Psychoanalysis and Psychotherapy

Free Associations

LIVING IN TWO WORLDS:

PSYCHODYNAMIC 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.

Such preoccupations have, of course, always been the stuff of literature, expressed with great beauty and intensity by George Eliot in Middlemarch:

That element of tragedy which lies in the very fact of frequency, has not yet wrought itself into the coarse emotion of mankind; and perhaps our frames could hardly bear much of it. If we had a keen vision and feeling of all ordinary human life, it would be like hearing the grass grow and the squirrel's heart beat, and we should die of that roar which lies on the other side of silence (1872, ch. xx, p. 226).

Here George Eliot is describing the anguish of a young wife, Dorothea, returning home from her honeymoon, having suffered deep

disillusionment about the state of marriage, and about her new husband in particular. Realizing that, in contrast to her preconceptions about him, Casaubon has "an equivalent centre of self, whence the lights and shadows must always fall with a certain difference" (ch. xxi, p. 243), Dorothea embarks on a process of mental struggle which constitutes the central energy of this long and complex novel.

Her 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'.

Middlemarch is a 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.

The 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.

Embedded 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.

This 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.

With 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.

DOING 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

the basic need to know the truth about oneself which is fostered by a mother who is able to discard preconceived theories about children, who is able to be continent and cognizant of her own infantile emotions and to respond to the projections and communications of her own particular infant in its particular context (1982, pp. 167-8).

There 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 Society.

Describing English middle-class education, he says:

a very large part [of it] is devoted to the training of servants. This is much more its characteristic than a training for leadership, as the stress on conformity and on respect for authority shows. In so far as it is, by definition, the training of upper servants, it includes, of course, the instilling of that kind of confidence which will enable the upper servants to supervise and direct the lower servants. Order must be maintained there, by good management, and in this respect the function is not service but Government. Yet the upper servant is not to think of his own interests. He must subordinate these to a larger good, which is called the Queen's peace, or national security, or law and order, or the public weal. This has been the charter of many thousands of devoted lives, and it is necessary to respect it even where we cannot agree with it (1987, p. 329).

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.

But 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 services.

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'.

The 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.

PARENTING 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 respond accordingly.

'Servicing' 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.

A 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.

In 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.

For 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.

PARENTING, THINKING AND SOCIAL WORK

The 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.

It 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.

It 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.

The 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.

Thinking 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.

Thinking 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.

A 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.

Coming 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 want him 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.

Fifteen 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.

Bion's 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.

Lacking, 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.

The 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 gratification.

I 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 daily practice.

Mrs F: What do you do with a boy who behaves like a child?

John (angrily): Give evidence. Give proof.

Mrs 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.

John: It wasn't raining.

Mrs F: Can I finish, John?

John: There were little drops.

Mrs F: It was soaking. I rang the school to find out if John was wet.

John: You treat me like a baby.

Mrs F: That's because you behave like a baby'. It was pouring with
rain and you were going to get wet.

John: I was looking for an umbrella.

Mrs 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.)

John (very angrily): It's lies, all lies.

Mrs 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.

John: All lies (covering his face with his hands).

Mrs 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.

Mrs F: It's just so difficult at home. He does behave like a child. It's bad for my health, apart from anything else.

John (growling): It's bad for your health. What about me? You don't care about me.

Mrs F: I do. Why do you think I was worried about you this morning? 1 was feeling for you.

John: 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.)

Mrs 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 health.

John: You don't. I'm often in my room sniffing and sneezing with the window open, no heat, because I'm not allowed it.

Mr 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.

John: I do.

Mrs F: You don't.

John: I do.

Mrs F: You don't.

John: Oh, it's all lies, it's always me, nobody else, just me.

Mrs F: Well, that's because you behave like that.

(Mr A at this point drew attention to John holding his arm in front of his face.)

Mrs 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.

John: That was a sarcastic laugh. (To Ms B it looked as if he were more on the verge of tears.)

Mr 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 oneself against.

Mrs 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.)

John (viciously): I can hit with words when I want to.

Mrs F: You see what I mean?

