The Washington Psychoanalytic Foundation has established two programs to reach out to children and those who provide for them in nursery, preschool, and school settings. Beatrice Smirnow coordinates the Child Care Consultation Center, a training and education program directed to day care providers, and Douglas Chavis coordinates the School Consultation Program, which provides clinical consultation to preschools and elementary, middle, and senior high schools.
These programs are not unique in the D.C. area. Over the years, several Washington analysts, including Arnold Meyersburg of the Washington Psychoanalytic Society and Dale Meers and Aimee Nover of the Baltimore-Washington Society, have labored in the front lines of the community to serve the needs of children. This kind of community outreach, of course, is also of value to psychoanalysis. Given the current climate of disrespect for intensive therapeutic treatment, it is more important than ever that analysts leave their offices and institutes to educate their communities about analysis and the application of analytic principles. It was in this spirit that the Washington Psychoanalytic Foundation was created in 1990, led first by Harvey Rich and currently by Derek Hawver. Below the authors describe their programs and the ups and downs experienced in bringing them to life. First Beatrice describes the Child Care Consultation Center; then Doug writes about the School Consultation Program.
This program began and evolved in a serendipitous way. It was started in 1991, when as a second-year candidate I spoke to Harvey Rich about volunteering some time to the foundation. He invited me to pursue an innovative idea—to set up an educational program for nannies to enhance their understanding of children's emotional development and needs. Given that the D.C. area has one of the highest concentrations of two-career families in the nation, it seemed likely we would generate some interest in such training, among both parents and nannies. Several of my fellow candidates joined me in creating the program, their enthusiasm fueled in part by their own experience with ill-trained nannies. We left several hundred brochures describing the program in the waiting rooms of pediatricians and obstetricians, hoping to reach those parents most likely to employ nannies. I also presented a talk at a Nanny Fair attended by sixty nannies from several states along the eastern seaboard Eventually I taught a five-session course on child development, but to a class of only three nannies. It was evident that, though there might be a need, there was little demand for what we were offering. Looking back, we probably underestimated the effect of the anxiety and guilt parents naturally feel at leaving their children in a nanny's care. Most parents may need to deny that their nanny requires any training. Certainly it seemed significant that we failed to elicit a single request for further information from parents with nannies.
However, we did hear from a parent who, after reading one of our brochures in a doctor's office, suggested to the board of directors of his child's day care center that we might offer some training to their staff. I had anticipated that eventually we would include day care providers in our program, as they have an impact on many more children than do nannies. At that point we decided to make them the focus of our attention.
Since changing direction two years ago, we have provided training sessions to 232 day care center teachers, aides, and directors. Our efforts were assisted by a grant from the Maryland Child Development Office and by our decision to offer continuing education credits to providers from Maryland. Randi Finger, Denise Fort, Alicia Guttman, Joan Liebermann, Maryann Vandeloo, and Camille Woodbury all volunteered their time to speak on such topics as Working with the Difficult Child, Kids in Crisis, Improving Communication (with parents as well as children), and Sexual Play. On occasion we used Stan Greenspan's “Floor Time” video as a starting point for discussion. The workshop on sexual play led to a miniconference, held in October 1994, on “Understanding Sexual Play among Preschool Children.” Judy Chused and Howard Benensohn spoke on the topic to forty-four enthusiastic and highly engaged day care providers. We then broke up into small groups in order to provide participants an opportunity to discuss their specific needs and apply what they had learned. We were impressed by how thoughtful and concerned many of these people were about the children in their care. They asked difficult questions and did not hesitate to reveal their own discomfort regarding children's sexual play. Given the nature of the topic, it seems likely that our audience was self-selected for openness of mind. Having dealt with sexuality, we went on to address aggression at a conference held in September 1995. Judy Chused spoke, along with Dominic Mazza, on the topic “Understanding Aggressive Behavior in Preschool Children.”
We charge ten dollars or less for workshops and up to thirty for the miniconferences, with proceeds going toward the costs of the program. All of the mental health professionals involved volunteer their time.
What effect our training sessions have on day care center staff remains unclear at this time. The evaluation forms that participants complete at the conclusion of each training experience have generally been positive. Often I have been touched by the eagerness of our participants to learn something new they can apply to difficult and at times harrowing situations. As one indication of our effectiveness, we have had several requests for consultants to go out to day care centers to provide additional training and consultation. We know of at least one instance in which a gender-disordered boy was referred for analysis. However, we do not know how our participants apply what they have learned. I have begun to consider employing some simple research instruments to help us understand the nature of the learning that goes on at our workshops and conferences.
