LIVING IN TWO WORLDS:
THEORY AND SOCIAL WORK PRACTICE*
by Margot Waddell
At the heart of current psychoanalytic thinking - investigating, as it does, the nature and development of character and personality - lies the issue of mental pain. Drawing on the work of Melanie Klein in particular, psychoanalysts have been exploring the ways in which - whether in the individual, the family, the community or society at large - growth may be fostered or held in abeyance to the extent that pain is variously modulated, modified or evaded.
preoccupations have, of course, always been the stuff of literature,
expressed with great beauty and intensity by George Eliot in
George Eliot is describing the anguish of a young wife, Dorothea,
returning home from her honeymoon, having suffered deep
awareness, we are told, had 'to be kept up painfully as an inward vision,
instead of coming from without in claims that would have shaped her
energies' (ch. xxviii). She was to endure an internal crisis in which the
apparent solidity of her inner world was rendered fragmentary and had to
be reintegrated and rethought. The process involved learning not
about things, as was her wont, but from her own experience. She
began to understand the suffering of others through her own capacity to
face the truth about herself, in contrast to her earlier preoccupations,
whereby she had sought to meet the needs of the disadvantaged by, for
example, building workers' cottages on the estate, and by other good work
'claims that would have shaped her energies'.
marvellous expression, in general, of the complexities of interaction
between the internal world and the external. More specifically, it
describes the tangle of forces, that 'inextricable web of affinities'
(history, culture, politics, predisposition, gender, family, sexuality -
particularly in relation to being a woman), which bears on us, in such a
way that one
individual develops and grows psychologically while another keeps that
growth suspended or arrested, clinging to the superficialities and
surfaces of existence.
Such notions constitute the main points of this article: first, how difficult it is to tolerate psychic pain. The personality is structured around the different ways of processing that pain, or failing to do so. The range extends from the unconscious strivings of the infant to evacuate its distress, to the large-scale social and political structures which conceal casualties, or at least avoid taking direct responsibility for them, by attempting to deal with them by a process which I shall call 'servicing' - as prevalent personally as it is professionally.
The second point focuses on the importance of discriminating between 'servicing', which nearly always implies action, with very particular overtones, and the quite distinct notion of 'serving', which may constitute not doing anything. 'Servicing' urges itself as a substitute for ‘serving' because the not-acting of serving brings us in contact with feelings: feelings which are very hard to bear - the conscious phenomena of unconscious psychic pain. Dr Ron Britton, in describing his experience of talking about a baby observation - the observation of an ordinary, good, mother-baby relationship - to a group of GPs, recalls that one GP said: 'I can't believe this. If 1 did believe it, then 1 would have to conclude that my practice is full of such painful experiences, and if 1 thought that, 1 would go mad' (personal communication). It may be more comfortable to be doing something, whether it is writing a prescription, making an interpretation, arranging a visit, than not doing so - although not doing anything does not constitute doing nothing.
third point I take from W. R. Bion: that pain can be more easily borne,
ultimately, if it can be thought about - for that requires a relationship
to the self and to 'serving'. Attacks on thinking take place as part of a
defensive structure against experiencing pain by way of action, or
'servicing'. This raises the issue both of what is meant by 'thinking' and
of the relationship between doing and being - a relationship which lies at
the heart of this article.
in this series of points is the problem of what actually constitutes
'helping' - a question which all of us who are involved in the so-called
'helping professions', or who are parents, or who are simply trying to be
ourselves, will have to be asking. Implicitly, this issue will constitute
the strongest link between the 'psychodynamic theory' and the ‘social
work practice’ of my title. Underpinning that link lies a model, perhaps
partial and controversial, based in a particular understanding of the
notion of parenting in the context of being a social worker.
model - of parent-child - is offered in full consciousness of how fraught,
and possibly invidious, the connotations and implications might appear in
a professional social work setting. Yet it encompasses certain values and
ways of being and thinking which belong together suggestively rather than
in strict correlation. In psychoanalytic theory and practice -
particularly that of Klein and Bion - it represents a highly sophisticated
mode of thinking about growth and development which brings the minutiae of
intrapsychic processes together with interpsychic and environmental
factors at their most gross and most refined. Such a model may throw light
on attempts to consider what constitutes ‘helping', by offering
analogies with a mode of thinking, well-tried and epitomized in the
training of child psychotherapists.
the themes of serving and servicing and of parenting in mind, I shall
begin by briefly considering the structural position of the social work
profession in society, before focusing on the predicament of the
individual social worker his/her internal world and that of the client,
and the relations among all these. Psychoanalytic work has been done on
the ways in which institutions and their hierarchical structures function
on the basis of an organized defence against anxiety; indeed, how their
very hierarchy and authority are constitutive of the means whereby the
continued existence of those institutions, however problematic, is
ensured. I am thinking specifically of the research done by Isabel Menzies
Lyth (1988) and Elliott Jaques (1955, 1970) on the ways in which societies
create their own systems of defence against pain (in particular, Menzies
Lyth's well-known study on hospitals), which is easily extrapolatable to
the welfare services generally. Less fully explored is how this organized
defence permeates the work not only of large institutions, but also of
individuals - the internal group structures which Bion began to elaborate
in his later writings.
