Karen Horney’s Contribution to the Strengths Perspective in Clinical Social Work

Tiffany Hung

Abstract

This paper seeks to recognize Karen Horney’s contribution to clinical social work by demonstrating the relevance of her psychoanalytic theory to the application of the strengths perspective in social work practice with mental health clients. Core concepts of Horney’s constructive theory of neurosis, including the distinction between mental health and pathology, man’s natural strivings toward self‐realization, and the constructive forces of the real self, are presented. Writings by Horney’s colleagues are drawn upon to elaborate her ideas about mobilizing constructive forces in the therapeutic process.

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My own belief is that man has the capacity as well as the desire to develop his potentialities and become a decent human being, and that these deteriorate if his relationship to others and hence to himself is, and continues to be, disturbed. I believe that man can change and go on changing as long as he lives. And this belief has grown with deeper understanding (Horney, 1945, p. 19).

Social work students are likely not to have heard of Karen Horney or to study her work in the course of their graduate social work education. Upon studying her work, one discovers the great potential for her psychoanalytic theory to make a significant contribution to clinical social work practice. This essay is in part a tribute to the contribution she has made to the field of mental health and in part an effort to stimulate interest in her ideas in the social work community. Specifically, it attempts to demonstrate that her theory supports and lays a solid foundation for the application of the strengths perspective in clinical social work.

The idea of using a strengths‐based approach to working with clients can be traced back to the very beginnings of the social work profession and was later more rigorously defined and conceptualized by Dennis Saleebey in his well‐known text, The Strengths Perspective in Social Work Practice. Saleebey (2002) writes that “practicing from a strengths orientation means this—everything you do as a social worker will be predicated, in some way, on helping to discover and embellish, explore and exploit clients’ strengths and resources in the service of assisting them to achieve their goals, realize their dreams, and shed the irons of their own inhibitions and misgivings, and society’s domination”; it means, furthermore, that “rather than focusing exclusively or dominantly on problems, your eye turns toward possibility. In the thicket of trauma, pain, and trouble, you can see blooms of hope and transformation” (p. 1).

Saleebey (2002) is very critical of the “disorder‐based thinking” of contemporary mental health professionals, whom he believes place overdue emphasis on psychopathology (p. 3). He implies that clinical social work has been seduced into adopting the pathology‐based practice philosophy which is popular among mental health professionals, in order to elevate the status of social work vis‐à‐vis other professions. Although the practice of clinical social work should be compatible with a strengths‐ based approach, “the infusion of psychodynamic thinking, the rise of private practice and vendorship, the mass appeal of DSM IV TR among other factors have driven social work toward a model of practice that is more heavily aligned with psychological thinking and psychopathology theories” (p. 18).

Were it not for Karen Horney, one might agree with Saleebey’s point that the adoption of psychoanalytic theories has diminished clinical social work’s interest in applying the strengths perspective in work with mental health clients. In many ways, Horney’s ideas reflect the spirit of the strengths perspective and have created the theoretical framework necessary for understanding clients from a strengths perspective. In fact, strengths‐based approaches to working with clients who struggle with mental health conditions arguably find their roots in Horney’s theory.

Karen Horney was born in Hamburg, Germany, in 1885. She studied medicine and psychiatry in Berlin and taught at the Berlin Psychoanalytic Institute from 1918 to 1932. Horney came to the United States in 1932 and served as Associate Director of the Psychoanalytic Institute in Chicago for two years. She then took a position at the New York Psychoanalytic Institute, where she remained until 1941, when she broke away from the institute and became one of the founders of the Association for the Advancement of Psychoanalysis and the American Institute for Psychoanalysis. Horney came to represent a radical shift from the framework of Freudian psychoanalysis in which she was trained. She is widely recognized as one of the first feminine psychologists as well as one of the first psychoanalytic thinkers who considered the role of culture in influencing individual psycho‐ dynamics (see The Neurotic Personality of Our Time, 1937). In New Ways in Psychoanalysis (1939), she challenged several concepts central to Freudian theory, such as “libido theory, the primacy of infantile sexuality, and the repetition compulsion,” while affirming what she believed was essential to psychoanalytic theory and practice (Rubin & Steinfeld, 1991, p. 3).

Perhaps her most radical concept, according to Rubin and Steinfeld (1991), was the idea that “what is psychologically healthy in human beings is qualitatively different from what is unhealthy.” That is, what is unhealthy operates according to completely different dynamics from what is healthy. Most other theories, in contrast, are “based on the premise that what is pathological is either an exaggeration or distortion of what is normal” (p. 4). Horney’s distinction between health and neurosis was one of the central tenets of her conflict theory of neurosis, which she set forth in Our Inner Conflicts (1945) and further developed in Neurosis and Human Growth (1950). In fact, Horney opened the latter work with the proposition that the neurotic process “is not only different in quality from healthy human growth but, to a greater extent than we have realized, antithetical to it in many ways” (p. 13). This standpoint opened up the possibility of thinking about patients’ strengths in ways which affirmed a person’s inner capacities and motivations for change and were therefore more in line with what present‐day social workers would recognize as the strengths perspective.

