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An explanation of the use of self during your field education experience that you may have encountered or that you might encounter A description of potential boundary c

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An explanation of the use of self during your field education experience that you may have encountered or that you might encounter A description of potential boundary c

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  • An explanation of the use of self during your field education experience that you may have encountered or that you might encounter
  • A description of potential boundary challenges in your field education experience

O R I G I N A L P A P E R

The Use of Self from a Relational Perspective

Carol Ganzer

Published online: 16 March 2007

� Springer Science+Business Media, LLC 2007

Abstract This article explores the implications of a

contemporary relational perspective on the use of self in

social work practice. The author is responding to an article

by Andrea Reupert, who interviewed social workers and

reported they tended to see their concept of self as indi-

vidualistic, autonomous, and only partially defined by

others, even though social work practice focuses on person-

in-environment. In this article, the author expands the

concept of self and argues that a contemporary view of the

therapist’s self is one that is dialogic, contextualized,

decentered, and multiple. Additionally, the author suggests

that this relational perspective has implications for teaching

and supervision. Several clinical vignettes are provided to

illustrate the concepts under discussion.

Keywords Use of self � Multiple selves � Supervision � Relational theory

The idea for this article began with a reading of Andrea

Ruepert’s, Social Worker’s Use of Self, published in this issue

of the Journal. The concept of use of self is a familiar one to

clinicians. From our earliest training in the field, we learn that

the relationship between clinician and patient fosters growth

and promotes change. The personal characteristics of the

therapist often enter into the therapeutic relationship as well,

helping to shape and refine the process. These characteristics

have been broadly defined (Woods & Hollis, 1990) as

empathy for the patient, warmth and concern, acceptance, and

a nonjudgmental approach. Additionally, the clinician, to the

best of her ability, maintains objectivity, models attitudes and

behaviors, and develops self-awareness and self-monitoring,

particularly of countertransference and its potential negative

impact on the treatment.

Andrea Reupert, in her qualitative study of use of self,

asks her interviewees to consider how they describe their

concept of self and how it impacts their clinical work.

Although the study had a limited number of participants,

the clinicians involved tended to see their concept of self as

unique and individualistic, and only partially defined by the

relational and environmental context of practice. To some

extent, Reupert attributes this highly individualistic and

autonomous sense of self to the Western tradition of rugged

individualism as well as to the failure of clinicians to fully

take into consideration the influence of social norms and

values in self-definition She finds it concerning that these

clinicians are reluctant to entertain the idea of the self as

socially constructed and contextualized, particularly since

historically social work training focused on a person-

in-environment framework, and the use of self in the social

work literature is discussed within the therapeutic envi-

ronment and not as autonomous or self-contained.

It is my intention in this article to expand the concept of

self and to argue that a contemporary view of self takes into

consideration the notion that the self of the therapist, as

well as the patient, is dialogic, contextualized, decentered,

and multiple. I will draw on the work of several relational

psychoanalytic theorists who have promoted this view of

the self and illustrate this relational self through clinical

vignettes.

The Relational Matrix

The late Stephen Mitchell coined the term relational matrix

to describe the way ‘‘psychological reality’’ operates

C. Ganzer (&) 2824 N. Richmond ST, Chicago, IL 60618, USA

e-mail: [email protected]

123

Clin Soc Work J (2007) 35:117–123

DOI 10.1007/s10615-007-0078-4

within a matrix that contains both ‘‘intrapsychic and

interpersonal realms’’ (1988, p. 9). Mitchell felt that earlier

drive—and even object relations—theories tended to

dichotomize the internal world of object relations and the

external relational world of the patient into an either/or

focus. He believed these realms ‘‘create, interpenetrate,

and transform each other in a subtle and complex manner’’

(p. 9). What does this shift in focus mean in terms of a

concept of self and how does it impact practice? Mitchell

tells us that, in his view, self does not exist ‘‘in a psy-

chologically meaningful sense, in isolation, outside a

matrix of relations with others’’ (p. 33). In contrast to the

individualistic self of the clinician defined by the partici-

pants in Reupert’s study, the relational self of the clinician,

as well as the patient, is acquired through and defined in the

context of relationships; and these relationships operate in

social, cultural, and political contexts. Mitchell also con-

tends that models of mind that place relationship as central

to psychological growth, such as ego or self psychology,

tend to privilege the self with concepts such as ‘‘self-

organization, ego functions, homeostatic regulation of

affects, developmental needs, a true or nuclear self, and so

on’’ (p. 9). These models would align more closely to the

findings of Reupert’s study, which place the therapist

outside of the patient’s relational world, providing ego

strength, self-structure, or self object functions. Conse-

quently, self-awareness, as described in Reupert’s study,

would be paramount for the clinician to both understand

and interpret the patient’s transferences and projections and

to be vigilant about countertransference and the potential

for enactments. In a relational approach self-awareness

would develop through interaction with the patient and be

cocreated with the patient in and through the environment.