THE WORK: BUILDING DEFENCES AND OFFERING RELIEF
A central characteristic of work in the public sector is the immense pressure it entails: the practical burdens, the sheer quantity to be done - and with wholly inadequate resources - quite apart from the specific nature of the stress and anxiety involved. On one level, and in perhaps quite a contradictory way, the function of working that intensively is effectively to eliminate a space for thinking and for digesting experience, let alone for initiating change, in the very areas in which thinking and change are most necessary. The intensity has both a defensive and a survivalist component - we would otherwise risk 'dying of that roar which lies on the other side of silence'. We would be in touch with that pain which, as George Eliot puts it elsewhere, 'is quite noiseless... Vibrations that make human agonies are often a mere whisper in the roar of hurrying existence' (Felix Holt , 'Introduction'). I am referring to the immense difficulty of doing the work - not so different, in some ways, from the difficulty of being a parent. Martha Harris, following Bion, speaks of
is a 'world' of difference between 'standing by' and 'being a bystander'.
In applying this analysis of 'doing the work' to the broad
political setting in which social workers serve and service their clients,
the contradiction has to be faced that 'doing the work' at all may also
reinforce the defences against anxiety. Of course, from a psychoanalytic
point of view, the social order itself acts as an organized defence
against anxiety, but this kind of issue must always be seen in the context
of an analysis of the widest social structures of the sort offered by
Raymond Williams in Culture and
English middle-class education, he says:
Raymond Williams here catches, with some precision and irony, the all
too easy elision between the notion of 'serving' and 'servicing', in that
while there is an ethos of serving in my usage, it is clear that the
function of servants here is to be servicing. The thrust is towards
conformity in the name of power and government and the dominant culture,
rather than individuality in the name of development and equality. But the
matter is further complicated, as he points out: 'Now it is true that much
of this service has gone to improving the conditions of the "lower
servants" [Dorothea's 'claims from without... '], but, because or its
nature, this has been improvement within a framework which is thought, in
its main lines, inviolate' (1987, p. 330).
In questioning why that framework should continue to be thought
'inviolate', we have to recognize that all positions on the spectrum
between upper and lower, left and right, good and bad, even those in the
name of action and mobilization against existing ills, can all too easily
function as forms of organization against anxiety, forms as split and
projective as those of the original situation. It should be stressed that
we are talking about political, not moral, inequality - a confusion which
often arises in the minds both of the 'upper servants' and of the 'lower'
- especially when professional 'help' is introduced not as a matter of
choice but as a matter of necessity or imposition. Distinctions have to be
made. The task of some social work, for example, is to provide for a kind
of indigence which results from disablement, for whatever reason: old age,
sickness, eccentricity. Although another order might also not be able to
abolish such distress, it might handle it differently: perhaps even as
something that could be confronted directly, not sequestered and concealed
in institutions or in euphemisms. The capacity to face and tolerate
this kind of pain is but one
of the many emotional burdens the social worker carries and is intrinsic
to the profession.
to call all indigence the morally corrupt consequence of capitalism is
also a form of defence. It might be that in a different system we could
address it differently, not calling it 'unfortunate' or 'culpable' but
seeing more objectively how it arises and dealing with it accordingly. It
could be argued that welfarism, in its 'benevolence', contributes to the
same implicit deformation as does Thatcherism. Yet, acting defensively, we
find ourselves too often on one side or the other of this polarization.
Most miseries are, on some level, penetrated by the social order - some
more directly than others. But the indigence which is clearly a function
of a particular political system, indeed constitutive of it, poses
stresses for the social worker of an additional, extrinsic kind:
consisting of both the necessity of undergoing that stress, and of being
an agent for the system on behalf of which (indirectly) he/she is picking
up the pieces - a system which is premised on the provision of those very
A distinction has to be made, in principle, between
these different forms of indigence, though in practice it may be much
harder to maintain. In other words, some differentiation has to be made
between the kind of mystification, on the one hand, which leads to unreal
ideas about how it may be possible to abolish the tract of distress
through the introduction of a different social order, and thinking
seriously, on the other, about in precisely what way people's daily
existence is penetrated by the social order which they subserve. The
welfare services clearly participate in creating a setting in which 'doing
the work' is both essential
and a defence against anxiety.
It has to be recognized how difficult it may be for an individual to be
working, on the one hand, for a system about which he/she may, on the
other, at best have profound reservations. The social worker may
experience him/herself as contributing to the sequestration of the
unacceptable face of capitalism in the course of the daily confronting,
dealing with, processing the manifestations of intolerable pain
on a personal, individual and intimate basis.
In that the worker is having to find the internal resources to carry this kind of stress and responsibility, it is not surprising that various survival devices are found. On a large scale, they take the form of increasingly complex proliferations of bureaucratic structures, changes of policy and therefore of organization - all of which, on some level, militate against thinking. On an individual level they induce excessive work, a tendency to act, an urgency to do something, to respond in kind to the dominant mode - by splitting, obsessing, carping, drinking, hardening or, indeed, becoming depersonalized: one of the main elements of the social defence designated by Isabel Menzies Lyth.
