Mark B. Borg, Jr. PhD, Emily Garrod, PhD, Michael R. Dalla, MA, and Jennifer McCarroll, PhD
[AUTHOR'S BIO: BORG]
[AUTHOR'S BIO: GARROD]
[AUTHOR'S BIO: DALLA]
Borg, Jr., M. B., Garrod, E., Dalla, M. R., & McCarroll, J. (2009). Can Psychoanalysis Exist Outside the Consulting Room? In B. Willock, R. Curtis, & L. Bohm (Eds.). Taboo or Not Taboo: Forbidden Thoughts, Forbidden Acts in Psychoanalysis (pp. 193-207). Madison, CT: International Universities Press.
THE PURPOSE OF THIS PAPER IS TO CHALLENGE the pervading conventional wisdom of two divergent approaches to psychological intervention by highlighting the intersecting aspects of interpersonal psychoanalysis and community psychology. In doing so, we challenge many of the common taboos of contemporary psychoanalytic theory regarding the activity of the practitioner. Such activities include that, in community practice, the practitioner is often the initiator of treatment (intervention), the practitioner participates in the daily life of the patient (community resident), and the practitioner has an explicitly didactic, educational role in addition to maintaining a traditional psychoanalytic role as facilitator of exploration. With these kinds of changes in the activity of the practitioner as compared to the activity of the analyst doing individual work, why should community work of this sort still be considered psychoanalytic? We propose a model that answers this question by retaining a strong notion of the unconscious and the use of transference-countertransference enactments in the community to inform practitioners. Our focus is an intensive four-year community intervention conducted in a housing project in an impoverished, underserved area of South Central Los Angeles, and the community changes which occurred as a result of this intervention.
Reverberations Between the Individual and the Community
We have previously noted a significant absence of psychoanalytic thinking in contemporary community research and action (Borg, Garrod, & Dalla, 2001), yet we have also found that psychoanalysts have made significant contributions to social and community theory (e.g., Altman, 1995; Fromm, 1955; Jones, 1964; Milman & Goldman, 1979; Smelser, 1998, Sullivan, 1964, among others). Although psychoanalysts have more generally shied away from direct community intervention, Freud (1921) himself posited a clear link between individual and community concerns and processes:
- The contrast between individual psychology and social or group psychology, which at first glance may seem full of significance, loses a great deal of its sharpness when it is examined more closely. It is true that individual psychology is concerned with the individual man and explores the paths by which he seeks to find satisfaction for his instinctual impulses; but only rarely and under certain exceptional conditions is individual psychology in a position to disregard the relations of this individual to others. In the individuals mental life someone else is invariably involved, as a model, as an object, as a helper, as an opponent; and so from the very first individual psychology, in this extended but entirely justified sense of the words, is at the same time social psychology as well (p. 69).
One important intersection between psychoanalysis and community psychology comes into focus by a common concern about the effect of trauma. In his development of the drive model, and abandonment of the seduction theory, Freud emphasized internal conflict, rather than interpersonal trauma and hardship, as the immediate basis for psychopathological processes and symptomatology. According to the drive model, it is the patient, motivated by the increasingly ego-dystonic experience of his or her neurotic symptoms, who seeks psychoanalytic treatment. Had Freud not completely abandoned his original seduction theory, the notion of actual trauma as the progenitor of psychopathological processes and symptoms would have remained more in the foreground of theory and practice. Greater emphasis on the role of trauma in personality development, an emphasis which informs the work of many contemporary theorists and practitioners (e.g., Bose, 1998; Bromberg, 1998; Coates & Moore, 1997; Davies, 1996; Davies & Frawley, 1994; Gartner, 1999, Herman, 1992; van der Kolk, McFarlane, & Weisaeth, 1996; among others), and the shifting view of causality which this emphasis creates, encourages the clinician to pay greater attention to real aspects of the interpersonal environment, rather than to attend solely to the individuals internalization and elaboration of interpersonal events. We suggest that this broadening of attentional focus signals a need for psychoanalytic theory to perceive and understand environmental conditions, which, by their deeply embedded and pervasive nature, can often impede the individual, or the community as a whole, from identifying a need for treatment. Rather than the individuals ability to distinguish specific, ego-dystonic symptoms that signal a need for treatment, the presence of trauma itself, within specific, targeted communities, may prove a potent indicator of the need for psychoanalytic intervention.
