Forum: Is it Unethical to Employ Freudian Theory in Clinical Social Work?

Archives > Volume 21 (2024) > Issue 2 > Item 11

DOI: 10.55521/10-021-211

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Marson, S. & Dovyak, P. (2024). Forum: Is it Unethical to Employ Freudian Theory in Clinical Social Work? International Journal of Social Work Values and Ethics, 21(2), 174-184. https://doi.org/10.55521/10-021-211

This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of IFSW.

Abstract

The threads of Freudian theory are introduced within our history of clinical social work. This excursion provides the foundation for assessing the relevance and contributions of Freud. Although we begin by assessing and questioning the ethical employment of Freudian theory within clinical social work, we end with the acknowledgement that Freudian theory is deeply ingrained within most facets of clinical social work. Acknowledging that Freudian concepts such as “penis envy” have lost credibility doesn’t take away from the relevance and importance of many of Freud’s mainstream therapeutic concepts.

Keywords: Freudian theory, clinical social work, intervention theory, ego psychology, theoretical credibility

Historical Foundation

In the 1960s and early 70s, the dominant conceptual framework for clinical social work (then called “psychiatric social work”) was Freudian. Even then, the use of Freud’s name had fallen out of grace and was replaced with the term “ego psychology.” During this timeframe, two books dominated the MSW curriculum:

• Blanck, G., & Blanck, R. (1974). Ego psychology: Theory and practice. Columbia University Press.
• Lidz, T. (1968). The person: His development throughout the life cycle. Basic Books.

Blanck and Blanck (1974) was a theoretically-based practice textbook that provided a conceptual framework for addressing a wide range of general mental health issues faced by social work clients. Lidz, on the other hand, was a textbook for social work and the Human Behavior and Social Environment (HBSE) curriculum. The first edition of the Lidz text was overtly chauvinistic — to the point that the book’s content made young male students cringe. Professors who adopted Lidz were often challenged by their students. Professors retorted by stressing that The Person was the only HBSE text that was based on a sample (n=16). The revised and final edition of this book was published in 1976. The title of the revised edition replaced the word His with His and Her.  Although the content was toned down, the revised edition continued to be chauvinistic and fostered a Freudian cringe factor. Female social work professors were rightly hypercritical.

Regardless of what curriculum in which a student was enrolled (psychology, social work, counseling, etc.), the employment of a theoretical framework was stressed. Embracing an eclectic framework was then condemned by most professors (Maddi, 1972).  Although a variety of theories were introduced, one theory dominated the curriculum. During the 60s to the mid-70s, the dominant theoretical theme in social work education was “ego psychology.” In social work, we witnessed a paradigm shift because of Pincus and Minahan (1974). They produced what we now call the generalist model in which a variety of different and often opposing theories could fit within a generalist paradigm. From this model emerged a gradual evolving free-for-all in which theories became situationally dependent. Clinicians would select a theory that would best solve the client’s distress. For example, although ego psychology was held in high esteem, it was recognized that behaviorism was much more effective in addressing phobia problems. The concept of one theory fitting all problems began to fade away. Thus, the contemporary clinician must be skilled with a variety of theoretical frameworks.

Correspondingly, with the mindset that one theory does not fit all, clinicians and academics were put in a position to evaluate the efficacy of theories. From this emerged the concept of empirically-based practice (now called “evidence-based practice”). This movement, of course, included an emphasis on outcome measurement. Outcome measurement was not a strength of ego psychology or other branches of the Freudian framework. In the end, we have come full circle. We began with a post Freudian movement when the eclectic use of theory for intervention was dominant. The academic world responsible for training clinicians condemned eclecticism. From there, we moved to a position that every student needed to be an expert with one interventive theory. We see the emergence of the notion that clinicians should be competent in the application of a wide variety of theories. Are we are beginning to see the re-emergence of eclecticism? The original meaning of eclecticism was pulling a variety of concepts (not necessarily related) from different theories and applying them as a unified whole to a clinical intervention. Today, eclecticism includes mastery of multiple theories and employing one when evidence-based practice demonstrates the theory’s power to direct a clinically defined outcome

