I have accepted the Hot Potato Award and agreed to write to my colleagues in The American about social workers. I am a recently graduated analyst from the San Francisco Institute and a social worker, the first admitted there with a waiver through the Committee on Non-Medical Clinical Training.
While many of you have lived your professional lives alongside social workers, I realize that others of you find us to be strange, unfamiliar animals. Even as The American's institutes open to us, one can sometimes feel something like Tigger sitting outside Pooh's door, wondering how long the “Hallo's” will go on. But, you may recall, Pooh does eventually invite Tigger in, even though Pooh has never seen an animal like this before.
Winnie-The-Pooh woke up suddenly in the middle of the night and listened. Then he got out of bed, and lit his candle, and stumped across the room to see if anybody was trying to get into his honey-cupboard, and they weren't, so he stumped back again, blew out his candle, and got into bed. Then he heard the noise again.
“Is that you, Piglet?”
But it wasn't.
“Come in, Christopher Robin,” he said.
But Christopher Robin didn't.
“Tell me about it tomorrow, Eeyore,” said Pooh sleepily.
But the noise went on.
“Worraworraworraworraworra,” said Whatever-it-was, and Pooh found that he wasn't asleep after all.
“What can that be?” he thought. “There are lots of noises in the Forest, but this is a different one. It isn't a growl, and it isn't a purr, and it isn't a bark, and it isn't the noise-you- make-before-beginning-a-piece-of-poetry, but it's a noise of some kind, made by a strange animal. And he's making it outside my door. So I shall get up and ask him not to do it.”
He got out of bed and opened his front door.
“Hallo!” said Pooh. “Hallo!”
“Hallo!” said Whatever-it-was.
“Oh, there you are!” said Pooh. “Hallo!”
“Hallo!” said the Strange Animal, wondering how long this was going on.
Pooh was just going to say “Hallo!” for the fourth time when he thought that he wouldn't, so he said: “What is it?” instead.
“Me,” said a voice.
“Oh!” said Pooh, “Well, come here.”
So Whatever-it-was came here, and in the light of the candle he and Pooh looked at each other.
“I'm Pooh,” said Pooh.
“I'm Tigger” said Tigger.
“Oh!” said Pooh, for he had never seen an animal like this before. “Does Christopher Robin know about you?”
“Of course he does,” said Tigger.
“Well,” said Pooh, “it's the middle of the night, which is a good time for going to sleep. And tomorrow morning we'll have some honey for breakfast. Do Tiggers like honey?”
“They like everything,” said Tigger cheerfully.
“Then if they like going to sleep on the floor, I'll go back to bed,” said Pooh, “and we'll do things in the morning. Good night.” And he got back into bed and went fast asleep. (From The House at Pooh Corner, E. P. Dutton.)
Tigger, the last character added to A. A. Milne's charming world of animals, brings a great deal of zest to every day thereafter. I am reminded of Otto Kernberg's remark, in “The Current Status of Psychoanalysis,” (JAPA, Vol. 41), that in Europe and Latin America “a strong cultural impact of psychoanalysis, lack of concern over the participation of nonmedical analysts in psychoanalytic organizations, and the more open and flexible nature of psychoanalytic education combine to foster dedication, enthusiasm, and creativity in psychoanalysis.” (I do hope that Dr. Kernberg will not mind his company in this paragraph. I am deliciously aware that in revealing my deep love of Milne's characters I place myself in other wonderful company, including Robert Gardner and Ted Jacobs, who have both recently quoted Milne.)
So, now that the “Hallo's” have been exchanged, what kind of animal are we social workers at your door? Let me make it clear immediately that Tiggers are a special species, not to be confused with all tigers. Tiggers do come with different stripes, after all. The term “social worker” is a confusing one because of its generic use. Unprotected legally, it is often used to refer to untrained people who fill positions in public agencies. The larger group that concerns us is the so-called “trained social workers,” referring to those with university-granted master's degrees. These are your tigers. The university-granted doctorate in social work is, with a few exceptions, a research or administrative degree, not a clinical one. Freestanding professional schools, however, are now springing up, and they do grant clinically based doctorates similar to those conferred by professional schools of psychology. This trend promises to grow stronger as clinical social workers seek parity with clinicians from other disciplines, but at present the overwhelming majority of trained social workers have earned an M.S.W.