The danger to be identified is that of a shift from the notion of ‘service’ (of which the verb is 'to serve') to a debased form of 'servicing'. The question always has to be asked: 'Service in the name of what?' For the problem of the social work profession is a structural one: in attempting to meet the needs of the individual client with inadequate resources servicing through material provision when underlying causes cannot be addressed - the social worker may be described as also servicing the needs of the state. Responsibility is carried - the life and death of adults and children, for example - for areas which, before 1968 and Seebohm's Report on Local Authorities and Social Services (which had the effect of changing the responsibility of social workers) would have been unthinkable. In the event of tragedy these days, the social worker bears the brunt of society's tendency to exonerate itself by blame rather than looking to the sources. With the different organization of the profession before Seebohm, the weight of that responsibility for life and death fell within the medical and legal hierarchy and not on individual social workers. The social worker, in other words, now bears a large-scale, or large-group, displacement of responsibility, and the political problem of the conflict between needs and resources, and the personal pain of continually being exposed to desperate, chronic and insoluble problems.
The strains are related, at root, to the different forms of indigence
mentioned above, and the pressure to shift from 'service' to 'servicing'
has two moments, often simultaneously experienced: the moment at which
better judgement of the actual needs of the case has to yield to other
exigencies, ultimately possibly legal, and the moment at which it becomes
impossible to keep hold of that better judgement, to continue to be able
to think and to serve, as opposed to resorting to 'servicing' as a way
of 'doing something'.
system is under stress, with clients under stress: social workers carry
the feelings engendered by each, as well as their own responses to them.
How can such things be thought about? A brief example may help to clarify
what I am trying to say. A young Iraqi mother, Mrs B, was admitted to
hospital to have a baby. There were a number of stressful factors in the
background involving not only language difficulties but worries about
housing, immigration, a sick member of the family, and so on. The birth
was normal, but afterwards the baby would not stop crying. The father,
because of the other problems, was able to stay for only very short
periods of time in the hospital. The mother was emotionally fragile in the
extreme: her own mother had just been refused entry to the country and she
was missing the rest of her extended family. It fell to a series of
nurses, sisters, doctors and, finally, cleaners to cope with the incessant
crying. Distress filled the ward; anxiety prevailed; different kinds of
feeding were tried; disagreement abounded; conflicting advice from other
mothers was offered; notes were lost; doctors blamed nurses; nurses blamed
orderlies; the baby cried, and cried, and cried. The mother cried. One of
the nurses dropped the baby and she cried.
The social worker was meanwhile trying to resolve the practical problems in Mr and Mrs B's lives and in the process banging her head up against racial policies and bureaucratic red tape. She was, initially, attempting to put the parents' minds at rest and to sort out accommodation, at least by the time they came out of hospital. Later she switched her attention and made a series of visits to the couple in a secluded room of the hospital, talking to them, sitting with them, 'holding' them, in terms of emotionally encompassing, and thereby in some degree relieving, their emotional distress. The baby swiftly calmed down and eventually stopped crying altogether. The nurses smiled, the ward relaxed.
The worker's function in that situation was to 'hold' the feelings
temporarily until the parents were able to perform that role which, in
turn, enabled the father, at least, to play a more effective part in
resolving the family's problems. By 'holding' 1 do not, however, mean
'passivity', which could represent to the child an active rejection of the
need to communicate and experience relief, but rather a responsive
presence which is active and transformative. For it is important that the
notions of serving and servicing do not become confused with being passive
and being active. In this respect 1 draw on Bion's concept of 'reverie'.
He stresses the 'activity' of the mother's receptive state of mind, and
the processing of the infant's unconscious communications which must occur
in order for there to be real understanding. An apparent passivity may,
none the less, constitute a presence which can inwardly digest; while a
different kind of passivity may constitute an impermeable barrier to the
communication sought by the infant, leaving him/her in a state not only of
unmodified, but of increased terror - Bion's notion of ‘nameless dread’.
In the case of Mr and Mrs B, 'holding' did not, of course, enable Mrs B's
mother to enter the country, nor did it provide them with a flat. Not in
the short term at least; in the mid term Mr B's increased capacity
positively affected both those areas and the family are now settled with
the mother-in-law in residence.
AS SERVING AND SERVICING
After such an example of the need to go on thinking,
1 want to move the issues of psychic pain and of 'serving' and 'servicing'
from the social to the individual sphere: to explore further the model of
parenting, examining it in the light of psychodynamic theory. This may
facilitate a way of
thinking about what 'helping' really means as a basis, or prerequisite,
for discussions about political priorities, policy, resources, and so on.
Bion's view was that psychoanalysis has no aspirations to free people of
conflicts but rather to equip them for resolving conflict. More crudely -
and more sadly - the social work profession epitomizes the problem of
sustaining, on a social level, a caring relationship which is not
primarily one of servicing; and demonstrates, on an individual one, that
that problem is related to the difficulty of tolerating what offering
one's mind, and emotions, and thought processes involves. It requires
ordinary, yet rare, capacities to receive, to undergo, psychically to
digest, whatever is expressed at the time; genuinely to be 'continent and
cognizant of one's own infantile emotions' and, with those in mind, to
represents doing things for people, with the illusion that needs can
always be met through material or practical resources. This is not to
suggest that resources may not put a floor under anxiety or destitution,
but rather that behind the impulse to provide there may be a belief that
children grow by having things done for them, rather than the opposite:
that they grow by being given space to discover who they are, not intruded
on or interfered with: neither internally by parents' expectations, hopes
or projections, nor externally by the stick-and-carrot form of learning
which tempts with rewards offered, or punishments threatened, which
tyrannizes, and in turn throws out whatever was learned as soon as the
testing time is passed.