The Link to Freudian theory

Acknowledging that theories evolve is critically important for clinical social workers to accept. The theoretical constructs that were learned at the university often become out of favor or even discredited during clinical experience. Here, we see the devolution of Freudian theory.  Within our intensive library search, we uncovered 1,057 books that criticize Freudian theory.  These criticisms most commonly fit within three categories which include:

• Unscientific Methodology
• Overemphasis on Sexuality
• Gender Bias

Among these three categories, the “overemphasis on sexuality” dominates critiques of the overall Freudian theoretical framework.

Perhaps the most cringeworthy sexual concept within Freud’s repertoire is “penis envy.” In fact, after two years of study (Marson & Dovyak, 2023), we have concluded that penis envy is the most offensive, and potentially harmful, therapeutic concept among Freud’s work. We must preface any discussion of penis envy by stating that Freud never addressed this issue without also including the parallel concept  “castration anxiety.”  Our qualitative analysis demonstrates that Freud placed less influence on penis envy then his followers.  Originally, penis envy was considered a problematic mental state that inhabits the psyche of all females. According to the theory, women feel incomplete, anxious and cheated as a result of not having a penis.

In the larger world, and still in some Western cultures, the concept of penis envy within psychoanalytic therapy strangely persists (Marson & Dovyak, 2023). It is hard to now imagine the use of penis envy as a perspective of dysfunction within psychoanalytic therapy. Within a therapeutic session, does a premise of penis envy suggest to a female client a cause for even greater mental distress? Our search of the literature finds no answer to this empirical question. And if the dynamic of penis envy was used within psychotherapy and incited emotional regression within a female client, would its application be unethical as in – “do no harm”?  This debate should be subject to a ‘flat-earth’ screening.

The stronger elements of Freud’s theories attempt to map this metaphoric algorithm that is the language of the unconscious. In the confines of psychoanalysis, we are challenged to scientifically subject our clients to the collection of ‘data in disguise’. The clinician learns how to translate the meaning of the unconscious narrative that reveal conflicts of motives and behavior. We have spent days assessing various experimental designs that would satisfy the rigors of a scientific review board (IRB) in producing an evidence-based outcome.  We are confident that none of our ideas would pass the standards for any fully functioning IRB. What has become transparent is that a macro therapeutic insight, filtered with a retrospective report, can describe a valid or invalid outcome that is grounded in sociological context, i.e. there was a time when ‘penis envy’ did accurately reveal a cultural power dynamic capable of perpetuating a latent consciousness.

Although Freud’s psychosexual stages of development have been harshly criticized over the past decades (Ogden & Ogden, 2013), these theoretical concepts are not directly applied within the therapeutic session (Dendy, 2010; Knight, 2017; Guignard, 2023). Freud’s concepts of psychosexual development provide a framework of understanding human behavior, whereas penis envy is a catalyst for dialog between a therapist and a female client. Within Freud’s theoretical repertoire, penis envy is a more serious ethical issue when compared to his psychosexual stages of development. Should Freud’s theory be totally rejected because of theoretical concepts such as penis envy and psychosexual stages of development?

Alternative Vision of Freudian Theory

The question to ask is, “how prevalent is Freudian theory used within clinical intervention?” In an intensive library review of journals, we uncovered journals that are exclusively Freudian (see Table 1 on next page: from Marson & Dovyak, 2023).

In reviewing these journal titles, two immediate conclusions can be drawn. First, an extraordinarily unexpected number of journals exist whose primary mission focuses on Freudian theory. Second, to compare the popularity of Freudian theory with another theory, we sought a list of journals that exclusively deal with behaviorism. Although behaviorism is held in high esteem as an interventive strategy, it fails to generate the interest in as many journals as we find with Freudian theory.

