Description
Due 07/19/19 by 2PM EST
Respond to the blog post of three colleagues in one or more of the following ways:
- Validate an idea in your colleague’s post with your own experience.
- Share an insight from having read your colleague’s posting.
Response to Charmaine
An explanation of the use of self during your field education experience that you may have encountered or that you might encounter
The use of self can be negative; however, when used appropriately, it can be positive and promote change within the client. Ganzer (2007) agrees by noting that the use of self can be beneficial to the therapeutic relationship. My field experience has exposed me to multiple situations where the use of self is helpful. My agency works with children and families in which the children have been maltreated and more than likely removed from their parents/caregiver’s care. When working with some parents and sharing that I too am a parent resulted in the client feeling like I was able to empathize with them as a parent. Also, during supervision, I am able to openly share and process any biases and prejudices I may have with my field instructor.
A description of potential boundary challenges in your field education experience
Many individuals view my agency as “the people who took my children” instead of viewing the agency for what it actually does, and that is to work effortlessly to sure the safety of the children and reunify the family. Many of our clients also are diagnosed with a mental illness; from mild to severe. With that being said, it is important for me to not share too much of my personal life with the client. For instance, I have shared that I am a parent but have not disclosed the age, gender, etc. with clients. Although some adult clients have asked and asked about what school my child attends. Instead, I am careful to use the use of self in a way that upholds my professional boundaries, while simultaneously empowering the client to draw their own conclusions and take ownership of their own decisions (Birkenmaier and Berg-Weger, 2018).
References
Birkenmaier, J., & Berg-Weger, M. (2018). Socialization into the social work profession. In The practicum companion for social work: Integrating class and fieldwork (4th ed., pp. 34-62).
Ganzer, C. (2007). The use of self from a relational perspective. Clinical Social Work Journal, 35(2), 117-123. Doi:10.1007/s10615-007-0078-4
Response to Phillip
An explanation of the use of self during your field education experience that you may have encountered or that you might encounter
The importance of the concept of mindful use of self to the field of social work permits an importance on self-awareness as a foundation to understanding the role of conscious use of self in the development of effective helping relationships at micro- and macrolevels of intervention. However as new social workers, we need to be reminded that they are just beginning the ongoing process of refinement of conscious use of self and that it applies at micro-, mezzo-, and macrolevels of intervention (NASW, 2000). When I think of self, I think of simply reflecting who I am and taking care of myself to better server/help others. “With self-care as the personal value, individuals formulate different plans to promote or enhance that value in their lives, utilizing various means of implementing those strategies. In this joining process, it is important to spend ample time reflecting on who we are as we sit across from those coming to us for support (Jacobson, 2001).
The “self” we bring into social work room as we empathize, connect, share, and respond has the potential to deeply affect those we therapeutically come into contact with. It is our responsibility as clinical social workers, and as mental health care practitioners in general, to ensure that we present our “selves” in a manner that is most likely to promote growth, healing, and empowerment in our clients. This is a career-long process, as we are constantly moved and shaped by our life experiences and by the people with whom we interact – including our clients – in a multitude of ways.
I am encountering taking care of self in the present or in the future. Personal therapy provides a safe place for us, as mental health care professionals, to work through our own dilemmas while simultaneously sharpening, polishing, and refining the “self,” we bring (Leiby, 1997). The literature suggests that personal therapy is a highly valued activity for therapists new and seasoned alike. “Moreover, many therapists assert that their own personal therapy was more important than coursework or supervision for their development of a professional identity into the therapeutic space”, as stated by Jacobson, 2001. My own personal therapy is weekly and I have benefited from this experience, as I can talk about though issues about work and personal life. I am taking care of my own self and making sure I am in the mental shape I need to be in this profession.
A description of potential boundary challenges in your field education experience
A potential boundary issues that I have is that our work is done in the community setting, so you see people that you know and that there sometimes are clients out when you are out. I try to make sure that I work in areas in which I do not go. Also, boundary issue is not sharing my personal life or pass down my own beliefs. I am openly gay, so when people see me outside of work with my fiancé people are quick to judge or pass conclusions. I keep personal life aside from work and do not impose my values on others. Especially in the area in which I live are not opening respondent of the LGBTQ community.
References
Jacobson, W. B. (2001). Beyond therapy: Bringing social work back to human services reform. SocialWork, 46(1), 51-62
Leiby, J. (199 7). Social work and social responsibility. In M. Reisch & E. Gambrill (Eds.), Socialworkinthe 21st century {pp. 3 59-367). Thousand Oaks, CA: Pine Forge Press.
National Association of Social Workers. (2000). Cultural competence in the social work profession. In Social work speaks: NASW policy statements, (pp. 59-62). Washington
Response to Sierra
- An explanation of the use of self during your field education experience that you may have encountered or that you might encounter
As a social worker I exemplify my use of self during my field education experience by bringing my attitudes, beliefs, and experiences to the therapeutic relationship. The use of self must be balanced between the professional and the personal. In my field placement I must determine what extent I would like to use the use of self. When sharing information with clients it can be both negative and positive experiences in terms of the professional encounter (Birkenmaier, & Berg-Weger, 2018). Some self-disclosure should be for the clients benefit. During my field placement I do not go into much detail about myself but with going through life experiences I am able to apply them in sessions. If a client shares the same beliefs as I do, I may agree with what they are saying or add to what they are saying while making sure it is about them.
- A description of potential boundary challenges in your field education experience
Potential boundary challenges in my field education experience may be interjecting too much and shifting the focus on yourself as an intern rather than the client. Doing so can be damaging to the therapeutic relationship. Self-disclosure can impede progress toward desired outcomes due to the discomfort of shared experiences. Boundaries are important to have just so the relationship between myself and the client can stay progressive (Birkenmaier & Berg-Weger,2018).
Reference:
Birkenmaier, J., & Berg-Weger, M. (2018). The practicum companion for social work: Integrating class and fieldwork (4th ed.). New York, NY: Pearson.
Clin Soc Work J (2007) 35:117–123
DOI 10.1007/s10615-007-0078-4
ORIGINAL PAPER
The Use of Self from a Relational Perspective
Carol Ganzer
Published online: 16 March 2007
Ó Springer Science+Business Media, LLC 2007
Abstract This article explores the implications of a
contemporary relational perspective on the use of self in
social work practice. The author is responding to an article
by Andrea Reupert, who interviewed social workers and
reported they tended to see their concept of self as individualistic, autonomous, and only partially defined by
others, even though social work practice focuses on personin-environment. In this article, the author expands the
concept of self and argues that a contemporary view of the
therapist’s self is one that is dialogic, contextualized,
decentered, and multiple. Additionally, the author suggests
that this relational perspective has implications for teaching
and supervision. Several clinical vignettes are provided to
illustrate the concepts under discussion.
Keywords Use of self Multiple selves Supervision
Relational theory
The idea for this article began with a reading of Andrea
Ruepert’s, Social Worker’s Use of Self, published in this issue
of the Journal. The concept of use of self is a familiar one to
clinicians. From our earliest training in the field, we learn that
the relationship between clinician and patient fosters growth
and promotes change. The personal characteristics of the
therapist often enter into the therapeutic relationship as well,
helping to shape and refine the process. These characteristics
have been broadly defined (Woods & Hollis, 1990) as
empathy for the patient, warmth and concern, acceptance, and
a nonjudgmental approach. Additionally, the clinician, to the
best of her ability, maintains objectivity, models attitudes and
behaviors, and develops self-awareness and self-monitoring,
particularly of countertransference and its potential negative
impact on the treatment.