Entering the Real World of Community Work
In response to the Los Angeles riots of 1992, the city hired a community psychology consulting organization to plan a community treatment intervention for South Central Los Angeles. The intervention in South Central initially targeted community leaders, members of the Resident Advisory Council, teachers, and other people in the community who were involved in the political and educational lives of a targeted community within South Central consisting of about 500 residents. Over the course of the project, 40 community leaders completed a year-long Train the Trainer program. These community leaders, after completing their own training then provided training in the program model, and consultation to the majority of other community members in the general area.
Statistical measures and group and individual interviews conducted during the course of the intervention, from 1993 to 1997, indicated that members of the community had begun20the process of working through the trauma (Borg, 1997). The outcome data suggested that people were able: 1) to increase their sense of security within their community; 2) to form and utilize social support; 3) to feel more in control of their social, environmental and political lives; and 4) to improve their physical health in numerous significant ways (Borg, 2002).
Bringing community residents and service providers together to address chronic and acute trauma was an essential element in the intervention (Mills, 1995). Participants were taught how rigid, conditioned patterns of thinking and feeling work to maintain biases, prejudice, and negative assumptions about other individuals within the community. After training, residents reported increased ability to communicate needs to each other. Residents also felt more respected and understood by community leaders and service providers, including the practitioners, building maintenance workers, teachers, police officers, politicians and rent collection staff. Residents felt a sense of increased trust in the community, which, in turn, enabled them to maintain a sense of responsibility toward the community and, hence, toward their individual lives.
While the program model was primarily cognitive-behavioral, the assessment indicated that it was increased interpersonal functioning, resulting from new modes of interpersonal interaction, that was the cornerstone of ongoing change. For example, we documented that it was actually the relationships that formed within the program, that had lasting results in increasing the communitys ability to empower itself (Borg, 1997; Borg et al. 2001). Conversely, changes in the community were directly related to the increased interpersonal functioning of individuals, supporting the interpersonal psychoanalytic notion that personality and character structure are dynamic formations that are impacted by changes in the environment (Fromm, 1947, 1970).
Intersecting Aspects of Interpersonal Psychoanalysis and Community Psychology: Community Character
Similar to individual character, communities also develop their own unique character (Borg, 2001). In the case of traumatized communities, they can develop a character comprised of rigidified, repetitive modes of interacting. In order to more fully understand how community character forms, we must first consider some interpersonal psychoanalytic notions about moderating anxiety. Interpersonal psychoanalytic theory describes the processes by which conditioned beliefs are created and maintained, through avoidance of anxiety. The social environment influences ones experience of anxiety (Sullivan, 1956). Therefore, an individuals perception of reality, and awareness of his or her own potential for new experiences of self, be those affective, cognitive or interpersonal, will be limited to the degree that his or her community provokes or soothes anxiety. A community characterized by fear, distrust, secrecy, hostility, and competition will engender chronic anxiety, calling for defensive maneuvers.
Community character is the communitys adherence to the implicit, unstated, but ever-present laws that govern and limit interactive patterns within a community (Borg et al. 2001). It is through the concept of community character that community practitioners can view community intervention through an interpersonally-oriented psychoanalytic vantage point. From this perspective, character is viewed to be the repetitive interpersonal behaviors or interactive patterns that characterize a persons life (Cooper, 1987, 1991; Fromm, 1947). At its most basic level these adaptive/defensive interactive patterns form a stable personality structure that is utilized to address needs for satisfaction and security in the face of experiences of anxiety (Sullivan, 1953; 1956). It is then reinforced and rigidified, according to the degree that these needs are threatened in a given relationship (e.g., parent-child relationships), in a specific community (e.g., taboos, local beliefs and prejudices), or within societies (e.g., formal laws, sanctioned rules of conduct, and cultural norms).
