Kimberlyn Leary has made significant impact on our field by addressing the intersection of psychoanalysis and sociocultural issues as a clinician, researcher, author, political appointee, professor, and most recently as senior vice president of the Urban Institute. As far back as the 1990s, Leary wrote and thought meaningfully about race, gender, culture, and class when few psychoanalysts were engaging these topics and many dismissed them as “not analytic.” Earlier this year, she agreed to spend some time with me over Zoom to discuss psychoanalysis and the diversities.
Justin Shubert: This year, in response to larger events in our country and the world, psychoanalysts have been talking a lot about race and sociocultural issues. How do you feel our field has grown in our sensitivity to issues of diversity?
Kimberlyn Leary: Psychoanalysis has consistently expanded its capacity to ask a broader set of questions about, as Anton Hart puts it, the diversities (not just diversity, but a broad range of diversities). Along with asking those questions, there's been some success at bringing new voices into psychoanalytic conversations, including by inviting people from outside of psychoanalysis to be in dialogue with analytic clinicians. And I think that's all been very affirmative.
In most ecosystems, the murder of George Floyd was so stark and shocking even though similar events have happened hundreds of times before. This time, Floyd's death was galvanizing and became an inflection point. One result is that psychoanalytic communities have engaged in broader dialogue without insisting that the conversation fit our psychoanalytic defaults. This has been the most promising trend I've seen. Not just rereading race, diversities, racial justice, and equity through a psychoanalytic lens but actually allowing new information to penetrate the field.
With attention to social justice, people are saying, “We want systems to change. It's not enough just to recognize disparities; we want interventions to change them.” So that's something I hear in almost every forum I'm a part of. An impatience with talk alone. Although talk is clearly necessary.
JS: When we see patients in our consulting rooms we are focused on affecting the individual in front of us, but as psychoanalysts we also have the ability to affect larger systems — certainly psychoanalysis but maybe even systems more far-reaching than our own. What do you see in terms of our opportunity to affect bigger social structures?
KL: For that opportunity to be leveraged, we have to better understand systems. Some psychoanalysts study systems theory, have a background in studying organizations, or work in a consultative capacity with companies. So there are experts among us. We can all be experts, I suppose, in our local systems, but large scale systems change is something people have to learn about if they want to change a system at scale. I've spent years talking with people and working with organizations, mayors, and other institutional leaders. Most don't know much about psychoanalysis and most are not particularly interested. You can use an idea from psychoanalysis, or even a way of thinking about challenges, but they will only listen if that idea helps them make progress on their problem.
It used to be the case, far less now, that we treated psychoanalytic ideas as pristine. A good deal of effort went into preserving them, almost in amber, before we could use them. Now people are interested in how we can hack things: You take a piece that works and you see where it opens up, in our case, a conversation. For example, I use the metaphor of the third ear all the time and people understand it. I talk about things that are implicit, and things that are unconscious, and how the past and history influence the present. At times, I've even figured out how to talk about projective identification in ways that make it semi-user friendly. That's where maybe you sacrifice some fealty to the original concept, but you engage a larger group of people in problem solving, and I think there's value to that.
JS: What are some ways individual psychoanalysts can get more involved in affecting larger systems?
KL: First, become involved in those larger systems. Sometimes we see ourselves as experts because we are experts in psychoanalysis, and so we imagine we should be invited into a system to consult. And sometimes we are. But being a part of a meaningful movement in a community—going to the local meetings, putting in the time and talking to people—that's the way to build trust.
Kimberlyn Leary, Ph.D., MPA, is associate professor of psychology in psychiatry, Harvard Medical School/McLean Hospital; associate professor, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health; and lecturer in public policy, Harvard Kennedy School.
Justin Shubert, PsyD, PhD, is a psychoanalyst in Los Angeles. He is the co-founder and former co-chair of the Committee on Diversities and Sociocultural Issues at the New Center for Psychoanalysis and chair of APsaA's Committee on Gender and Sexuality.
Want to get involved in systems? Find ways to engage people in conversations and to listen. And psychoanalysts do that pretty well. We listen pretty well. So we can use what we know.
JS: Our field has historically been so homogenous. How can we make psychoanalysis more accessible to both patients and prospective candidates from different backgrounds?
KL: It's not all economics. Often there's a somewhat biased assumption that the reason we don't have candidates of color or patients of color is because of the fees. Now that's not untrue in many instances, but it's not the only reason because there are plenty of people who have money who are from a variety of cultures and backgrounds, and they don't come to see us either. I think part of it is how we are perceived, not always unjustly.
The Michigan Psychoanalytic Institute did some things really well. One was to create liaison committees to different communities. This was the brainchild of Marvin Margolis. The purpose of the initiative wasn't necessarily to try to attract candidates and patients. Or maybe it was, but over the long term. The proximate goal was to get into conversation with people. How do you find out what's meaningful to the Arab community in Detroit? How do you understand the Black community in Ferndale? And how do you get to know the organizations that are speaking for those communities and join in? It led to some wonderful things. For example, I took an extension division class at the Michigan Institute with a Black Studies professor from the University of Detroit and Mel Bornstein, a psychoanalyst; we all read the same texts but they looked at them in different ways, and it was a way of engaging in meaningful cross-talk. That's one way to do it.
