1980s, it discusses the reasons for the greatly diminished role of psychoanalytic theories in social work curricula. It concludes that there is little reason for optimism about psychoanalysis regaining a prominent position within the profession at the present time and comments on some implications of this state of affairs for those committed to advanced clinical training.

WHEN THE BUBBLE BURSTS: NARCISSISTIC VULNERABILITY IN MID-LIFE

Mid-life poses many stresses that are taxing even for those with relatively cohesive selves and good compensatory structures as well as those who show more severe pathology. This article will discuss mid-life issues, a self psychological perspective on mid-life, and will describe three individuals whose presenting problems were triggered by mid-life events that stimulated their underlying narcissistic vulnerability. The article will discuss and illustrate special emphases in the treatment of such patients drawing on self psychological theory generally.

Clinical and Ecological Approaches to the Borderline Client

A combination of developmental and transactional theoretical formulations is necessary in working with young people with borderline personality. A case example illustrates how intervention with individual, family, and social environment can lead to improved functioning.

Social Casework and the Dying Person

Utilizing an ecological perspective, treatment that was originally aimed at helping a young woman live a fuller life changed to helping her die

Book Review: The Family Inside: Working with the MultipleThe Family Inside: Working with the Multiple. By BryantDoris, KesslerJudy, and ShirarLyndaNew York: W. W. Norton, 1992. 268 pp.

Multiple personality disorder (MPD) is one of the most intriguing, complex, and challenging syndromes to face mental health practitioners. Although it was once thought to be a somewhat rare disorder, the apparent recent increase in its incidence in the patient population, particularly in those individuals who have had histories of sadistic and sometimes ritualistic sexual abuse, has led to renewed interest in its diagnosis and rreatment. The professional literature, however, has not kept pace with the clinical interest in this topic. With some exceptions, most of what has been written about MPD predates the expansion and revisions of our understanding of developmental and treatment processes. Consequently, clinicians of all disciplines who are interested in MPD and its treatment will find The Family Inside: Working with & MultipJe a most welcome contribution. Written in a highly readable, nontechnical, clinically grounded style, this book helps readers to understand the inner experience of the person with MPD, the nature of symptomatology, developmental and family origins of the disorder, techniques and stages of treatment, and difficult treatment issues. It also considers the special problem of ritualistic abuse. With great clarity of presentation, this volume delineates the nature, origins, and consequences of the mechanism of dissociation and family dysfunction in the evolution of MPD. The book systematically describes the different personalities that persons with MPD reflect and explains their functions in warding off and dealing with the experience and memory of trauma. The book takes the reader through the developmental process from birth to adulthood and describes the evolution of MPD. The inclusion of excerpts from the life and treatment experiences of one of the authors, herself a now-integrated multiple, gives the book a reality that illuminates the nature of the disorder and the interventive principles that are outlined and discussed throughout the chapters. Dedicated to the memory of Virginia Satir, a pioneer in the field of family theory and therapy, The Family Ins& uses her formulations for its theoretical framework. Although offering an important perspective, this framework seems overly simplistic in accounting for the complex evolution of MPD. Thus, in my view, the book lacks a solid theoretical base that can serve as a guide to intervention. Some attempt to incorporate-r at least to discuss-more recent contributions from psychodynamic theories such as ego psychology, object-relations theory, and self psychology would have been welcome. A major strength of the book is its effort to specify treatment principles and guidelines in the beginning, middle, and integration stages of treatment. Discussion of difficult situations that occur is also helpful. Included are such issues as establishing structure; the use of co-therapy; building communication; dealing with loss of control and chaos; retrieving memory and feelings; the role of denial; working with anger, abusive personalities, negative introjects, and resistance; and dealing with substance abuse, borderline traits, and paranoid personalities. Although some points are treated summarily, an indepth discussion of the multiple’s coping cycle describes some of the complexity of the treatment process and is particularly helpful. Despite commenting on the vicissitudes of transference and countertransference, the authors focus scant attention on this important topic. Their recipe-like approach to treatment conveys, perhaps unintentionally, the message that MPD is an easy disorder to treat and seems to minimize the often exacting, overwhelming, and tumultuous nature of the treatment process for both the patient and the therapist. Persons with MPD have almost always suffered extreme and repeated trauma, the horror of which was so great as to have led to the disorder. The treatment process is extremely threatening to the patient’s personality system and creates internal struggles that sometimes take on life-and-death proportions. Even the most experienced therapists are greatly stressed by the devastating acts to which patients have been exposed, the suffering of the different personalities of the multiple,

32.95.

