Real World Clinical Blog: I Believe in Ghosts
by Dr. Danna Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way
The more I practice clinical social work, the more I believe in ghosts. I don’t mean ghosts in the classic sense. I don’t mean apparitions or floating white sheets with two cut out eyes. Instead, I mean that our work is haunted, on many levels, by relationships and historic interactions from the past. Moments of stuckness, incomprehensibility, and clinical frustration can often be understood when we open our perceptions to the role that the past is playing in the present. Ghosts invariably and subtly inform our work. Considering this possibility can unleash tremendous psychological liberation.
My belief in ghosts is multi-dimensional. First, I think that the very self worth and dignity of our field is dictated by ghosts of the past. In almost any clinical team meeting, social workers feel that they are at the bottom of the professional totem pole. This is ironic, given that the knowledge that we have of clinical work holds tremendous nuance and complexity. Strikingly, we are also almost the least paid player at many professional tables. Why? It certainly can’t be that our work is of less import. Quite the opposite, really, we offer tremendous cohesion to treatment teams while providing unique relief to struggling clients. Our training and skill set make this specific form of relief possible.
I don’t know exactly why. I have some hypotheses, all related to ghosts. There is the obvious parallel process between the long-standing marginalization of our treatment populations and our professional marginalization. Clearly, systemic, institutional racism and classism have long characterized the functioning of our country. Within this social stratification, social workers remain cast aside, mirroring our clients' fragmented, forgotten and chaotic lives.
One of our founding and most supportive mothers is certainly Anna Freud, Sigmund’s daughter. Anna was Sigmund’s last born, sixth child. Before finding out about his wife’s pregnancy, Freud had started to speak impassionedly about the essential need for the accessibility of birth control. In this effort, he was talking about his own exhaustion from having kids. Anna wasn’t wanted. Perhaps in response to this painful knowledge, she fought hard to make meaning of the child psyche. She used her findings to empower social workers with tools to effectively work with children. The dynamic between Sigmund and Anna is a relic that we are still wrestling with. Social work, perhaps the wise child or counterpart to psychiatry and psychology, often feels like the last child to join the clinical family. Ghosts of the past, felt in the present.
On a more micro level, I often find that working dyadically with a client is mis-understood. The possibility of there ever being just two people in relationship is a psychic myth. In any clinical dynamic, there is both silent and roaring ancestry. This ancestry is present for the social worker and the client, alike. While this can be referred to as transference and countertransference, of course—I like to talk and think about ghosts.
The ghosts are certainly not limited to those who have actually died, although this is often the case. I had a client recently crying about her pervasive feelings of hopelessness and despair. She just can’t seem to find her way out of it. We finally started talking about her sister’s death nearly 15 years ago. She said that she fears that the experience of joy would mean that she has stopped missing her sister. She is being held hostage by the simultaneous disavowal and engagement of her sister’s ghost. To do this work well, we need to welcome the ghost, name the ghost, and free her from the ghost by befriending it. Talking to the ghost allows us to invite in the possibility of the ghost’s wisdom. Her sister would never want her to be beholden to sadness this way. Refusing to welcome her only propagates the sometimes malignant experience of grief. When, in fact, grief can heal.
Another client is working as a TSS worker in a rough inner city school. The student he accompanies through the day is being viciously bullied. As he sees the bully, he feels overcome by insatiable rage and violence. To regulate this ire, he must interact with the ghost he holds of his inner bullied, child self. In recognizing the haunting presence of his own, wounded past, he can begin to properly serve his client. Without recognizing the ghost, his ghost, he is imprisoned by a spirit that can not distinguish between past and present.
When taking a new job, we invariably battle the ghosts of the past employee and workplace dynamics that existed before us. Researching this history makes us more adept at navigating the pitfalls created by an unresolved era. When working with new clients, it is essential to ask what their experiences with past social workers have been. Why? Because we need to know about the ghosts that preceded us in order to understand how the present is, often, inexplicably playing out. Learning about how a past employee at our agency has violated boundaries, welcomes a ghost.
Hearing that a client has never trusted a social worker before, welcomes a ghost.
Ghosts, certainly, are only scary when we ignore and deny them. The freedom of our present is made possible by peacefully and fearlessly facing our always haunted pasts. The past makes itself known in the present, simply in disguise. Our work, as clinical social workers, is the unrelenting disrobing of the disguises that surround us.
Dr. Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. Read more about clinical supervision in her book, Real World Clinical Social Work: Find Your Voice and Find Your Way.