Monday, December 14, 2009

Psychoanalytic Treatment in Contemporary Social Work Practice: An Interview with Dr. Carol Tosone

[Episode 54] Today's Social Work Podcast, Psychoanalytic Treatment in Contemporary Social Work Practice: An Interview with Dr. Carol Tosone, addresses two questions: First, is psychodynamic treatment relevant in contemporary social work practice? In other words, does it meet the needs of the clients, the agencies, and the funding sources? Second, has clinical social work abandoned social work's historical commitment to advocating for social change? I think they are questions worth thinking about.

Well, in order to answer some of these questions, I spoke with Dr. Carol Tosone about contemporary psychoanalytic treatment. Dr. Tosone completed her psychoanalytic training at the Postgraduate Center for Mental Health, where she was the recipient of the Postgraduate Memorial Award. She is an Associate Professor at the Silver School of Social Work at New York University, the recipient of the NYU Distinguished Teaching Award and is a Distinguished Scholar in Social Work in the National Academies of Practice in Washington, D.C. In 2007, Dr. Tosone was selected for a Fulbright Senior Specialist Award for teaching and research at the Hanoi University of Education in Vietnam. She is the editor-in-chief of the Clinical Social Work Journal, and the executive producer and writer of four social work education videos. And she is an expert in shared trauma – which is when a client and therapist experience the same traumatic event. I interviewed Carol about shared trauma in Episode 90:

Download MP3 [37:01]

Ask any social work student today what the organizing framework for social work practice is, they won't say, "psychodynamic theory." They'll likely say "the strengths perspective," or "ecological systems theory." When my students do research papers on the best approaches to addressing mental health problems, they usually write about cognitive and behavioral treatments, perhaps because the evidence-base is dominated by studies of cognitive and behavioral approaches. When I ask my students what theoretical perspectives seem to be most consistent with their values and perspectives, they usually say "CBT" or "solution-focused." I usually only have one or two students who take a psychodynamic perspective. My students are usually surprised to hear that in the early 20th century, the social work profession adopted Freudian psychoanalysis as the organizing framework for providing direct services to clients. Social work pioneers such as Mary Richmond were psychoanalytic social workers. The dominance of psychodynamic treatment continued for decades. Even during the 1960s and 70s, when social work returned to its community organizing roots and mezzo and macro level changes were seen as the best way to improve clients' lives, most direct practice social workers identified as psychodynamic. For example, in 1982, a national study reported that even though most clinical social workers were eclectic in their practice, their preferred theoretical orientation was psychoanalytic (Jayaratne, 1982). Fast forward to 2009. Psychoanalytic treatment is widely dismissed as being patriarchal, oppressive, and out-of-touch with the needs and realities of social work clients. Insurance companies are requiring that clinicians use treatments that are short-term, empirically validated, and cost-effective. Agencies are increasingly requiring clinical staff to use prescribed treatments. Clinical social work education has moved towards teaching evidence-based practice, and learning about treatments with a cognitive behavioral, rather than psychodynamic basis. So, if students seem to prefer non-psychodynamic theories, agencies and insurance companies are mandating the use of non-psychodynamic treatments, and an increasing number of schools of social work are teaching cognitive and behavior-based evidence-based treatments, what place does psychodynamic treatment have in contemporary social work practice?

Well, in order to answer some of these questions, I spoke with Dr. Carol Tosone about contemporary psychoanalytic treatment. Dr. Tosone completed her psychoanalytic training at the Postgraduate Center for Mental Health, where she was the recipient of the Postgraduate Memorial Award. She is an Associate Professor at the Silver School of Social Work at New York University, the recipient of the NYU Distinguished Teaching Award and is a Distinguished Scholar in Social Work in the National Academies of Practice in Washington, D.C. In 2007, Dr. Tosone was selected for a Fulbright Senior Specialist Award for teaching and research at the Hanoi University of Education in Vietnam. She is the editor-in-chief of the Clinical Social Work Journal, and the executive producer and writer of four social work education videos. And she is an expert in shared trauma – which is when a client and therapist experience the same traumatic event. I interviewed Carol about shared trauma in Episode 90:

In today's podcast, Carol and I talked about what distinguishes contemporary dynamic treatment from traditional psychoanalysis, the role of attachment theory in contemporary dynamic treatment, how talk therapy changes the way the brain processes information, and how brief dynamic treatment can be used in typical social work agency settings. Carol emphasized that contemporary psychoanalytic treatment and concrete services, such as case management, referral, or advocacy work, are not mutually exclusive. She shared how she came to see herself as a social worker first and an analyst second. We ended our conversation with information about resources for social workers in school and in the field who might be interested in learning more about contemporary dynamic treatment. In addition to talking about the journal she edits, The Clinical Social Work Journal and a video series she produces, Carol suggested that the best resource social workers have is other social workers and encouraged clinical social workers to write more and share their insights and experiences.