Two years of graduate work are required for this degree. Courses span community organization, group work, and case work. When I took my degree, analysts taught half my clinical courses. Unfortunately, since then a trend has set in that applies as much to social work as to psychology and psychiatry, with analysts being excluded from the training of most clinicians. There is a difference with social workers, however.
As part of the curriculum, social work students spend two days a week in an agency their first year of training and three days a week in their second. For the student interested in clinical social work, this second-year placement will usually be in an agency that provides outpatient psychotherapy to adult and child patients. These agencies provide senior staff members as supervisors, so that students are exposed to the orientation of the agency, as well as to the wider community. For example, while the School of Social Welfare at UC-Berkeley, where I studied, is antianalytic, students learning to do psychotherapy there can spend a large amount of time in supervision with analytically informed psychotherapists. In addition, many of the agencies in which students intern use analysts as consultants. Because of the history and tradition of social work, which dictates that it will be more community-based than other mental health specialties, and also because of overriding financial considerations in this time of university budget cutbacks, this unique system, which preserves the ties between social work education and psychoanalysis, is not apt to change, despite the wishes of many department chairs. Several colleges, including Smith, use a system involving “block” placements, where students spend a portion of their years working full-time, thus allowing them greater access to psychoanalytically oriented agencies.
Okay, now you see how tigers get their training. But why would anyone who wishes to be a psychotherapist choose this training? Motivations vary. Not all of us know at the age of 21 what we want to do for the rest of our lives. The M.S.W is a flexible degree that can lead to a wide range of career choices, a degree that takes a predictable two years to attain. Many young adults lack the emotional and financial support to aspire to more. Where I came from, women weren't supposed to be educated at all; any advanced degree was hard won. A degree that took what seemed an eternity to complete, an eternity offering no visible means of support, was impossible to consider. But perhaps the various motives for following different career tracks to psychoanalytic training might ultimately be stimulating to psychoanalysis itself. Edward Weinshel and Owen Renik touched on this recently when they wrote, “Increased appreciation of the fact that many different career paths, each with its special virtues, can lead to the practice of effective psychoanalysis, bespeaks a movement away from the notion that a single correct
psychoanalytic point of view can be demonstrated“ (Psychoanalytic Inquiry, Vol. 11).
Another reason for choosing this path to psychoanalytic training, a reason I hope is not scorned by the analytic community, is that social work has its own proud tradition of being on the front lines where people need help. A feeling of activism and an attitude of “Let's get something done” is central to its professional culture. Trained social workers have historically and in contemporary times appeared all over the world, at all levels of society, to try to tackle the problems of human existence. This spirit of community dedication might, by the way, enhance psychoanalysis significantly. While I know that psychoanalysts accuse social workers of wanting to rush in and help, and social workers accuse analysts of caring more about their theories than about their patients, these are caricatures. Wouldn't we agree that psychoanalytically informed help is an asset, whatever name is given the delivering hands (or paws)?
After graduation, tigers' paths begin to diverge, as different careers are taken up. Social workers interested in psychoanalytic psychotherapy usually find jobs where psychoanalytically informed supervision and consultation are available. They may, after completing the additional requirements for a state license, end up in private practice, usually as a licensed clinical social worker, or L.C.S.W. (Requirements vary by state but always involve further clinical experience under the close supervision of an already licensed social worker, as well as the satisfactory completion of written and oral exams.) Having satisfied further requirements, they may eventually become board certified diplomates, a title conferred by the American Board of Examiners upon more senior and accomplished clinicians. Thus, a confusing alphabet soup—M.S.W., L.C.S.W., B.C.D.—signifies different accomplishments recognized by different authorities. There is no definitive sequence to the listing of these credentials after one's name, and one may choose to use all of them or only one. I, for example, have received all three but use only the familiar-feeling M.S.W.
