Preface

One morning in 1987, I sat in the cafeteria of the Jewish Hospital of Brooklyn/Interfaith Medical Center, where I had been a social worker for 15 years. I was trying to come to grips with the shifting organizational definitions of social work vis a vis the other professions moving into areas that had traditionally been social work’s ‘domain’.  I certainly wasn’t alone in this effort, as it had become a major preoccupation of social workers in hospitals, nursing homes and a variety of health care settings all over the country. Health care and health care financing were undergoing unprecedented and radical changes; it was dramatically affecting the way hospitals and health care organizations were reorganizing.

At the time, I was the assistant director of our social work department, struggling with these issues in a number of service areas for which I had administrative and supervisory responsibilities: Oncology, Sickle Cell, Dialysis, Substance Abuse, HIV-AIDS and OPD Mental Health.

That morning, munching on a Danish and stirring my coffee, it dawned on me: it’s a mistake to define our profession – for ourselves or others – or provide a rationale for claiming areas of responsibility within the organization based primarily on ‘what we do’.  We could not adequately find stability or focus in the swirling waters of this health care environment based primarily on tasks: discharge planning, case management, resource provision and referral, counseling or psychotherapy. Social work may have a deep tradition and experience of work in these ‘task’ areas, but has no exclusive claim to them. Other professions were training themselves in the very same skills that have been the mainstay of our practice in a variety of arenas in health care and other fields.

The insight over that cup of coffee was this: we needed to anchor our efforts at presenting ourselves to our audiences, not only in terms of competence in what we can do, but in terms of the meaning of what we do; and for that we needed to start with our professional narrative – with the realities that evoked the profession of social work in the first place

Considering that narrative, a series of metaphors, concepts and a frame for defining social work emerged. The applications of that frame to social work in hospitals as well as to ethics in long term care are presented in Soundings: explorations of social work in a changing health care environment.

The following series of essays are attempts at using this frame to provide a social work perspective on the practice of psychotherapy. The opportunity to present these ideas was occasioned by the International Conference for the Advancement of Private Practice in Social Work at their conferences from 2005 through 2008. I would like to thank the Board of ICAPP and their conference committee for their generous invitations to present in this series of conferences.

Postscript

In the first essay of this collection, I made the statement: “… a strong identity is not necessarily equated with a highly defined self.” To be sure, there were some raised eyebrows and queries as to what that statement meant. However, for anchoring professional as well as personal identity, I believe this goes to the heart of the matter.

Competence in what we can “do” is certainly important, both personally and professionally, when it comes to our interplay within the arenas of our families, communities and society at large. But what we can do, as important as that may be, remains simply derivative of how we understand who and what we are. It is within that understanding that we can see more clearly the uniqueness of the meaning of what we do. By maintaining a vital and deep comprehension of the meaning of our professional behaviors – and consequent awareness of our actions as dialogue within society – access to our capacity for creatively imagining new possibilities between us emerges. This is the surest ground for professional as well as personal viability … despite the vicissitudes of politics, economy and change within our micro and macro societies.

The meaning of what we do is best revealed in our open minded and open hearted exploration of the narrative of our profession. All those ‘theories’ only really make sense and anchor us as we embrace and comprehend the struggles of those who have gone before us to address, engage and articulate the meanings for all of us of the endless varieties of disruptions that have befallen our clients.

As social work practitioners of psychotherapy, a deep and grounded awareness of the meaning of our profession vis a vis society affords us a profoundly comprehensive understanding of the traditional psychoanalytic concepts such as transference, counter transference and the therapeutic relationship.  Rooted in the struggle with the realities of disruption for over a hundred years, we bring an expanded and enriched understanding of ‘therapeutic space’ that integrates the most intimate realities of relationship with the powerful forces at work in our communities and society as a whole.

The strength of our professional identity and the point of reference for any effort to define ourselves in any field of practice lies always with our presence and invitation into the ‘in between spaces’ of our clients’ struggles within their families, communities and society for intimacy, love, hope and genuinely meaningful participation.

For thoughts and comments, please send to: jdonnellydsw@gmail.com

©  2009 James Donnelly, DSW.LCSW

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South Garden Press, New York