mother, for example, may use herself as an object-to-be-clung-to, an
ersatz breast, a meeter-of- needs, much as she might a dummy ('pacifier')
or a bottle - to soothe temporarily, thereby alleviating the difficulty of
being in contact; evading the real pain. A breastfeed during a telephone
conversation, albeit consisting of protein, fat and carbohydrate, is very
different for the infant from one of inward attention to the emotional
experience. Children, as we know, may fail to thrive not from starvation
of material sustenance but from starvation of psychic sustenance. The
breast that is produced as soon as there is a whimper may not be the kind
of breast from which psychological food can be taken. What may be being
offered is a form of putting off/fobbing off, avoiding emotional
engagement - an experience which becomes part of the 'just-a-minute',
'I'll -be- there-in-a-sec.'
way of being so prevalent in households with several small children.
other words, both the actual pressure of events and a particular kind of
emotional response - perhaps arising from the mother's or caretaker's
uncertainty about her capacity to bear pain, or to cope with anxiety,
frustration and greed can promote acting in order to provide a temporary
and illusory sense of relief. Such ways of being may develop into
habitually unsatisfactory means of 'ful-filling' emotional lack.
Materially, sweets or videos are all too obvious examples; the counterfeit
emotions are harder to detect. These means become endemic in the most
apparently intimate modes of relating, to form part of the defining
culture of any particular family.
Psychoanalytic experience shows that 'character is deeply etched by the preferred modes of learning [in any single family or culture] and that these preferred modes are in turn deeply influenced by the modes current in the nurturing family group and its state of organization' (Meltzer, 1986, p. 155). Ironically, the mother who offers herself as, in effect, one form of substitute for relating may, depending on her state of mind, be engendering quite as perverse a mode of relating as that based in the belief that material objects should meet what are experienced as material needs. For in so doing she may both degrade herself and engender in others an expectation that the person in that role can be used as a lavatory (with the attendant contempt), and a notion that that way of being is somehow fundamental to what it means to 'care'. The danger is that this kind of apparent fulfilling of needs, answering requests, being depended on - in short, 'servicing' - may be at the direct expense both of the servicer and of the serviced. At its most general, and perverse, it is a way of keeping oppressed and oppressor securely in the same relationship - whether based on guilt, or contempt, or a mistaken notion of dependability. (The masochist, it must always be remembered, calls the tune.) It is clearly evident in inequalities of race, class and sex. It goes to the heart of our professional identities.
the purposes of this argument, however, my primary emphasis is on those
aspects of the individual's experience that militate against thinking and
drive towards action. It is the mother who has been through the pain of
mutual relinquishment who will be able, in turn, to enable her child to
develop a sense of inner independence, not the one who offers herself as
an object-to-be-clung-to, unable to modulate the force of her infant's
separation anxiety - the one who fearfully slips out without saying
goodbye: 'It will be less upsetting if I just disappear.' It is the
mother's feelings that are here being attributed to the child, and it is
she who has the difficulty in tolerating mental pain.
THINKING AND SOCIAL WORK
inability to establish boundaries, to assert limits - though usually
easier as the line of least resistance - may often engender a difficulty
in tolerating any
pain or frustration, and thereby actually hinder development. This
formulation, of course, begs essential questions, and points to the line
of fissure in the use of the parenting model as applicable to social work
practice. The model, as I have said, is intended suggestively, rather than
concretely. Social workers do have a duty to help their clients fight for
every scrap of comfort they can and this, surely, is a legitimate form of
business. Clearly, on occasion, the client's 'demandingness' will be a
mask for another kind of poverty. But, applied crudely, to suggest that
this displacement is the dominant form of the social worker-client model
can reinforce dominant, paternalist, social work ideologies, in which the
client is inadequate. The pain is immense: to reduce it to 'lack of
parenting' would be a gross simplification, no better than the
reductionism of 'lack of money'. Neither approach does justice to 'life at
the bottom'. Some way has to be found of thinking about these problems so
that the material and the emotional can be brought into a more subtle
relation than hitherto.
is this 'thinking' aspect that must now be explored, for it represents a
determining factor in the capacity to develop a rich, fully dimensional
inner world and to draw on the resources of that inner world to be as
bravely oneself as possible - and therefore, I suspect, as effective as
possible. By 'thinking' I refer not so much to an intellectual activity
often used merely defensively, as a bulwark against feeling - as to an
emotional one. Thinking in this sense constitutes the process whereby the
raw data of emotional experience may be digested in such a way that
unconscious symbol-formation (as in dreams) and ultimately conscious
thoughts may occur. It constitutes, in other words, the process whereby
individuals acquire the capacity to get to know the reality of their own
feelings and emotions, as opposed to being narcissistically identified
with, or imitating, those of others, thus removing them from the truth of
their own experience.
is probably true that many of those who find their way to social services
are internally as well as externally deprived - in other words,
'indigent'. This is indicated best, perhaps, by a characterization of the
problems presented as ones in which thinking tends to be in abeyance, and
action and reaction predominate. (The story of the Tower of Babel, in
which action precludes communication, powerfully depicts this point in
both its simplicity and its import.) This mode of being clearly typifies
institutional and group life in particular, and therefore pertains also to
wider social structures.