I recorded today's interview at the University of Texas at Austin's school of social work. Carol was at UT to give the inaugural Sue Fairbanks Lecture in Psychoanalytic Knowledge. I want to thank the Sue Fairbanks lecture organizing committee, particularly Vicki Packheiser, for helping to coordinate the interview with Carol. You might hear the sound of children playing in the background - Carol and I spoke in an office right above a daycare center. So, without further ado, on to the interview with Dr. Carol Tosone and contemporary psychoanalytic treatment in social work practice.


Jonathan Singer: So, Carol, thanks so much for being here today on the podcast talking with us about psychoanalytic treatment. And my first question is: What is psychoanalytic treatment?

Carol Tosone: Well, thank you, Jonathan, I’m very excited to be here. And psychoanalytic treatment, I think, really is dependent on who’s asking the question and who’s answering it. In the sense that I think a lot of people have different views about what constitutes psychoanalytic treatment. So unfortunately what happens is that traditionally people assume that when you’re talking about psychoanalytic treatment someone will be on the couch, it will be four to five times per week. And then when you look at the very vulnerable clients that we work with, people will say, “Well you, you can’t do that with our clients.” And also what’s happened is that there’s been somewhat of a schism between clinical social work and social work proper in that a lot of people now view clinical social workers as doing the psychoanalytic treatment with the worried well, if you will, the very well-to-do clients. In fact, that’s really a very erroneous assumption about what constitutes psychoanalytic treatment within the realm of social work. So, to clarify, what we do is really to take core psychoanalytic principles and incorporate contemporary research, particularly in attachment theory. There’s tremendous amount of research that’s come out, particularly around areas of trauma, and we’re taking that knowledge and applying it to the understanding of populations at risk, the very vulnerable populations who are generally severely traumatized. So, rather than four or five times a week on the couch, if anything, what contemporary psychoanalytic practice within social work is very flexible so that what you will find is that you’ll be working with someone sometimes once a week, sometimes as needed. You will be recommending other types of adjunctive treatment, you will be having the person do things like journaling, you might advise them to go to yoga, you might even encourage music therapy, dance therapy, a lot of the more creative therapies that come into play. And that’s considered part and parcel of the treatment. So, it’s really very different than the image that a lot of people have in mind around what constitutes psychodynamic treatment.

Jonathan Singer: What are some of the assumptions of contemporary psychoanalysis, and how are they similar to, and different from, traditional psychoanalytic treatment?

Carol Tosone: Well, in some way, first I think you need to understand the assumptions that are in common. The assumptions that there is an unconscious, that one reaction brings about another reaction. So I think that’s something that’s very clear. Issues around transference come to the fore, whether or not it’s in treatment or it occurs with other people. There is a sense that, that we have a template laid down very early on and that that’s something that continues throughout our life. So I think those are the things that are clearly in common. What happens is that, in many respects, you might use different words to describe it so in traditional treatment we would talk about the transference, and more so now we would talk about internal working models. So that the language is a little bit different in traditional psychoanalysis versus what attachment theory has contributed.

Jonathan Singer: So, you mentioned attachment theory. Could you say more about that in the context of treatment?

