Analytic Service to Adolescents Takes Psychoanalysis to the Streets

Three and half years ago when the social worker I was supervising in the Chicago Institute Psychotherapy Program asked if I would be willing to visit the alternative high school where he worked, I reluctantly agreed. “Geez, I'll have to change my Wednesday patients and schlep all the way out to Cicero,” I said to myself. Morton Alternative School (MAS) was just beyond the west side of Chicago in Cicero. Forty students were placed there having been expelled from the two regular high schools, usually for violent and gang related behavior.

During that visit I met with the school principal, teachers, and staff and also sat in on one of the student groups. At the end of my visit, Dave Myles, the social worker, along with the principal, Rudy Hernandez, thanked me for coming. “No,” I quickly said, “thank you for inviting me.” I asked if I might come the following week. They agreed. The following week I asked if I might come just one more time. Soon my Wednesday morning patients were permanently rescheduled. I have been “schlepping,” no, racing out to MAS every week ever since.

What happened was that I immediately fell in love with the kids, the principal, teachers, and parents. On the one hand, I heard horrible stories in staff meetings and in the student groups. One student had been walking out of his house a few months earlier, was shot four times and miraculously survived. Another, after being kicked out of her house by her mother, began cutting herself regularly. One student, when I asked why he had written, “Forgive me,” in gang script on his notebook, said quietly, “Because of all the bad things I have done.” One parent sadly reported to me that he was trying to be more involved with his son, “but the gang is pulling him away from me.”

But what hooked me about each of the students was that in school, in the one safe, reliable, and predictable place in most of these kids' lives, they were just kids! The bravado, the gang related aggression and protective behavior seemed left at the security door each morning. Once inside, they were just kids and in so many ways no different from my own—wanting to be listened to, understood, having aspirations and longings, and just trying to be, well, teenagers.

But what hooked me about each of the students was that in school, in the one safe, reliable, and predictable place in most of these kids' lives, they were just kids!

Back in the 1960s Martin Luther King marched through a mostly white Cicero to protest racist housing and school policies and was stoned. Today Cicero is mostly Hispanic and economically poorer than it was back then. Gang violence on the streets and in the schools—including the elementary schools—remains alarmingly high. I became aware of the brutal statistics confronting these kids and educators trying to help. As reported by the Children's Defense Fund , every day in America: 2,861 high school students dropped out of school; 7,883 children were abused or neglected; and 5 children under the age of 20 committed suicide. Every second, a high school student was suspended; every 9 seconds, a high school student dropped out; and every 37 seconds, a child was born to a mother who was not a high school graduate. Moreover, 1 in 3 children was at least one year behind in school, and 1 in 8 children would never graduate from high school.

For Latino children the numbers are more dramatic. Every day in America for Latino children: 751 were born into poverty; 1,005 babies were born to mothers who were not high school graduates; 2,357 public school students were suspended; and 561 high school students dropped out. Every day!

Tragically the internal worlds and the everyday lives of these kids create endless obstacles. Depression, anxiety, anger, and, maybe the worst of all possible feelings, hopelessness and cynicism, were rampant in the school—for students and staff. I quickly witnessed Myles, maybe the most trusted adult at the school, gaining access to their inner and interpersonal worlds. And in a relatively short period of time, the kids in one of his groups allowed me access as well. Myles would introduce me as, “Dr. Smaller, he's in my club [gang] downtown,” and that was enough information for them. By the second year, I was sometimes referred to as “Dr. Walkaway,” a reference to an ongoing discussion about “walking away from a confrontation,” while maintaining respect.

Over a number of months, Myles and I discussed the idea of creating a program that would allow some of the most severely troubled students to be seen individually and more intensively. I would try to raise funds to hire an additional social worker to work with students and another to work with their families. We would offer home visits since parents often did not or could not make it into school for meetings.

I kept thinking about how many years before at the University of Michigan I had heard Selma Freiberg remark in front of a large audience, that although she had become a psychoanalyst, she, of course, still did home visits if she thought it was indicated. And, certainly, August Aichorn's application of psychoanalytic ideas to his work with Vienna delinquents back in the 1930s was on my mind.

The Analytic Service to Adolescents Project (ASAP) was born through these discussions with Myles, Marty Laub, the head of development at the Chicago Institute, and also the Institute Committee on Multi-Cultural Issues. We saw an opportunity for our institute to provide not only an innovative service to the community but also to learn about the world of this community and, with proper evaluative tools, describe the impact of applied psychoanalytic treatment. If successful, why not replicate it in other schools? Laub and I began informal discussions with a foundation that might provide support.

Unfortunately the most resistance to the project came from some faculty at our institute. Was this the proper use of psychoanalytic ideas, the institute, the staff? Were we putting ourselves in legal jeopardy? These were dangerous kids! Would we be paying social workers too much by offering $50 or $60 an hour?

Our concern for these students and the committed principal and school staff facilitated perseverance regarding the institute resistance and prospective funders. Even after being turned down once for funding, we resubmitted and finally received a $20,000 grant from the Arthur Foundation. With that support, I was able to raise another $8000 from an individual donor and from our own American Psychoanalytic Foundation.

We completed our first project school year last June. Of the original six students, five remain in school with one to graduate in December. One student was ultimately expelled but was replaced with another who returned to school this fall. All 40 students were given a depression and anxiety scale test at the beginning of the year and at the year's end comparing the impact of the intervention on the six project kids to the larger group. All 40 students scored beyond the most severe levels of depression and anxiety in the pretest, but slightly improved over the course of the year. However, when the six students who received individual treatment were compared with the larger group, these students' levels of depression, anxiety, and stress were significantly lower by the year's end.

We also learned that home visits were not necessarily the answer. Parents in this community are reluctant to have a home visit out of anxiety that something more of the family life will be exposed. Also, a visit from someone at the school evoked anxiety and concern about being criticized for parenting. We have made adjustments and have more to learn in our second year.

In our site visit last spring from the Arthur Foundation by the foundation president and a member of the Grants Committee (a former Berwyn mayor and Cook County judge) the project was significantly praised. For me the highlight of the visit and our first year was when one of our students, in front of the site visitors, spontaneously said, “This [group] is a place where you can get things out but not like with friends…. It's where people care about what you are going through. And that's helped me control my temper. It used to get me into trouble. Now I just can't wait to graduate.”