Two characteristics facilitate the employment of Freudian theory. A number of Freudian theoretical concepts have bled into a wide variety of mental health interventions. Within our extensive literature review, we uncovered specific Freudian clinical concepts that have become an integral part of professional conversation. The concepts are (alphabetical order):

• Countertransference
• Defense mechanisms
• Ego
• Ego strength (not in Oxford Dictionary of the English Language)
• Freudian slip
• Libido
• Preconscious
• Subconscious
• Talk therapy as nonmedical
• Therapeutic confidentiality
• Transference

Two terms require additional comments:

1. Within the adjudication process and documentation, clinical social workers who violate boundary issues (particularly of a sexual nature) are described by using the Freudian terms transference and countertransference. Within the English language, there are no other words that captured the essence of meaning found within these two Freudian concepts (as generated from artificial intelligence).
2. Although talk therapy/counseling has existed since the early 1800s, we do not see literature that stresses the importance of confidentiality until Freud’s writing. Although women were considered the property of men during Freud’s lifetime, he did not disclose information derived from therapeutic sessions to clients’ husbands. Freud was uncharacteristic for his time. He treated the female “patient” as a person and not as property of her husband and/or father.

Without a doubt, traditional Freudian concepts have found their way into alternative theoretical frameworks.

We note that many Freudian concepts have entered the realm of “public domain.” The best example can be found in the work of Winick (1997). As a psychologist and lawyer, Winick offers a comprehensive assessment of a wide range of theories within the context of therapeutic intervention for involuntary clients who have been ordered by the court to receive therapy. The book includes an assessment of psychotherapy, behavioralist interventions, psychotropic medications, electroconvulsive therapy, electronics stimulation of the brain, and psychosurgery. The primary audiences for this book included lawyers and judges. The book review (Marson, 2000) notes:

…in surveying the major issues and tenants of behavioral therapy, he employs psychoanalytic language. I found myself chuckling as I read this chapter, but I am well aware that psychoanalytic jargon has entered street language. In short, the author explains behaviorism by employing a psychoanalytic framework. Although mental health professionals will see Winick’s explanation as awkward, it might be the most efficient summary for lawyers and judges.

For those professionals who are only slightly familiar with therapeutic intervention, Freudian concepts are public domain material. Even those without the educational background have a fundamental understanding of Freud’s psychoanalytic theory. Jargon from the era of Woody Allen movies is clearly recognizable as Freudian. Freudian concepts are fully integrated into the language of the people. Freudian concepts persist as part of the public domain.

The most powerful example of Freudian concepts moving into the public domain include transference and countertransference. The notion of Electra and Oedipal complexes were the catalysts for the existence of transference and countertransference. Transference and countertransference are no longer linked to the Freudian concepts but retain their value in understanding, categorizing and intervening in clinical intervention. As stated earlier, these Freudian concepts continued to be frequently used today. In a cursory review of literature, we discovered 35,150 citations in which transference and countertransference were the central themes. These two concepts alone continue to have a powerful influence within the minds of the contemporary clinician.

Baby Out With The Bathwater?

In a monumental and controversial move, Freud was the first professional to demedicalize psychotherapy. He strongly contended that a medical degree was not required to be a competent psychotherapist. His position was unprecedented and was coupled with the medical community’s expansive opposition. His position was also the catalyst for the evolution of “psychiatric social work.” Historical records demonstrate that psychiatric social workers were the first non-physicians to qualify as psychotherapists (Ruffalo, 2022). It is clear that if the medical community, during Freud’s time, were more rigorous and vigilant gatekeepers, clinical social work would not exist.

Few people will disagree with the statement that Freudian theory includes some offensive and theoretically weak concepts. The centerpiece of our discontent is the concept of “penis envy” and Freud’s traditional psychosexual stages of development. That being said, there is another side to Freudian theory. Freudian concepts are deeply embedded into the collective consciousness of Western civilization. Freudian concepts are deeply embedded into everyday life and are part of the public domain. In other words, Freud is not getting acknowledged for his contribution.