Carol Tosone: Sure, attachment theory, it really began with John Bowlby and he was active in the British Psychoanalytic Society and he actually became ostracized because Freud, at the time, obviously felt that one was seeking gratification in drives, urges, etcetera. The id is, actually, is kind of fallen from use in our parlance, if you will. But he said that no, that an infant from birth is object-seeking. So the idea is that when an infant is born, the drive is for connection to other. And that, at the time was different, and he wasn’t really welcomed, let’s say. He became ostracized in terms of writing, his ability to speak at the society, and so his work, if you will, got shelved for a few years and it became more popular with the relational psychoanalytic movement that went from looking at the asymmetry of an analytic relationship, meaning I am the, I am the doctor, I am the provider, I am the all-knowing and you I will, you know, give my information to and whatnot. And, it really emphasizes more the symmetry of the relationship and the give-and-take and the idea that the clinician, your counter-transference isn’t so much your blind spot, but your counter-transference is, in fact, the major tool that you’re using in working with somebody to understand their experience and the belief about the transfer of those emotions from one to the other and the understanding of it. So, it’s a very different view, if you will. Now, with attachment theory, what we know is that there are different attachment styles. Someone is securely attached, you know, meaning that they’re comfort with a level of distance, they’re comfortable with the level of connection, the ability to vacillate between the two is not problematic. Then you have different insecure attachment styles. Someone can be insecure-avoidant. Someone can be insecure- ambivalent or anxious, as we call it. The avoidant person is someone, I like to talk about it in terms of relationships styles, you oftentimes see the partner that is avoiding commitment, they’re avoiding closeness. And the anxious-ambivalent one is that one that seeks proximity to the other, feels very uncomfortable/anxious when they’re not available. And that developed from Mary Ainsworth’s study of the “Strange Situation” and it’s since been applied to the understanding of romantic relationships, Hazen and Shaver. It’s been applied to the understanding of trauma, certainly Fonagy, Mary Target. And in doing so, what we know with the insecure attachment styles is that that kind of governs someone’s experience so that the way in which they approach most people in the world is from those particular styles. And, most recently, Main and Hess had done more work and really found a fourth style, a disoriented or disorganized attachment style. And this is a style of insecurity that’s tremendously chaotic and it springs from a child experience of growing up in a very chaotic environment so that there is a to-and-fro of the parent, there’s an instability, they’re available, they’re not. And we see so many of the populations we treat in social work, many of the people we treat can be categorized as such. So, issues such as substance abuse, conduct disorder, hyperactivity, people who have a proclivity towards being survivors of domestic violence. These areas, many of the people might be categorized in this fourth type of attachment style. And, in terms of the treatment, the emphasis is all around establishing a secure base and using the relationship to make changes in the person’s development. Now also, attachment style is married, if you will, now to neural science in that we understand that the building, that what we develop, what we describe as neuronal plasticity, basically the building of brain, the structuring of the brain and restructuring, has to do with its interaction with the environment and the people in it. So that if you have an early experience that’s either over-stimulating, let’s say, through abuse or under-stimulated by neglect, that can be corrected by positive exchanges in the environment, and no better place to do that than within the social work relationship. Because, if you think about it, many of our clients, they haven’t had this stability in their past, they haven’t had it in their personal life. So, oftentimes, that social worker, that social work intern could be the first person that provided a concerted attention, a concerted effort to help them. And that attention, if you will, helps the person develop changes in the brain structure. We know that Casalino’s work is a wonderful illustration of all of the changes that occur in the psychotherapeutic process, that you develop changes just as you can in any point in the life cycle.

Jonathan Singer: So, Carol, you’re talking about how the relationship between the social worker and the client made changes in their attachment. And I was wondering, do you have an example of what that looks like?