Andrea Reupert, in her qualitative study of use of self,
asks her interviewees to consider how they describe their
concept of self and how it impacts their clinical work.
Although the study had a limited number of participants,
the clinicians involved tended to see their concept of self as
unique and individualistic, and only partially defined by the
relational and environmental context of practice. To some
extent, Reupert attributes this highly individualistic and
autonomous sense of self to the Western tradition of rugged
individualism as well as to the failure of clinicians to fully
take into consideration the influence of social norms and
values in self-definition She finds it concerning that these
clinicians are reluctant to entertain the idea of the self as
socially constructed and contextualized, particularly since
historically social work training focused on a personin-environment framework, and the use of self in the social
work literature is discussed within the therapeutic environment and not as autonomous or self-contained.
It is my intention in this article to expand the concept of
self and to argue that a contemporary view of self takes into
consideration the notion that the self of the therapist, as
well as the patient, is dialogic, contextualized, decentered,
and multiple. I will draw on the work of several relational
psychoanalytic theorists who have promoted this view of
the self and illustrate this relational self through clinical
vignettes.
The Relational Matrix
C. Ganzer (&)
2824 N. Richmond ST, Chicago, IL 60618, USA
e-mail: caganzer@aol.com
The late Stephen Mitchell coined the term relational matrix
to describe the way ‘‘psychological reality’’ operates
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within a matrix that contains both ‘‘intrapsychic and
interpersonal realms’’ (1988, p. 9). Mitchell felt that earlier
drive—and even object relations—theories tended to
dichotomize the internal world of object relations and the
external relational world of the patient into an either/or
focus. He believed these realms ‘‘create, interpenetrate,
and transform each other in a subtle and complex manner’’
(p. 9). What does this shift in focus mean in terms of a
concept of self and how does it impact practice? Mitchell
tells us that, in his view, self does not exist ‘‘in a psychologically meaningful sense, in isolation, outside a
matrix of relations with others’’ (p. 33). In contrast to the
individualistic self of the clinician defined by the participants in Reupert’s study, the relational self of the clinician,
as well as the patient, is acquired through and defined in the
context of relationships; and these relationships operate in
social, cultural, and political contexts. Mitchell also contends that models of mind that place relationship as central
to psychological growth, such as ego or self psychology,
tend to privilege the self with concepts such as ‘‘selforganization, ego functions, homeostatic regulation of
affects, developmental needs, a true or nuclear self, and so
on’’ (p. 9). These models would align more closely to the
findings of Reupert’s study, which place the therapist
outside of the patient’s relational world, providing ego
strength, self-structure, or self object functions. Consequently, self-awareness, as described in Reupert’s study,
would be paramount for the clinician to both understand
and interpret the patient’s transferences and projections and
to be vigilant about countertransference and the potential
for enactments. In a relational approach self-awareness
would develop through interaction with the patient and be
cocreated with the patient in and through the environment.
The clinicians in Reupert’s study leave us with the sense
that they value their personal characteristics, their selfawareness, and their use of self as instruments or tools to
effect change; and while they view the therapeutic alliance
as a necessary component of treatment, it is secondary to
their use of self derived from their own self-understanding
and intrinsic to their own development. This use of self
may involve how one implements a technique, or what one
self discloses, or how one handles humor, all factors that
emanate from the therapist and that place her on the
periphery or outside the patient’s world. For Mitchell the
therapeutic encounter is between two persons, therapist and
patient, which levels the playing field and gives each participant somewhat equal status. The therapist no longer
functions as knowing expert who provides interpretation
and fosters insight, but rather is a participant in creating
and constructing new transferential meanings. The clinician enters into and is embedded in the patient’s relational
world through enactments that repeat old ways of being for
the patient. In order for treatment to get underway, the
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therapist enters the patient’s relational world or perhaps
‘‘discovers’’ herself ‘‘within it’’ and is ‘‘in some sense
charmed by the patient’s entreaties, shaped by the patient’s
projections, antagonized and frustrated by the patient’s
defenses’’ (1988, p. 295). According to Mitchell, the
therapist finds herself in ‘‘one of the patient’s predesignated categories and is experienced by the patient in that
way’’ (p. 295). Rather than remaining an autonomous,
individualistic, and objective observer in the patient’s
drama, the therapist takes on various roles and ‘‘attributes’’
of figures in the patient’s intrapsychic and interpersonal
matrix, and together therapist and patient rework the patient’s narrative and rewrite the patient’s story, changing
the patient’s perception of the figures to ‘‘allow greater
intimacy and more possibilities for varied experienced and
relatedness’’ (p. 296). For the therapist,
the struggle is toward a new way of experiencing
himself and the patient … to find an authentic voice in
which to speak to the patient, a voice more fully
one’s own, less shaped by the configurations and
limited options of the [patient’s] relational matrix, in
so doing to offer the [patient] a chance to broaden and
expand that matrix. (p. 295)
In other words, through the mutual influence of therapist
and patient, embedded in the relational matrix, new
meanings are constructed, and new ways of being emerge
for the patient.
Multiple Selves
Another important contemporary view of self that has
evolved from relational theory is the idea that there is not
one cohesive, identifiable, or unitary self that we can
locate. Rather, as Bromberg has argued, the self is viewed
as ‘‘decentered, and the mind as a configuration of shifting,
nonlinear, discontinuous states of consciousness in an
ongoing dialectic’’ (1998, p. 173). These states are ‘‘linked
to each other, to the external world, and to the past, present,
and future’’ (p. 168). It is through this linking that we
connect aspects of our personal history and experience to
give us the illusion of cohesiveness. In treatment then, the
clinician moves from a focus on the repressed or
unconscious contents of the patient’s intrapsychic world to
incorporate and reflect on the enactments of the intersubjective world of the clinician and patient. The self that we
encounter may be various selves that the patient experiences as old ways of being with another. The perceptions
evoked by enactments do not cohere with the patient’s past
experiences but shift as the patient, together with the
clinician, plays out various scenarios from the past. What
Clin Soc Work J (2007) 35:117–123
has been dissociated or excluded enters the awareness of
the patient and clinician and the possibility occurs for new
narratives to be coconstructed. The self in this framework
becomes a participant in a drama that is played out through
the transference-countertransference transactions and
reflected upon by both parties, which allows for multiple
realities to emerge and discordant perceptions to be discarded so that the various self states can be linked into
cohesive reality and integrated into the patient’s lived
experience and form the basis for a new self-narrative.
The Therapist’s Participation
While we have come a long way from the idea of the therapist
as a blank screen promoting abstinence, anonymity, and
neutrality in practice, nonetheless, we still rely on the therapist’s technical expertise and effective interventions. This
tendency speaks to the role of self as instrument or tool and
assumes that the therapist has some degree of knowledge of
what the patient may need. Over 20 years ago, Hoffman
(1983) wrote an article that has had a significant impact on
contemporary views of the therapist’s participation in treatment. Hoffman argues that the therapist participates in the
coconstruction of transference and that this participation is
inevitable, whether or not she recognizes it. This coconstruction of meaning that involves the thoughts, feelings, and
behaviors of the therapist, as well as the patient, has a part in
shaping how the patient’s experience unfolds in the treatment.