According to interpersonal theory, individuals will protect themselves from anxiety through the use of selective inattention, or, in cases of trauma (such as the South Central community had clearly experienced), through dissociation (Sullivan, 1953). But self-protection from anxiety can also create and maintain the conditioned beliefs that divide community members and hinder mutual understanding and effective collaboration. This defensive experience also keeps community members from actively identifying problems and seeking help. Significant, self-sustaining community change requires intervention that addresses the functioning of problematic aspects of the community character. Changes in this character are reflected in open, mutually supportive interpersonal exchanges which, over time, reduce the anxiety associated with assuming new beliefs, roles, and communication strategies.
Crisis, experienced at the community level, is often the impetus to loosening the community character in ways that include structural change. Communities have a tendency toward stasis, and crisis and intervention can create new movement (Lundberg, 1998). Change is reflected in new, more flexible and communicative patterns of interaction.
Breaking Taboos: The Active Practitioner
Community interventions challenge many of the taboos and practices of contemporary psychoanalytic theories regarding the activity of the practitioner. Yet, as conceived here, community work can still retain a strong psychoanalytic sensibility.
Trauma was the factor initiating the South Central intervention, not the community members themselves. In response to the riots of the South Central Los Angeles community, city officials sought community-based approaches to address the manifestations of both20acute and chronic trauma in the community. A community mental health organization was contracted to implement an intervention that would address such chronic issues as impoverishment, intra-racial violence, racism, unemployment, drug/alcohol abuse, and academic failure, and acute problems, related to the crisis itself, such as rioting, looting, arson, and inter-racial violence. As compared to individual psychoanalytic work in which the patient nearly always initiates treatment, community work conceived through a psychoanalytic lens necessarily breaks this proviso.
As compared to individual psychoanalytic work, which happens only in the consulting room at pre-specified times, community work also requires the practitioner to actively participate in the daily life of community members. This pushes even progressive understandings of the involvement of the practitioners personality in the treatment to its upper most limits. Community interventions often require that practitioners be extremely flexible, in terms of their roles, throughout the intervention. Interventions included participation in family dinners, weddings, graduations, funerals, and numerous daily activities.
While the dramatic departure from a traditional boundaries of analytic work required by community intervention might initially appear taboo in its radical deviance from standard analytic practice, we argue that the multiple and intimate contacts between practitioners and community members fall within the bounds of a contemporary, interactive view of psychoanalytic community work as conceived here.
Although traditional psychoanalysis has eschewed didactic or psychoeducational approaches to individual or group problems as forms of non-analytic engagement or acting out, community work often involves teaching. For example, the intervention in South Central was designed as a series of workshops to teach residents how to advocate for themselves and their community. At first blush, then, it may seem as though this greatly increased activity of the practitioner is certainly not compatible with a psychoanalytic approach to treatment. In the sections that follow, however, we will challenge this assumption.
A Psychoanalytic Approach to Community Work
We believe in the viability of doing psychoanalytic community work based on the retention of a strong working notion of the unconscious and the use of transference-countertransference enactments in the community to inform practitioners. For example, Freuds (1930) injunction, Where id was, there shall ego be (p. 80) speaks directly to the educative process underlying psychoanalytic practice. What distinguishes psychoanalysis from other educational experiences is its emphasis on bringing heretofore-unconscious aspects of experience into conscious awareness, primarily through the process of transference. Likewise, a psychoanalytic approach to community work emphasizes making the unconscious conscious. Community interventions that, particularly in their early stages, emphasize more didactic approaches to group interaction, may still, in later stages, facilitate opportunities for unconscious experiences to become manifest through transferential processes. In the Los Angeles intervention, for example, an initial didactic focus on interactive processes between group members facilitated participants ability to become increasingly aware of their engagement in transferential distortions with one another and the underlying motives that fueled these distortions.