Freudian theory is a victim of “stigmatization.” The label of “Freudian Theory” has become more disreputable than most of the ideas housed within Freudian Theory. For example, the notion of “socialism” is condemned by a large number of retired Americans, but Social Security is embraced.  This Social Security system is a product of socialism (Marson, 2019). In fact, we are at the point where many retirees vigorously deny that Social Security is a product of socialism. Social Security is accepted but socialism is not. This vision of Social Security (not being a dimension of socialism) is logically untenable. In many sectors of the mental health professional community, Freudian theory is condemned but the central concepts of Freudian theory are embraced. Just like socialism.

In our review of current clinical social work practice, we have uncovered a pattern in which Freudian concepts are routinely employed within intervention. The question, “is it unethical to employ Freudian theory in clinical social work?” might be a misnomer. Perhaps a more appropriate question would be, “is it ethical to employ Freudian concepts without acknowledging credit?” Ironically, we see patterns among younger clinical social workers who lack adequate general understanding of Freudian theory. They don’t seem to be aware that many of the concepts they employ within their intervention strategies emerged from Freudian theory. Freudian concepts have been usurped and are now part of the public domain. When we think about it, the lack of acknowledgement and infiltration within the public domain, is the highest compliment one can attribute to Freud.

We are interested in your comments, email them to journal@ifsw.org.

References

Blanck, G., & Blanck, R. (1974). Ego psychology: Theory and practice. Columbia University Press.

Dendy, E. B. (2010). Inherent contradictions in the ego ideal. The Psychoanalytic Quarterly, 79(4),991–1023. https://doi-org.proxy181.nclive.org/10.1002/j.2167-4086.2010.tb00474.x

Guignard, F. (2023). The interpretation of Oedipal configurations in child analysis. In N. P. Franch, C. Anzieu-Premmereur, M. Cardenal, & M. W. Salomonsson (Eds.), The infinite infantile and the psychoanalytic task: Psychoanalysis with children, adolescents and their families, (pp. 58–64). Routledge.

Knight, Z. G. (2017). A proposed model of psychodynamic psychotherapy linked to Erik Erikson’s eight stages of psychosocial development. Clinical Psychology & Psychotherapy, 24(5), 1047–1058.
https://doi-org.proxy181.nclive.org/10.1002/cpp.2066

Lidz, T. (1968). The person: His development throughout the life cycle. Basic Books.

Maddi, S. (1972). Personality theories: A comparative analysis. Dorsey.

Marson, S.M. (2019). Editorial: What is Socialism? The Journal of Social Work Values and Ethics, 16(2), 1-3.

Marson, S. M. (2000). A book review of The Right to Refuse Mental Health Treatment in The Journal of Psychiatry and Law, 27 (2), 341-344.

Marson, S.M. & Dovyak, P. (2023). Penis envy: A longitudinal qualitative analysis. Journal of Psychology & Behavioral Science, 11(1), 42-53.

Pincus, A., & Minahan, A. (1973). Social Work Practice: Model and Method (1st ed.). F. E. Peacock Publishers.

Kendler, K. S., Tabb, K., & Wright, J. P. (2022). The Emergence of Psychiatry: 1650–1850. American Journal of Psychiatry, 179(5), 329 335. https://doi.org/10.1176/appi.ajp.21060614

Ogden, B. H., & Ogden, T. H. (2013). The analyst’s ear and the critic’s eye. In Routledge eBooks. https://doi.org/10.4324/9780203523063

Ruffalo, M.L. (2022, April 11). Psychotherapy as a medical treatment. Psychiatric Times. https://www.psychiatrictimes.com/view/psychotherapy-as-a-medical-treatment

Winick, B.J. (1997). The right to refuse mental health treatment. American Psychological Association.