As with Mitchell’s model, both therapist and patient are
caught up in enactments of old ways of being. These enactments are part and parcel of the treatment and form the basis of
therapeutic action. Use of self in this configuration requires
that the therapist not only tolerate ambiguity and uncertainly
but also immerse herself in it; for it is by entering the patient’s
world and experiencing it that the therapist can work with the
patient to emerge from it. This process often involves an
inquisitive and curious stance on the part of the clinician and
the self disclosure of the countertransference. It is by the
therapist and patient working through and reflecting on
enactments that involve therapist’s and patient’s transference
and countertransference transactions that a space is created for
new patterns of interaction to develop. The therapist’s use of
self then becomes an interactive, subjective, and empathic
means of furthering therapeutic action and portending a
positive outcome to the treatment. Let us explore some of
these ideas in the context of a treatment case.
The case of Ana
This case is a treatment that has been ongoing for nearly
5 years, and this brief vignette is drawn from a larger case
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study (Ganzer, 2006). I have presented this case with Ana’s
permission, for she believes her experience will benefit
others in similar situations. Ana is a woman in her early
30 s who was arrested, charged, and convicted of abusing
her 4-year old daughter, Aida. She served several years in
prison and was on probation for 2 years. Ana was referred
to me in connection with her child welfare case and her
desire to be reunited with her children. She presented as
frightened, hostile, and distrusting with her own history of
abuse and neglect. Initially, she would come to my office
only with another individual, usually one of her relatives. I
was uncertain about my ability to work with Ana, as her
case file indicated that she had made threats against other
workers and had been physically aggressive toward child
welfare staff and court officials. At the time I began
treatment with her, there was an Order of Protection forbidding her to have any contact with her children. After the
first few sessions, Ana seemed more relaxed and less tense.
She stated that she appreciated the fact that I did not accuse
her of the abuse of her daughter but was willing to hear her
story. After 3 months she no longer brought a relative with
her to sessions.
Over time, Ana and I addressed her deep-seated anger
issues, and she began to show changes in her behavior
toward others. Ana, who had only given me her phone
number, became comfortable enough to share it with her
caseworker, whom she began to trust as well. After a year
Ana’s frequent outbursts of anger diminished. The court
and the therapists involved with the family all concurred
that Ana had made good progress. As a result of this and
her improved control of her impulses, Ana was given
limited supervised visitation with her children; and after
2 years, the children were returned home to her husband.
Ana continued to live with friends and slowly began to
have unsupervised time with her children. Ana made slow
but steady progress toward reunification with her family.
After 2 years of work, she was given overnight visits. The
Monday morning after the second weekend visit between
Ana and her children, I received a phone call from her
caseworker. Ana had called the caseworker frantic that a
detective was on his way to her home to arrest her for
hitting Aida. The next day I learned that Ana had been
arrested and charged with assault. She pled guilty to the
charge and was given 3 years of probation, and her children were returned to the child welfare system. After her
return to treatment, Ana began to disclose in greater detail
her own history of physical abuse. With this history in
mind, I would now like to explore aspects of this treatment
from a relational point of view.
Neil Altman, in his writing on community practice,
makes the point that a clinician working with a disenfranchised population may take on various roles in the
transference such as ‘‘rescuer, victim, abuser, and
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neglectful parent’’ (1995, p. 2). In retrospect, I find that I
played out these roles with Ana and she brought various
aspects of herself to me in the treatment. These roles were
often enacted from the dissociated contents of our intrapsychic world and encountered through projective identifications that only later I identified and reflected upon
either by myself or with Ana.
In the early stages of treatment I found myself enacting
the role of rescuer with Ana. She idealized me and felt that
I was the only one who could help her. Aspects of my self
that responded to Ana’s maternal transference to me allowed me to dissociate the more negative qualities of Ana’s
behavior and to focus on her control of impulses and anger.
The more grandiose aspects of my therapeutic personality
allowed me to promote her rehabilitation to the court, while
disregarding the darker moments when she would have
angry outbursts. When I stated to a colleague that I saw the
real Ana, she corrected me by saying that I saw one side of
Ana, the good side, but disregarded the other side.
So, much of my work with Ana was a response to her
projective identifications with me as her rescuer and savior,
and I entered her world and assumed these roles. In effect I
was caught in playing out the old roles with Ana, roles that
represented her relationship with her now-deceased father,
and formerly abusive but now supportive mother. I was
able to provide new experiences and a new way of being
with her, and Ana was able to progress and make significant changes that were noted by others. I also found myself
assuming the role of victim as I struggled with agency
personnel who were not in favor of Ana’s reunification
with her children as well as the court officials who found
Ana to continue to be at risk of harming her children. It was
not until Ana was arrested for a second time that other
aspects of our various selves were played out.
After I learned that Ana was released from jail, I found
myself avoiding calling her to set up an appointment. I told
myself that it was her responsibility to contact me, despite
the fact that I had often called her in the past and that she
had left me a frantic message on the day of her arrest. I did
not visit her at the jail, although I could have done so; I
gave myself the excuse that I was too busy to take off a few
hours. I was slipping into the role of neglectful parent and
soon found myself showing aspects of the abuser. When
she finally called and resumed treatment, I found myself
raising my voice in a session, demanding that she change
her behaviors or I would not be able to work with her.
Somewhere in the middle of my pronouncements, I realized that I was being less than empathic or nonjudgmental.
I turned to Ana and apologized for losing my temper but
also disclosed my disappointment and sadness over what
had transpired in the past few weeks. Unlike others in her
life, I did not abandon her but was able to discuss how my
feelings were impeding our continued work. Ana then told
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me that she realized how difficult it was for me and that she
was sorry that all my hard work with her was wasted. This
was the first instance of Ana relating to me as a separate
person and not an idealized projection. From that point on
Ana was able to disclose more details of the physical and
emotional abuse she experienced in her childhood, and our
therapeutic work continued.
How do we locate the use of self in this clinical vignette
and what value does it have for therapeutic work? It was
through enactments that I became embedded in Ana’s
relational world, and these enactments were shaped by
Ana’s ‘‘projections, antagonized and frustrated by [her]
defenses’’ (Mitchell, 1988, p. 295). My entry into her
world was not a carefully orchestrated set of interventions
or conscious use of self, but rather I discovered myself in
the enactments. I then was able to reflect upon my roles and
either share my feelings with Ana or use them to work with
her defenses. I did not experience myself as autonomous or
objective but rather caught in enactments of old ways of
being with Ana, at times the abandoning and abusive
mother, at others times the rescuer, and yet at other times
the victim. This participation was unwitting and unrecognized, but, as Hoffman asserts, inevitable. My thoughts,
feelings, and behaviors, as well as Ana’s, helped to shape
the direction that treatment took and allowed Ana to begin
to have some empathy for me as a separate person, and we
were able to resume treatment.
