The most recent issue of the Candidate Connection, the Candidates’ Council newsletter was devoted to psychoanalysis in the community. The new co-editors, Danielle Dronet and Valentino (Luca) Zullo, candidates from Cleveland, are the founders of Siggy's Village, located in Collinwood, a neighborhood in Cleveland. Siggy's Village offers pro-bono, low cost and/or insurance reimbursed psychoanalytic psychotherapy. They engage the local community and provide psychoanalytic ideas and therapy to adults, children and families.
As more and more social workers are pursuing psychoanalytic training, they are continuing a long and noble tradition of community clinical intervention. This type of work can take the community as a whole as the patient, building resilience in the community by developing social structure. Intervention in the community can also take the form of clinicians entering community settings to provide individual and group psychotherapy, and consultation in an institutional setting such as a school, prison, or community center, as well as in private homes. Psychoanalysts from all professional backgrounds have embarked on community work, applying psychoanalytic concepts and theory to inform their work with individuals, groups and institutions. Central to psychoanalytic principles is the understanding by our profession that the unconscious is operating in all human activity, and if unacknowledged, these unconscious thoughts can be enacted and determine ensuing events.
Psychoanalysts engaging in community intervention attempt to ameliorate severe social and psychological distress. Analysts in the Trenches, an excellent collection of papers edited by Bruce Sklarew, Stuart W. Twemlow and Sallye M. Wilkinson in 2004 contains a paper that depicts a school-based mourning project in Washington, D.C. The interventions were based on Elvin Semrad's ideas on resistance to mourning. Semrad's work with patients was informed by Freud's Mourning and Melancholia (1917). Semrad understood his patients resisted grieving by utilizing the avoidant defenses, including denial and projection, to manage their feelings of emptiness. Semrad intervened by investigating the facts of the losses, encouraging the patients to speak of their losses, and when the patients spoke lucidly, they communicated their pain without falling into psychosis.
In the school-based mourning project, the authors noticed that children living in violent inner-city neighborhoods had the same primitive defenses, and fragile ego-organization, as Semrad's hospitalized patients. The inner-city children who participated in the project came from dangerous, impoverished communities with a paucity of community supports and over-stressed parents. The children in this community had no models for grieving. Often the parents eschewed their own grieving. They believed grieving was a sign of weakness, and if they experienced their grief, it would interfere with their effectiveness as parents. Psychoanalysis provided an understanding that underlying the violence that
pervaded the neighborhood were feelings of shame, humiliation, hopelessness, and a feeling of having been “dissed.” A cycle of retaliation was the norm, where one violent act would yield another violent act to “save face” for the first victim.
The clinical interventions employed in the school were active methods such as music, drawings, drama, clay and games which enabled the participants to express their grief and eventually to articulate the feelings of loss, sadness and anger that, if left unvoiced, would be acted out in a violent way or result in depression. Eventually the children were able to verbalize their feelings about the person in their life who had died.
It is stressful for the therapist to leave the safety and containment of her office and step out into the community to provide clinical services. Psychoanalytic concepts and techniques, while demanding of the clinician, can provide a sense of control and safety in facilitating the deepening of our understanding of clinical work with distressed people in unconventional settings. The application of psychoanalytic concepts to community work dignifies all involved by acknowledging the unconscious within each of us.
I want to end with a quote from Christopher Bollas, which ran in the New York Times Opinionator section, October 17, 2015: “We all know the wisdom of talking. In trouble, we turn to another person. Being listened to inevitably generates new perspective, and the help we get lies not only in what is said but also in that human connection of talking that promotes unconscious thinking.”