Imagine this scene: it is the end of the last class of the last quarter of the last year in the institute's curriculum. The candidates are excited, proud, relieved, and also a bit leery. How will they synthesize their analytic identity? Will psychoanalytic practice prove viable? The instructors have tried to address some of their concerns through a newly minted course, “Applications of Psychoanalytic Thinking in the Community.” The students' verbal feedback begins with a most satisfying statement: “For the first time in my training, this course helped me think about the future.”
Why place such a premium on the future? To say the obvious, times have changed Inroads by managed care and governmental regulation cause today's graduates to be particularly mindful of what it means to be an analyst. The tasks of professional individuation have shifted. Honing one's grasp of theory and technique no longer necessarily confers a thriving analytic practice.
In contrast to past convention, analysts want to step out from behind the transferential screen to offer the public the best of psychoanalysis. This has broadened the opportunities for analysts to use psychoanalytic resources that will increase public understanding. Prior issues of TAP and meeting programs over the past ten years underscore the burgeoning interest in analytic practice outside the consultation room. As APsaA past president Bob Pyles said, the American “has become both a profound voice for patient advocacy and a potent force for social change.”
Why not incorporate the American's developing external vision into the Topeka curriculum? Stuart Twemlow and I set out with two objectives: to demonstrate alternative analytic career choices, and to examine how traditional psychoanalytic practice can morph into new dimensions without compromising analytic values.
Via teleconferencing, an analyst expert on a particular kind of outreach joins each class. We prepare by reading papers describing the expert's work and discussing our questions prior to the teleconference. With the guest analyst “in the room,” we probe for the analytic inferences and principles underlying community interventions. We discuss the challenges in launching programs and tailoring interventions; we review outcome data. After the guest analyst signs off, we rehash the discussion with particular attention to how the interventions converge or diverge from the inference-making and interpretation of clinical psychoanalysis. We also examine the analyst's role relative to other professionals and concerned citizens.
A brief description of the topics addressed by guest instructors illustrates the range covered by the course. Jonathan Cohen of New York City presented research demonstrating how “the first ‘R‘” in learning is for “reflective capacities.” Through the Center for Social and Emotional Learning, Cohen consults internationally regarding the efficacy of the 300-plus curricula for emotional literacy currently available. Carole Kusché of Seattle elaborated on one such empirically validated curriculum: PATHS (for Promoting Alternative THinking Strategies) [see “Using Analytic Knowledge to Teach Emotional Literacy,” TAP 33/1]. She graciously made available examples of grade school assignments and lesson plans for review as she discussed the underlying “affective-behavioral-cognitive-dynamic model of development.” The tangible access to educational materials, as well as the analyst behind them, made the concepts and — more importantly — the feasibility of community intervention come alive.
Sallye Wilkinson, Ph.D., is an instructor at the Topeka Institute for Psychoanalysis and the Menninger School of Psychiatry.
Violence also begs for analytic understanding, and several classes are devoted to facets of that topic. An analytic point of view can go far in helping enforcers of the law to function more reflectively and actively as peacekeepers. Similarly, intrapsychic and intersubjective facets of the perpetrator's psyche, as well as dynamics that may unwittingly encourage violence within the community, can be plumbed through analytic examination. [See the report on the American's public forum on youth and violence on page 16 and the APsaA's position statement on the problem of violence on page 17.]
Walt Menninger of Topeka shared how he has bridged the great divide between the action-oriented, adaptively paranoid, take-care-of-business style of police officers and the reflective, relatively emotive predilections of an analyst. For more than thirty-five years he has helped local police officers anticipate tahe psychological challenges of their work. As a result, the rate of “burning out” (e.g., through suicide, addiction, spousal abuse, etc.) after the deadly shooting of a suspect has dropped to zero.
James Gilligan (Boston) offered a comparable analytic perspective on the interactions of shame, violence, and recidivism. His psychoanalytic conceptual tools are actively sought both at the highest levels of U.S. government and internationally.
Stuart Twemlow (Topeka) has developed a method of assessing violent milieus that has been successfully applied to public schools, city council squabbles, and stabilizing whole communities. In essence, Twemlow and team cause identifications with the bully, victim, and bystander to become dystonic, thereby empowering students, teachers, politicians, administrators, and citizens to contain malevolent impulses for the greater psychological health of them all.
Vamik Volkan (Washington, D.C.) has elevated psychoanalytic understanding resources to the global level. His formulations about how “chosen traumas” and “chosen glories” become a litmus test for large group identity could only be generated by a creative psychoanalyst.
Other aspects of community life also benefit from the use of psychoanalytic understanding. Alan Felix (New York) explained how a “critical time intervention,” based on Mahler's theory of separation-individuation, dramatically reduces the incidence of homeless men returning to the streets [see “Treating the Homeless Mentally Ill,” TAP 31/2]. Salman Akhtar (Philadelphia) shone light on the profound challenges to one's identity created by immigration: Familiar clinical foci, such as the Oedipus complex or use of self objects, take on particular meanings given the exigencies of first-, second-, and third-generation immigrant family life.
Mark Smaller (Chicago) coached the class on disseminating information. He threw the doors wide open to the world at large with extremely practical guidelines for collaborating with the media. Further, he underscored the win-win experience inherent in sharing psychoanalytic understanding resources with the public.
I engaged the class in working from the ground up to create an interactive children's museum for mental health. This would be accomplished, first, by helping representatives from the community's stabilizing groups (e.g., education, law enforcement, religion, and social services) to examine how they contribute to the internalization of social responsibility. The second step, creating interactive “exhibits,” would be icing on the cake for this exercise in community reflection.
In the future we will bring to class what we have learned as executive committee members of Topeka's Healthy Community Initiative. This effort, led by Twemlow, seeks to unearth unconscious factors that hobble the psychological well being and prosperity of our town.
In addition to our guest faculty, the encouragement of Bruce Sklarew, chair of the Committee on Psychoanalysis, Community and Society, and the foresight of Bill Jeffrey, past TAP editor, and interest of Prudy Leib, current TAP editor, have been a steady backdrop for this educational effort.
A time-limited discussion group to explore how applied psychoanalytic courses could be added to curricula around the country is being planned for coming meetings of the American. Interested parties should feel free to contact Sallye Wilkinson for details on time and place at .