This vignette further underscores that the therapeutic
self is contextualized, decentered, and multiple as Bromberg argues and not cohesive or unitary. In my work with
Ana various dissociated states and aspects of self came to
the fore as Ana and I enacted past experiences and played
old roles with which she was familiar. I offered new ways
of being through continuing the treatment with her and
disclosing my countertransference feelings of sadness and
disappointment over her loss of impulse control. Through
our ability to reflect on the various selves we presented to
each other, Ana and I were able to repair our therapeutic
relationship. Most recently Ana commented that she has
been able to act out her anger less frequently but to verbalize it instead.
Use of Self in Training and Supervision
In her concluding remarks, Reupert suggests that the
training and supervision of clinicians should incorporate
their personal qualities, as well as emphasis on theory and
technique. She notes that the social workers interviewed
bring more to their work than their professional knowledge
and skill. Several of the clinicians in her study found that
the way to best use self was to suppress the personal
aspects of self in favor of professional knowledge and skill.
Clin Soc Work J (2007) 35:117–123
Several others saw themselves as a creating a presence
through a process that was highly intuitive. These views of
self assume that the clinician can objectively know when
and how to use the self and that she has the ability to
identify, reflect upon, and objectively evaluate it. Reupert,
in this issue (DOI: 10.1007/s10615-006-0062-4), references Yan and Wong (2005), who have identified problems
with objective knowledge, and Kondrat (1999), who
suggests that the training clinicians receive has also
contributed to this objective stance.
I have argued elsewhere (Ganzer & Ornstein, 1999,
2004) that although relational theory has influenced social
work practice, supervision has lagged behind in embracing
these ideas. How would processes such as those described
in the study differ from supervision and education in a
relational matrix? In the former, the autonomous, selfaware, professional self of the supervisor would tend to
reinforce the hierarchy that is often inherent in a supervisory relationship with the supervisor being in a one up
position and the therapist in a one down. In the early stages
of a social worker’s career, she builds a professional self
through seminars, practicums, and ongoing clinical supervision. The traditional view sees supervision as provided
by an experienced supervisor who imparts knowledge to
the supervisee and gives careful consideration to case
material and suggests appropriate and useful interventions.
Sometimes the supervisor may focus on the dynamics
between the supervisee and the patient, but rarely is the
focus on those between the supervisor and the supervisee.
In turn, the supervisee gains knowledge and skill and
acquires insight and awareness. In this approach knowledge, power, and authority are vested in the supervisor.
A relationally oriented approach to supervision is less
hierarchical and more one of mutual influence among all the
parties: supervisor, supervisee, and patient. While the
supervisor brings her knowledge and experience to bear on
the case, the supervisee brings her knowledge and experience of the patient. Instruction then is replaced by dialogue
and negotiation. In this model, power and authority are
shared and knowledge about the patient is coconstructed. A
relational model shifts the role of the supervisor from that of
expert to participant, operating in a matrix that incorporates
intrapsychic, interpersonal, environmental, and organizational aspects of all the parties. Let us turn to a brief vignette
that illustrates a relational approach to supervision.
Self in Supervision
Ellen, a young, bright, energetic therapist pursuing an
advanced degree, had been a practicing clinician for
several years and was at the dissertation stage in her career.
As part of her program, she selected supervisors to whom
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she would bring difficult cases. She came to me with a case
that exasperated her and caused so much anxiety that she
was certain she was not helping the patient. She described
her patient, Moira, as anxious and consumed with worry.
The worry was often about small things, such as daily
activities, but more recently had been directed at fearing
that something tragic would happen. Ellen, in turn, felt
very anxious when she was with Moira, fearing that Moira
would drop out of treatment because Ellen might say or do
the wrong thing. Consequently, Ellen felt paralyzed and
was waiting for the other shoe to drop.
While the roles that supervisor and supervisee take on in
supervision may not be as dramatic as the ones Altman
(1995) thought characterized community practice, nevertheless, we do play out various dramas. At the time Ellen
consulted with me, I was new to the faculty of the school
where she was a student. She had been referred to me by
another student with whom I had a successful supervisory
relationship. Among the various roles I found myself
playing were teacher, expert, and colleague; Ellen’s roles
were those of student, supervisee, and colleague. The role
that was less available to my consciousness had a more
parental, authoritative cast to it, while the role to which she
had less access was that of disappointing child.
I entered Ellen’s relational matrix with the patient
through an impasse in treatment. When Ellen and I
reviewed her process recordings, I did not find anything to
suggest she was making comments that might cause Moira
to leave treatment. I could not account for the level of
anxiety Ellen was experiencing, and I began to experience
my own sense of anxiety as to whether I could give her the
direction she seemed to ask for with her patient. I soon
slipped into the role of expert. What I noticed was that
Ellen was giving Moira detailed interpretations of her
thoughts and actions or expanding on what Moira has been
telling her to make connections. I began to look for ways
that Ellen could intervene with her patient. Ellen, being a
willing student, started to shape her comments according to
my suggestions. Together we worked on ways that Ellen
could provide more of a containing environment for her
patient, but Ellen remained very anxious about the treatment. Neither of us could account for the excessive anxiety. Despite our efforts, Ellen’s anxiety did not abate nor
did the anxiety of her patient, and I remained an uneasy
supervisor afraid to disappoint my supervisee.
As Ellen continued to worry that she was disappointing
her patient and thought she might need to refer her to another therapist, I began to reflect on what might be going
on in my relationship with Ellen and in the worlds that we
shared. Why was I so anxious about my work with Ellen?
Since I was a new supervisor for students at the school, I
had anxiety of my own. Many of the students had completed a structured course of study and had in depth
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knowledge of theory that I had learned autodidactically
through my own reading. Also, many of my students had
more years of clinical practice than I had. Was I really able
to be an effective supervisor? Was I up to the task?
Through this reflection, I realized that I was enacting
Ellen’s anxiety in my relationship with her, and I found
myself caught up and embedded in her world. Her anxiety
had evoked mine, and her patient’s anxiety had evoked
hers. In retrospect, I believe what was being projected
between us was our unspoken fears of failure and disappointment in our relationship.
I told Ellen that I was curious about her anxiety and her
feeling that she was at an impasse with her patient and that
I was at an impasse with the consultation. I wondered if
anything in her own dynamics might have some bearing on
the treatment. I knew that Ellen had a therapist with whom
she discussed her issues, and I was not suggesting that we
form a therapeutic relationship but rather that we look at
what might be going on between us and between her and
the patient. While I acknowledged that there was a parallel
process involved in this supervision, I felt that more was
being enacted and that it was important to open up a space
for us to explore the transactions rather than my attempting
to direct the course of the treatment.
After a few more sessions, Ellen began to talk about the
ways in which she and Moira were similar. Moira was a
graduate student pursing a master’s degree that Ellen currently held. They both came from the same religious
background, and their fathers attended the same medical
school and practiced in similar areas of medicine. Both
Ellen and Moira experienced their fathers as strict and
demanding. Both women were required to demonstrate
academic excellence and achieve at all cost. Ellen began to
give me more information about her background, her difficult relationship with her father, her conflicts with her
siblings, and her current feeling that in some ways she did
not want to grow up. Moira’s problems, she felt, were so
closely related to her own development and personal issues
that she thought she might be confusing them with her own.