action-reaction axis is often associated with somewhat two dimensional
personalities: a clinging to social forms and mores; to received opinion
or current fashion; to the latest relationship; to particular
qualifications, or training requirements; to an obsession with information
rather than meaning; to surface rather than content; to appearance rather
than essence; to group identity rather than one's own 'thought'; to
institutionally acceptable ways of being, rather than the courage to be
oneself. Some recent psychoanalytic thinking has pursued this point in
particular. It originates with Bion, who offers a specific meaning for the
baby's long period of dependency: it is to experience the mother as a thinking
object, the essence of her loving care and attention. Yet, as
frequently stated in Joyce McDougall's work (1986), thinking is a burden
and stating one's feelings is frequently painful and humiliating: we all
adopt somatic symptoms of various kinds, narcissistic problems,
addictions, 'secondhand' ideas and discharge in action, to take the place
of psychic work - of thinking and feeling.
and feeling constitute hard, emotional work - active processes, at the
heart of this model of parenting: the taking in of the infant's or child's
painful experience, the containing of it, the relieving of the most
distressed aspects, and the handing of it back in a more tolerable form.
The active-passive axis suggests a way to understand parenting so that
forms of mothering, and whatever functions one may wish to group together
under fathering, may be seen to be part of the role of parenting
generally, rather than belonging to sex-specific roles within the family.
about 'thinking' (as 1 am using the term, following Bion) enables us, in
quite a precise way, to distinguish the notions of serving and servicing
that underlie the present discussion. When experience, or mental pain, is
psychically indigestible, modes of evacuation are found: illness, for
example, violence, addiction, meaningless talk, certain kinds of group
behaviour, and, most obviously at times, action itself. All of us, at one
time or another, draw on these readily available forms of relief - they
permeate daily life and are captured in our literature. One has to pay
attention to the nature of these responses as modes of communication and
try to understand them for what they may represent. The mother of a
severely battered two-month-old child, Billy, describes herself as losing
control when he refused to eat the cake she had made for him. She
expressed her primitive rejection by hitting him repeatedly.
sequence of incidents occurred recently which in one sense read like a
parody of a psychoanalytic case study, but in another beautifully
illustrated the way in which emotionally indigestible experiences are
enacted in the ordinary behaviour of young children. It describes a series
of exchanges between two four-year-olds, Peter and Elizabeth, in which the
heavy sexual innuendoes, clearly suggesting some unconscious transaction
between the children, expressed dimensions of experience which neither was
able to assimilate into their normally happy and uninhibited relationship.
back in the car from school one afternoon, Elizabeth was heard to say to
Peter: 'Would you like to sit on a dinosaur?' Peter's response was: 'No,
because it might bite my bottom.' When they got home they played excitedly
in the garden; while they were playing Elizabeth, uncharacteristically,
wet her pants. Her dress, shoes, socks, ‘everything’, was soaked and
she was most upset. While she was being dried she said: 'I don't
in here while I change.' Peter's response, some moments later, was:
'Would you like to come up and see my room? '0h, I know all about your
room', was the knowing reply.
minutes later Peter was found looking crestfallen and miserable on the
edge of his bed. 'She is playing with my marbles', he said. Five minutes
later: 'It's very cold in here, I want my radiator on and my quilt over
me.' One minute later he was fast asleep. Meanwhile Elizabeth left. Peter
awoke with a raging temperature. Assuaged by jelly Babies and 'Umbongo',
his temperature subsided and within a couple of hours he was back to his
normal self. On Monday morning, however, despite an apparent total
recovery over the weekend, he felt unable to return to school (Elizabeth
was in his class) and remained at home playing with his marbles. It was
not until Wednesday that the trauma finally subsided.
view was that it is the growth of the capacity for thinking about
emotional experiences which enables the individual to learn, thereby
becoming a different person with different capabilities from the person of
the past. George Eliot describes a similar notion of emotional
development: 'to conceive with that distinctness which is no longer
reflection but feeling - an idea wrought back to the directness of sense,
like the solidity of objects...' (Middlemarch,
ch. xxi, p. 243). This kind of psychodynamic process is based on a notion
of parenting as constituting a mental and emotional availability to
receive and, as it were, process the infant's evacuations of psychic pain
and distress. An adult's capacity to wait, to draw on his/her own internal
resources, to understand and respond, is felt to be crucial to the child's
capacity, in turn, to internalize the experience of being understood and
thereby psychically, as well as physically, 'held' in a kind of primary
skin. This is what it means to ‘serve': the capacity to 'stand by',
one's own internal resources at the ready. From this kind of secure,
internal state the infant derives some potential for thinking for
him/herself; experiencing a dependable and consistent presence from which,
in time, he/she may become independent the experience of pain and
discomfort being now modulated.
or not being able to make use of, this experience, the baby may, as
described by Esther Bick, find other means of holding itself together:
develop what she calls a 'second skin', sometimes evident, initially,
through a quality of particularly physical muscularity or by various
sensory means of attachment - the eye fixed to a light, perhaps; the body
to a surface - maybe later recognizable by a kind of 'adhesive' quality in
the mode of relating (Harris Williams, ed., 1987; Meltzer, 1975). The
difference between the two modes might be made by the mother who
serves, by being available
by 'thinking' emotionally, as opposed to the mother who services by doing
instead of thinking.