The clinicians in Reupert’s study leave us with the sense

that they value their personal characteristics, their self-

awareness, and their use of self as instruments or tools to

effect change; and while they view the therapeutic alliance

as a necessary component of treatment, it is secondary to

their use of self derived from their own self-understanding

and intrinsic to their own development. This use of self

may involve how one implements a technique, or what one

self discloses, or how one handles humor, all factors that

emanate from the therapist and that place her on the

periphery or outside the patient’s world. For Mitchell the

therapeutic encounter is between two persons, therapist and

patient, which levels the playing field and gives each par-

ticipant somewhat equal status. The therapist no longer

functions as knowing expert who provides interpretation

and fosters insight, but rather is a participant in creating

and constructing new transferential meanings. The clini-

cian enters into and is embedded in the patient’s relational

world through enactments that repeat old ways of being for

the patient. In order for treatment to get underway, the

therapist enters the patient’s relational world or perhaps

‘‘discovers’’ herself ‘‘within it’’ and is ‘‘in some sense

charmed by the patient’s entreaties, shaped by the patient’s

projections, antagonized and frustrated by the patient’s

defenses’’ (1988, p. 295). According to Mitchell, the

therapist finds herself in ‘‘one of the patient’s predesig-

nated categories and is experienced by the patient in that

way’’ (p. 295). Rather than remaining an autonomous,

individualistic, and objective observer in the patient’s

drama, the therapist takes on various roles and ‘‘attributes’’

of figures in the patient’s intrapsychic and interpersonal

matrix, and together therapist and patient rework the pa-

tient’s narrative and rewrite the patient’s story, changing

the patient’s perception of the figures to ‘‘allow greater

intimacy and more possibilities for varied experienced and

relatedness’’ (p. 296). For the therapist,

the struggle is toward a new way of experiencing

himself and the patient … to find an authentic voice in

which to speak to the patient, a voice more fully

one’s own, less shaped by the configurations and

limited options of the [patient’s] relational matrix, in

so doing to offer the [patient] a chance to broaden and

expand that matrix. (p. 295)

In other words, through the mutual influence of therapist

and patient, embedded in the relational matrix, new

meanings are constructed, and new ways of being emerge

for the patient.

Multiple Selves

Another important contemporary view of self that has

evolved from relational theory is the idea that there is not

one cohesive, identifiable, or unitary self that we can

locate. Rather, as Bromberg has argued, the self is viewed

as ‘‘decentered, and the mind as a configuration of shifting,

nonlinear, discontinuous states of consciousness in an

ongoing dialectic’’ (1998, p. 173). These states are ‘‘linked

to each other, to the external world, and to the past, present,

and future’’ (p. 168). It is through this linking that we

connect aspects of our personal history and experience to

give us the illusion of cohesiveness. In treatment then, the

clinician moves from a focus on the repressed or

unconscious contents of the patient’s intrapsychic world to

incorporate and reflect on the enactments of the intersub-

jective world of the clinician and patient. The self that we

encounter may be various selves that the patient experi-

ences as old ways of being with another. The perceptions

evoked by enactments do not cohere with the patient’s past

experiences but shift as the patient, together with the

clinician, plays out various scenarios from the past. What

118 Clin Soc Work J (2007) 35:117–123

123

has been dissociated or excluded enters the awareness of

the patient and clinician and the possibility occurs for new

narratives to be coconstructed. The self in this framework

becomes a participant in a drama that is played out through

the transference-countertransference transactions and

reflected upon by both parties, which allows for multiple

realities to emerge and discordant perceptions to be dis-

carded so that the various self states can be linked into

cohesive reality and integrated into the patient’s lived

experience and form the basis for a new self-narrative.

The Therapist’s Participation

While we have come a long way from the idea of the therapist

as a blank screen promoting abstinence, anonymity, and

neutrality in practice, nonetheless, we still rely on the thera-

pist’s technical expertise and effective interventions. This

tendency speaks to the role of self as instrument or tool and

assumes that the therapist has some degree of knowledge of

what the patient may need. Over 20 years ago, Hoffman

(1983) wrote an article that has had a significant impact on

contemporary views of the therapist’s participation in treat-

ment. Hoffman argues that the therapist participates in the

coconstruction of transference and that this participation is

inevitable, whether or not she recognizes it. This cocon-

struction of meaning that involves the thoughts, feelings, and

behaviors of the therapist, as well as the patient, has a part in

shaping how the patient’s experience unfolds in the treatment.