Carol Tosone: Sure, I’d be happy to provide an example. What I can’t provide, certainly, is the neural imaging that would show changes in their brain structure that would support that. And I think that’s one of the disadvantages, if you will, in social work, in that so much of our work, I think, is intuitive. It’s very right brain to right brain communication and I think that’s something that we can’t readily document, given the nature of these studies that we undertake and things like that. But, certainly I’ll give you an example of someone I worked with a while back, who was actually an older woman. She came from a very impoverished background, she was on Medicaid. She came from a family where there was a history of alcoholism, physical abuse. And, actually, she had conducted much of her life in the same way in that she had been abusive to one of her children, she married someone who was alcoholic, she was a survivor of domestic violence, and she had so many of the multiple problems, the environmentally, challenged, you know, she was environmentally challenged in that way. And what I think it was in doing the work with her, first of all, she had no self-esteem, she had no respect for her own insights into situations. So what you’re doing is you’re helping someone attune themselves to what they feel, what they think, and in just supplying empathy. You have them really start to see themselves and experience themselves in a different way. And, in many respects, that relationship was the first corrective relationship she ever had in her life. So that rather than anticipating the neglect, and at first her, you know, her dukes were up, she was waiting for fight, and when we kind of talked about her anticipation of it, how she experienced me, me clarifying that my intent wasn’t to hurt her in any way, once she was able to let that in, you already have changes taking place in the brain. You have new neural pathways that are being laid down. What happens when somebody’s been traumatized is you have a fight/flight response. If you were in the war, and, you know, obviously you hear gunfire, and then you hear a, when you come back, you hear a car backfire, you’re primed. You respond in the same way because the brain is already in a survival mode and it’s what we call the reptilian brain and it just takes over. Now, what happens is through learning, through learning that one, that is not gonna happen, through developing new associative paths, if you will, that a car backfiring is a car backfiring. By giving people tools around breathing exercises, exposure therapy, etcetera, etcetera, you start to change new pathways. And similarly, in the relationship what happens is that you start, when you start providing a different experience, the person can take in a different template, if you will, of what the other is like and that someone can care about you and give to you and not be there to hurt you. So what happens is, in terms of brain functioning, the brain starts basically opening up, it starts developing new ways of processing experience, processing emotional experience that have a more positive valence. And as that increases, that’s what we talk about working through in growth, is that that’s when you see people have the capacity to do more things that they hadn’t before. If you’re busy being primed to fight and suddenly you don’t have to do that, you now have, be it psychic energy, however you want to describe it, you now have the ability to really use that energy towards more positive ends. So, here’s a woman that went back and she started to develop some hobbies, she started to be more remorseful with one of her children and work on establishing a different relationship. And, I think, the reason I use this example is here’s a woman who’s in the latter stage of her life that many people would say it’s not possible. That’s not true at all. The changes are possible throughout the life cycle.

Jonathan Singer: Well, it sounds like there was a lot of really positive change with that client in terms of her relationship with others, the way she kind of experienced herself in the world. And, when I was listening to the story I was thinking about, perhaps when she first came in, because of her trauma, she saw you as somebody who is maybe unsafe. And I know in traditional psychoanalytic and psychodynamic thinking that that’s called transference, that what the client projects onto the social worker, the therapist. And in traditional psychoanalytic models, the resolution of transference provides this basic framework for therapeutic change. But, given that this work often takes months or years, how would one work towards transference resolution in a brief therapy framework?

Carol Tosone: Well, I think what’s interesting, many of our students and I’ll say, who wants to do long work, and they all say, you know, long-term work, and everybody raises their hand and what they don’t understand is that the work they’re doing is a short-term model. They’re at the most working nine months with somebody, and that’s usually a short-term model. So, we have to keep that in mind. Now, when we talk about transference traditionally, absolutely, it took years. The idea was the resolution of it, that they came to see their provider as someone very different. However, nowadays, the work with transference is oftentimes called “pragmatic psychoanalysis,” if you will. That’s what’s done in psychoanalysis proper, Ted Jacobs had written a book about that basically, and that is that if you are sitting with somebody and you keep talking about “our relationship, our relationship,” I’ve certainly had patients say to me, “Hey, no offense, I don’t really care about you, I just need help, you’re supposed to help me with it.” And they don’t want to talk about it, so what happens is that you can work with the transference, not in an explicit way but in a more implicit way. And that the only time, in terms of dynamic short-term work, I will work with somebody, usually in the transference, when there’s a negative transference and it interferes with the working alliance. In the beginning you have a short period of time, you want to establish the alliance as I did with that particular client. It was problematic, I clarified, I asked what I had done wrong to make sure we had a different understanding. I said, “If you experience me like this in the future, please let me know,” each session, “Is there anything I said or did that makes you feel uncomfortable?” So, I did a lot of monitoring of what’s going on, which I think is important. But it was also more supportive-based. So when you’re working short-term and you’re working with the transference on a more short-term basis, the emphasis is that they experience you in a more helping type of way, that they see you as someone who is on their side, that you’re working together in the working alliance. That’s the most important thing that people have because they don’t want to focus on the relationship. You focus on the relationship when you want to illustrate a point, when you want to illustrate a difference. So with this woman, as she outlined all of these problematic relationships towards the end of the work I was able to say to her, “But you’re capable of something else, look at our work together, you had a very different experience. You weren’t fighting with me, you were able to take in what I said.” And I had actually given her some insight about a problem that she was very angry at other people for but that she had been able to grow and to take in that information. So, you use a transference to really talk about a change so that you can underscore the growth that’s taking place. So that’s how I work with the transference in a more short-term model. Now, in, um, brief dynamic treatment, such as I was trained, at the University of Pennsylvania with Lester Luborsky, Paul Crits-Christoph, I had done my dissertation work with them and I had done some treatment within their clinic. And in that work you have a sixteen session model and very early on I’m working in the transference – what was your sense in the first meeting? What was your sense in working with me? What did you expect? How did you expect me to be? Clarifying anything that I did that concerned you. You’re working in the transference constantly, you know. But you do it in a way where you talk about it, but you talk about it in relation to the experience with people in their lives and contrasting it. And so when someone says, “Oh, this is hopeless,” you point out, no it isn’t. Look what you’re doing right here, right now with me, you’re capable of it. So you, again, you use the relationship to underscore a different experience. And that, of course, feeds back to what we talked about before in terms of changes in brain structure, attachment, etcetera, facilitating a more secure attachment.

