Making the Case

Why we teach psychodynamic theory

By Faye Wolfe

What’s the good of teaching psychodynamic theory to social work students? “With its emphasis on relationships and internal life, psychodynamic theory provides a way of understanding our internal psychological selves,” said Associate Dean of Academic Affairs Marsha Kline Pruett, M.S., M.S.L., Ph.D. Calling it a “transformative approach,” one that is at the heart of a wide range of therapies, she upholds the value of psychodynamic theory being foundational within the SSW curriculum.

In recent years, a number of social work degree programs have moved away from psychodynamic theory, in particular emphasizing science-based interventive approaches or cognitive-behavioral modalities. Introduced into the field of social work 20 years or so ago, there are also good reasons why social workers should apply only those therapies with scientific evidence of their effectiveness.

With various estimates putting the number of types of psychotherapies as high as 500, and with the complexity of clinical issues that social workers are addressing, there is real pressure to use only what is most relevant and effective. The issue of which should prevail is less like a battlefield with flags flying at either end, and more like a thicket, a dense tangle of questions, assumptions and semantics.

“Psychodynamic theory really should be spoken of as theories,” said Ora Nakash, Ph.D., professor and the chair of the HBSE sequence. “The theory itself has evolved dynamically. It’s an umbrella of ideas and critiques of the theory that Freud put forth a hundred years ago.”

Psychodynamic theory has certainly evolved since the man whom poet W.H. Auden called “a whole climate of opinion” promulgated his concepts. Its family tree includes such Freudian disciples and dissenters as Jung, Rank, Adler, Erikson, Fromm, Lacan and Klein—key thinkers in the development of modern psychology. Among its progeny, which include attachment theory, object relations theory, self-psychology, crisis theory, supportive-expressive theory, Nakash pointed out that fundamental psychodynamic principles—the existence of the unconscious, the importance of childhood experiences, the significance of relationships, the value of the bond between therapist and client—have never lost their relevance and are widely applicable. “It’s a very deep and broad concept.”

RELEVANCE OF RELATIONSHIPS

SSW doctoral candidate Jamie Daniels, M.S.W. ’14, finds the psychodynamic emphasis on relationships particularly meaningful. Perhaps that’s partly because Daniels’ own life is relationship-rich, as a daughter, a mother, a spouse, an academic advisor to master’s-level students, Smith’s Diversity and Inclusion Fellow and one of the three 2019–20 Marta Sotomayor Fellows, who help support the School’s anti-racism commitment. She also maintains a private practice.

Magdalene Kwakye and Melissa Tines participate in a role play during class.

Magdalene Kwakye and Melissa Tines participate in a role play during class.

“I work with people of diverse backgrounds and with a range of issues, seen through a social justice lens,” explained Daniels. “I consider external factors: living with poverty, domestic violence, violence in a community. In my private practice, ninety-nine percent of my clients are people of color, queer, trans or other identities on the margins. I listen to how they make meaning out of their lives, and I ask myself how do we push and pull and prod at those narratives, reclaim them in the service of growth?”

Daniels’ own narrative is one of struggle and self-discovery. “I dropped out of high school and had my first child at 17. Then I got my GED and went to Mount Holyoke College,” she said matter-of-factly, as if it were no big deal. “I started to find my voice, and once I was on the road of education, I couldn’t get enough.”

With a laugh, Daniel calls herself a “Smith groupie,” but her commitment to its pedagogy is serious.

“At SSW, we learn about the classical history of therapy and how theory evolves over time—we don’t throw it out,” she said, adding, “We also learn how to evaluate clients, make assessments, manage the ebb and flow of cases, recognize a client’s need for referral and the need to weep, the need to be seen.”