As with Mitchell’s model, both therapist and patient are

caught up in enactments of old ways of being. These enact-

ments are part and parcel of the treatment and form the basis of

therapeutic action. Use of self in this configuration requires

that the therapist not only tolerate ambiguity and uncertainly

but also immerse herself in it; for it is by entering the patient’s

world and experiencing it that the therapist can work with the

patient to emerge from it. This process often involves an

inquisitive and curious stance on the part of the clinician and

the self disclosure of the countertransference. It is by the

therapist and patient working through and reflecting on

enactments that involve therapist’s and patient’s transference

and countertransference transactions that a space is created for

new patterns of interaction to develop. The therapist’s use of

self then becomes an interactive, subjective, and empathic

means of furthering therapeutic action and portending a

positive outcome to the treatment. Let us explore some of

these ideas in the context of a treatment case.

The case of Ana

This case is a treatment that has been ongoing for nearly

5 years, and this brief vignette is drawn from a larger case

study (Ganzer, 2006). I have presented this case with Ana’s

permission, for she believes her experience will benefit

others in similar situations. Ana is a woman in her early

30 s who was arrested, charged, and convicted of abusing

her 4-year old daughter, Aida. She served several years in

prison and was on probation for 2 years. Ana was referred

to me in connection with her child welfare case and her

desire to be reunited with her children. She presented as

frightened, hostile, and distrusting with her own history of

abuse and neglect. Initially, she would come to my office

only with another individual, usually one of her relatives. I

was uncertain about my ability to work with Ana, as her

case file indicated that she had made threats against other

workers and had been physically aggressive toward child

welfare staff and court officials. At the time I began

treatment with her, there was an Order of Protection for-

bidding her to have any contact with her children. After the

first few sessions, Ana seemed more relaxed and less tense.

She stated that she appreciated the fact that I did not accuse

her of the abuse of her daughter but was willing to hear her

story. After 3 months she no longer brought a relative with

her to sessions.

Over time, Ana and I addressed her deep-seated anger

issues, and she began to show changes in her behavior

toward others. Ana, who had only given me her phone

number, became comfortable enough to share it with her

caseworker, whom she began to trust as well. After a year

Ana’s frequent outbursts of anger diminished. The court

and the therapists involved with the family all concurred

that Ana had made good progress. As a result of this and

her improved control of her impulses, Ana was given

limited supervised visitation with her children; and after

2 years, the children were returned home to her husband.

Ana continued to live with friends and slowly began to

have unsupervised time with her children. Ana made slow

but steady progress toward reunification with her family.

After 2 years of work, she was given overnight visits. The

Monday morning after the second weekend visit between

Ana and her children, I received a phone call from her

caseworker. Ana had called the caseworker frantic that a

detective was on his way to her home to arrest her for

hitting Aida. The next day I learned that Ana had been

arrested and charged with assault. She pled guilty to the

charge and was given 3 years of probation, and her chil-

dren were returned to the child welfare system. After her

return to treatment, Ana began to disclose in greater detail

her own history of physical abuse. With this history in

mind, I would now like to explore aspects of this treatment

from a relational point of view.

Neil Altman, in his writing on community practice,

makes the point that a clinician working with a disen-

franchised population may take on various roles in the

transference such as ‘‘rescuer, victim, abuser, and

Clin Soc Work J (2007) 35:117–123 119

123

neglectful parent’’ (1995, p. 2). In retrospect, I find that I

played out these roles with Ana and she brought various

aspects of herself to me in the treatment. These roles were

often enacted from the dissociated contents of our intra-

psychic world and encountered through projective identi-

fications that only later I identified and reflected upon

either by myself or with Ana.

In the early stages of treatment I found myself enacting

the role of rescuer with Ana. She idealized me and felt that

I was the only one who could help her. Aspects of my self

that responded to Ana’s maternal transference to me al-

lowed me to dissociate the more negative qualities of Ana’s

behavior and to focus on her control of impulses and anger.

The more grandiose aspects of my therapeutic personality

allowed me to promote her rehabilitation to the court, while

disregarding the darker moments when she would have

angry outbursts. When I stated to a colleague that I saw the

real Ana, she corrected me by saying that I saw one side of

Ana, the good side, but disregarded the other side.