I disclosed my own feelings of anxiety to Ellen as well
as how I recognized that I had been playing the role of an
authority figure, the one with the expert knowledge.
Through our ongoing dialogue, Ellen and I came to realize
that we both felt pressure to repair the situation and that
both of us were grappling with issues of competence.
Moira, as well, was concerned about her graduate studies
and her competence in her internship. Ellen hoped to ‘‘fix’’
herself by reducing Moira’s anxiety, which to a great
extent was Ellen’s own anxiety, while I was feeling pressure to ‘‘fix’’ the treatment. Once we came to this realization in our work together, my own anxiety about
‘‘fixing’’ Ellen’s case diminished, and Ellen’s patient settled into the treatment and began to move forward in
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working through her family issues and pursuing her career
path in social work. Ellen, in turn, felt more competent as a
therapist.
The relational matrix in which Ellen, her patient, and I
were embedded encompassed more than the treatment. It
involved the parental and family constellations, the academic environments, and the social work careers in which
each of us participated. The self each of us used in our
various roles was contextualized by this matrix. While I
was viewed as a supervisor with expertise, Ellen was
actually more knowledgeable about her patient and her
own participation in the treatment. From a relational
viewpoint, Ellen and I coconstructed the meaning of all
these variable as we looked for ways to link our perceptions and to understand how we experienced the anxiety in
the supervision. The selves we used in our work consisted
of aspects of our personal history, our professional lives,
and our current roles as therapist and supervisor. What was
in the foreground were the roles created by the academic
environment where Ellen was required to consult on her
case, and I was the chosen supervisor. What was dissociated was the intrapsychic and interpersonal residue from
our personal histories. When Ellen and I explored her object relations and role in her family of origin, she was then
able to identify the anxiety as coming from her struggle to
achieve and her reaction to her critical, demanding father.
She no longer projected her anxiety onto her patient, and
the patient began to respond to the shift and found her
sessions calming. When I recognized my desire to impart
both theoretical ideas and clinical interventions, to show
my expertise, I was able to begin a dialogue about the
treatment rather than attempt to direct it. The personal
struggles with competence and achievement, emanating
from our early experiences, colored the way in which we
worked together; and while it did not create conflict between us, it affected the course of the patient’s treatment.
Once we identified and articulated the nature of the anxiety, the patient improved, and the supervision became one
of mutual participation.
Concluding Remarks
As Reupert’s study confirms, the use of self has a profound
and meaningful influence on social work practice and has
been an essential component in clinical treatment. Like
Reupert, I am curious as to why the clinicians she interviewed tended to see their use of self as so unique and
individualized, particularly since the profession has stressed the importance of the relationship for positive outcomes in therapy and has maintained a focus on person-inenvironment. For one, the study sample is quite small, and
that may affect the reported outcomes. Also, the clinicians
Clin Soc Work J (2007) 35:117–123
interviewed are Australian. Relational theory, as I have
discussed it, has its roots strongly placed in American soil
and on
DOI 10.1007/s10615-007-0078-4
ORIGINAL PAPER
The Use of Self from a Relational Perspective
Carol Ganzer
Published online: 16 March 2007
Ó Springer Science+Business Media, LLC 2007
Abstract This article explores the implications of a
contemporary relational perspective on the use of self in
social work practice. The author is responding to an article
by Andrea Reupert, who interviewed social workers and
reported they tended to see their concept of self as individualistic, autonomous, and only partially defined by
others, even though social work practice focuses on personin-environment. In this article, the author expands the
concept of self and argues that a contemporary view of the
therapist’s self is one that is dialogic, contextualized,
decentered, and multiple. Additionally, the author suggests
that this relational perspective has implications for teaching
and supervision. Several clinical vignettes are provided to
illustrate the concepts under discussion.
Keywords Use of self Multiple selves Supervision
Relational theory
The idea for this article began with a reading of Andrea
Ruepert’s, Social Worker’s Use of Self, published in this issue
of the Journal. The concept of use of self is a familiar one to
clinicians. From our earliest training in the field, we learn that
the relationship between clinician and patient fosters growth
and promotes change. The personal characteristics of the
therapist often enter into the therapeutic relationship as well,
helping to shape and refine the process. These characteristics
have been broadly defined (Woods & Hollis, 1990) as
empathy for the patient, warmth and concern, acceptance, and
a nonjudgmental approach. Additionally, the clinician, to the
best of her ability, maintains objectivity, models attitudes and
behaviors, and develops self-awareness and self-monitoring,
particularly of countertransference and its potential negative
impact on the treatment.
Andrea Reupert, in her qualitative study of use of self,
asks her interviewees to consider how they describe their
concept of self and how it impacts their clinical work.
Although the study had a limited number of participants,
the clinicians involved tended to see their concept of self as
unique and individualistic, and only partially defined by the
relational and environmental context of practice. To some
extent, Reupert attributes this highly individualistic and
autonomous sense of self to the Western tradition of rugged
individualism as well as to the failure of clinicians to fully
take into consideration the influence of social norms and
values in self-definition She finds it concerning that these
clinicians are reluctant to entertain the idea of the self as
socially constructed and contextualized, particularly since
historically social work training focused on a personin-environment framework, and the use of self in the social
work literature is discussed within the therapeutic environment and not as autonomous or self-contained.
It is my intention in this article to expand the concept of
self and to argue that a contemporary view of self takes into
consideration the notion that the self of the therapist, as
well as the patient, is dialogic, contextualized, decentered,
and multiple. I will draw on the work of several relational
psychoanalytic theorists who have promoted this view of
the self and illustrate this relational self through clinical
vignettes.
The Relational Matrix
C. Ganzer (&)
2824 N. Richmond ST, Chicago, IL 60618, USA
e-mail: caganzer@aol.com
The late Stephen Mitchell coined the term relational matrix
to describe the way ‘‘psychological reality’’ operates
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within a matrix that contains both ‘‘intrapsychic and
interpersonal realms’’ (1988, p. 9). Mitchell felt that earlier
drive—and even object relations—theories tended to
dichotomize the internal world of object relations and the
external relational world of the patient into an either/or
focus. He believed these realms ‘‘create, interpenetrate,
and transform each other in a subtle and complex manner’’
(p. 9). What does this shift in focus mean in terms of a
concept of self and how does it impact practice? Mitchell
tells us that, in his view, self does not exist ‘‘in a psychologically meaningful sense, in isolation, outside a
matrix of relations with others’’ (p. 33). In contrast to the
individualistic self of the clinician defined by the participants in Reupert’s study, the relational self of the clinician,
as well as the patient, is acquired through and defined in the
context of relationships; and these relationships operate in
social, cultural, and political contexts. Mitchell also contends that models of mind that place relationship as central
to psychological growth, such as ego or self psychology,
tend to privilege the self with concepts such as ‘‘selforganization, ego functions, homeostatic regulation of
affects, developmental needs, a true or nuclear self, and so
on’’ (p. 9). These models would align more closely to the
findings of Reupert’s study, which place the therapist
outside of the patient’s relational world, providing ego
strength, self-structure, or self object functions. Consequently, self-awareness, as described in Reupert’s study,
would be paramount for the clinician to both understand
and interpret the patient’s transferences and projections and
to be vigilant about countertransference and the potential
for enactments. In a relational approach self-awareness
would develop through interaction with the patient and be
cocreated with the patient in and through the environment.