The idea for a School Consultation Program was first proposed by Toni Hani, who was then chair of the child analytic faculty at the Washington Institute. He asked me to organize a preschool consultation program with the help of Stan Greenspan, who had volunteered his time to start the program. I was delighted to become involved, for many reasons, not the least of which was the opportunity to work with Stan. My own child psychiatric and child analytic experience in evaluating and treating preschoolers was sparse, and I relished the opportunity to work with someone as expert as he.
The first task was to become educated about preschoolers. Stan knew the director of a local preschool, and I started spending some time there observing and consulting. I would evaluate the children as best I could and then consult with Stan. We did this for about four months. When I felt more comfortable and knowledgeable, I tried to find preschools and nursery schools that desired psychoanalytic consultation.
What a shock! I found the community cautious, to say the least. When I mentioned psychoanalysis, I was asked if I saw children on couches. Indeed, the “P” word was heard only with fear and suspicion. I began emphasizing the developmental aspect of my work rather than the psychoanalytic. I could at least establish myself as someone who saw things as they did It was discouraging to learn that there were preschools that had no interest whatever in having child analysts as consultants, even pro bono as a community service. They were fearful about psychoanalysis, fearful about our motives, and protective of the children. Many, of course, had heard of Stan, and that was often helpful in overcoming their apprehension.
In meeting with the schools, I emphasized our developmental approach, our experience and
training, and our interest in providing community service. I explained that for any consultant to be truly useful to a school, a long-term commitment would be needed to develop knowledge of the school and a feeling of mutual trust. Within this framework, the consultant would give a specified amount of time — usually an hour and a half every other week on a regularly scheduled basis. I also told the schools that our consultants would be there for them, available for any tasks the school might deem worthwhile. The consultant's activities might involve meetings with individual children, meetings with parents or teachers (either individually or in groups), or classroom observation.
Within a short time, five schools were involved, all preschools. As time went on, we became involved with elementary, middle, and senior high schools as well. Participants, past and present, include Howard Benensohn, Ira Dosovitz, Carla Elliot-Neely, Randi Finger, Denise Fort, Paul Prunier, Joe Silvio, and Camille Woodbury. Stan remains available as a consultant. Our growth has been limited only by the interest of child analysts.
Looking back over the past year at the school where I consult, I see a fascinating mix of problems and challenges. Most commonly, there are children with difficulties in class — inattention, hyperactivity, aggressivity, learning difficulty, depression, etc. Usually I conducted an in-class evaluation. I would observe the child in the preschool setting, often talking and playing with the child while juggling three other children at the same time. Any history was obtained from the teacher. I then shared with the teacher my idea of what the problem was, and suggested possible interventions within the classroom and with the parents. When the teacher felt it necessary, I met the parents. Parents also know that I am at the school at certain times on a regular basis, and it is not unusual for them to come in and consult with me about concerns they may have, child-related or not. At times I was called on to meet with groups of parents. These meetings ranged from didactic sessions to group discussions. One such meeting this year involved a six-year-old boy who was sexually abusing other children. The parents of the children involved were concerned and angry over the way the director was handling this difficult problem, and the director had asked me to meet with them. It was a most challenging situation: the director wanted to turn the meeting into a didactic session led by me, while the parents needed to vent their frustration and anger.
Through the help of Joe Silvio, the School Consultation Program expanded in yet another direction. Joe's sister worked within the Washington public school system and provided contacts that enabled me to arrange two “peer supervision” groups for public elementary school counselors. Paul Prunier has led one of the groups, and I the other. My group has been meeting once a month for the past three years. Virtually the same eight to ten counselors have participated from the beginning, which suggests the value the group has for them. The group has been especially interesting for me, in that I hear about the mental health problems of children with difficulties I might never see in my office. I also gain a deeper appreciation of the difficulties faced by children and schools in the effort to educate. These counselors bring to the group their unique perspective—a view of the dynamics of the parent-teacher-child-classroom-school system. The group has allowed us to develop and use this perspective for understanding further the problems counselors face.
Another component of the School Consultation Program is a course, entitled School Consultation and Child Evaluation, offered as part of the curriculum at the Washington Institute. Through the years, this course has evolved into a peer supervision and support group that participants have found helpful, educational, and collegial. It provides an opportunity to meet with colleagues in the consultative trenches and to share experiences, problems, and interesting vignettes about our forays into consultation.
All in all, the School Consultation Program continues to blossom as it enters its fifth year. Participants work hard, and the program as a whole represents several hundred hours a year of community service. We have had an opportunity to learn from the many children we see and hear about, and to become involved in challenging social systems quite different from that of our private practices.