So, much of my work with Ana was a response to her

projective identifications with me as her rescuer and savior,

and I entered her world and assumed these roles. In effect I

was caught in playing out the old roles with Ana, roles that

represented her relationship with her now-deceased father,

and formerly abusive but now supportive mother. I was

able to provide new experiences and a new way of being

with her, and Ana was able to progress and make signifi-

cant changes that were noted by others. I also found myself

assuming the role of victim as I struggled with agency

personnel who were not in favor of Ana’s reunification

with her children as well as the court officials who found

Ana to continue to be at risk of harming her children. It was

not until Ana was arrested for a second time that other

aspects of our various selves were played out.

After I learned that Ana was released from jail, I found

myself avoiding calling her to set up an appointment. I told

myself that it was her responsibility to contact me, despite

the fact that I had often called her in the past and that she

had left me a frantic message on the day of her arrest. I did

not visit her at the jail, although I could have done so; I

gave myself the excuse that I was too busy to take off a few

hours. I was slipping into the role of neglectful parent and

soon found myself showing aspects of the abuser. When

she finally called and resumed treatment, I found myself

raising my voice in a session, demanding that she change

her behaviors or I would not be able to work with her.

Somewhere in the middle of my pronouncements, I real-

ized that I was being less than empathic or nonjudgmental.

I turned to Ana and apologized for losing my temper but

also disclosed my disappointment and sadness over what

had transpired in the past few weeks. Unlike others in her

life, I did not abandon her but was able to discuss how my

feelings were impeding our continued work. Ana then told

me that she realized how difficult it was for me and that she

was sorry that all my hard work with her was wasted. This

was the first instance of Ana relating to me as a separate

person and not an idealized projection. From that point on

Ana was able to disclose more details of the physical and

emotional abuse she experienced in her childhood, and our

therapeutic work continued.

How do we locate the use of self in this clinical vignette

and what value does it have for therapeutic work? It was

through enactments that I became embedded in Ana’s

relational world, and these enactments were shaped by

Ana’s ‘‘projections, antagonized and frustrated by [her]

defenses’’ (Mitchell, 1988, p. 295). My entry into her

world was not a carefully orchestrated set of interventions

or conscious use of self, but rather I discovered myself in

the enactments. I then was able to reflect upon my roles and

either share my feelings with Ana or use them to work with

her defenses. I did not experience myself as autonomous or

objective but rather caught in enactments of old ways of

being with Ana, at times the abandoning and abusive

mother, at others times the rescuer, and yet at other times

the victim. This participation was unwitting and unrecog-

nized, but, as Hoffman asserts, inevitable. My thoughts,

feelings, and behaviors, as well as Ana’s, helped to shape

the direction that treatment took and allowed Ana to begin

to have some empathy for me as a separate person, and we

were able to resume treatment.

This vignette further underscores that the therapeutic

self is contextualized, decentered, and multiple as Brom-

berg argues and not cohesive or unitary. In my work with

Ana various dissociated states and aspects of self came to

the fore as Ana and I enacted past experiences and played

old roles with which she was familiar. I offered new ways

of being through continuing the treatment with her and

disclosing my countertransference feelings of sadness and

disappointment over her loss of impulse control. Through

our ability to reflect on the various selves we presented to

each other, Ana and I were able to repair our therapeutic

relationship. Most recently Ana commented that she has

been able to act out her anger less frequently but to ver-

balize it instead.

Use of Self in Training and Supervision

In her concluding remarks, Reupert suggests that the

training and supervision of clinicians should incorporate

their personal qualities, as well as emphasis on theory and

technique. She notes that the social workers interviewed

bring more to their work than their professional knowledge

and skill. Several of the clinicians in her study found that

the way to best use self was to suppress the personal

aspects of self in favor of professional knowledge and skill.

120 Clin Soc Work J (2007) 35:117–123

123

Several others saw themselves as a creating a presence

through a process that was highly intuitive. These views of

self assume that the clinician can objectively know when

and how to use the self and that she has the ability to

identify, reflect upon, and objectively evaluate it. Reupert,

in this issue (DOI: 10.1007/s10615-006-0062-4), refer-

ences Yan and Wong (2005), who have identified problems

with objective knowledge, and Kondrat (1999), who

suggests that the training clinicians receive has also

contributed to this objective stance.

I have argued elsewhere (Ganzer & Ornstein, 1999,

2004) that although relational theory has influenced social

work practice, supervision has lagged behind in embracing

these ideas. How would processes such as those described

in the study differ from supervision and education in a

relational matrix? In the former, the autonomous, self-

aware, professional self of the supervisor would tend to

reinforce the hierarchy that is often inherent in a supervi-

sory relationship with the supervisor being in a one up

position and the therapist in a one down. In the early stages

of a social worker’s career, she builds a professional self

through seminars, practicums, and ongoing clinical super-

vision. The traditional view sees supervision as provided

by an experienced supervisor who imparts knowledge to

the supervisee and gives careful consideration to case

material and suggests appropriate and useful interventions.

