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Psychoanalytic treatment is primarily understood to be an in-depth therapeutic endeavor that takes place in a protected time and space between an analyst and patient, usually multiple times a week and over a long time. But perhaps from the earliest days of psychoanalytic history, many in the field have sought to expand psychoanalytic principles to both understand and intervene in problems beyond the consulting room. I plan to look at the circumstances and procedures and the effects produced when a psychoanalyst widens the narrow treatment frame. It is often the situations of greatest disturbance, such as domestic and school violence, bullying and being bullied, poverty and deprivation, and social upheaval such as war and terrorism, that compel the analyst to extend the frame beyond the consulting room. In my own work, such examples have included consulting to schools that have experienced student suicides and staff-student sexual encounters, to a domestic violence center where I have worked with the counselors in managing their own vicarious traumatization.
Of course the very question of what can be called psychoanalytic treatment is hotly debated. Different theoretical schools often also differ in how they define the clinical psychoanalytic situation. Different frequencies of sessions, use or not of the couch, work with groups, families, and with larger systems have all been called psychoanalytic treatment by some. By studying the extensions of the analytic frame in different situations, can we find sufficient fundamental and essential therapeutic techniques and modes of therapeutic action to create a definition of psychoanalytic treatment that can encompass these different settings? Or should the application of analytic principles to situations other than the one-on-one traditional psychoanalytic setting to be called just that—applied psychoanalysis—meaning less than psychoanalysis?
As with most analysts who work with children today, by far the most common situatio