analogy between this kind of 'mothering' on the part of the caretaker and
a way of thinking about professional roles should, by now, be evident. At
the heart of it lies the experience of a thinking, holding relationship in
which primary anxiety may be modulated, and therefore better tolerated. At
root, the relationship is one of dependence on the internalization of a
certain kind of prototype experience. It results from - and in turn
engenders - the capacity to take in and digest mental pain; to use it for
growth and development, instead of searching for substitute forms of
offer the following example of a rather Pinteresque dialogue, to
illustrate how the organization and mode of functioning of a particular
family group may have originated in the kinds of process I have been
describing and be painfully reproducing that same process, in different
terms, at the expense of each individual family member. The following
exchange is an extract from one of a series of family consultations with
two co-therapists, Mr A and Ms B, which were suggested in response to
complaints about the behaviour, school difficulties and general
disruptiveness of fifteen-year-old John, the only child of elderly,
impoverished parents. The father was unemployed and had some kind of
unexplained and unspecified psychiatric history. This kind of indigence
makes them typical, perhaps, of what a social worker might confront in
F: What do you do with a boy who behaves like a child?
(angrily): Give evidence. Give proof.
F described at length a situation that had arisen over John's anorak. She
had wanted John to wear the anorak that morning because it was raining.
It wasn't raining.
Mrs F: Can I finish, John?
There were little drops.
F: It was soaking. I rang the school to find out if John was wet.
You treat me like a baby.
F: That's because you behave like a baby'. It was pouring with
I was looking for an umbrella.
F: I had thrown the umbrellas away. (She described to the therapists how
they had broken and how the covering had come off the spikes.)
(very angrily): It's lies, all lies.
F: And there is something else. The teacher said you were messing around
in French and you said you couldn't stay late to make up for work because
your mother would be furious.
All lies (covering his face with his hands).
F continued after a moment, talking about John being reported on by his
mother and teacher. Mrs F said that she had rung the school to find out
whether John was wet, because she was worried about him sitting in soaking
clothes all day. Ms B said that there seemed to be some anger about being
reported on in the session and that she and Mr A were being asked to
adjudicate on this issue.
F: It's just so difficult at home. He does behave like a child. It's bad
for my health, apart from anything else.
(growling): It's bad for your health. What about me? You don't care about
F: I do. Why do you think I was worried about you this morning? 1 was
feeling for you.
You are worried about yourself, not me. No one can feel somebody else's
feelings. You can't feel the painful bump on my face. (He was very angry.)
F: Of course not, but I can sympathize. But you want to be treated like an
adult. You behave like a child. What do you expect? I worry about your
You don't. I'm often in my room sniffing and sneezing with the window
open, no heat, because I'm not allowed it.
and Mrs F (aghast): That's not true, he is allowed it, but he is asked to
turn it off when he leaves the room; he never does.
Mrs F: You don't.
F: You don't.
Oh, it's all lies, it's always me, nobody else, just me.
F: Well, that's because you behave like that.
A at this point drew attention to John holding his arm in front of his
F: Oh, that's not for real, that's just for effect. He only does it here.
See how he is laughing. It's only for effect.
That was a sarcastic laugh. (To Ms B it looked as if he were more on the
verge of tears.)
A: What 1 was trying to say was that we've heard about someone who cannot
distinguish if it is raining or not, to protect himself against it, but
here in a session words seem to be very dangerous; weapons to protect
F: I can assure you John is well enough able to protect himself. He can
certainly hold his own with words. (He was, in fact, a Scrabble champion.)
(viciously): I can hit with words when I want to.
Mrs F: You see what I mean?
I do it because it's done to me. (Mr and Mrs F both gasped.)
Yes, it is, the only reason I can speak like this is because you are here
so 1 won't get clouted (nodding to Ms B and Mr A).
and Mrs F: We never clout you, John. When? (outraged).
Yes, you do. That's how I learned to keep silent, to keep things to
You know what I would like to do? Get a room and a grant in two years when
I've got some more exams, and leave home.
F: Yes, he does, this is true and I think it would be a good thing. He'd
be more grown-up. We can't live with this tension anyway. It's terrible
for all of us.
B: It seems to me there is an idea that separation solves things, that the
problems are such that they can't be worked out. Perhaps the feeling is
that separating would be the only thing, that we can't stay here and work
F: Well, John wants to get away from us and I think that's a good thing.
No, I don't want to get away from you, I just need to be with
F: Oh, so it is not us.
No, it's not you. I just want to be independent.
F: I agree that's a good thing. It can't be worse than it is now.
A: I have the impression that everyone in this family has at some
time the fantasy of leaving, of getting out, abandoning the family.
F: I do. Everyone needs a break, to get away from it all.
F: Yes, that would do you good.
F: Everyone wants holidays.
Yes, to have a break (sarcastically).
A: But my idea is about different feelings - of hate and anger. The
fantasy is that if one member left, the dirt would be left in the other
two, and the one could have pure paradise. The dirt is left behind.