In another instance, it was the examination and working-through of unconscious experience that later allowed for more effective psychoeducation. Community members were initially drawn to the intervention by curiosity about the political endorsement that surrounded it. Soon, it became apparent that many people attending the workshops were actually the unacknowledged leaders of the community, though they overtly disavowed this. These apparent leaders, through their endorsement, increased other members receptivity to the program. It became evident that these members, despite their disavowals, were the gatekeepers of the community and that they were, at best, deeply ambivalent about the intervention itself.
Practitioners began to notice that unconscious efforts to sabotage the program were being enacted by these leaders. At one point, an important meeting had been scheduled and one of the perceived leaders had agreed to pass out flyers for the meeting. On the day of the meeting, no one showed up. Upon exploration, it was discovered that, somehow, the resident had forgotten to hand out the flyers. When questioned, the resident expressed anger that he had been chosen (even though he had volunteered) to deliver the flyers.
When this was explored in the group setting, other leaders supported the resident in his anger, and previously unexpressed emotions began to surface. This led to a powerful experience wherein community members described their shared experience of hope and disappointment in previous community interventions. Although this was not overtly articulated in the group process, it became apparent that residents had unconscious wishes to be passively gratified, and fears of abandonment and disillusionment of these wishes. This was revealed through an increase in concrete demands for tangible services from the practitioners (such as building repairs, salaried positions, and cable TV), and expressions of anger and disappointment when these demands went unfulfilled. Residents also voiced clear expressions of distrust and hostility toward program practitioners as outsiders who, like all previous outsiders would tantalize community members with hope which, ultimately, would lead to disappointment. The airing of these emotions provided the first opportunity for community members and practitioners to have a real dialogue with each other about their respective hopes, plans, resources and limitations. Community members experienced themselves and the practitioners in a new way when, upon voicing anger and fear, rather than expressing it through sabotaging behavior, their feelings were met with attention, interest, and respect. For the first time, when practitioners began to explain their roles in the intervention as facilitators rather than fixers, community members began to have some genuine, experiential understanding of what was actually being offered. Didactic informational offerings became embroiled in enacted modes of interaction between practitioners and residents that ultimately loosened the defensive character of the community.
In another example of a psychoanalytic approach to community work, practitioners enacted conflicts within the community in their professional relationships with each other in a way that ultimately resulted in improved communication among community members. As mentioned previously, practitioners often assumed a participatory role in the daily life of the community, these interactions provided a fertile ground for enactment of unconscious conflict. Interpersonal ideas about transference-countertransference dimensions of psychoanalytic treatment address enactment as an ever-present dimension of the process. Levenson (1983) states that the transference becomes a highly intensified replay of the material under discussion (p. 11). As a part of the intervention, longstanding conflicts among members of the community were highlighted, and, through their enactment in the transference-countertransference matrix, were made amenable to intervention.
For instance, a small group of men formed an organization to represent the communitys needs to their political representatives. The women in the community felt that this was a good idea and decided to form an organization of their own. Emotionally heated debates ensued over which group would be recognized by community practitioners as the communitys primary and legitimate representative body. In discussion among themselves, a male practitioner involved with the mens group and a female practitioner involved with the womens group began to enact a longstanding community conflict. The male practitioner argued that the men in the community had historically experienced a heightened sense of disenfranchisement in the community, due to overshadowing and marginalization by the women. The female practitioner argued that the men were not able to follow through with their commitments in their personal lives, and that there was no reason for the women to expect them to be responsible within this context.
