IN THE HEYDAY of psychoanalysis's popularity in the mid-20th century, pronouncements by analysts were taken as the final word on what was happening in the mind. As the new millennium approached, some leaders urged modesty about its claims. “Complacency has become more difficult for us, and modesty more seemly,” said Edward Weinshel looking at our discipline in 1991. This caution is more apt than ever as psychoanalysis increasingly grapples with the world outside the psyche and the office—what is referred to with the broad term “Social.” How prepared are we to take on this realm? Although Freud speculated broadly about group and societal phenomena in his later years, he did not provide much theoretical structure. Most mental health training omits formal attention to social phenomena (except social work, where training often includes systems awareness and community engagement). For many of us, this is new territory.
Psychoanalysis has historically shown animosity to individuals who proposed ideas about the Social. Psychoanalytic leaders in the mid-20th century, concerned about codifying and regulating a new profession, felt a need to protect the field from any dilution of its intrapsychic self-definition. Dissenters were ignored or excluded. Many of the prejudices and caste elements of society were repeated in psychoanalytic organizations. Fortunately, we now acknowledge that the individual is embedded in multiple layered and overlapping social systems. Organized psychoanalysis has recognized embedded biases like racism and homophobia. In the intellectual realm we see a need for learning and training about social phenomena. IPA, APsA, and component societies are making active efforts towards inclusion and curricular recognition. The Social is with us. But what is the Social?
The Social is complex. The individual interacts—both externally and intrapsychically—with a range of social groupings: dyad, family, small group, organization, class, religion/race/ethnicity, political party, culture, and society. Any or all of these may bear on a particular moment or ongoing phenomenon. For example, one or more of these may be salient in a treatment encounter. Or in our organizational membership practices. We can also identify psychosocial themes that cut across these levels: violence, racism, power, or leadership, for example.
To understand and intervene in these dynamics, psychoanalysts can contribute in three areas: (1) social psychoanalytic theory, (2) community psychoanalysis, and (3) social advocacy. What I discuss here are distinctions among these three realms of the Social in psychoanalysis—theory, application, advocacy.
Psychoanalysis is moving into an exciting, challenging era, melding our historic focus on the psychological, subjective insides with this newer recognition of the individual's social context. In this move, with modesty in mind, we can look to neighboring social science disciplines—social psychology, sociology, anthropology, political science, history, and economics. We don't have to reinvent a special psychoanalytic Social. But by virtue of psychoanalysis remaining largely outside academia, it offers a unique capacity for breadth and synthesis. We can develop a “psychosocial analysis.” It will be a more responsible, powerful, and precise discipline if we keep in mind the distinctions, the sorting out, that I will present.
I suggest the term social psychoanalysis for our theory models of multiperson phenomena and their connection to the intrapsychic. Here's a familiar example at the level of the dyad: transference. In his most definitive discussion of the idea, the paper “The Dynamics of Transference” in 1912, Freud used the term in two ways. He said that transference is the unconscious projection of past relationships onto present interactions. And, he used the term to describe the interpersonal process that goes along with this projection—the analytic situation facilitates an interaction that repeats something the patient carries inside (we now see that the therapist has a subjective contribution, too). Most other modern psychoanalytic theories have included or added the social to the intrapsychic: the ego as first mediator with the outside; object relations theory; Kohut's selfobject; Lacan's emphasis on language. Interpersonal and relational groups have made dyadic processes central to their theory models.
Social psychoanalysis is akin to theories in social psychology
or social psychiatry. Historically, Alfred Adler and John Bowl by had early experience working with delinquent youth alongside their analytic training. In their conceptual writing they were highly aware of family and peer cultural factors. They made significant contributions to analytic thinking about power and attachment, respectively. Both had a strong social emphasis; unfortunately, the ideas of both men were excluded from mainstream analytic thinking in their time. But in recent years Bowlby's attachment theory has garnered analysts' attention as research on infant-mother interaction provides understanding of children's and adults' psychology. The psychoanalytic study of power is less developed, and at a time of fragile democracy deserves attention.
Going beyond the dyad, analytic models of family and small group function again seek to conceptualize the individual psyche in processes of a cluster of other people. Wilfred Bion's Experiences in Groups provides an analytic model of processes at this level, distinguishing groups' intended functioning (“work group”) from blocked functioning (Dependency, Fight-Flight, Pairing). The study of individual-organizational function has been taken up by the Tavistock Group.