Jonathan Singer: Social work students oftentimes want to do clinical work and they make this distinction between advocacy work, you know, resource referral, case management, and then clinical practice or therapy. The folks that are listening to this podcast are really excited about what you’re talking about in terms of dynamic treatment and working with the relationship. Are you saying that they need to consider themselves therapists and get trained in dynamic treatment and not do the resource referrals and advocacy work, or not?

Carol Tosone: Jonathan, thank you so much for asking that question because that gives me the opportunity to really clarify a misunderstanding about clinical work. That the dichotomy between clinical work and concrete services is it’s a false dichotomy. And I think it takes tremendous clinical skill to be able to deliver concrete services. Now, think about how many students make referrals and the person doesn’t take them up on it. So if you think about all of the effort that someone puts forth in offering and researching and providing these resources for people and they don’t take them up on it. What a clinical perspective does is it works on understanding why that doesn’t occur. How do you engage somebody so that they’d be able to accept the service? How does it become an aspect of the relationship and a gift and understood in that perspective? And I think concrete service is really a misnomer because it’s as if it’s not abstract, as if it’s something kind of lesser than. Again, a big misunderstanding. And let me give you an example. I’ve done a lot of consulting with hospitals, and in social work departments, let’s say if you’re working to help someone accept placement in a nursing home. Now, to realize the amount of clinical acumen that it takes to do that, you, in a very rapid period of time, you have to have someone trust you in terms of their finances, whereas most partners don’t trust each other with finances, so you need someone to be able to be honest, you need someone to depend on you, they need to be able to depend on your judgment about what’s good for them. And in order to do that, it takes a tremendous amount of skill. And I’d really suggest that I’ve found in doing that type of practice, that that takes more skill than it does when I, in my psychoanalytic work where I have someone on the couch and I’m working with them on a long-term basis because to engage someone, to be able to display empathy in a way that they can convey in a short period of time is very, very important. And what I teach our students is that we are really systems experts. We have an understanding of the psychodynamic, the intrapsychic system in interaction with the interpersonal system and then in interaction with the larger environmental systems within our society, and that’s really our niche, that’s really our expertise. It’s a pet peeve of mine when social workers really diminish what we know, or that they accept their job description, if you will, that’s defined by someone else, that’s defined by a hospital administrator, for instance, with an MBA, or is defined by a psychiatrist who chooses to lead the treatment team. And, if I can, let me just tell you a brief story about my experience when I had taught at Temple medical school as assistant professor of social work in psychiatry. We were interviewing a patient who was depressed, an African American woman, and we were trying to illustrate interviewing skills to medical students. And so, a woman’s brought in and there’s a psychiatrist talking about how to give a psychiatric assessment, a psychologist comes in to talk about how to do a psychological assessment, and then I was brought in from a psychoanalytic perspective. So, in walks this woman, 200 medical students, she’s very upset, she doesn’t anticipate so many students. So she comes in, she sits down, she’s angry. The psychiatrist immediately launches into his mini mental status exam, asking specific questions. She responds in a very terse manner. And you can see the audience, the medical students getting uncomfortable because this woman is not cooperating; she’s not really facing the interviewer. Same thing with the psychologist. Then it comes to my turn. So, I, you know, I introduce myself, I ask her what she’s been told about coming here. Well, she’s been told that there were only going to be a handful of students, which there weren’t, and I said I totally understand that, I apologized on behalf of the people that had organized it. And I said that I certainly would understand if at this point she wanted to stop this interview because that’s what she wasn’t expecting. She said no, that wasn’t necessary, she thanked me for my concern, and I suggested that maybe if we just faced each other, we could focus on ourselves and not worry about the audience, per se, would that be helpful to her. She said yes. I said, “If at any point I ask you a question that you’re uncomfortable with, please let me know and I’ll be glad to either drop it or rephrase it.” She thanked me and I proceeded to ask a number of questions. And then I also had said before that, I said that I just want to thank you on behalf of everyone in the room because you’re teaching us how to interview, so I want to thank you for what you’re doing for us. And with that, the medical students all clapped and the woman is now obviously more animated, more, has more self esteem, she’s more elated. And so after I had finished asking my questions I said, “Is it ok if the medical students ask you some questions?” She says, yes, she turns to them and she’s correcting their questions, offering suggestions about better ways to ask it. And then the interview ends, we thank her. After she leaves, one of the medical students raised his hand and he said to me, “Can you tell me, Professor Tosone, what was the psychoanalytic technique you were using to engage this woman?” And I have to tell you that at that point in my career I was more, I was an analyst, I was a faculty member in a medical school. I wanted to get far away from social work because there was no self esteem, no one understood what I did, and it was at that moment, it was a defining moment in my career that I realized was social work had to offer. So I said to the medical students, I said, “Well, actually, this wasn’t something I learned in psychiatry. This was something I learned in my first semester of social work school. We call it “starting where the client is.” And I took such delight in watching 200 students take copious notes on what I had said. And I think it really speaks to the power of social work. And while I was at Temple we also did psychoanalytic rounds and we would interview, you know, different people that came in. And it was striking that they were so busy titrating someone’s medication and ignoring the fact that when the person left they had nowhere to live, they had tremendously strained relationships. So the psychodynamic aspects of the environment were not taken into account. And that is what social work can offer better than any other profession. No profession is better suited to that than us.