The clinicians in Reupert’s study leave us with the sense
that they value their personal characteristics, their selfawareness, and their use of self as instruments or tools to
effect change; and while they view the therapeutic alliance
as a necessary component of treatment, it is secondary to
their use of self derived from their own self-understanding
and intrinsic to their own development. This use of self
may involve how one implements a technique, or what one
self discloses, or how one handles humor, all factors that
emanate from the therapist and that place her on the
periphery or outside the patient’s world. For Mitchell the
therapeutic encounter is between two persons, therapist and
patient, which levels the playing field and gives each participant somewhat equal status. The therapist no longer
functions as knowing expert who provides interpretation
and fosters insight, but rather is a participant in creating
and constructing new transferential meanings. The clinician enters into and is embedded in the patient’s relational
world through enactments that repeat old ways of being for
the patient. In order for treatment to get underway, the
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therapist enters the patient’s relational world or perhaps
‘‘discovers’’ herself ‘‘within it’’ and is ‘‘in some sense
charmed by the patient’s entreaties, shaped by the patient’s
projections, antagonized and frustrated by the patient’s
defenses’’ (1988, p. 295). According to Mitchell, the
therapist finds herself in ‘‘one of the patient’s predesignated categories and is experienced by the patient in that
way’’ (p. 295). Rather than remaining an autonomous,
individualistic, and objective observer in the patient’s
drama, the therapist takes on various roles and ‘‘attributes’’
of figures in the patient’s intrapsychic and interpersonal
matrix, and together therapist and patient rework the patient’s narrative and rewrite the patient’s story, changing
the patient’s perception of the figures to ‘‘allow greater
intimacy and more possibilities for varied experienced and
relatedness’’ (p. 296). For the therapist,
the struggle is toward a new way of experiencing
himself and the patient … to find an authentic voice in
which to speak to the patient, a voice more fully
one’s own, less shaped by the configurations and
limited options of the [patient’s] relational matrix, in
so doing to offer the [patient] a chance to broaden and
expand that matrix. (p. 295)
In other words, through the mutual influence of therapist
and patient, embedded in the relational matrix, new
meanings are constructed, and new ways of being emerge
for the patient.
Multiple Selves
Another important contemporary view of self that has
evolved from relational theory is the idea that there is not
one cohesive, identifiable, or unitary self that we can
locate. Rather, as Bromberg has argued, the self is viewed
as ‘‘decentered, and the mind as a configuration of shifting,
nonlinear, discontinuous states of consciousness in an
ongoing dialectic’’ (1998, p. 173). These states are ‘‘linked
to each other, to the external world, and to the past, present,
and future’’ (p. 168). It is through this linking that we
connect aspects of our personal history and experience to
give us the illusion of cohesiveness. In treatment then, the
clinician moves from a focus on the repressed or
unconscious contents of the patient’s intrapsychic world to
incorporate and reflect on the enactments of the intersubjective world of the clinician and patient. The self that we
encounter may be various selves that the patient experiences as old ways of being with another. The perceptions
evoked by enactments do not cohere with the patient’s past
experiences but shift as the patient, together with the
clinician, plays out various scenarios from the past. What
Clin Soc Work J (2007) 35:117–123
has been dissociated or excluded enters the awareness of
the patient and clinician and the possibility occurs for new
narratives to be coconstructed. The self in this framework
becomes a participant in a drama that is played out through
the transference-countertransference transactions and
reflected upon by both parties, which allows for multiple
realities to emerge and discordant perceptions to be discarded so that the various self states can be linked into
cohesive reality and integrated into the patient’s lived
experience and form the basis for a new self-narrative.
The Therapist’s Participation
While we have come a long way from the idea of the therapist
as a blank screen promoting abstinence, anonymity, and
neutrality in practice, nonetheless, we still rely on the therapist’s technical expertise and effective interventions. This
tendency speaks to the role of self as instrument or tool and
assumes that the therapist has some degree of knowledge of
what the patient may need. Over 20 years ago, Hoffman
(1983) wrote an article that has had a significant impact on
contemporary views of the therapist’s participation in treatment. Hoffman argues that the therapist participates in the
coconstruction of transference and that this participation is
inevitable, whether or not she recognizes it. This coconstruction of meaning that involves the thoughts, feelings, and
behaviors of the therapist, as well as the patient, has a part in
shaping how the patient’s experience unfolds in the treatment.
As with Mitchell’s model, both therapist and patient are
caught up in enactments of old ways of being. These enactments are part and parcel of the treatment and form the basis of
therapeutic action. Use of self in this configuration requires
that the therapist not only tolerate ambiguity and uncertainly
but also immerse herself in it; for it is by entering the patient’s
world and experiencing it that the therapist can work with the
patient to emerge from it. This process often involves an
inquisitive and curious stance on the part of the clinician and
the self disclosure of the countertransference. It is by the
therapist and patient working through and reflecting on
enactments that involve therapist’s and patient’s transference
and countertransference transactions that a space is created for
new patterns of interaction to develop. The therapist’s use of
self then becomes an interactive, subjective, and empathic
means of furthering therapeutic action and portending a
positive outcome to the treatment. Let us explore some of
these ideas in the context of a treatment case.
The case of Ana
This case is a treatment that has been ongoing for nearly
5 years, and this brief vignette is drawn from a larger case
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study (Ganzer, 2006). I have presented this case with Ana’s
permission, for she believes her experience will benefit
others in similar situations. Ana is a woman in her early
30 s who was arrested, charged, and convicted of abusing
her 4-year old daughter, Aida. She served several years in
prison and was on probation for 2 years. Ana was referred
to me in connection with her child welfare case and her
desire to be reunited with her children. She presented as
frightened, hostile, and distrusting with her own history of
abuse and neglect. Initially, she would come to my office
only with another individual, usually one of her relatives. I
was uncertain about my ability to work with Ana, as her
case file indicated that she had made threats against other
workers and had been physically aggressive toward child
welfare staff and court officials. At the time I began
treatment with her, there was an Order of Protection forbidding her to have any contact with her children. After the
first few sessions, Ana seemed more relaxed and less tense.
She stated that she appreciated the fact that I did not accuse
her of the abuse of her daughter but was willing to hear her
story. After 3 months she no longer brought a relative with
her to sessions.
Over time, Ana and I addressed her deep-seated anger
issues, and she began to show changes in her behavior
toward others. Ana, who had only given me her phone
number, became comfortable enough to share it with her
caseworker, whom she began to trust as well. After a year
Ana’s frequent outbursts of anger diminished. The court
and the therapists involved with the family all concurred
that Ana had made good progress. As a result of this and
her improved control of her impulses, Ana was given
limited supervised visitation with her children; and after
2 years, the children were returned home to her husband.
Ana continued to live with friends and slowly began to
have unsupervised time with her children. Ana made slow
but steady progress toward reunification with her family.
