Reflective Practice and Psychodynamic Understanding

REFLECTIVE PRACTICE AND PSYCHODYNAMIC UNDERSTANDING

Abstract
This paper will review how I have used writing to process moments of tension or uncertainty with three clients: Eddie, C. F., and Kayla (names changed). In what follows, I will first give a brief background sketch of the client, share parts of a client’s stories from my own reflective writing and then present the core concepts from those theorists who helped me make sense of what had occurred, thus guiding my work with the client. I met each of these clients while working at their high schools on the South Side of Chicago.

EDDIE PRICE
I first met Eddie Price while working as a mentor and advisor at a charter high school in 2013. This was my first year out of college, my first fulltime job, and my first time working as an advisor to high school students. This was also the year I decided I’d need to get a degree in social work in order to better understand the social-emotional lives of the young people who so often get pushed out of our public education systems. 

Mr. Price (we called students by their last names) was often the subject of disciplinary action. He was known to wander hallways and classrooms when he was supposed to be seated at a desk. He had an Individualized Education Program (IEP), and a Behavior Intervention Plan (BIP), but these seemed largely ignored by teachers and school administration. It was clear that the school staff did not understand what was going on inside of him. I did not either, but I wanted to. I wrote the following piece to contend with the first, small instance I truly connected with Mr. Price. I felt—for the first time—I was able to hear and hold the truth he’d been trying to get out.

> > > . < < <

December 2013

Mr. Price,

You are standing with your arms and head against the window, as a lot of guys do when kicked out of class—across the street is a snow field, a train, a house where no one lives. The window is cold. You’ve been kicked out of class again, maybe for the second time that day, or fourth, or more. You’re the kid who always talks over me, everyone. You’re always breaking apart a calculator, or taking your belt on and off, or tapping, tapping, standing in corners when you should be in seats. A few nights before this moment, your mom kicked you out again, and you were back with your dad, a less hurtful more heartful man who doesn't want but loves you. I don't know what we're going to do with you, your parents say, your teachers say, the deans say, you say. I don't know what to do with you anymore.

You’re the student I think about on the commute home, especially when it rains and everything feels a little leaky. Do you know what you’re doing to yourself? Do you have control? You’re the one my parents know, my friends know, the story I pull out over dinner; a name I sigh with. The Dean told me the other day that you’re on your way out of the school, that I should log every single thing you do wrong and make a case against you. I nodded sad, knowing that the lack of “respect” (You told me once that you don’t care about respecting people based on age or position, but the respect they give you. Do I give you respect? Do you make it impossible? What does that word even mean?) you show me on one day alone could fill up pages. 

At this window you were quiet, and frowning at a thing far in the snow. You pull your forehead off the glass for a moment to pinch in the window release and open it an inch—two inches on one side where the window slants broken in its frame. The  air bites us, and I blurt Price (loud, cutting off the “Mr.”) while I motion for you to close it back. It’s habit more than anything, the redirection—I actually kind of like the cold. The security guard saunters by and closes the window himself, unaware of our everything.

I expect this to set you off, for you to go on one of your diatribes about mankind’s bullshit, white man’s bullshit, about place and race and other things brilliant beyond your capacity to package. About the nice white men in nice black suits in nice tall buildings who make decisions for not nice kids like you down in Englewood. I expect you to look over my shoulder like you always do when we’re talking, and when I say we’re talking, I mean you’re talking and I’m listening. I expect you to tell me again how that teacher screwed up your grade, or how you got in a fight with your mom after you snuck out while you were suspended because she told you not to leave the house while suspended and after 4:30 is technically post-suspension. How she hit you, or you said she did. I expect you to fume. I expect not to know what to say, again. 

But you’re quiet for once. When you begin talking again, it’s in a whisper, almost a mumble—almost as if you’d forgotten me next to you. 

“It just sucks that we have to die. That everyone has to die. Can't just a few people live? I just can't believe that everyone has to go. That doesn't seem right.”

I ask you how this came up. You whisper on, as if accidentally answering my question.

“It's why I am how I am. I don't know where I'll be tomorrow, but I want to know I'll die having really been alive. So few of us are really alive.” Your voice trails off into mumbles I can’t know. Your gaze stings glued out this window, now closed.

> > > . < < <

The work of Melanie Klein and Harry Stack Sullivan help me contextualize the internal workings of Mr. Price, the systemic factors that contribute to his overall being and this complicated moment that we shared. 