John: I do it because it's done to me. (Mr and Mrs F both gasped.)

John: 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).

Mr and Mrs F: We never clout you, John. When? (outraged).

John: Yes, you do. That's how I learned to keep silent, to keep things to myself.

(Pause)

John: 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.

Mrs 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.

Ms 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 things through.

Mrs F: Well, John wants to get away from us and I think that's a good thing.

John: No, I don't want to get away from you, I just need to be with
adults, relate to the adult world and myself.

Mrs F: Oh, so it is not us.

John: No, it's not you. I just want to be independent.

Mrs F: I agree that's a good thing. It can't be worse than it is now.

Mr A: I have the impression that everyone in this family has at some time the fantasy of leaving, of getting out, abandoning the family.

Mrs F: I do. Everyone needs a break, to get away from it all.

Mr F: Yes, that would do you good.

Mrs F: Everyone wants holidays.

John: Yes, to have a break (sarcastically).

Mr 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.

Mrs 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.)

Mrs 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.

Mr F: Yes, meanwhile, things could be nice. It's only two years. (He sighed deeply.)

John: Yes. Only two years. (He turned away and said something under his breath.)

Mrs F: What did you say? John: Nothing.

Mrs F: You did. John: I didn't.

(There was silence. Mrs F continued.)

Mrs 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.

John (very distraught): There is so much pressure (holding his head). I'd like to get away from that at least.

(A long, painful silence.)

Mrs F: Let me ask you something. Did you think it was raining this morning?

(Pause. Ms B commented that the session had come full circle - to the point where it began.)

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.

John: I get laughed at.

Mrs F (surprised and sarcastic): Well, that's new, he's never said that before. I don't believe it, whatever next?

(Mr F spluttered.)

John: I do. 1 am surrounded by iguanas.

Mrs F: Why do they? It's a perfectly ordinary anorak.

John: I don't know. They just do.

Mrs F: Who?

John: I don't know.

Everybody. Mr and Mrs F (together): Well!

Mr 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.

Mrs F: What was that? Oh, about what to do with a boy who behaves like a child?

Mr 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.

Mrs F: But I threw it away because it was dangerous. We really didn't have one... (etc.)

Leaving 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.

Mr 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.

The 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.

In 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 process.

The 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).

CONCLUSION: PSYCHODYNAMICS IN SOCIAL WORK

In 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.

Attacks 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).

The 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.

There 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.

The 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 difficult.

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.

REFERENCES

Bion, W.R. (1962) Learning from Experience. Heinemann.

______ (1983) Attention and Interpretation. Heinemann.

Boston, M. and Szur, R., eds. (1983) Psychotherapy with Severely Deprived Children. Routledge.

Eliot, G. (1868) Felix Holt. Blackwood.

______ (1872/1965) Middlemarch. Blackwood/Harmondsworth: Penguin.

Harris, M. (1982) 'Growing points in psycho-analysis inspired by the work of Melanie Klein', Journal of Child Psychotherapy, 8 (2).

Harris Williams, M., ed. (1987) Collected Papers of. Martha Harris and Esther Bick. Perth: Clunie.

Jacques, E. (1955) 'Social systems as a defence against persecutory and depressive anxiety', in Melanie Klein et al., eds. New Directions in Psycho-Analysis. Tavistock.

______ (1970) Work, Creativity and Social Justice. Heinemann.

McDougall, J. (1986) Theatres of the Mind: Illusion and Truth on the Psychoanalytic Stage. Free Association Books.

Meltzer, D. (1975) 'Adhesive identification', Contemporary Psychoanalysis 2(3).

______ (1986) Studies in Extended Metapsychology: Clinical Applications of Bion's Ideas. Strath Tay: Clunie.

Menzies Lyth, 1. (1988) Containing Anxiety in Institutions. Free Association Books.

Seebohm, F. (1968) (Chairman) Report of the Committee on Local Authority and Allied Personal Social Services. HMSO, Cmnd. No. 3703.

Williams, R. (1987) Culture and Society: Coleridge to Orwell. Hogarth.