After 2 years of work, she was given overnight visits. The
Monday morning after the second weekend visit between
Ana and her children, I received a phone call from her
caseworker. Ana had called the caseworker frantic that a
detective was on his way to her home to arrest her for
hitting Aida. The next day I learned that Ana had been
arrested and charged with assault. She pled guilty to the
charge and was given 3 years of probation, and her children were returned to the child welfare system. After her
return to treatment, Ana began to disclose in greater detail
her own history of physical abuse. With this history in
mind, I would now like to explore aspects of this treatment
from a relational point of view.
Neil Altman, in his writing on community practice,
makes the point that a clinician working with a disenfranchised population may take on various roles in the
transference such as ‘‘rescuer, victim, abuser, and
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neglectful parent’’ (1995, p. 2). In retrospect, I find that I
played out these roles with Ana and she brought various
aspects of herself to me in the treatment. These roles were
often enacted from the dissociated contents of our intrapsychic world and encountered through projective identifications that only later I identified and reflected upon
either by myself or with Ana.
In the early stages of treatment I found myself enacting
the role of rescuer with Ana. She idealized me and felt that
I was the only one who could help her. Aspects of my self
that responded to Ana’s maternal transference to me allowed me to dissociate the more negative qualities of Ana’s
behavior and to focus on her control of impulses and anger.
The more grandiose aspects of my therapeutic personality
allowed me to promote her rehabilitation to the court, while
disregarding the darker moments when she would have
angry outbursts. When I stated to a colleague that I saw the
real Ana, she corrected me by saying that I saw one side of
Ana, the good side, but disregarded the other side.
So, much of my work with Ana was a response to her
projective identifications with me as her rescuer and savior,
and I entered her world and assumed these roles. In effect I
was caught in playing out the old roles with Ana, roles that
represented her relationship with her now-deceased father,
and formerly abusive but now supportive mother. I was
able to provide new experiences and a new way of being
with her, and Ana was able to progress and make significant changes that were noted by others. I also found myself
assuming the role of victim as I struggled with agency
personnel who were not in favor of Ana’s reunification
with her children as well as the court officials who found
Ana to continue to be at risk of harming her children. It was
not until Ana was arrested for a second time that other
aspects of our various selves were played out.
After I learned that Ana was released from jail, I found
myself avoiding calling her to set up an appointment. I told
myself that it was her responsibility to contact me, despite
the fact that I had often called her in the past and that she
had left me a frantic message on the day of her arrest. I did
not visit her at the jail, although I could have done so; I
gave myself the excuse that I was too busy to take off a few
hours. I was slipping into the role of neglectful parent and
soon found myself showing aspects of the abuser. When
she finally called and resumed treatment, I found myself
raising my voice in a session, demanding that she change
her behaviors or I would not be able to work with her.
Somewhere in the middle of my pronouncements, I realized that I was being less than empathic or nonjudgmental.
I turned to Ana and apologized for losing my temper but
also disclosed my disappointment and sadness over what
had transpired in the past few weeks. Unlike others in her
life, I did not abandon her but was able to discuss how my
feelings were impeding our continued work. Ana then told
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me that she realized how difficult it was for me and that she
was sorry that all my hard work with her was wasted. This
was the first instance of Ana relating to me as a separate
person and not an idealized projection. From that point on
Ana was able to disclose more details of the physical and
emotional abuse she experienced in her childhood, and our
therapeutic work continued.
How do we locate the use of self in this clinical vignette
and what value does it have for therapeutic work? It was
through enactments that I became embedded in Ana’s
relational world, and these enactments were shaped by
Ana’s ‘‘projections, antagonized and frustrated by [her]
defenses’’ (Mitchell, 1988, p. 295). My entry into her
world was not a carefully orchestrated set of interventions
or conscious use of self, but rather I discovered myself in
the enactments. I then was able to reflect upon my roles and
either share my feelings with Ana or use them to work with
her defenses. I did not experience myself as autonomous or
objective but rather caught in enactments of old ways of
being with Ana, at times the abandoning and abusive
mother, at others times the rescuer, and yet at other times
the victim. This participation was unwitting and unrecognized, but, as Hoffman asserts, inevitable. My thoughts,
feelings, and behaviors, as well as Ana’s, helped to shape
the direction that treatment took and allowed Ana to begin
to have some empathy for me as a separate person, and we
were able to resume treatment.
This vignette further underscores that the therapeutic
self is contextualized, decentered, and multiple as Bromberg argues and not cohesive or unitary. In my work with
Ana various dissociated states and aspects of self came to
the fore as Ana and I enacted past experiences and played
old roles with which she was familiar. I offered new ways
of being through continuing the treatment with her and
disclosing my countertransference feelings of sadness and
disappointment over her loss of impulse control. Through
our ability to reflect on the various selves we presented to
each other, Ana and I were able to repair our therapeutic
relationship. Most recently Ana commented that she has
been able to act out her anger less frequently but to verbalize it instead.
Use of Self in Training and Supervision
In her concluding remarks, Reupert suggests that the
training and supervision of clinicians should incorporate
their personal qualities, as well as emphasis on theory and
technique. She notes that the social workers interviewed
bring more to their work than their professional knowledge
and skill. Several of the clinicians in her study found that
the way to best use self was to suppress the personal
aspects of self in favor of professional knowledge and skill.
Clin Soc Work J (2007) 35:117–123
Several others saw themselves as a creating a presence
through a process that was highly intuitive. These views of
self assume that the clinician can objectively know when
and how to use the self and that she has the ability to
identify, reflect upon, and objectively evaluate it. Reupert,
in this issue (DOI: 10.1007/s10615-006-0062-4), references Yan and Wong (2005), who have identified problems
with objective knowledge, and Kondrat (1999), who
suggests that the training clinicians receive has also
contributed to this objective stance.
I have argued elsewhere (Ganzer & Ornstein, 1999,
2004) that although relational theory has influenced social
work practice, supervision has lagged behind in embracing
these ideas. How would processes such as those described
in the study differ from supervision and education in a
relational matrix? In the former, the autonomous, selfaware, professional self of the supervisor would tend to
reinforce the hierarchy that is often inherent in a supervisory relationship with the supervisor being in a one up
position and the therapist in a one down. In the early stages
of a social worker’s career, she builds a professional self
through seminars, practicums, and ongoing clinical supervision. The traditional view sees supervision as provided
by an experienced supervisor who imparts knowledge to
the supervisee and gives careful consideration to case
material and suggests appropriate and useful interventions.
Sometimes the supervisor may focus on the dynamics
between the supervisee and the patient, but rarely is the
focus on those between the supervisor and the supervisee.
In turn, the supervisee gains knowledge and skill and
acquires insight and awareness. In this approach knowledge, power, and authority are vested in the supervisor.
A relationally oriented approach to supervision is less
hierarchical and more one of mutual influence among all the
parties: supervisor, supervisee, and patient. While the
supervisor brings her knowledge and experience to bear on
the case, the supervisee brings her knowledge and experience of the patient. Instruction then is replaced by dialogue
and negotiation. In this model, power and authority are
shared and knowledge about the patient is coconstructed. A
relational model shifts the role of the supervisor from that of
expert to participant, operating in a matrix that incorporates
intrapsychic, interpersonal, environmental, and organizational aspects of all the parties. Let us turn to a brief vignette
that illustrates a relational approach to supervision.
