Joan Berzoff (ed): Falling Through the Cracks—Psychodynamic Practice with Vulnerable and Oppressed Populations

The book, Falling through the cracks: Psychodynamic practice with vulnerable and oppressed populations, has been a long time in coming. Editor Joan Berzoff brings together a group of psychodynamically skilled clinicians to write about their work with populations that are historically oppressed or stigmatized in our society. What is most notable about this book is how each chapter keeps as its focus, the role social forces such as structural inequality, racism, discrimination, power and privilege, have on the causes, symptoms, treatment, and outcome of the issues that contribute to a client’s need for services. Seldom does an edited book accomplish the task of maintaining its focus without seeming repetitive or overly general. The first chapter begins by outlining the importance of practicing under a bio-psychosocial perspective. It explains how our internal psychological world results from our unconscious motivations, biological pre-dispositions and vulnerabilities, as well as our position to and within various social systems. A brief review of four psychodynamic theories is given: drive, ego, object relations and self psychology, followed by an emphasis on attachment theory. These theories are also the topic of Berzoff’s co-authored book Inside out and Outside, first published in 1996. Psychodynamic theory is positioned outside of its all too often ‘‘authoritarian or constricting’’ (p. 21) context and Berzoff succinctly explains how theorists, such as Klein and Fanon, are helpful to our understanding of social oppression. The utility of critical race theory, dynamics of power and privilege as well as the influence of the social contexts in which we see our clients are described. Finally, the chapter introduces some of the emerging views of the influences that oppression has on our biological development. The environment that is experienced by infants has a great influence on their biological development. For example, abuse, neglect, trauma, and attachment have a significant influence on brain development, as does chronic stress from experiences of discrimination and other forms of oppression. All of these themes are explained in more detail through the use of theory and case examples in the proceeding chapters. Chapters 2 and 3 are written by clinical social workers Kita and Segal respectively, who work with oppressed populations in specific practice settings that are wrought with systemic oppression. Chapter 2 concerns itself with the prison population and Chap. 3 with a homeless shelter. Each author gives careful case examples that clearly demonstrate the usefulness of psychodynamic principles, such as Bion’s theory of the ‘‘container and the contained’’’ (p. 44), and how this relationship transforms both client and worker. Particularly salient is the point that Kita, the author of the second chapter, makes, ‘‘we all have the potential to be offenders, however uncomfortable that is for us to consider’’ (p. 71). Winnicott’s theory of the true and false self (p. 102) is poignantly illustrated through Segal’s case example of a homeless women who, as a result of abuse and neglect, developed a false self that impeded her ability to safely mother her child. Chapter 4 was written by an interdisciplinary pair, Konrad and Morton, with many years of clinical experience using a relational approach. They discuss their work with mothers who struggle from addiction. They demonstrate how important early relationships are in the development of a person’s ability to relate. Also briefly discussed is how neuroscientific research has shed light on the biological implications of L. W. Rozas (&) Puerto Rican and Latino Studies, University of Connecticut School of Social Work, 1798 Asylum Ave., West Hartford, CT 06117, USA e-mail: lisa.werkmeister_rozas@uconn.edu