Dialectical Constructivism in Clinical Social Work: An Exploration of Irwin Hoffman's Approach to Treatment

Abstract

We explore selected concepts of Irwin Hoffman's approach to treatment as delineated in Ritual and Spontaneity in the Psychoanalytic Process. These ideas are drawn against the backdrop of the current climate of evidence-based practice and the trend toward prescriptive approaches to treatment. We discuss and explore Hoffman's conceptualization of the dialectics of ritual and spontaneity and of being and mortality, his discussion of collaborative exploration, and his delineation of the concept of liminal moments. Although these ideas were originally developed in a psychoanalytic framework, we argue that they are equally applicable in social work practice. We present a case vignette to illustrate the effectiveness of Hoffman's approach with a client who was in a transitional living program for homeless individuals and who had a 30-year history of alcohol and drug addiction as well as chronic mental illness. Finally, we discuss some of the unsettling implications of Hoffman's ideas, especially in terms of a transformed understanding of the opportunities and challenges for the therapist's participation in the therapeutic dyad. We view Hoffman's contribution as an organizing framework for developing and expanding clinical social work practice in the 21st century.