Horney (1950) theorized that “inherent in man are evolutionary constructive forces, which urge him to realize his given potentialities” (p. 15). This means that “man, by his very nature and of his own accord, strives toward self‐ realization, and that his set of values evolves from such striving.” That is, under favorable conditions, individuals have a natural propensity to grow and realize their unique potentialities. Through this process one develops a healthy way of being which is unique to each individual—what Horney called the “real self,” ones fundamental core of aliveness. The constructive forces of the real self are the sources of growth in each person. Neurosis is a result of disturbances in ones human relationships and environment which “divert our constructive energies into unconstructive or destructive channels,” leading to alienation from self and neurotic processes of development (p. 15). Horney did not view obstructive or destructive forces as innate to man, as did earlier Freudian theories of instinctual conflict and repression. She used the metaphor of the process by which an acorn grows into an oak tree to illustrate her ideas about development: Given the right conditions, an acorn will naturally grow into an oak tree, but its development may be thwarted by a variety of adverse environmental influences.

Ultimately, Horney (1945) called her theory of neurosis a “constructive” one. Her reasons were twofold: On the one hand, she was guarded against the “unrealistic optimism” that neuroses could be “cured” by simple means (p. 18). On the other hand, she called her theory “constructive” because it allowed for the possibility that neurotic conflict could eventually be resolved rather than simply endured, resulting in “a real integration of personality” (p. 19). Her stance was in large part a reaction against Freud’s pessimism regarding man’s ability to change and achieve happiness.

The overall goal of therapy, according to Horney’s formulation, was to create the conditions necessary within the individual to allow the constructive forces of the real self to have a chance to grow. Therefore, Horney proposed that the therapeutic process involved two complementary and concurrent objectives: One was to undermine the obstructive forces impeding a person’s growth, and the other was to mobilize that person’s constructive forces in the service of self‐realization (Horney, 1950). As one of her disciples, Harold Kelman (1953), put it, the objectives of therapy are “to identify, undermine and dissipate obstructive and destructive pat‐ terns of existence while concomitantly identifying, supporting, extending and expanding constructive patterns of living” (p. 4).

The latter objective appears to reflect a strengths‐based approach to practice, as defined by Saleebey (2002). In fact, much of what Horney wrote on the subject of mobilizing constructive forces affirms the strengths perspective. She acknowledges that “there are healing forces operating in the patient from the very beginning,” although “at the onset of analysis, they are usually deficient in vigor and must be mobilized” before they can assist the patient toward his goals (Horney, 1950, p. 348). The patient’s interest in getting help is itself a constructive force. Although the patient’s reasons for seeking help at the outset may be questionable, the analyst is to “make use of these motivations” to engage the patient in analytic work (Horney, 1950, p. 349). When the patient begins to wonder how well he actually knows himself, the analyst will actively try to bring the patient’s sense of self‐ alienation to the patient’s awareness. The analyst will also “not lose an opportunity to encourage explicitly any sign the patient gives of greater independence in his thinking or feeling, of assuming responsibility for himself, of being more interested in the truth about himself” (Horney, 1950, p. 351). He will point out the ways in which any moves toward self‐ realization have positive effects on the patient’s relationships and functioning. Finally, as the real self emerges, the analyst will help the patient explore what makes it possible for him “to be more spontaneous, to make a decision, or to be active in his own behalf” (Horney, 1950, p. 352).

Unfortunately, Horney did not develop her ideas on mobilizing constructive forces much further since she focused most of her intellectual career on identifying the basic neurotic trends and defense mechanisms and integrating her findings into a dynamic theory of neurosis. Using her lectures and writings as a foundation, her colleagues later elaborated on her ideas about constructive forces. Morton Cantor (1967) suggested that mobilizing constructive forces begins with eliciting them from the patient. Eliciting constructive forces starts as soon as the analyst and patient discuss the patient’s reasons for seeking help and is especially relevant when reviewing a patient’s history. He points out that traumatic experiences in a patient’s history are not as important as how the patient responded to them. The analyst will often find that constructive forces were at work, as evidenced by the patient’s resilience and ability to tolerate psychic pain and learn from his experiences. When this is the case, the analyst should elicit these constructive forces in the patient by “questioning, underlining and clarifying what is being presented.” At the same time, the analyst is “welcoming constructive elements the patient may never before have paid much attention to…and encouraging further moves in this direction” (p. 192).

