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Dr. Aiello offers the beginning social work clinician a practice primer of pragmatic and theoretical value. She weaves situational practice technique tightly to the theory social workers draw upon to inform intervention with great skill and clarity. Complex understanding of the social work approach to treatment of children and adolescents are simplified without oversimplification, creating a clear dialog without loss of subtlety or the delicate interpersonal dynamics implicit in the process. Every case vignette is perfectly chosen to elucidate the heart of a specific intervention and the theory informing it.
Aiellos theory base is relational, "informed by. . . a great many social and psychodynamic concepts." These are successfully applied to clinical work with children and adolescents. Including many helpful tips, she speaks to the unique gifts of the individual therapists as they influence the growth in self-understanding and self-regulation of children. Her book thus supports and encourages the beginner. She deliberately chooses difficult, even extreme, cases, testing and demonstrating the efficacy of contextual and relational theory bases in the most challenging situations.
This book is divided into five sections, three of which address phases of treatment, beginning, middle and termination. A separate section discusses specific therapy issues and another presents modalities and special therapeutic programs. Section one, addressing the beginning phase of therapy, lays out relational theory in its diverse forms: ego psychology, self-psychology, object relations, systems theory and developmental theory. Thus, she summarizes a vast literature in a very short space. Discussing assessment within these theory bases, she provides practical techniques for the initial session, play therapy, psychopathology (emphasizing trauma and post traumatic stress syndrome) and learning disabilities.
Section two probes the deepening relationship evolving between therapist and client, with an excellent presentation of transference and counter transference dynamics. Typical presenting problems and clinical difficulties in response are dealt with next, exemplified by recounting poignant case histories. Section five, a bit of a let down, devotes a scant five pages to the termination phase of therapy. It must be noted that the case study presented to demonstrate termination is atypical for social work practice, recapitulating a long-term (perhaps five year) therapy, with a termination phase of one year. The beginning as well as the advanced clinician will need more assistance with the dynamics of termination than this chapter can offer, particularly since social work practice in general rarely affords therapist and client such a lengthy time, luxurious time frame for either therapy or therapeutic working through its ending. Even here, Aiello has useful comments and tips, including a valuable framing of the ritual of gifting the therapeutic ending.
Chapters three and four deal with typical themes in clinical social work, compressing volumes of wisdom into succinct discussions and correlated case stories. I would have liked more discussion on teen depression, medication, and suicide; however, the themes she did cover were handled masterfully: Illness, death, emergent sexuality, foster care and adoption, and multicultural issues were thoroughly explored. Modalities and programs were also well addressed; along with family therapy, adolescent group therapy, and specific treatment settings and placements.
This is the work of a skilled, compassionate and experienced clinician, supervisor and teacher who speaks directly to the concerns of a beginning clinician in clear, straight-forward language, retaining appreciation of the complex and intricate balance between theory and practice, therapist and client. Aiello answers well the question she poses in the introductory chapter, "How can we translate these theories into plain, practical speech that is useful to our clients?" The question itself illumines her approach; a client centered one that makes skillful eclectic use of theory to facilitate client healing, growth and empowerment. Indeed, the children and adolescents she introduces to her reader come alive in her pages.
She addresses therapeutic intervention as "a deeply human and relational art" with a social work perspective, the pragmatic attention to disadvantaged contexts interwoven with universal psychological concerns and conditions. She gives a clear explanation of the social work orientation and how it has influenced psychoanalysis and the social work contribution to psychotherapy.
Deliberately chosen severe problems point subtly to our need as a society to devote resources to our childrens health, demonstrated by subtle correlation between successful outcomes for children and resources invested in adequate therapeutic remediation. These mild references to our national refusal to generate adequate resources for troubled children were perhaps too subtly stated to create much impact on her readers. However, since her intended audience is comprised of beginning social work practitioners, perhaps more emphasis on the unmet needs of children would have amounted to preaching to the choir.
Yet, it is important to notice Aiellos correlation between sustained improvement in child and adolescent functioning and resources for thorough treatment, a factor as vital as the skill and devotion of the clinician. Since this commitment of resources by society is the first premise held by social workers, the raison dêtre for the existence of the profession, no emphasis on the social work perspective is complete without a strong argument in this area. In this book, the social work perspective is elucidated more successfully in discussions of diverse and culturally disadvantaged populations. It literally shines when discussing female adolescent sexuality, physically disabled children and children placed in residential and day treatment programs.
I predict a place on the social work clinicians bookshelf for this excellent practice primer long beyond the days of internship, as a continuing reference and support for work with challenged and challenging clients and populations.
Patricia Reed is a student at Iliff School of Theology in the dual program at the University of Denver's School of Social Work. She will gradaute in May 2000 with an M.Div. (master of divinity) and in May 2001 with an M.S.W. She is currently completing my internship in inpatient addiction recovery programs and has experience in teaching educational and preventive programs in the substance abuse field. In addition, she has a concentration in pastoral counseling and an undergraduate degree in psychology and religion.
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