After World War II there was interest in “national character,” questioning whether there was a differential susceptibility to fascism, for example. The Authoritarian Personality by Theodor Adorno et al. in 1950 was an effort by social psychologists to identify a general personality type that would be susceptible to fascist ideologies and resulting mass movements. Erik Erikson's studies of national character and his psychobiographies of Mahatma Ghandi and Martin Luther link psychoanalysis with religion, colonialism, and historical change. Erikson's works stand as nuanced versions of what he calls psychohistory. He delineated the complexity of such studies, attending to the interwoven contributions of individual psychology, family background, social class and caste, and historical moment. More recently there have been efforts to frame racism and caste in psychoanalytic theory.
My own involvement with theorizing in the Social has involved a study of values and acculturation in a psychiatric therapeutic community. In my book The Healing Community, I developed a general model of acculturation to a special group. I began with studying how patients entering a psychiatric therapeutic community adopted its values, and how that process contributed to internal change. I supported the model with cross-cultural parallels such as “medicine societies” among the Zuni and a healing cult in Ethiopia. Terms borrowed from sociology and anthropology—“healing charisma” and “communitas”—were useful in characterizing a special sort of social-individual interplay. This was an elaboration of a theory of individual psychological influence through group action. Although my descriptions of clinical services contained helpful
“how-to” information for leaders of groups and organizations, my focus was on understanding the individual-group process and developing a general model.
Currently there is theorizing of “racial” issues in intrapsychic terms—“the social unconscious,” “Black rage” or “pathologic whiteness.” Whatever one thinks about the validity or utility of such terms, they reflect an interest in conceptualizing the psychologies involved in the “racial” division of American society. (We now understand that the term “race” has no scientific standing and is a construct of groups seeking to separate others and hold power and status over them. Hence the quotation marks.)
I hope it is clear that social psychoanalysis is an immense realm of thinking and modeling. Potentially there is cross-fertilization between intrapsychic and social theories. Psychoanalytic awareness of intrapsychic phenomena such as drivenness, ego defenses, attachment, and internal object relations can contribute to the understanding of how the individual behaves in a small group or mass situation. In the other direction, understanding from the social sciences can inform us of conditions, pressures, and attitudes that affect the psyche, and they can provide language and structure. Many of these links may be further developed, particularly border concepts that have an element of both the internal and the social like power, norms, roles, beliefs.
When we move into the action realm, we are dealing with applied social psychoanalysis. Psychoanalytic centers in Boston and San Francisco have developed community training tracks as an option for candidates. A candidate who elects this track works with the staff of a social agency, providing an analytic perspective on clients and/or staff groups. Faculty experienced in agency consultation provide supervisory backup. Learning flows up and down through this system of client-agency-candidate-supervisor. This was my own experience consulting for a community mental health agency in Palo Alto, California. I brought understanding of individual dynamics to staff groups; my knowledge of social phenomena and concepts also enabled me to provide group/social system consultation. The experience increased my skills at the organization/individual interface.
One of the key participants in negotiations between the warring parties of the Troubles in Northern Ireland was John, Lord Alderdice, a psychoanalytically trained psychiatrist and
determined peacemaker. In the rancorous process that led to the 1998 Good Friday agreement, Alderdice recognized the importance of listening to both aggrieved parties, and insisted they listen to each other. He set a frame for the often bitter, insulting, provocative conversations that was private and confidential. His psychoanalytic understanding of trauma, shame, and affect regulation informed his guidance of peace talks, and in containing continued bitterness after an agreement was signed. Alderdice understood that the injuries and passionate beliefs of both parties could not be suppressed, but that they could be contained. The peace has largely stuck.
Here is an example from my experience applying social psychoanalytic ideas to a hospital ward situation. I was assigned to be the administrator of a psychiatric inpatient unit at the National Institute of Mental Health. I quickly became aware that there was competition between the nursing staff—many of whom had worked previously on a therapeutic milieu unit where they felt empowered—and the psychiatric/psychology staff who did individual and family therapy with inpatients. Both groups felt that their mission was the most vital. This led to each group ignoring or undercutting the other. The unit had a high level of threatening and violent patient behavior; there were two seclusion rooms. Having read several studies of patient-group processes in such units, I concluded that the behavior of our patients reflected the staff schism. Like children who may express anxiety about parental strife in naughty, limit-testing behavior, the patients acted up because their staff “parents” were fighting. I instituted a system of small staff meetings focused on a few shared patients. Both groups were represented, with the goal of arriving at understanding of each patient's dynamics along with developing a working strategy together. Over a few months the unit's violence level came down, and we were able to close both seclusion rooms.
