Learning to Do Psychoanalytic Therapy with an Inner City Population

Community mental health centers serve given populations residing within a stipulated catchment area. This geographic delineation of their mandated constituency fosters socioeconomic and psychopathological heterogeneity. To best serve this diverse patient population, most centers have developed innovative therapeutic concepts such as Lazare's “negotiated approach to patienthood” . Concomitant to the expansion of community psychiatry, a slow but steady interest in the role of dynamic psychotherapy as a treatment modality for different socioeconomic groups has evolved. Cole (1962), Bernstein , Siassi and Messer (1976), among others, have stressed the need to explore issues pertinent to the therapists, the patients and the technique itself if we are to understand the applicability of psychoanalytic therapy among patients belonging to different socioeconomic and cultural backgrounds.

This paper will focus on specific technical approaches geared to facilitate the use of psychoanalytic psychotherapy on a group of inner city patients who, upon initial evaluation, do not meet the criteria for this type of treatment. These inner city clients reside within the mandated catchment area of an Adult Outpatient department affiliated to a Medical School and to a Community Mental Health Center.

The Center's catchment area population is socioeconomically and culturally diverse. Hispanic and Black residents predominate in the northern portions, also known as Hispanic Harlem or “El Barrio.” A higher-income and better educated white population occupies its southern section. This Caucasian group tends to utilize other available facilities within the area which are not established as Community Mental Health Centers.

The Center's patient population is approximately 45 percent Hispanic, of which half are solely Spanish-speaking; 30 percent White; and 25 percent Black. The average amount of schooling, as determined by a random