F (outraged): I think that's a terrible thing to say. I've never heard of
such a thing. It's not about that at all.
John: He didn't mean dirt like that. He meant the dirt of bad feelings, and anger and that kind of thing. I'd be violent if I were allowed. There is a boy at school I'd really like to hit hard. (He spoke very angrily.)
F: Well, anyway, he didn't mean just for a holiday, he meant for good and
so did you. You can do that in two years.
F: Yes, meanwhile, things could be nice. It's only two years. (He sighed
Yes. Only two years. (He turned away and said something under his breath.)
F: What did you say? John: Nothing.
F: You did. John: I didn't.
F: You did. John: I didn't.
was silence. Mrs F continued.)
F (wistfully): Yes, I think I'd like to go away for a time. What about
you? You haven't spoken (turning to her husband). You'd probably better
stay at home (Mr F nods). But only if he could be nice.
(very distraught): There is so much pressure (holding his head). I'd like
to get away from that at least.
long, painful silence.)
F: Let me ask you something. Did you think it was raining this morning?
Ms B commented that the session had come full circle - to the point where
Mrs F: How do you mean? (There was a pause.) Oh, that we were discussing the same thing before. What was that then? (She asked John, who looked puzzled.) Oh, you mean the anorak. I don't understand why you won't wear it.
I get laughed at.
F (surprised and sarcastic): Well, that's new, he's never said that
before. I don't believe it, whatever next?
(Mr F spluttered.)
I do. 1 am surrounded by iguanas.
F: Why do they? It's a perfectly ordinary anorak.
I don't know. They just do.
I don't know.
Mr and Mrs F (together): Well!
A took up the image of the umbrella. He said that Mrs F had asked him a
question at the beginning of the session that had never been answered.
F: What was that? Oh, about what to do with a boy who behaves like a
A: As if, like the umbrella, you were wanting something from us you don't
have but that it Is very difficult to use what you do have.
F: But I threw it away because it was dangerous. We really didn't have
aside any speculation as to the sources of this family's psychodynamics, I
want to draw attention to a few points in this extremely painful session
and offer some brief comments. In terms of the process, the most striking
feature is the nature of the verbal communication, or rather
non-communication. Legalistic attention to detail, the extreme difficulty
in using metaphor, the literalness of expression and tendency to
concretization reduce the possibility of meaning and emotional contact to
a minimum. Such a mode attacks any link between the different family
members or between the family as a group and the therapists. For example,
the issue of leaving the family is experienced as 'everybody needs a
holiday'. Secondly, there is the clear, conscious denial of anything
actually painful, as opposed to irritating or worrying, in John's
experience: his communications are systematically denuded of any of the
significance that he tries so desperately to bring to them.
and Mrs F clearly find it very hard to take in any thought or reflection
that might be digested and used for insight into their son's situation.
Such insight might well be too dangerous; it might throw into disarray the
family's precarious system of defences and confront them with intolerable
pain. Their hope, understandably, was that they would be offered
information, advice, a 'prescription' which they could then go away with
and put into practice. The accumulation of facts as bricks in the wall
against feeling was all too poignantly clear in the session. The
consequences of the parents' difficulties were writ large in the son; the
particular form in which the blind eye was turned had become woven into
the fine texture of daily discourse. In the process, they engaged in an
active destroying of any incipient emotional links between those present
in the room. They exercised a legalistic dismemberment, in the course of
which content was rendered devoid of all meaning.
therapists were concerned not so much to give advice about John's
behaviour, or about the family circumstances, as to try to enable them to
think about the ways in which they were relating to each other during the
session itself. The difficulty of doing so, whatever the collective or
individual motives - conscious or otherwise - is evident in the dialogue.
Words were thought to be objects, usually weapons; speaking itself became
action; meaning was distorted and links systematically scrambled, lest the
family's pain, and the suffering of each individual, be experienced.
drawing on a model of parenting, excessive responsibility should not be
left with the adult. The infant's own contribution to the care available
has also to be addressed. For infants, like children and grownups, all
have different capacities to make use of what is on offer. One infant may
root for the breast, search it out until he/she finds it, and then take
pleasure and both physical and emotional nourishment from it. Another,
when the breast is not immediately available, may withdraw. A third may
rage to the point of being unable to feed, turning away from what is felt
to be a source of persecution rather than gratification. An adult
correlate to this might take the form of a kind of shouting rejection. an
enraged inability to accept what is on offer, albeit limited. It may be
that by understanding such a response, by the closest observation of its
impact on one's own feelings, a way of thinking may emerge about the
meaning of the communication which may then be shared. In the area of
social work this is almost certainly going to be a painful and isolated
importance of understanding the impact of pain on the workers' feelings
and putting that to use is particularly evident in trying to 'help'
severely deprived or abused children - an area where distress is, perhaps,
least bearable. Repeatedly demonstrated is the endless enactment by such
children of the feeling of being dropped, of being got rid of (often
painfully reproduced by the 'caring' agencies themselves). The task is not
to offer substitute care and parenting in order to rectify past
deficiencies; rather, it is to enable the individual to respond to what
may now be on offer. The significance of the awareness of a space in
someone's mind cannot be minimized; this kind of receptive attention may
be a unique experience for such a child. As one therapist puts it: 'the
legacy of the abandoned child is usually not only the burden of being
abandoned but of being left with extremely inadequate mental resources to
cope with a degree of pain which would overwhelm the most favourably
brought-up child' (Mary Boston and Rolene Szur, eds., 1983, p. 76).