Melanie Klein (1975) says there are two main “positions” of the self that emerge within one’s first year of life: the paranoidschizoid position and the depressive position. She presumes that the paranoidschizoid position “causes human beings to develop fears centered in the preservation of self, which manifest through anxious and persecutory actions,” and that the depressive position roots from a “conflict between loving and destructive (good/bad) impulses, which gradually become one over the course of development” (Borden, 2009, pp. 68-69). Klein and her followers believe that, although the paranoid-schizoid position predates the depressive position, “fluctuation between the stages never ends” (Rasmussen and Salhani, 2010, p. 499).

I was easily frustrated when Mr. Price was on one of his “diatribes,” or when he felt the need to speak up against something he viewed as unjust, but perhaps, as Klein would say, he spent most of his time in the “paranoidschizoid” position, unable to view a given situation as having both good and bad qualities. This moment we shared at the window was the first time that I saw Mr. Price slip into the “depressive” position. He could see, at once, the beauty of life and the sadness that it must someday end. He could see his own actions as a reflection of this tension. A lot of the young people I’ve worked with in schools spend much of their time in the paranoid-schizoid position; at any moment, they may jump into verbal or physical argument. This is often necessary for their own literal survival. What does this mean, then, that so much of these young people’s time is spent preserving oneself? By simply bearing witness to Eddie’s frustration or anxiety rather than arguing with it, I could have shown him how it looks like to have someone make him feel heard when experiencing negative emotions; shown him that good and bad can happen in the same moment.

Sullivan (1956) uses the term “selective inattention” to describe the “controlling awareness of the events that impinge upon us” (p. 38). With this concept in mind, I see how Mr. Price often focused hard on one thing at a time. This may have been a necessary coping mechanism at home, a way to keep his mother’s verbal and physical outbursts at bay. At school, he was selectively inattentive to teachers and administrators when he did not find their tone respectful. Perhaps these tones reminded him of his mother, perhaps not. Regardless, Mr. Price was often viewed by those teachers and administrators as rude, sarcastic, and disrespectful (ironic, given his appreciation of respect). This often landed him in trouble; roaming the hallways; unheard. To authentically engage Mr. Price would require these workers to imagine the reasons for his selective attention, and to react in a non-punitive manner to his moments of paranoid-schizoid outbursts.

C. F.
Around the same time that I met Mr. Price, I encountered C. F., who was a freshman. Quiet, mostly. A writer. The world was heavy to him. He was quick to grin, but walked as if there were sandbags on his shoes, and tended to say morbid things more easily than pleasant ones. In my presence, he wrote a chilling poem about violence in his community, his home as safety, and his own fear of death. Two years later, he was shot and killed in front of his house.

> > > . < < <

July 2016

I am not expecting it to be an open casket funeral. If I had been given a choice whether or not to see his body, I would have chosen not to—I don’t have a choice. There it is—there he is—at the front of the congregation, the casket so lavish and so clean, royal almost, his skin so waxy—and I purposefully scoot over as to have someone’s head in front of me, as to not see. 

From here, I can see the security guard from school—who seems to be a funeral director on the weekends—take a tool out of his jacket that hooks onto the casket. He begins to crank the casket closed, so slowly—he could have done this so much faster. 

From here, I can see Mr. F.’s father—also Mr. F.—clutching the pew. Clutching the pew with his hands like claws, so tight, curling into himself, like if he held long enough, strong enough his son would come back. 

I can see him see his son for the last time.

I can see Mr. F.—still. I can see him still clutching his boxing gloves, still with that peaceful face, still so young and so just starting life. 

From here, I can see a grown man wail, heave, run out of the congregation. 

From here, I can see a long line of seventeen-year-old boys, so well dressed, so trying to hold themselves together, holding themselves together. This isn’t their first time doing this. I cringe thinking I ever told them to sit down, quiet down, DUDE, calm down.

From here, I can’t see through my own hot tears, wondering if I’m allowed to cry here. If it’s my place to cry here. 

For the first time, I want to believe in a religion—I want to hold onto something when nothing feels right. When good kids, the poets and peace warriors, are shot to death outside their houses, when the bullet goes through the front door, when the kid’s single father, a UPS driver, can’t talk except through heaves, when he can’t afford to make a program for the funeral, when the other seventeen year-old boys raise money to make a program for the funeral.

Reading his poetry, it almost seems like Mr. F. knew he was going to die young all along. I want to believe that he was on a throne.

> > > . < < <

Nancy McWilliams (2004) believes that a clinician’s role is not to lead a client to a given destination, but to walk alongside the client and to “make the journey safe” (p. 31). In general, I agree with this. But how could I walk alongside C. F. when we did not share the same road? How can a clinician make the journey safe when the need for safety becomes so literal? When it is not a metaphor? We can have control over what happens in our classrooms or community centers or offices, but outside of those spaces, our clients are on their own; it is sobering to recognize this. 

