Clinical Work in the Inner City

I am grateful for the opportunity, afforded by Stuart Twemlow and Nadia Ramzy, to solicit, and introduce, the papers that are part of this special section on psychoanalytic work in an inner city context. Especially in the United States, psychoanalysis has paid scant attention to application of its therapeutic procedures to impoverished people or people of Third World ethnicity. In a capitalist context, psychoanalysis has become a private practice, with practitioners charging the highest fees that the market will bear. American mainstream cultural values, enshrined in ego psychological criteria of analyzability, have had an exclusionary effect on people of Third World cultures, including African Americans, Asian Americans, and Latino Americans. The result is that the therapeutic potential of psychoanalysis for inner-city people has been largely undeveloped. Psychoanalytic thinking about social issues, including race, social class, and culture has also remained a backwater. (But, for exceptions, see Altman, 1995, 2000, Cushman, 1995, Holmes, D.E., 1999, Kovel, 1970, Leary, 1997, 2000, Schacter & Butts, 1971). Given this dearth of attention to social issues and to the needs of the most neglected people in our society, it is especially gratifying that the editors of this journal have encouraged this special section.

We lead off with the paper on transference and countertransference around food and money by Toni Heineman. Dr. Heineman has been a ground breaker in the provision of psychoanalytically informed therapeutic services to underserved people, foster children in particular. The “Children's Psychotherapy Project” in San Francisco involves dozens of therapists working pro bono in long-term therapy with foster children, and participating in consultation groups in which they can discuss their clinical experiences. Some of the fruits of this labor are evident in Dr. Heineman's paper. Freud's (1909) provision of food to the rat man notwithstanding, food has traditionally