At some point many social workers seek this further training, usually in psychoanalytically based programs. Again, I spent two years at Mt. Zion in the Department of Psychiatry as an NIMH fellow. By now 1 am describing a Tigger who is likely to appear at your door. With stripes quite different from those sported by other tigers living in the social work Forest, Tiggers are a tiny minority of graduate social workers. But remember, 90,000 state-licensed social workers are listed by the American Board of Examiners in Clinical Social Work, making them the largest group of trained professionals among the mental health specialties. The Bureau of Labor Statistics estimates that over half of all mental health services in this country are delivered by social workers. So, while only a very small proportion of social workers are determined to take more intensive analytic training, they come from a rather large pool of potential candidates. And certainly, if we believe that psychoanalytic thinking has
much to offer all psychotherapists, everyone benefits from a more collegia! association between psychoanalysis and social work.
Many of us have shown up in quite varied places. Like Tigger, I bounced around the Hundred Acre Woods, sticking my psychoanalytically informed nose into many concerns. I was a consultant to preschools, public and private elementary schools, Head Start programs, day treatment centers, welfare agencies, adoption agencies, parent groups. I added a children's service to a private hospital and served on the board of a child treatment facility. I supervised students from many different disciplines, at both the graduate and postgraduate levels, at most of the major training centers in the Bay Area, and for seven years did research in early child development. Most of these endeavors involved contact with psychoanalysts. Once again, my experience is not atypical for a certain proportion of social workers.
By the time Tigger gets to you, he or she is a very determined animal who has sought out this particular door. But why this door? Now, there's a question we have certainly asked ourselves. Unlike our younger colleagues who are just starting out, we have full, successful practices and lose money by entering training—not only its direct cost, but the income that could have been earned in hours now devoted to deepening our knowledge of analysis. To this financial sacrifice may be added the reproaches of social work friends who have resented The Americans former policy of exclusion and who therefore view the institution as a political enemy.
Having traveled this circuitous, often arduous route, many of us already feel more identified with psychoanalysis than with social work perse, so that the shift to viewing ourselves as psychoanalysts has presented many more external difficulties than internal conflicts of identity. Robert Wallerstein and Edward Weinshel read the current trend toward considering psychoanalysis not a subspecialty of psychiatry, but an independent psychological discipline, as a change that makes the identity of the psychoanalyst primary rather than secondary (Psychoanalytic Quarterly, Vol. 58). Thus, I consider myself to be a psychoanalyst who was originally trained as a social worker, a transition in my own identity that has been attended by pride.
Now, I have come to you with a well-documented track record, a rather sure bet to succeed in training. And I am grateful. My personal and professional life has been immeasurably enhanced; the education, the community, and the legitimization have had a synergistic effect. Had this route been unavailable to me, I would probably have landed eventually at one of the other two institutes in town or have traveled to find training. But for myself, I am glad of the home I have chosen. I am fortunate that The American found a way, in an egalitarian spirit, to evaluate me on my merits.
Lest the successful ending to my story lull you into thinking simply, “Here's a job well done,” let me remind you of the losses. I have achieved analytic training in the second half of my life and my career, with the smell of mortality about me. Had you taken me twenty years earlier, training me would have entailed some risk, but all this bouncing around could have been in your backyard. Instead of being a strange animal in the woods, I could have been an ambassador for psychoanalysis. The younger and therefore less accomplished social workers at your door have not gotten there easily, nor are they pursuing the most comfortable option for themselves. They are a special species.
But now let me put this Tigger issue in a broader context. It is the interaction of Milne's many different animal characters, each with a unique perspective and cast of mind, that provides the creative fabric of the stories. Credentialed social workers are a logical group from which to recruit analytic candidates, but our search might more ambitiously be conceived of as a search for talented and dedicated people, whatever the string of unfamiliar initials trailing after their names. Maxwell Citelson, over a quarter of a century ago, stated in a plenary address to The American, “I think the time has come for psychoanalysis to accept its identity as a separate scientific discipline, whose practitioners can be various kinds of intellectually qualified persons who are humanly qualified for the human experiment. That is the psychoanalytic situation” (JAPA, Vol. 12).
Today, the time has come.