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Neil Altman, a psychologist who maintained part of his practice in an inner city clinic during his psychoanalytic training, has written this book in an effort to extend psychoanalytic insight and practice into what he believes has been an analytically neglected sector of the United States population. He attributes the disinterest of psychoanalysis with inner-city public clinic work to analysts’ desires for patients with particular educational backgrounds, a “Calvinistic” ability to tolerate frustration, excessive interest in adhering to a classical ideal of analytic anonymity, and the fact that public clinic administrators have traditionally not looked kindly on intensive psychotherapies. In addition, public clinics maintain a focus on symptom relief, rely on pharmacological and behavioral approaches, and utilize intensive case management (further moving the locus of treatment out of the analytic office). Thus, psychoanalysts have concentrated their efforts in private practice where “not incidentally, there is more money to be made.” Altman says his book is part of a larger project to integrate the social and psychological within psychoanalytic theory and practice in the tradition of Sullivan, the British object relations theorists, Lacan, and a number of feminist psychoanalysts.
In Chapter 1, he describes the poverty, deprivation, physical and sexual trauma, racism, prevalence of drugs and crime, and the need to do more with less in the way of social and familial supports present in the inner city. He also cites the work of Anthony and Cohler (1987) and Neiman (1987) regarding “resilience” that children can develop in response to adversity. He then discusses a number of treatment issues frequently present in work with inner-city patients including good-bad splits that often develop in the transference, the narcissistic needs of the therapist to have patients keep