Conceptual developments 1920 to 1998

This section focuses on approaches which have influenced mental health social work in the United Kingdom and the United States, rather than all available models. Psychodynamic approaches

As outlined above, mental health social work originated within the psychoanalytic fold, even though social workers did not practise psychoanalysis as a method.

Since the 1950s, social workers have tended to select from the range of psychodynamic perspectives those theories which were more focused on the ego, rather than on the id or the unconscious. The impact of ego psychology was and is in evidence in terms of understanding how people come to develop and maintain mental distress and mental illness, the importance of family dynamics, and of attachment to significant others. (7,8.,9 and 1°»

American social workers, such as Golan,(H.» developed the crisis approach in its application to all areas of social work. Based on Erickson's notion of the normal crisis every person goes through when moving from one stage of life to another, major life events—such as the birth of a premature baby or when a family member is discovered to be suffering from terminal illness—lead initially to panic reactions. However, with professional support people can reorganize their reactions more constructively, enabling them to reduce the duration of the natural panic reaction, to become ready for change at the point of crisis, and to learn from it in terms of improving their coping strategies and emotional responses. Crisis work was of short duration, assuming that people's ability to change lasts for no more than 6 months at a time, in part depending on the urgency and centrality of the problem they are facing and in part on their ability to mobilize sufficient energy for change.

The problem-solving approach also originated from the United States, developed by Perlman during the 1950s and 1960s. (12> Although the psychodynamic understanding of relationships is in evidence in her work, she focused on the process of social work with individuals and families (casework) and the client-worker relationships. Observing that clients tended to first bring up requests for practical help, she suggested that the presenting problem is important to work with even if it is not necessarily the most bothersome issue for the client, as it allows the client and the worker to develop good working relationships based on a partnership in problem solving. The term 'problem solving' was taken from learning theory and is also used in the training of medical students. Perlman accepted that there is also a place for short-term and not just long-term work—unlike the protagonists of the more traditional psychoanalytic approach.

The identification of child abuse, especially child sexual abuse, and its implications for the mental health of children and adults in both the United States in the 1970s and in the 1980s in the United Kingdom led to a refocusing on the psychodynamic approach among social workers in this area. (13) As all other approaches have paid less attention to relevant interpretation and intervention strategies applicable to this group, the psychodynamic approach filled in the void.

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