When Freud visited North America in 1909 to lecture at Clark University, the ideas he put forth there held great appeal for social workers, many of whom had become disenchanted with the current state of their knowledge and methods. Manipulations of the environment combined with the giving of advice were being viewed as insufficiently effective in modifying how people viewed themselves or in altering their behavior. It is not surprising, then, that nine years later, when the School for Social Work at Smith College was founded, it based its teaching on psychoanalytic principles. Many, perhaps most American schools of social work eventually followed suit. By the 1930s M.S.W. social workers were incorporating ideas about unconscious functioning into their thinking on diagnosis and treatment, and had become keenly aware of the ways in which past experiences could affect their clients' actions and reactions in the present, not least in the therapeutic interview. A number of these workers saw also that the concepts they applied to clients were equally relevant to their own lives, and many looked to personal analysis as an important aspect of their education.
In the early forties, when some of us were beginning our graduate training, drive theory is what we learned; but before we took our degrees, ego psychology was fast replacing it as the preferred way of thinking. In those days the great majority of students in social work schools were women, and most of the analysts brought in to teach them were male. We budding social workers, intrigued with their theories, often dreamed of ways we might enjoy more than a mere sampling of this exciting new perspective. In the clear light of day, however, we had to resign ourselves to feelings of frustration that the analytic institutes in which those physicians had trained were not open to those in our profession. Yet our wishes were at least partially granted, for not only in the classroom, but also in the field placements or internships that were part of every program, our supervisors continued to steep us in analytic ideas, and nearly every agency or clinic had psychoanalysts as consultants.
Ego psychology and “psychiatric social work” were long compatible. When first introduced to our profession, the new formulation was eagerly greeted; it was found more congenial than the earlier emphasis on the dangerous id. Leading educators in our field pronounced ego psychology the theory for social work. It led us to respect defenses, and it enhanced our compassion to realize that denial, projection, and repression were instituted by the person to ward off various kinds of painful feelings.
Upon graduating, most of us sought work in agencies, clinics, or hospitals where we could best further our psychoanalytic knowledge, and our skills in using it, to help whatever types of clients we might then be serving. So we looked for places where the supervisors were analytically oriented. And when we were fortunate in our choice of work arena, the agency itself sometimes paid for us to have analytic consultation on our cases, often with one of the several European analysts who had recently immigrated to the United States.
We entered personal analysis as soon as we could afford it, and although at that time analysts in The American were forbidden to train us, many privately disagreed with that rule, and much “bootleg” training went on. So, denied entrance to the official institutes, we attended seminars and workshops designed by analysts, and sought analytic supervision, often with “imported” woman analysts who seemed particularly helpful in our treatment of children. There was much two-way learning that went on in these situations, for many social workers had a clientele not ordinarily seen by medical analysts, either in their private practice or in their clinic work. It was widely acknowledged that physician analysts regularly referred to social workers cases deemed too troublesome for their own practices, and we learned together what permutations of approach might be indicated.
Some of us privileged to hear Erik Erikson deliver his first papers predicted that his development of analytic theory would be particularly important for social work, for his was a biopsychosocial approach. Indeed, his 1950 classic, Childhood and Society, was for many years on the reading list of nearly every school of social work in the country. It afforded us a framework in which we could view a wide etiological spectrum illuminating the many problems to which human beings fall prey.
In the years immediately following World War II, and for several decades thereafter, psychoanalysis thrived throughout the academic world, taught not only in schools of social work but in psychiatric residencies and, to some extent, in departments of psychology. Ego supportive therapy continued to be the prime mode of treatment in most Veterans Administration clinics and other settings in which social workers commonly practiced. Again, a great deal of mutual learning went on as social workers, psychologists, and analysts worked together on treatment “teams.” Social work began to attract more males into the field, and it seemed to some of us at first that their influence tended to move us a bit from the one-on-one treatment model to a larger scene.
By the 1950s a few social workers had begun to enter private practice at least part-time, a development that created considerable controversy within the profession. The National Association of Social Workers officially questioned whether the private practitioner was any longer engaged in social work, and what some of us playfully called “the Inquisition” was instituted, with a prestigious panel of “real” social workers traveling about the country conducting interviews with those of us belonging to this “deviant subgroup.” The fear seemed to be that we would cease to feed into the mainstream in any way that would contribute to its development, and that we would neglect our “social responsibility.” Ironically, what was found was that private practitioners, whether full- or part-time, were in fact engaging in more community and social action than those who remained safely in traditional settings; the latter were inclined to shift the responsibility to their agencies. It was also the private practitioner who most often reached out to other professions in the community that might benefit from psychoanalytic ideas. Many of us began to offer consultation with teachers, lawyers, doctors, and nurses, sharing our knowledge with them and in turn learning more about the challenges they faced and how what we knew might be adapted in other areas of concern.
