Clinical Wisdom and Theoretical Advances: Alberta Szalita's Contributions to Psychoanalysis

AT THE RECENT CELEBRATION of Alberta Szalita's ninetieth birthday, I heard anecdotes from several people whose lives had been irrevocably changed by her. What was as impressive as the magnitude of the effect she had on each of these people was the variety of effects. Each person had had an indelible, unique experience of her, testament to her ability to find what is essential in a person and work with it.

I first met Szalita when I was in training at the New York State Psychiatric Institute at Columbia University. I was working on what was called the Community Psychiatry Unit, which included the most severely psychotic patients who could not afford the more exclusive care of private units. Many of them were exemplars of the “revolving-door” syndrome. It was a time of great and sudden change at the Psychiatric Institute. Psychodynamically oriented faculty members were being let go, and a new crop of psychiatrists was coming in whose main interest was psychopharmacology and research. During the first few months of my work on the Community Unit, the psychological and social concerns of the patient were discussed at the daily staff meetings. Rather suddenly, with the organizational change, the discussions shifted to diagnosis and medication.

In that context, Szalita gave a course in psychiatric interviewing. The format was simple: one of the psychiatry residents or psychology interns would interview a patient in front of the entire staff. Usually, these interviews would go nowhere, and we could see the supposed futility of trying to do psychotherapy with psychotic patients. But after about fifteen minutes of an agonizing interview, Szalita would step in and continue the interview. It was astonishing. Somehow, communication was established, and the patient started to make sense. It seemed a miracle, and I vowed to learn from Szalita what she was doing (Blechner, 1997).