ABSTRACT
We all struggle with our “Ghosts in the nursery” as described by in-home social workers, Fraiberg, Edelson, and Shapiro (1975) that shape our interactions as adults. With insight, behavioral changes, and experience, we hope that we are able to not replay unhealthy interpersonal patterns in our adult relationships. Unfortunately, sometimes through a combination of biological, psychological, and sociological factors, individuals develop rigid patterns of behavior, that while normal on one end of the spectrum of personality traits, have amplified to the extent that pathology results (Paris, 1997). In the profession of social work where we are trained to focus on strengths and the social structures that can impede healthy growth, we are vulnerable to overlooking or minimizing the diagnoses that imply rigid, dysfunctional patterns of coping that “constantly create situations that replay failures” (Millon & Davis, 2000, p. 13). Kirk, Wakefield, Hsieh, and Pottick (1999) studied a group of 250 MSW students and found that despite an assumption that social work students would over-diagnose pathology, respondents were able to distinguish between disordered and non-disordered youth. Of particular interest is the finding that a subset of students displayed bias but in the opposite direction, of under-diagnosing a psychiatric or mental disorder. Social work, while assessing clients via a biopsychosocialspiritual perspective, poses tremendous challenges to keeping a balance of appreciating the bidirectional effects of each of these components in our lives and the lives of our clients. The difficulty is in over-diagnosing or under-diagnosing while maintaining the “start where the client is” maxim of social work practice.