Clinical interest in individuals who show early developmental arrests and entrenched characterological difficulties that interfere with their functioning has generated a growing literature in recent years. Readers will find Stephen M. Johnson’s The Symbiotic Character a creative contribution to this effort. In part one of this volume, Johnson presents an updated formulation of his characterologicaldevelopmental model. In part two, he delineates the nature and origins of the symbiotic character and summarizes theoretical approaches to it, highlighting the work of Fairbaim, Masterson, and Weiss and Sampson. In part three, Johnson specifies treatment objectives and considers and illustrates crucial themes and issues that arise in the treatment of patients with symbiotic disturbances. The appendix includes a glossary of selected developmental concepts and a researchbased chronology of developmental events and milestones. In presenting his general characterologicaldevelopmental framework, Johnson argues that

Book Review: The Symbiotic CharacterThe Symbiotic Character. By JohnsonStephen M.. New York: W. W. Norton, 1991. 254 pp.

In the beginning paragraphs of Family Therapy Techniques, Salvador Minuchin and H. Charles Fishman suggest that their book, after it is read, should be discarded. They view the therapist as a healer, “a human being concerned with engaging other human beings therapeutically, around areas and issues that cause them pain, while always retaining great respect for their values, areas of strength, and esthetic preferences. The goal, in other words, is to transcend technique.” Happily both Family Therapy Techniques and Lynn Hoffman’s Foundations of Family Therapy are two excellent books that overcome the all too prevalent tendency to portray families in trouble as systems to be manipulated with innovative gimmickry. Although each book is quite distinctive in its contribution, both present an impressive perspective for understanding and intervening in family difficulties. Both volumes should be read, reread, and shelved in a convenient location by anyone who is seriously engaged in the practice, supervision, teaching, and learning of clinical social work with families or family therapy. Hoffman’s book is the more ambitious, scholarly, and intellectually challenging of the two volumes. More concerned with establishing a unified theoretical framework that can guide practice than with the techniques of intervention per se, Hoffman engages in an interesting examination of various models of family treatment and the theories that inform them. Her quest for a unified theory leads her to consider not only the family’s homeostatic processes that are so vividly described by the early family systems pioneers, but also those familial processes that lead to sudden shifts or leaps within the family system, a topic of more recent interest. The early chapters trace some of the historical developments in the evolution of the family field reviewing the work of Bateson, Jackson, Haley, Bowen, and Wynne. Hoffman, who knew many of these individuals, is able to capture some of the excitement of the early period in which there was a gradual shift away from a linear and psychodynamic model of causplity to a more circular and transactional one. She then turns to an exposition of cybernetic theory as it contributes to understanding family movement as well as homeostasis and examines critically the various typologies of family communication and structure that have evolved. In several fascinating chapters that follow, Hoffman systematically presents balance theory as it helps to understand the development of family paradigms, triads, and the management of triangular conflicts in pathological systems. Having laid the theoretical foundations for viewing family malfunctioning, Hoffman turns to identifying the foci and processes of intervention reflected in idiosyncratic approaches such as those of Satir, Whitaker, Ackerman, Erickson, and Jackson; in historical approaches as reflected by Bowen and Boszormenyi-Nagy; in ecological and structural approaches as represented by Auerswald and Minuchin; and in strategic and systemic approaches are reflected by Haley and Palazzoli. Because of the strong theoretical presentation generally, and the reliance on cybernetic conckpts specifically, some sections of the book are heavy going. Those looking for a “how to do it” manual of assessment and treatment may be tempted to cast the book aside prematurely. This would be unfortunate, because the perspective on family functioning that is embodied in these difficult chapters is critical to practice. The chapters that give more illustrative material help the theory to come alive. Similarly, the review of selective interventive approaches is more lively, particularly those sections dealing with the structural, strategic, and systemic models. Perhaps the book is overly ambitious and suffers from covering too much ground. Because no unifying theory exists at present, the massive amount of material that the book tries to assimilate is sometimes overwhelming and confusing. Nevertheless, the book is impressive and makes a substantial contribution to the family treatment literature. Family Therapy Techniques is a highly readable