Jonathan Singer: Carol, that’s a great story. Could you talk about some resources that are available for social workers who, like myself, got very excited about being a social worker listening to that story, to learn more about dynamic treatment and all the things that we’ve been talking about here today?

Carol Tosone: Thanks, Jonathan, I’d be happy to do that. But the first thing I want to say is that I think for every listener that what you need to do is you need to commit to being a resource yourself. That is to writing more in the field, we don’t do enough writing as social workers. So you need to really work on becoming your own resource and disseminating that to colleagues. That’s number one. And towards that end, I took over as editor-in-chief of the Clinical Social Work Journal, and what I’ve tried to do is there’s a misunderstanding that, again, it’s just for people in private practice that read the journal. And what we’ve really done is we are showing in all of the research articles we accept, they have to have clinical relevance. In all of the applied theory, if you will, articles, etcetera, what we tried to do is show its relevance to social work populations at risk. So if a journal can’t really demonstrate, I mean, if a journal article can’t really demonstrate that, then it’s really not appropriate for a journal. So what we try to do is to show we take psychodynamic skills, but they are applied towards populations at risk. Um, and in terms of resources, just on our journal website, we have recommended readings for students and by specific categories, by specific populations. And so people can access that and just download it. We’ve also distributed it to schools of social work across the country. It was sent to every dean so that they have that resource as well. Another thing towards that end and, again, I’m talking about things that I’ve done and that’s simply because, again, I feel a responsibility that when we have these beliefs around clinical versus concrete, we need to do specific things to really get that out to other people. So we developed a video series for the Council on Social Work Education. Right now they have two, we have two under submission. One is, the first one is called Why Am I Here Engaging the Reluctant Client? And we took actual student process recordings and what we did was clinical supervision around it so that they can see that this very simple interview that they might not construe as clinical, all of the clinical aspects it has. And then we have one on working with older adults called Rewarding Challenges. And we have two more coming out, one working with older adults who are abusing substances, a growing problem. Then we have one on trauma. One of my areas of expertise is shared trauma where the client and clinician are exposed to the same traumatic event. I personally, uh, live and work in lower Manhattan, so 9/11 I had the unfortunate experience of having a plane fly overhead when I was with a client. That kind of generated my interest in that. And as well as disaster work and work with survivors with trauma like sexual abuse. So we have examples of that. And what we do is we have reenactments of interviews, we have supervisory sessions to debrief about it and then we have teaching points so that people cannot only see what happens but then also what you do is you see what happens in supervision and how that’s handled.

