Psychoanalysis in the Inner City

This special issue offers a perspective on how psychoanalytic principles can be used by an agency, in this case Community Services Institute (CSI), a mental health clinic working in the inner cities in and around Boston and Springfield, Massachusetts, to reach out into disadvantaged communities using the clinic as a long-term attachment site. This is an example of how the applied psychoanalytic principles learned at the Menninger Clinic has resulted in the agency's providing close to one million home visits of psychotherapy in the most disadvantaged communities in and around Boston and Springfield, Massachusetts. CSI's home visits all involved psychotherapy with children and families, most of whom were referred by the state's child welfare department. The average length of treatment is four years for a majority of the clinic population with a number of cases extending over 10 years. CSI is a state licensed outpatient mental health clinic funded by Medicaid and managed by Value Options and Boston Medical Center. CSI provides psychiatric outpatient care, psychotherapy, and psychological testing. CSI also has a pre-doctoral internship in Psychology that features a psychodynamic orientation as a central element in training in psychological testing, treatment, and supervision. Neurofeedback and other non-analytic approaches are all welcome in providing long-term psychotherapy to multiple-problem families as described in (Sacco Campbell, and Ledoux, this issue; Clark et al., 1982). CSI also offers doctoral psychology fellowships and social work internship that also use this same psychodynamic approach in the field training, psychological evaluation and supervision experiences.

This clinic's philosophy is grounded in what can be described as “old school,” dynamic, eclectic, and ecological treatment principles. The overall agency philosophy uses a psychodynamic frame within which many different approaches to treatment are woven together to support families. Clinical supervis