Self in Supervision
Ellen, a young, bright, energetic therapist pursuing an
advanced degree, had been a practicing clinician for
several years and was at the dissertation stage in her career.
As part of her program, she selected supervisors to whom
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she would bring difficult cases. She came to me with a case
that exasperated her and caused so much anxiety that she
was certain she was not helping the patient. She described
her patient, Moira, as anxious and consumed with worry.
The worry was often about small things, such as daily
activities, but more recently had been directed at fearing
that something tragic would happen. Ellen, in turn, felt
very anxious when she was with Moira, fearing that Moira
would drop out of treatment because Ellen might say or do
the wrong thing. Consequently, Ellen felt paralyzed and
was waiting for the other shoe to drop.
While the roles that supervisor and supervisee take on in
supervision may not be as dramatic as the ones Altman
(1995) thought characterized community practice, nevertheless, we do play out various dramas. At the time Ellen
consulted with me, I was new to the faculty of the school
where she was a student. She had been referred to me by
another student with whom I had a successful supervisory
relationship. Among the various roles I found myself
playing were teacher, expert, and colleague; Ellen’s roles
were those of student, supervisee, and colleague. The role
that was less available to my consciousness had a more
parental, authoritative cast to it, while the role to which she
had less access was that of disappointing child.
I entered Ellen’s relational matrix with the patient
through an impasse in treatment. When Ellen and I
reviewed her process recordings, I did not find anything to
suggest she was making comments that might cause Moira
to leave treatment. I could not account for the level of
anxiety Ellen was experiencing, and I began to experience
my own sense of anxiety as to whether I could give her the
direction she seemed to ask for with her patient. I soon
slipped into the role of expert. What I noticed was that
Ellen was giving Moira detailed interpretations of her
thoughts and actions or expanding on what Moira has been
telling her to make connections. I began to look for ways
that Ellen could intervene with her patient. Ellen, being a
willing student, started to shape her comments according to
my suggestions. Together we worked on ways that Ellen
could provide more of a containing environment for her
patient, but Ellen remained very anxious about the treatment. Neither of us could account for the excessive anxiety. Despite our efforts, Ellen’s anxiety did not abate nor
did the anxiety of her patient, and I remained an uneasy
supervisor afraid to disappoint my supervisee.
As Ellen continued to worry that she was disappointing
her patient and thought she might need to refer her to another therapist, I began to reflect on what might be going
on in my relationship with Ellen and in the worlds that we
shared. Why was I so anxious about my work with Ellen?
Since I was a new supervisor for students at the school, I
had anxiety of my own. Many of the students had completed a structured course of study and had in depth
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knowledge of theory that I had learned autodidactically
through my own reading. Also, many of my students had
more years of clinical practice than I had. Was I really able
to be an effective supervisor? Was I up to the task?
Through this reflection, I realized that I was enacting
Ellen’s anxiety in my relationship with her, and I found
myself caught up and embedded in her world. Her anxiety
had evoked mine, and her patient’s anxiety had evoked
hers. In retrospect, I believe what was being projected
between us was our unspoken fears of failure and disappointment in our relationship.
I told Ellen that I was curious about her anxiety and her
feeling that she was at an impasse with her patient and that
I was at an impasse with the consultation. I wondered if
anything in her own dynamics might have some bearing on
the treatment. I knew that Ellen had a therapist with whom
she discussed her issues, and I was not suggesting that we
form a therapeutic relationship but rather that we look at
what might be going on between us and between her and
the patient. While I acknowledged that there was a parallel
process involved in this supervision, I felt that more was
being enacted and that it was important to open up a space
for us to explore the transactions rather than my attempting
to direct the course of the treatment.
After a few more sessions, Ellen began to talk about the
ways in which she and Moira were similar. Moira was a
graduate student pursing a master’s degree that Ellen currently held. They both came from the same religious
background, and their fathers attended the same medical
school and practiced in similar areas of medicine. Both
Ellen and Moira experienced their fathers as strict and
demanding. Both women were required to demonstrate
academic excellence and achieve at all cost. Ellen began to
give me more information about her background, her difficult relationship with her father, her conflicts with her
siblings, and her current feeling that in some ways she did
not want to grow up. Moira’s problems, she felt, were so
closely related to her own development and personal issues
that she thought she might be confusing them with her own.
I disclosed my own feelings of anxiety to Ellen as well
as how I recognized that I had been playing the role of an
authority figure, the one with the expert knowledge.
Through our ongoing dialogue, Ellen and I came to realize
that we both felt pressure to repair the situation and that
both of us were grappling with issues of competence.
Moira, as well, was concerned about her graduate studies
and her competence in her internship. Ellen hoped to ‘‘fix’’
herself by reducing Moira’s anxiety, which to a great
extent was Ellen’s own anxiety, while I was feeling pressure to ‘‘fix’’ the treatment. Once we came to this realization in our work together, my own anxiety about
‘‘fixing’’ Ellen’s case diminished, and Ellen’s patient settled into the treatment and began to move forward in
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working through her family issues and pursuing her career
path in social work. Ellen, in turn, felt more competent as a
therapist.
The relational matrix in which Ellen, her patient, and I
were embedded encompassed more than the treatment. It
involved the parental and family constellations, the academic environments, and the social work careers in which
each of us participated. The self each of us used in our
various roles was contextualized by this matrix. While I
was viewed as a supervisor with expertise, Ellen was
actually more knowledgeable about her patient and her
own participation in the treatment. From a relational
viewpoint, Ellen and I coconstructed the meaning of all
these variable as we looked for ways to link our perceptions and to understand how we experienced the anxiety in
the supervision. The selves we used in our work consisted
of aspects of our personal history, our professional lives,
and our current roles as therapist and supervisor. What was
in the foreground were the roles created by the academic
environment where Ellen was required to consult on her
case, and I was the chosen supervisor. What was dissociated was the intrapsychic and interpersonal residue from
our personal histories. When Ellen and I explored her object relations and role in her family of origin, she was then
able to identify the anxiety as coming from her struggle to
achieve and her reaction to her critical, demanding father.
She no longer projected her anxiety onto her patient, and
the patient began to respond to the shift and found her
sessions calming. When I recognized my desire to impart
both theoretical ideas and clinical interventions, to show
my expertise, I was able to begin a dialogue about the
treatment rather than attempt to direct it. The personal
struggles with competence and achievement, emanating
from our early experiences, colored the way in which we
worked together; and while it did not create conflict between us, it affected the course of the patient’s treatment.
Once we identified and articulated the nature of the anxiety, the patient improved, and the supervision became one
of mutual participation.
Concluding Remarks
As Reupert’s study confirms, the use of self has a profound
and meaningful influence on social work practice and has
been an essential component in clinical treatment. Like
Reupert, I am curious as to why the clinicians she interviewed tended to see their use of self as so unique and
individualized, particularly since the profession has stressed the importance of the relationship for positive outcomes in therapy and has maintained a focus on person-inenvironment. For one, the study sample is quite small, and
that may affect the reported outcomes. Also, the clinicians
Clin Soc Work J (2007) 35:117–123
interviewed are Australian. Relational theory, as I have
discussed it, has its roots strongly placed in American soil
and on
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