Cantor (1967) also recognized the “general human help of the analyst,” or what contemporary clinicians might refer to as the therapist’s “use of self” in the therapeutic relationship, as a mobilizing force, by which he was referring to the analyst’s “humanness, his emotional attitude towards the patient, not just his interpreting, directing, correcting, etc.” (p. 193). Similarly, Nathan Freeman (1953) wrote that “the therapist’s interest in the patient’s growth and his belief in his ability to grow can be a productive, stimulating call to the blocked constructive forces” (p. 13).

Harold Kelman (1953) emphasized that the “motive power” behind all positive changes we see in patients are their constructive forces, which he also called “assets” (pp. 4‐5). He went on to describe the specific assets one might find in patients, including past and present capacity to form positive interpersonal relationships, the ability to feel, will, think, and act, the development of wisdom, the ability to reason, a sense of humor, and the capacity for psychological thinking. Kelman (1953) believed that with such knowledge of constructive forces, the “tendency to focus one‐sidedly on pathology and irrationality will shift to a proportionate emphasis on the assets and liabilities in the whole person, and toward the end of a more effective and productive therapy.” He pointed out that therapists often do not see a patient’s assets even when they are looking for them and that “the tenacity for life and growth is often far greater than we may give our patients credit for” (p. 8).

Frederick Allen (1953) made an intriguing point that even in the patient’s symptom, a constructive force is operating. The symptom indicates that the individual is “in one way or another attempting to solve a dilemma” (p. 9). It is also evidence of vitality within the patient which has not yet been released for creative living. Allen (1953) believed that even resistance to the therapist’s interventions could be interpreted as a manifestation of the patient’s constructive forces since it represented the patient’s attempts to “maintain the integrity of his ego” and “contain[ed] the nucleus of the patient’s quality to use the therapist to effect change” (p. 10).

Karen Horney’s theory of neurosis and human growth is compatible with the strengths perspective in social work and has even provided a conceptual framework for understanding clients from a strengths perspective. However, Horney’s standpoint does not entirely align with social work values, and social workers are not encouraged to adopt it wholesale. For example, like most of the psychoanalysts of her time, she remained within the framework of a hierarchical “doctor‐patient” relationship and did not emphasize the exchange between person and environment as a locus of both strengths and liabilities. Horney’s greatest achievement was her willingness to understand human beings first from the perspective of their health and natural strivings to develop their potentialities. Consequently, she began to rectify her profession’s over‐emphasis on pathology and open its eyes to the “blooms of hope and transformation,” as Saleebey (2002) put it. Her outlook affirmed the inherent dignity and worth of individuals and their innate capacity to grow and achieve healthy relationships with themselves and others. In this regard, she represented a radical break from the past and laid the groundwork for applying the strengths perspective to clinical social work practice. For her contribution, Karen Horney deserves a place among the many psychoanalytic theorists studied by social work students.

References

Allen, F. (1953). Constructive forces operating in the individual. In K. Horney (Ed.), Constructive forces in the therapeutic process (pp. 8‐10). American Journal of Psychoanalysis, 13, 4‐19.

Cantor, M. (1967). Mobilizing constructive forces. American Journal of Psychoanalysis, 27, 188‐199.

Freeman, N. (1953). How to mobilize constructive forces. In K. Horney (Ed.), Constructive forces in the therapeutic process (pp. 11‐13). American Journal of Psychoanalysis, 13, 4‐19.

Horney, K. (1945). Our inner conflicts: A constructive theory of neurosis. New York: W. W. Norton & Company, Inc.

Horney, K. (1950). Neurosis and human growth: The struggle toward self‐realization. New York: W. W. Norton & Company, Inc.

Kelman, H. (1953). What are constructive forces? In K. Hor‐ ney (Ed.), Constructive forces in the therapeutic process (pp. 4‐8). American Journal of Psychoanalysis, 13, 4‐19.

Rubin, J. & Steinfeld, S. (1991). Foreword. In K. Horney, Neurosis and human growth: The struggle toward self‐ realization (pp. 1‐9). New York: W. W. Norton & Company, Inc.

Saleebey, D. (2002). Introduction: Power in the people. In D. Saleebey (Ed.). The strengths perspective in social work practice, third edition (pp. 1‐22). Boston: Allyn and Bacon.

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About the Author

Tiffany Hung is a graduate of Harvard University, where she majored in East Asian Studies. For her first‐year placement, she worked as a Housing Specialist at Catholic Guardian Society and Home Bureau, a homeless shelter for women and children ages 0‐2 years, providing case management and supportive counseling for clients. For her second‐year field placement, she worked at the Karen Horney Clinic, providing outpatient psychotherapy for children and adolescents ages 4 to 18. Her major method at HCSSW is Clinical Practice with Individuals and Families. Ms. Hung can be reached at thung@post.harvard.edu.

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