In thinking of C. F.’s stark poem of violence and death, Ian Suttie’s theory about the difference between the psychopathy of wartime and peace comes to mind. He theorizes that in war, “the traumatic factor was adult fear of death and injury, and perhaps horror and discomfort at the conditions of life. In peace, the ‘traumata’ are infantile anxieties and resentments, whose nature and origin have been completely repressed (Suttie, 1935/1998, p. 203). It is clear that C. F. is not preoccupied with “infantile anxieties,” but—because of the conditions in which he lives—a real adult fear of death.

Susan Kemp (2010) writes that “as places get under our skin, they become repositories of individual and collective meaning” (p. 120). I am inclined to believe that at a cellular and psychological level, we connect with places, and places not only shape our memories and the narratives we tell about ourselves, but they shape the makeup of our bodies. When I land at the airport in Northern California—where I grew up—my first deep breath of that sharp, clean, cool Pacific air calms my body. I am home. C. F. was scared to walk down the block he lived on. And ultimately, he was not safe there—he was killed just in front of his house by a drive-by shooter. In his poetry there was the sense one could—that he might—survive the ‘traumata.’ But places seep into us. Our places, our communities, impact the very fiber of our existence.

Alfred Adler (1927) writes about the notion of Gemeinschaftgefuhl, or “feeling of community” (p. 134). Borden (2009) further draws upon this “human compulsion for community and communal life” (p. 29). He proposes that through this feeling of community, we learn to empathize, understand connectedness among beings, and build interdependence with and amongst one another. But what if our feelings of community are feelings of chaos, of rupture? C. F.’s poem includes references to falling asleep to gun sounds, screams, and moans. If interdependence and empathy do not mark our communities, can we still learn to build connectedness amongst beings? I would like to believe that it is possible, in C. F.’s story, to find a narrative where struggle and hardship are the catalyst for deep interdependence amongst beings.

This phenomenon of community interdependence is explored in Rebecca Solnit’s book A Paradise Built in Hell (2010). Solnit follows communities who unite after natural and manmade disasters. She writes, “If paradise now arises in hell, it’s because in the suspension of the usual order and the failure of most systems, we are free to live and act another way” (p. 7). I believe that we can learn new ways of being from both joyous and difficult moments of community—and that we can redefine community not as something merely geographical, but spiritual, and restorative. Though a deeper commitment to appreciating the resiliency of community could not bring C. F. back, perhaps it could help survivors be present for one another.

KAYLA
I did not know Kayla well when I was asked by my supervisor to sit with her and her mom in a school conference room to wait for the SASS (Student Assessment and Support Services) worker to show up and assess whether she needed to be hospitalized. Kayla was on medication to control hallucinations, and she’d been talking to voices all day. My supervisor thought she may need her medication adjusted. While I sat with them, I watched Kayla and her mom argue for almost two hours until, finally, Kayla got up and ran out of the room and out of the school. I was not trained for this moment—and often, in crisis work, we don’t have time to think. Not knowing what else to do, I followed her.

> > > . < < <

December 4, 2016

Dear Kayla,

You got up from your seat before I knew what you were doing. You got up from your seat, and walked out of the conference room and didn’t listen to your mom talking through tears telling you to sit down, come back, it’s gonna be okay, baby. 

You walked across the hallway and through the doors to the school and I couldn’t believe you could do that, couldn’t believe that a public school these days wouldn’t have security guards at every door, couldn’t believe that I wanted security guards blocking kids from going through doors. I couldn’t believe that you turned the corner, kept walking; that you seemed to know where you were going.

I didn’t mean to yell at you when you kept walking. I didn’t mean to raise my voice but I wanted you to hear me, and maybe I wanted you to think I was doing something, no, maybe I wanted some karmic pull in the universe to know that I was doing something so I wouldn’t get in trouble for letting you leave out the school like that. I didn’t mean to think about myself getting in trouble, losing my internship, when I should have been thinking about you, your safety, getting you to safety. I didn’t mean to almost cry. 

You were in another place, a you place, walking away from me, from the school, from your mom, going towards where you already were in your head. Every half block, you would look back at me and laugh, pretend to run a little, or scowl hard with a fuck you and a stop fucking following me. 

We walked for six blocks like this, like it had been days of this. 

You stopped at the 65th and Cottage bus stop and just sat. Your face changed, whole body changed, suddenly. You were not hard anymore. You got younger, sitting there. You were a kid who spilled milk or broke a vase, not a six-foot 17-year old in a bout of psychosis. You didn’t want me to see you like this, or maybe you wanted me more than you wanted, telling me not to fucking touch you or you’d fucking beat me. I wanted to wipe your mascara. 