Jonathan Singer: And we can put links on the social work podcast website so that folks know how to get to that information.

Carol Tosone: Yes, and I’d be happy also to provide lists, a more general list of other resources because there are a number of people in other organizations that are working towards this end as well.

Jonathan Singer: That’s great. Well, Carol, this has been fascinating. Thank you so much for spending time today talking about contemporary psychoanalytic treatment and for really making that connection between the myth of the clinical social worker and social work as people practice it today.

Carol Tosone: Thank you, Jonathan. And I really want to thank you for what you do for the profession because I think your podcast can reach so many people across the globe, so many social workers across the globe, who are really craving knowledge in our area. And so to really present them with the up-to-date knowledge in social work is so important and it’s a tremendous service so I want to thank you for what you do.

Jonathan Singer: Thank you.


References and Resources

  • Rosenthal Gelman, C. (Executive Producer/Writer/Narrator/Supervisor), Tosone, C. (Executive Producer/Writer), & McVeigh, L. (Executive Producer). (2006). Rewarding Challenges: Social Work with Older Adults [Training Video/DVD]. United States: New York University.

  • Rosenthal Gelman, C. (Executive Producer), Tosone, C. (Executive Producer), McVeigh, L. (Executive Producer), & Roach, A. (Director/Producer). (2005). No Periods, Only Commas [Community Service Media]. United States: New York University.

  • Tosone, C. (Writer/Associate Producer/On Screen Supervisor), McVeigh, L. (Director/Executive Producer), & Rosenthal Gelman, C. (Writer/Associate Producer) (2003). Feel Free to Feel Better [Training Video]. United States: Project Liberty Federal Emergency Management Agency.

  • Rosenthal Gelman, C. (Writer/Executive Producer) McVeigh, L. (Director/Producer), Tosone, C. (Writer/Executive Producer/Narrator/On Screen Supervisor). (2002). Why Am I Here: Engaging the Reluctant Client [Training Video] United States: Council on Social Work Education.

APA (6th ed) citation for this podcast: 

Singer, J. B. (Producer). (2009, December 14). #54 - Psychoanalytic Treatment in Contemporary Social Work Practice: An Interview with Dr. Carol Tosone [Episode 54]. Social Work Podcast [Audio podcast]. Retrieved from


My Social Work Network said...

I find your blogs very informative. I think your contribution would be important on My Social Work Network ( -a free online community for social workers. We are looking for social workers to contribute resources, blogs, articles, and invite you to participate. Plus, the site should help you gain more readership. I hope it serves as a helpful resource in your work.

standingbaba said...

Thanks Jonathon from N Ireland. Studying for exams and your podcasts are a great source for revision.

drew said...

This interview was outstanding! Dr. Carol Tosone spoke to the theory, tools, and approach that I feel most drawn to in my social work practice. I particularly found her correction about the false dichotomy of clinical social work and case management to be powerful and true. Great work and many thanks all around.

Jonathan B. Singer, Ph.D., LCSW said...

Thanks everyone for the positive comments about the Social Work Podcast and the interview with Dr. Carol Tosone. Thanks for listening and thanks for posting.


Rachel said...

This was an excellent and clear interview. MAkes me more motivated to start my studies in SW (I am awaiting to hear if I have been accepted).
Thank you from Tel-Aviv for sharing this knowledge with the globe :)

Joe said...

I've listened to about 8 episodes on The Social Worker Podcast and I have enjoyed them all. This interview is by far my favorite. A wealth of inspiring information and Dr. Tosone's professional experience and background as well as her thought-provoking guidance only helped to enforce why I want to enter the field of Social Work! Thanks so much for creating this show (and all of the other episodes too).

raymund jagan said...

An excellent interview, a real eye-opener. Thank you very much and God Bless.