A number of institutes are experimenting with a third case being a community case. I've had the privilege of consulting with institutes that are thinking about taking the architecture of psychoanalytic training and tweaking it. One way is to allow the candidate's third case to be based in a community setting, but have it count fully to training hours. No one is asking you to do something extra; that's your case. It's not easy to do because you have to have a lot of organizational change behind it. Other institutes have looked for health or public initiatives that are happening in their cities, for example, like ThriveNYC, and tried to figure out where they can plug in and be helpful.
One big challenge for us is that psychoanalysis is not organized. In some ways, it's really a confederation of small business owners. Some can afford to or are willing to have sliding scale fees and some are not. And again, that's only going to solve part of the problem. Some analysts are willing to work in ways that are more open and connected to the patients' preferences. But there's no silver bullet. Instead, you have to figure out ways to be in conversation with people who are doing work to promote equity, while being really humble about our struggle. But also being clear about the value we
KL: Yes, I think it is. But there is some capacity that's growing. And I always think that, genuinely, psychoanalysis has a case of itself changing that it ought to be proud of: the way analysis has changed at the theoretical, organizational, and clinical level with respect to LGBTQ+populations. Though imperfect, there's a story of success and a story of needed ongoing work. I was Program Committee chair for three years a while back. There are successes when you look to the APsaA program, which reflects increasing diversity about who is invited to speak. The tricky thing about success is that you don't want to say, “Oh look we've done it! We've had five Black people presenting at the winter meeting.” That's not what I mean. But it's giving people a sense that this unfamiliar work, of advancing equity—it turns out they're already doing it. These uncomfortable conversations—they're already in them.
JS: That's important to be reminded of. I suppose we each have our own ideas about what success or progress will mean for our field in the future. What is your hope for psychoanalysis?
KL: I see some of my hope actually being realized right now. My hope is that organizational change continues to open up opportunity. I see some of that happening, whereby it is a little less complicated to learn about psychoanalysis. There are pathways to learning as a fellow, an associate, or as a candidate. I don't think that being a candidate should be the end-all be-all. But the way the system is constructed, training analysts need candidates, so there's a financial incentive to focusing on candidacy.
I've been proud to watch young candidates of color I know around the country who are themselves. They show up as they are to psychoanalytic meetings and they speak their minds more often than in the past. I think there's more awareness among some of the senior people that they aren't driving the show in quite the way they were before. And that they don't need to. I've been pleased to watch these young, talented people being themselves as they undertake analytic training.
JS: And there's room for them to do it?
KL: Right, in certain places in this country, in certain institutes there is room. But I want more of that. That's what I would like—more of that. And that depends on all of us.
Years ago, one of my Michigan instructors, Barnaby Barratt, was working at a hospital in Detroit on a non-psychiatric medical unit. He helped the medical teams understand the whole patient, not just the organ system that had failed or was being repaired. He used all his psychoanalytic acumen and even psychoanalytic language to do it. But he did it in such a way that he was attuned to the problems of the unit. The medical team came to think that psychoanalysts were especially helpful people to have around. When Barratt left, the team wanted another psychoanalyst. I think the goal has to be to meld skills and utility: “I've got skills but what do you need help with?” Maybe you need help with just getting the office organized, and while you're helping them to organize the office you're talking to people.
JS: To be humble rather than coming in as the “expert.”
KL: The most important experience I had in that realm was when I was at the White House Council on Women and Girls. We wanted to do something that would be meaningful at scale, that would, in fact, affect millions of people. That's the power of the federal government. And there were a variety of options, but you could also make the wrong bet. So we spent a lot of time engaging with communities and with people who had lots of ideas about how we could beneficially affect women and girls of color. We didn't come in with our ideas alone. We spent time asking communities: “What do you see as the greatest need, and what could we do in order to make a difference?”
One of those listening sessions was with adolescent girls who were 13-17. And unlike most settings, where you have a representative token kid, and you turn to them for a representative token opinion, this listening session was made up entirely of Black and Brown girls. The audience consisted of philanthropists, city leaders, and White House officials. The event was organized for the purpose of having us just listen to the girls. We weren't even permitted to ask them questions. It was incredible because their stories and testimony gave us a window we would not have had if we were busy with our questions, trying to get confirmations of our existing ideas. Instead, we had the opportunity to learn and that experience shaped the portfolio of the work I did in the Obama White House.
Want to get involved in systems? Find ways to engage people in conversation and to listen. And psychoanalysts do that pretty well. We listen pretty well. So we can use what we know.
think we can add to a conversation. We have a whole literature of “othering” that is incredibly helpful in making sense of racial injustice. It's just that we may not always be in the lead, and that is hard sometimes for analysts, to not be in the lead. But we have a lot to contribute if we're willing to be in collaboration.
JS: Right, it seems so simple when you say it—that we need to join, listen, and offer our skills when they can be helpful. This is just what we do in our clinical work actually, but it's harder for us to engage on a larger scale. Gathering analysts with the willingness to tolerate the anxiety of joining other systems can be challenging.