I began consulting in preschools in the San Francisco Bay area about eight years ago. I was giving two hours of my time (pro bono) to a local preschool on a weekly basis. Over the years, I also supervised one or two of the interns assigned to other centers. During the years of my consultation to the preschools, I became interested in setting up a therapeutic preschool. In working with preschool directors and early childhood educators, I learned of their strong feelings about mainstreaming problem children. Therefore, rather than moving toward setting up a traditional therapeutic nursery school, I gradually began thinking about the therapeutic classroom model: a therapeutic classroom environment that supports the social, emotional, and cognitive development of children.
As the concept of the therapeutic environment in the classroom took form, it seemed clear to me that teachers played a pivotal role in this theoretical model. In other words, teachers are conceptualized as an auxiliary ego for the personality development of the children, i.e., an extension of the parents.
A grant from the Miriam and Peter Haas Foundation three and a half years ago made this model a reality, and a site was chosen for the project, the Burnett Child Development Center. The community is located in a highly industrial area, and although it has some of the most beautiful vistas of the area, the neighborhood has been physically, economically, and geographically marginalized. Of the community's 28,000 residents, 64 percent are African-American, 19 percent are Asian/Pacific Islanders, and 9 percent are Hispanic. These numbers represent 4 percent of San Francisco's 750,000 people. Unemployment among African-American males between the ages of eighteen and sixty-five was 62 percent when the project was conceived in 1995. Single mothers were in charge of 30 percent of the households. The average household income was more than $14,000 lower than the citywide average, and 40 percent of the families were receiving AFDC. This high-risk community was chosen because of its strong need for mental health services.
The Burnett Child Development Center is licensed to serve 270 children: 120 preschoolers and 150 children who are bused to the Child Development Center after school. The project is designed to serve seventy-five preschoolers. The grant has allowed for some ancillary services for the fifty children in the after-school program.
There were many challenges in implementing this project. Most important was the building of a relationship with the San Francisco public preschools. The collaboration between the San Francisco Psychoanalytic Institute's Child Development Program and the San Francisco Unified School District was a venture into unfamiliar territory. Having traveled across the world from one culture to another, I thought traveling across the city of San Francisco, between San Francisco Psychoanalytic Institute and the Burnett Center, would be a walk in the park. However, crossing the boundary of race and class proved very challenging—and yet, in the end, rewarding. As an outsider, I needed to take time to learn about the centers culture and its community's preconceived notions of psychoanalysis.
My primary goal in the beginning of the project was to develop a relationship with the director and the teaching staff. To that end I sat in the three preschool classrooms observing the children and the child-staff interaction. It quickly became apparent that the staff held the children at arm's length. I was surprised to realize they didn't even call the children by name. Most of the interaction was disciplinary in nature. The children spent anywhere from five to nine hours at the center and were taught by a morning and an afternoon staff. Sometimes there were as many as four different teachers during one day. It wasn't unusual for a child to be put down for a nap by one staff member and be wakened by another. In brief, the chaos of the children's experience at the center seemed to mirror the chaos and unpredictability in their family lives.
The overwhelming task of working with seventy-five children (three preschool classrooms, twenty-five children per classroom) and their families, along with twenty to twenty-five staff members, was made possible with the hiring of a mental heath team. The team consisted of a child psychologist (working sixteen hours per week), a social worker (eighteen hours per week), and a consulting teacher (eighteen hours per week). I spent two mornings a week (six hours per week) at the center. After the initial six months, most of my time was spent in supervision. On a weekly basis, I supervised the on-site social worker and the child psychologist. I also meet weekly with the principal and with a group of the teachers.
The entire staff participated in monthly Saturday workshops in which the entire mental health team was present. We used these workshops for didactic seminars on child development and mental-health perspectives. The teaching staff was paid a stipend for attending the various training meetings. In the various staff training formats, the teachers learned and came to appreciate the following psychoanalytically informed principles:
Learning occurs in the context of a relationship.
If the emotional basis of learning is addressed, the cognitive learning is promoted.
Behavior has meaning.
Attempts to understand the child's behavior are the key to helping the child improve problematic behavior.
Once a child was identified in the weekly classroom meeting and presented at the weekly case conference, he or she would then be referred for an assessment by the mental health team and subsequently be assigned to an intern for individual and family therapy or referred to playgroup therapy. It was alarming to hear about the recurrent trauma and loss in the children's lives. Trauma, as we are accustomed to it as psychoanalysts, seems to be an ongoing experience. Over time, as I got to know the teaching staff individually, I was impressed with the frequency of traumatic experiences in their lives. It seemed clear the teaching staff's detachment and avoidance of any emotional connection to the children was a defense
Shahla Chehrazi, M.D., is an associate clinical professor of psychiatry at U.Cal.–San Francisco. She is clinical director of the Therapeutic Classroom Project and has a private practice in child and adult analysis.
against the children's overwhelming neediness. The staff's daily exposure to the intense primitive longings and affects of the children is indeed anxiety provoking. At times, I went to the playground or the classrooms during my visits and made a point of learning each child's name and addressing him or her by name.
In the second year of the project, we instituted daily small group meetings, which met fifteen minutes every morning. The goal for this small group, consisting of eight children and one staff member, was to greet every child by name, focus on staff-child interaction, and develop a sense of belonging within the small group. These attachment groupings are called social skill groups. As the teaching staff felt acknowledged and supported by the mental health team, they were then able to acknowledge and support the children emotionally.
Weekly parent support groups and monthly family recreation nights were additional unique features of the Therapeutic Classroom Project that promoted a sense of community between the teacher and the parents. We were able to observe how the intensive training of the teaching staff, along with the mental health services for the children and their families, strengthened and improved the quality of caregiving both in the classroom and at home.
This year, based on the success of the project, we were able to obtain a second grant to replicate the project at a new site through the City and County of San Francisco. This second project includes an additional seventy-five children and their families from the same community.
Our experience with the therapeutic classroom project demonstrates that psychoanalysis has a great deal to contribute to early childhood intervention in a high-risk community.