In addition, because students demanded to be taught by those who also practice, many of us were already teaching in colleges and universities, offering something else students were demanding—psychoanalytic theories to be applied in various settings. Now, so unlike the arrangement we faced in our own education, students were learning analytic theory from social workers, with at least as many women as men among them. It was frequently we social workers who introduced students to such developments in psychoanalysis as object relations theory and self psychology. And it was usually we who taught courses on growth and development, drawing on the writings of Anna Freud, Sybille Escalona, Bowlby, Greenacre, Mahler, and Spitz.
Jean B. Sanville, Ph.D., is president of the IPA-affiliated Los Angeles Institute and Society for Psychoanalytic Studies and edits the Clinical Social Work Journal.
In the 1960s in the schools, a rift began to appear between social work and psychoanalysis. Psychoanalysis—and I would include here many of the social workers who had embraced it—had not adequately demonstrated its usefulness to people in the lower socioeconomic groups or to those of different races and cultures. Confronting their instructors, students began questioning whether analytic theory was of any value in work with the clients they served. Family and group therapy began to thrive, and practitioners of these modalities turned increasingly to systems, learning, and communications theory to comprehend the interactions they observed. Many schools of social work, hoping to help more people faster, began to drop psychoanalysis in favor of alternative approaches. Elsewhere in the academy, similar changes were occurring. Pills were beginning to win out over the psychotherapies as the preferred mode of treatment in departments of psychiatry. It was becoming harder and harder for professional schools to justify the teaching of psychoanalysis; instead they reached for what they thought were more efficient and less expensive means of treating the severe biopsychosocial problems they found themselves confronting.
By the 1970s, as some of us saw things, psychoanalysis itself had begun to extend its services to the kinds of patients social workers had always treated, those now called “narcissistic” or “borderline,” and exciting new ways of understanding and treating these syndromes were developing. But it seemed clear to many clinicians in the social work realm that most of the old schools of social work (with some important exceptions) were not likely again to make a home for psychoanalytic ideas. A great many of us saw ourselves as “independent” practitioners, whether or not we worked privately. We disliked our old name, “psychiatric social workers,” suggesting as it did that we were auxiliary or subservient to psychiatrists. So, renaming ourselves “clinical” social workers, we became sufficiently active politically that we succeeded in obtaining the first licensure in the nation, even though the National Association of Social Workers came in and, pitting its strength against ours, opposed us. We formed the first Society for Clinical Social Work, and many professionals split with the NASW, seeing its actions as evidence of animosity toward the clinical. Within a few years most states had Societies for Clinical Social Work, which in 1971 came together in a federation.
It was through the Education Committee of the California Society for Clinical Social Work that the first extramural doctoral program was established. Where most existing doctoral programs in universities and colleges educated only for administration or research, we wanted to educate for clinical practice from a psychodynamic perspective. Today, the California Institute for Clinical Social Work grants a state-approved Ph.D., holders of which are eligible to teach in any graduate school in California. And many did, at least until the recent strictures on hiring teachers of analytic persuasion. Despite this, the institute has turned out more than sixty graduates, who serve in a variety of settings and offer supervision and consultation to numerous others. Illinois today has a similar institute, and another is being developed in Washington, D.C.
The National Federation of Societies for Clinical Social Work publishes the quarterly Clinical Social Work Journal, a majority of whose articles are written from a psychoanalytic perspective, which most clinical social workers would seem to prefer.
Meanwhile, on the East Coast, analytic institutes that train nonmedical clinicians have been thriving for many decades, and two of them—the Freudian Society and the Institute for Psychoanalytic Training and Research—have recently been admitted to the IPA. On the West Coast, the Los Angeles Institute and Society for Psychoanalytic Studies will shortly be celebrating its twenty-fifth anniversary, and together with the Psychoanalytic Center of California has also been accepted into the IPA. These institutes have always accepted social workers for training, as well as psychologists and psychiatric nurses. Although we may or may not agree with Freud that medical training is a sometimes curable obstacle, we do believe that psychoanalysis will be improved by incorporating those in related disciplines.
Ironically, one of the luckiest breaks to befall The American may well be its having lost the suit filed against it by the American Psychological Association. Analysts will now have to do what they could and should have done from the beginning—admit nonmedical candidates into their institutes. It is sad that such a move had to be brought about by legal coercion, and indeed it may be some years before we can be anything like “one big happy family.” But The American and the new groups in the IPA are attempting at least to make friends, and to design together an umbrella organization for psychoanalysis in North America.
I think we can predict that all analysis will be richer as we work together and learn together. A multidisciplinary organization made up of medical and nonmedical professionals, women and men, will be better able to develop theories and practices that may not only regain the esteem once enjoyed by psychoanalysis, but be seen as relevant to the problems of the nineties and those of the century to come.