Carolyn Saari, The Environment: Its Role in Psychosocial Functioning and Psychotherapy.

New York: Columbia University Press, 2002. $49.50 hardcover, $22.00 papercover.

In her new book, Carolyn Saari sets out to integrate developmental and clinical social work practice theories to address, as she sees it, shortcomings in current thinking in sufficiently accounting for the influence of the social environment on human functioning. The problem, she writes, has been that:

   "Clinical social work, as a profession, has always believed in the
   importance of the environment and has regarded theories of the
   "person-in-situation" or the "person-environment configuration"
   as necessary in order to understand human needs ... Yet because
   paradigms of Western thought separated the individual and the
   environment into two quite different frameworks, it has been
   extremely difficult to find a viable bridge between these inner
   and outer aspects. Thus social work theories have espoused either an
   intrapsychic approach or a more social approach, with the advocates
   of each both criticizing and competing with those of the other ..."
   (p. 2)

For Saari, it is the limited attention to environmental influences in psychoanalytic theory, specifically, that she seeks to address. Her approach to this problem is a novel one: to answer these limitations through an integration of psychoanalytic theory with post-modernist philosophies. Saari proposes that post-modern thought, particularly social constructivism, can supply a view of the significance of social context that could in effect move psychoanalytic theory into the 21st century.

Saari organizes the nine chapters of her book into three sections, each aimed primarily toward building an integrated theory of both perspectives. In the first three chapters, she discusses the foundational views of Freudian theory, and integrates more recent ideas from developmental theory and research and post-modern concepts, such as language and meaning, and culture and identity. In this section, among other contributors, she refers to the cognitive psychologist Katherine Nelson's tri-partite theory of the development of meaning and relies on this viewpoint as a major organizing framework for the book, consistent, as she sees it, with the post-modern emphasis on meaning-making as a central human activity. In the second set of three chapters, Saari explores Michel Foucault's ideas about psychotherapy, particularly his assertion that psychoanalytic psychotherapy is an instrument of social control and oppression, as a backdrop for framing the discussion of the contemporary role of psychotherapy. In the final three chapters, the author expresses her views about a theoretical basis for psychotherapy that integrates the influence of the environment from the perspective of social constructivism. The case illustrations, found in eight of the nine chapters of the book, are particularly well-written (most have appeared in other publications of the author) and work well as illustrations of her major points.

It isn't hard to see why post-modern thought has become a major influence in our profession in recent years. Consistent with many of our core professional values, and our discomfort with the medicalized role of the expert, post-modern thought calls attention to the problems of biases in social science that favor the world views of socially dominant groups and exclude the experiences of oppressed populations. However, the use of post-modernism to address deficiencies in psychoanalytic theory strikes me alternately as curious and ironic. To begin with, because most social work practitioners are not as concerned about Freudian theory as Saari is, and operate on the basis of more holistic models, I doubt that her view of a rift between intrapsychic and social theories is widely shared. Ironically; Freudian and social constructivist views share one important characteristic: isolation from the scientific community. While the isolation of Freudian theory is a result of obsolescence, the isolation of social constructivists from positivist scientific inquiry is self-imposed. In their view, any attempt at so-called objective observation is misguided and a violation of the subject's true experience.

I am among those who believe that post-modernist views cannot provide our profession with a strong practice theory base. Pursuing such a path will present the same sort of intellectual dead-end that befell our Freudian-inspired colleagues. Contrary to post-modern views, it is indeed possible to discover truths about the human condition that translate into viable practice interventions, as a myriad of examples of evidence-based practice can demonstrate. The contradiction between social constructivism and evidence-based practice is illustrated, but not acknowledged, in what Saari calls her `Guidelines for the Construction of New Meaning' [in psychotherapy]. Guideline number one reads: "The absence of known universal truth requires the clinician to pay careful attention to the ethics and values of the mental health professions ..." In contrast, guideline number four asserts, "Newly created meaning should be informed by and consonant with the best available understanding of human development and functioning" (p. 117). How can the best available understanding of human functioning be recognized as such in the face of the absence of known universal truths? It seems that we are being told that empirical inquiry into human functioning is ok as long as we don't conclude that our findings may be applicable to all people. If we were to take this apparent message seriously, we would have to abandon a considerable portion of our knowledge base.

Our response to the inadequacies of our theory base and social science should not be a blind embracing of an idea that leads to what is in effect nihilism in our practice theories and science. We social workers are dedicated to fostering understanding of human diversity in its many facets, and in doing so we should also dedicate ourselves to making our scientific systems better, more inclusive, and more accountable, not abandoning the ever-growing scientific base of our profession.

Timothy Page
Louisiana State University