PSYCHODYNAMICS IN SOCIAL WORK
concluding it should be emphasized that the word 'psychodynamic' is used
to describe the individual's engagement with internal as well as external
relationships. My concern is not with the application of psychodynamic
theory to social work practice so much as with what it means to be
informed by a particular way of thinking, to have it as part of an
assumptive world. This thinking constitutes a way of construing reality,
based in a simultaneity of different kinds of experience and to be
encompassed only through the closest attention to the internal as well as
the external world. Yet there is a paradox involved: the necessity of
thinking in order to modulate pain, and the difficulty of doing so because
pain is so hard to bear, and the forces against thinking so recalcitrant,
and becoming ever more so.
on thinking take all sorts of forms, most of them encountered daily in
therapeutic and social work practice. They usually represent evacuations
of distress, projections of pain. These projections, whether for the
purpose of getting rid of bad feelings or of having them understood,
require a receptive presence to organize them into some kind of coherent
experience which can then be addressed in its own terms. This kind of
thinking does involve a lot of 'not knowing' - 'Living in the question',
as Keats put it. A premature reaching for solutions, whether practical or
theoretical, may be of less use than simply, initially at least, ‘standing
by’ with that capacity which Keats calls 'negative capability': 'when a
man is capable of being in uncertainties, mysteries, doubts, without any
irritable reaching after fact and reason' (Letter to George and Thomas
Keats, 21 December 1817).
baby, individual, couple, family who are merely
serviced need not grow';
instead, they may well develop a dependent, angry contempt or precarious
idealization of the 'helpers'. Social work, in particular, brings the
individual up against the necessity of tolerating both the pain consequent
upon the nature of social realities and the pain of human suffering, which
together require political as well as individual ways of thinking about
them and then acting accordingly. The problem is how to contain both kinds
of thinking. The model I am using does clarify vital elements of the
individual experience. Yet at the moment, apolitical stance would have to
consider that thinking in terms of mothers responding, albeit helpfully
(serving, not servicing), to babies is an intolerably inadequate way to
confront a major part of democratic social structure: adults relating to
adults. It is possible to be a very valuable psychotherapist and avoid
much of the impact of this contradiction, or gap, in thinking. Part of the
problem of being a social worker is that it is intrinsically not possible,
and becoming ever less so.
are perspectives from which the distinction between serving and servicing,
and the value 1 have attached to that, clearly has to be contested. In one
sense servicing can be seen as related to a way of thinking for which
there will be strong arguments. It could be said to be consumerist,
democratic, non-intrusive; whereas serving may be thought to have rather
'servile' overtones, suggesting a feudal structure, a limitless,
bottomless, dependent and oppressive relationship. Yet my view of these
issues rests in the indispensability of something in the notion of
serving, used in its more archaic sense, that its more archaic sense, that
is omitted from servicing. This should not be understood as an argument
for psychotherapy with social work clients but as an attempt, rather, to
draw attention to the potential significance of a particular state of mind
on the part of the individual social worker, and a capacity on his/her
part to hold contradictions, be inward with the pain of self and others,
and to understand something of the psychodynamics of the way in which that
pain is expressed.
predicament lies in being the one who is both holding the burden of
individual psychic pain, accumulated in quantity, and carrying the strain
of holding contradictions inherent in the ways the problems pose
themselves - those ways being inherent, in turn, in political realities.
The questions have to be addressed from a number of vertices, the
difficulty being that there is something about social work that leads to
those different vertices massively imploding in on each other, occupying
the same space simultaneously, making thinking about experience doubly
The argument is not for inaction but to suggest, rather, that non-action may at times be the most helpful approach not, as has been said, as a bystander, but as somebody who 'stands by'. In some states of mind, action may constitute a form of mindless servicing; in contrast to serving which may invite or facilitate thinking. Servicing is, at root, antidevelopmental (the negative grid thinking of Bion's later work). Those, on the other hand, who have the capacity to 'serve' may also offer the hope of development to others. The difficulty of doing so originates in the difficulty of tolerating mental pain - not only unconsciously, in the context of early infantile experience and in the ways in which infantile modes of being permeate more adult forms of functioning, but also, more consciously, in terms of the processes of social functioning at large. I have tried to suggest that a space for thinking about the most effective resources may be both a key to understanding, and therefore to alleviating problems, and at the same time the most difficult thing to do, both for internal and external reasons. This kind of heightened awareness of the issues may be hard to maintain; it may echo that roar on the other side of silence: it may 'drive us mad', as with the GP mentioned above. It may be only momentarily graspable, but it is none the less worth striving for.
* This article is based on a memorial lecture given in 1985 to an audience of whom many - perhaps most - were not psychotherapists. It was in honour of Pam Smith, teacher, social worker, psychotherapist, some of whose beliefs and concerns 1 hope to have reflected in the pages that follow. With thanks to Pam herself and to the many social workers whom 1 have taught and supervised over the years.
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The Human Nature Review © Ian Pitchford and Robert M. Young - Last updated: 28 May, 2005 02:29 PM