So where should I go from here? Should I hold you here, keep you here, younger, away from the crisis worker and the police and the hospital and your mom and even the school, away from all these systems that you know weren’t made for you? Can I decide what makes you safe? Or should I let you go, let you get on the bus, trust that you are going where you need to be?

> > > . < < <

In crisis work, we often do not have time to think before acting—but instead, must act immediately, and think later. In my interaction with Kayla, I did not have time to reflect about the best possible course of action. Therefore, I used the process of personal writing to recover time I did not have in that moment.

Reflecting on this moment with Kayla, I remember Karen Horney’s (1945) theories of personal defense, as summarized in Borden (2009): “(1) moving towards other, seen in irrational needs for love and approval, (2) moving away from others, marked by withdrawal and isolation, and (3) moving against others, represented in unchecked need for power” (p. 128). In the mere twenty minutes we were together, Kayla depended highly on the last two patterns of defense. Looking back, I think of the multiple ways in which I could have responded to her when she moved away from, and against, me. I could have stayed at the school. I could have run after her (I was afraid she’d run, too). I could have gotten angry (I raised my voice more than I should have). I could have called the police (I did not have my phone on me; they were called anyway). It is important to recognize that within two-person work (Wachtel, 2011), my reactions to Kayla were just as important as her actions towards me.

Once Kayla sat down at the bus stop, I made the decision to stand about ten feet away from her, and not to talk to her unless she spoke to me. Although it felt uncomfortable to just stand there, I see now that I was practicing what Carl Rogers (1959) refers to as “unconditional positive regard,” or, to “value the person, irrespective of the differential values which one might place on his specific behaviors” (p. 208). I made clear to Kayla that I was there for her—that she was accepted exactly as she was. In that moment her defenses broke down. She became vulnerable, as her body physically relaxed. Although she still presented me with curse words and threats, she teared up while doing so.

Rogers’ and Horney’s theories feel deeply in line with my own moral system. However, I also recognize the ways in which I may not always want to respond with positivity, or compassion. I may be moved to correct someone, to direct them, or overthink my actions. It is important to remember that with Kayla, and the other students about which I wrote, some of the most impactful moments have been ones where I’ve sat back, listened, and accepted exactly what was happening while it was happening. 

CONCLUSION

Social work demands reflective practice. This paper focuses on writing as a reflective practice as a bridge towards theories. Although psychodynamic theories are particularly apt for reflective writing, given their own narrative nature, reflective writing can find a home alongside other clinical theories, and across the ecological system of micro-, meso-, and macrolevel social work. 

As practitioners who engage in writing as a ref lective practice, we may regain time after a crisis, both to remember and re-root, and to understand opportunities for future interactions. Or, like Coles, we may find emergent “moments of liveness” in client interactions, thereby moving away from relying solely on quantifiable “symptoms” and towards a more humanistic practice.

REFERENCES

Adler, A. (1927/1998). Understanding human nature. Center City, MN: Hazelden Foundation.

Borden, W. (2009). Contemporary psychodynamic theory and practice. New York: Oxford University Press.

Coles, R. (1989). The call of stories. Boston: Houghton Mifflin. 

Horney, K. (1945). Our inner conflicts. New York: Norton.

Kemp, S. (2010). Place matters: Towards a rejuvenated theory of environment for direct social work practice. In W. Borden (Ed.), Reshaping theory in contemporary social work: Toward a critical pluralism in clinical practice (pp. 114-145). 

Klein, M. (1975). Envy and gratitude and other works, 1946-1963. New York: Delacorte.

McWilliams, N. (2004). Psychoanalytic psychotherapy. New York: Guilford.

Rasmussen, B. & Salhani, D. (2010). A contemporary Kleinian contribution to understanding racism. Social Service Review, 84, 491-513.

Rogers, C. (1959). A theory of therapy, personality, and interpersonal relationships, as developed in the client-centered framework. Psychology: A Study of a Science, 3, 184-256.

Solnit, R. (2010). A paradise built in hell: The extraordinary communities that arise in disaster. New York: Penguin. Sullivan, H. S. (1956). Clinical studies in psychiatry. New York: Norton.

Suttie, I. (1935/1988). The origins of love and hate. London: Free Association Books.

Wachtel, P. (2011). Therapeutic communication (2nd ed.). New York: Guilford.

DANIELLE LITTMAN is a second-year clinical student in the A.M. program at the School of Social Service Administration. Prior to coming to SSA, Danielle worked as a teaching artist in several Chicago schools, and as a community liaison for the Chicago Park District's Department of Culture, Arts, and Nature. Danielle's practice and research interests center around place, youth voice, creative qualitative methodologies, and person-centered practice. Danielle holds a B.A. in Theatre and Creative Nonfiction Writing from Northwestern University.