Sometimes the supervisor may focus on the dynamics

between the supervisee and the patient, but rarely is the

focus on those between the supervisor and the supervisee.

In turn, the supervisee gains knowledge and skill and

acquires insight and awareness. In this approach knowl-

edge, power, and authority are vested in the supervisor.

A relationally oriented approach to supervision is less

hierarchical and more one of mutual influence among all the

parties: supervisor, supervisee, and patient. While the

supervisor brings her knowledge and experience to bear on

the case, the supervisee brings her knowledge and experi-

ence of the patient. Instruction then is replaced by dialogue

and negotiation. In this model, power and authority are

shared and knowledge about the patient is coconstructed. A

relational model shifts the role of the supervisor from that of

expert to participant, operating in a matrix that incorporates

intrapsychic, interpersonal, environmental, and organiza-

tional aspects of all the parties. Let us turn to a brief vignette

that illustrates a relational approach to supervision.

Self in Supervision

Ellen, a young, bright, energetic therapist pursuing an

advanced degree, had been a practicing clinician for

several years and was at the dissertation stage in her career.

As part of her program, she selected supervisors to whom

she would bring difficult cases. She came to me with a case

that exasperated her and caused so much anxiety that she

was certain she was not helping the patient. She described

her patient, Moira, as anxious and consumed with worry.

The worry was often about small things, such as daily

activities, but more recently had been directed at fearing

that something tragic would happen. Ellen, in turn, felt

very anxious when she was with Moira, fearing that Moira

would drop out of treatment because Ellen might say or do

the wrong thing. Consequently, Ellen felt paralyzed and

was waiting for the other shoe to drop.

While the roles that supervisor and supervisee take on in

supervision may not be as dramatic as the ones Altman

(1995) thought characterized community practice, never-

theless, we do play out various dramas. At the time Ellen

consulted with me, I was new to the faculty of the school

where she was a student. She had been referred to me by

another student with whom I had a successful supervisory

relationship. Among the various roles I found myself

playing were teacher, expert, and colleague; Ellen’s roles

were those of student, supervisee, and colleague. The role

that was less available to my consciousness had a more

parental, authoritative cast to it, while the role to which she

had less access was that of disappointing child.

I entered Ellen’s relational matrix with the patient

through an impasse in treatment. When Ellen and I

reviewed her process recordings, I did not find anything to

suggest she was making comments that might cause Moira

to leave treatment. I could not account for the level of

anxiety Ellen was experiencing, and I began to experience

my own sense of anxiety as to whether I could give her the

direction she seemed to ask for with her patient. I soon

slipped into the role of expert. What I noticed was that

Ellen was giving Moira detailed interpretations of her

thoughts and actions or expanding on what Moira has been

telling her to make connections. I began to look for ways

that Ellen could intervene with her patient. Ellen, being a

willing student, started to shape her comments according to

my suggestions. Together we worked on ways that Ellen

could provide more of a containing environment for her

patient, but Ellen remained very anxious about the treat-

ment. Neither of us could account for the excessive anxi-

ety. Despite our efforts, Ellen’s anxiety did not abate nor

did the anxiety of her patient, and I remained an uneasy

supervisor afraid to disappoint my supervisee.

As Ellen continued to worry that she was disappointing

her patient and thought she might need to refer her to an-

other therapist, I began to reflect on what might be going

on in my relationship with Ellen and in the worlds that we

shared. Why was I so anxious about my work with Ellen?

Since I was a new supervisor for students at the school, I

had anxiety of my own. Many of the students had com-

pleted a structured course of study and had in depth

Clin Soc Work J (2007) 35:117–123 121

123

knowledge of theory that I had learned autodidactically

through my own reading. Also, many of my students had

more years of clinical practice than I had. Was I really able

to be an effective supervisor? Was I up to the task?

Through this reflection, I realized that I was enacting

Ellen’s anxiety in my relationship with her, and I found

myself caught up and embedded in her world. Her anxiety

had evoked mine, and her patient’s anxiety had evoked

hers. In retrospect, I believe what was being projected

between us was our unspoken fears of failure and disap-

pointment in our relationship.

I told Ellen that I was curious about her anxiety and her

feeling that she was at an impasse with her patient and that

I was at an impasse with t

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