People may assume that psychodynamic therapy is all about the Oedipus complex and penis envy, and that it focuses on the inner life to the exclusion of external realities— the latter a criticism often directed at its antecedent, psychoanalysis. “Even experienced clinical counselors are apt to speak of the psychodynamic approach as if it is forever wedged in the Victorian age,” Russell Fulmer wrote in his 2018 paper “The Evolution of the Psychodynamic Approach and System.” “Such equivalency is akin to speaking of computers as if they function no differently than their circa 1980 forerunners.” SSW is committed to teaching concepts that go beyond foundational psychodynamic theories and venture into contemporary relational theories that weave in strands from different traditions, including interpersonal psychoanalysis, British school object-relations theories, self-psychology and existential psychoanalysis. Students dive even deeper in SSW’s advanced elective courses, where they are further exposed to cutting-edge conversations about race and racism in psychoanalysis, including in-depth critical reading of writings by Dalal, Leary, Suchet, Tummala-Narra and Holmes, among others, that critique psychoanalytic theory and integrate concepts that have been historically absent such as those related to race, gender and sexuality.

“What is most powerful is how we learn to integrate EBPs and the psychodynamic theoretical frame,” Daniels said, “I believe in EBP. It would be unethical not to base treatment on what has been shown to work, what is rooted in research and evidence.”

Nakash takes that comment further, noting that there is a growing body of neuroscientific, developmental and clinical research that supports the validity of key elements of psychodynamic theory. Particularly in the last 10 to 20 years, there has also been, she said, “booming empirical support” for the efficacy of psychodynamic therapy. As one source of such information, she cited Jonathan Shedler’s extensive survey of research literature, summarized in the 2010 paper “The Efficacy of Psychodynamic Psychotherapy,” which describes the results of meta-analysis of numerous scientists’ findings, from 1980 on.

“In meta-analysis,” she said, “the efficacy of psychodynamic interventions, short-term and long-term, is proving out.” In fact, she adds, in some studies, it has been shown to be more effective than cognitive-behavioral therapy or drugs.

A survey of studies done on the subject turns up recent research affirming Nakash’s point. Peter Fonagy of the University College London and Ellen Driessen, at Vrije Universiteit Amsterdam, for example, have found psychodynamic therapy beneficial for treating chronic depression. Investigating the efficacy of psychodynamic therapy isn’t easy. The range of variables—what it’s being used to treat, the length and setting of treatment, how psychodynamic therapy is defined, what it’s being compared to, just for starters—make it challenging. And there are forces at work that mean it is less likely to be studied in the first place by researchers—and by social work students.

“The world is looking for a fast fix,” said Kline Pruett, noting that evidence-based approaches tend to be “precise, pragmatic, crisis-oriented and shorter-term than psychodynamic treatment.” The demand for a fast fix comes from insurers, government agencies, and a society that, in general, is used to high-speed delivery of… everything.

Another reason that psychodynamic theory has lost ground to other theories, Kline Pruett believes, is that it uses jargon. In her roles as author, researcher and consultant, Kline Pruett is committed to translational science: “thinking complexly and sharing it simply.” She often presents psychodynamic concepts to people who need to understand mental health concepts for their work, judges, for example. “We need to make the theory accessible and understandable by developing curricula, games and other activities that use the concepts and get people excited about them.”

Ultimately, Kline Pruett thinks SSW’s “both/and” approach prepares students better than an “either/or.” “Educating students is not about teaching them the ‘intervention du jour.’ It’s not about changing history—you learn from it,” said Pruett. “Moving away from psychodynamic theory means giving up the chance for students to learn about a central motivator of human behavior and about a way of thinking beyond symptom reduction. Our emphasis at SSW is about teaching our students and, ultimately, our profession, to help people in a long-term way.”

Critical, too, is teaching SSW students how to be informed consumers of research. “They may not all be interested in becoming active researchers,” said Nakash, “but they still need to understand how to think critically, how to approach evaluating research done by others, how to discern between good and bad research. Our School holds those analytical values dear.”

When all is said and done (and most likely that won’t be happening soon, if ever), about which theory, which modality is best, SSW keeps its eyes on the prize, in Nakash’s words, “teaching students to be focused on human nature, dedicated to treating suffering and promoting health.”

As she works on her doctoral thesis, Jamie Daniels is propelled by her desire to become a more skilled, insightful practitioner, researcher and writer. Ultimately, she hopes to keep “helping the most vulnerable in our society”—with the aid of her psychodynamic glasses. ◆