Psychoanalytic Treatment in Contemporary Social Work Practice: An Interview with Dr. Carol Tosone

Episode 54: Today's podcast, Psychoanalytic Treatment in Contemporary Social Work Practice: An Interview with Dr. Carol Tosone, addresses two questions: First, is psychodynamic treatment relevant in contemporary social work practice? In other words, does it meet the needs of the clients, the agencies, and the funding sources? Second, has clinical social work abandoned social work's historical commitment to advocating for social change? I think they are questions worth thinking about. Ask any social work student today what the organizing framework for social work practice is, they won't say, "psychodynamic theory." They'll likely say "the strengths perspective," or "ecological systems theory." When my students do research papers on the best approaches to addressing mental health problems, they usually write about cognitive and behavioral treatments, perhaps because the evidence-base is dominated by studies of cognitive and behavioral approaches. When I ask my students what theoretical perspectives seem to be most consistent with their values and perspectives, they usually say "CBT" or "solution-focused." I usually only have one or two students who take a psychodynamic perspective. My students are usually surprised to hear that in the early 20th century, the social work profession adopted Freudian psychoanalysis as the organizing framework for providing direct services to clients. Social work pioneers such as Mary Richmond were psychoanalytic social workers. The dominance of psychodynamic treatment continued for decades. Even during the 1960s and 70s, when social work returned to its community organizing roots and mezzo and macro level changes were seen as the best way to improve clients' lives, most direct practice social workers identified as psychodynamic. For example, in 1982, a national study reported that even though most clinical social workers were eclectic in their practice, their preferred theoretical orientation was psychoanalytic (Jayaratne, 1982). Fast forward to 2009. Psychoanalytic treatment is widely dismissed as being patriarchal, oppressive, and out-of-touch with the needs and realities of social work clients. Insurance companies are requiring that clinicians use treatments that are short-term, empirically validated, and cost-effective. Agencies are increasingly requiring clinical staff to use prescribed treatments. Clinical social work education has moved towards teaching evidence-based practice, and learning about treatments with a cognitive behavioral, rather than psychodynamic basis. So, if students seem to prefer non-psychodynamic theories, agencies and insurance companies are mandating the use of non-psychodynamic treatments, and an increasing number of schools of social work are teaching cognitive and behavior-based evidence-based treatments, what place does psychodynamic treatment have in contemporary social work practice? Well, in order to answer some of these questions, I spoke with Dr. Carol Tosone about contemporary psychoanalytic treatment. Dr. Tosone completed her psychoanalytic training at the Postgraduate Center for Mental Health, where she was the recipient of the Postgraduate Memorial Award. She is an Associate Professor at the Silver School of Social Work at New York University, the recipient of the NYU Distinguished Teaching Award and is a Distinguished Scholar in Social Work in the National Academies of Practice in Washington, D.C. In 2007, Dr. Tosone was selected for a Fulbright Senior Specialist Award for teaching and research at the Hanoi University of Education in Vietnam. She is the editor-in-chief of the Clinical Social Work Journal, and the executive producer and writer of four social work education videos. And she is an expert in shared trauma, which is when a client and therapist experience the same traumatic event. In today's podcast, Carol and I talked about what distinguishes contemporary dynamic treatment from traditional psychoanalysis, the role of attachment theory in contemporary dynamic treatment, how talk therapy changes the way the brain processes information, and how brief dynamic treatment can be used in typical social work agency settings. Carol emphasized that contemporary psychoanalytic treatment and concrete services, such as case management, referral, or advocacy work, are not mutually exclusive. She shared how she came to see herself as a social worker first and an analyst second. We ended our conversation with information about resources for social workers in school and in the field who might be interested in learning more about contemporary dynamic treatment. Carol suggested that the best resource social workers have is other social workers and encouraged clinical social workers to write more and share their insights and experiences. I recorded today's interview at the University of Texas at Austin's school of social work. Carol was at UT to give the inaugural Sue Fairbanks Lecture in Psychoanalytic Knowledge. I want to thank the Sue Fairbanks lecture organizing committee, particularly Vicki Packheiser, for helping to coordinate the interview with Carol. You might hear the sound of children playing in the background - Carol and I spoke in an office right above a daycare center.