In the era when anonymity and neutrality were foremost aspects of the analytic role, reticence about political or social values tended to carry over to norms for public behavior. Analysts divided over theory models, with the divisions splitting institutes, or bringing about whole new organizations, but we did not comment as much about politics outside psychoanalysis. Now the divisive issues concern social externals like race and ethnicity. In other words, analysts are like everyone else—polarization and heated partisanship have become normal. Interest groups express their presence and expectations of inclusion and power sharing more vigorously.
Analysts have recognized the internal biases that used to justify discrimination against non-MDs, LGBT individuals, women, and nonwhites. Each of these struggles has forced analysts' attention to the impact of power differences and their roles in institutional behavior. We have left neutrality and taken sides. In a similar manner analysts have reacted to American or Israeli-Palestinian politics and violence in a split way, with some analysts identifying with one group or the other, while some attempt to mediate. Without commenting on any of the particulars in these situations, I want to emphasize that in these important controversies what is going on is advocacy on behalf of ideas, interest groups, and causes—something different from theory or application.
Psychoanalysis has benefitted from courageous advocates who have drawn attention to bias, exclusion, privilege. But advocacy carries with it the risk of spiraling into a paranoid situation where the parties are in a zero-sum trap. We know these dilemmas in the relationships of our patients, and sometimes the stuck transference-countertransference impasses of our own work. At the national and international levels we see division leading to war and genocide. Perhaps the answer comes back to Alderdice's strategy of “enforced listening.” As analysts we have developed capacities for such listening with our patients, for containing passion and delaying action long enough to absorb what we hear, and how it makes us feel. This will be important as we reexamine our governance practices, build the Social into training, and consider where it fits in the clinical situation.
A reminder of modesty. I once led a case study group in which a South American–raised therapist presented her therapy work with a patient who had grown up in France, the child of Swiss and Iranian parents. The members of my study group themselves represented more than half a dozen ethnicities and nationalities. We could, of course, do no more than touch on a few of the familial, cultural, and developmental aspects of the treatment, along with considering the unique fit of two personalities. We hardly had time to digest the role of diversity within the study group, how the cultural perspective of each member of the study group might be affecting their perception of the case. This brings us back to the modesty with which I began. Just as the psyche is infinitely complex, so too is the social surround in which we treat and discuss. The task is to heighten our awareness, and to maintain that awareness steadily enough so that we begin to intuit the most salient social factors at a given moment.
The distinction between theory (social psychoanalysis), application (community psychoanalysis) and psychoanalytic advocacy is vital. The enterprise of psychoanalysis as a field of thought, models, and theories rests on a conviction that, both clinically and theoretically, analysts move between subjectivity and a striving for objectivity. This tension is reflected in the number of theories that say that the crucial element in the treatment process is the movement between passion and reflection, beginning with Freud's recognition of transference/countertransference and the role of interpretation.
When psychoanalysts are acting politically, this distinction becomes especially important—for example, as we begin the challenging task of finding a place for the Social in our curricula. On the applied side, we need to consider how to help analytic students recognize and respond to issues of family, ethnicity, and politics in their offices. Does teaching the Social mean systemic racism, or might we teach about status, class, power, and bias as ubiquitous? Or is this advocacy in the name of theory? If this is teaching social psychoanalysis, is it the best way? Would less loaded subject matter provide wider awareness and sensitivity? If we acknowledge the almost infinite complexity of the Social, what is the best way to teach about it—recognizing that we cannot provide students with multiple PhDs?
Each aspect of the Social is important. Although sometimes more than one bears on a given situation, it will be vital to bear in mind the three different meanings of the psychoanalytic Social: theory, application, and advocacy. The Social is a challenge for psychoanalysts. At the same time, the upsurge of interest in the Social is an opportunity for enrichment of psychoanalytic theory, teaching, and action. In any aspect of our lives as analytic therapists—in our offices, in our organizations, in the community, in our political life—it is useful to keep clear which realm we are in. If we can do this, I believe that there is a greater chance that the Social will have a lasting place, and not be the psychoanalytic excitement du jour.
Richard Almond is a psychoanalyst in Palo Alto, California and faculty at the San Francisco Center for Psychoanalysis, Oregon Psychoanalytic Center, and Stanford Medical School. He founded the Palo Alto Psychoanalytic Psychotherapy Training Program.
First published online February 2025