In allowing themselves to identify with the parties in conflict, to the degree of affectively embodying their respective positions, the community practitioners were able to empathize with community members feelings of anger at their being misunderstood, their efforts thwarted, and their motivations maligned. Gradually, the practitioners, from their respective positions of gender-based identification, were able to work through initial reactions of denial and projection and, through identifying mutual underlying feelings of helplessness and sorrow, to form a common bond. What creates change, according to Levenson (1972), is the practitioners ability to be trapped, immersed, and participating in the system and then work his way out (p. 174). The experience of becoming embedded and gradually emerging from this enactment enabled the community practitioners to articulate the depth and nature of one significant longstanding area of community conflict. They were then better able to help community members increase their awareness of and communication about this conflict. Enactment became the means of deepening awareness of pervasive community interactions and patterns of thinking, feeling, relating and behaving.
The intervention in South Central turned on a notion of empowering community members. Empowerment theory describes the process whereby people in communities develop collaborative solutions that work for them (Berger & Neuhaus, 1996; Fawcett, et. al, 1984; Rappaport & Hess, 1984; Rappaport & Seidman, 2000; Warren, 2001). Using the South Central intervention as a model, an interpersonal psychoanalytic approach to community treatment begins as a psycho-educational intervention where the practitioners take on the dual roles of being both observers and participants in the process of change (Sullivan 1953, 1954). This experiential model provides a focus on what happens within and between individuals and groups at the time that it is occurring through increasing explorations of the transference-countertransference dimensions of the group interactions. Group members work within a supportive makeshift community to explore the complex and often covert processes of community systems as they experience them directly, in ways that have been usually inattended in real life circumstances in their community.
The participant-observer status serves as an entry point into the process of collaboration. In turn, the collaboration supports the process wherein change and growth are initiated and increasingly sustained from inside the community (Bright, 2000; Perkins & Zimmerman, 1995). The process of collaboration, therefore, serves as the most general framework of the community intervention. Ultimately, collaboration forms a base of support wherein residents are able to mutually develop hypotheses about past, current, and future community functioning and implement their own ideas and strategies accordingly.
It was only by acknowledging that the residents were the experts on this communitys needs that the community was willing and able to open what had traditionally been a closed system. In the spirit of collaboration, educational processes eventually reverberate between practitioners and residents. The knowledge and awareness of daily living within this community was taught by the residents, while it was more general and conceptual ideas that were taught by practitioners in the workshops. By explicitly focusing on the a bi-directional educational practice, the residents and practitioners were able to establish a collaborative learning loop that supported the idea that everyone involved in the project was both a teacher and a student.
In this process, traditional notions around learning and education could at times set up important challenges to the process of collaboration. There was an inherent tendency in residents and practitioners to slip into the traditional medical model default mode: practitioner = expert, resident = patient (Albee, 1996; Bloom, 1996; Rappaport, 1981). In such re-enactments of traditional roles, a collaborative framework was utilized to challenge the typical expert-patient roles and to reframe the working relationships that were being created within the project. Without such collaborative reframing (Watzlawick, Weakland, & Fisch, 1974), the practitioners ran the risk of imposing their own goals for the community instead of facilitating a process whereby the community could determine what it needed on its own terms.
The intervention targeted characterological defensive patterns of interaction manifest in the community character through analysis and working-through of historical patterns as they were experienced in the here-and-now of transference/countertransference enactments. The intervention targeted the community character as it had been internalized, responded and reacted to, and maintained in the community as a shared and mutually created reality. The details of the community character structure were collaboratively brought to light. This was accomplished by honing in on and working-through characterological defenses against the pain, anxiety, and environmental forces that had intergenerationally protected the community through the use of rigid, inflexible patterns of interaction that were highly resistant to change.
In recognizing the emotional contours of the community character, residents were able not only to consciously change it, but also to experience a great appreciation of their community for the adaptive aspects of its character in the face of historical trauma. In the course of recovery and empowerment, the community exhibited a gradual shift from patterns of reacting to an internalized and perpetual sense of unpredictable danger to an internalized a sense of community-supported safety. This shift included moving from a history of dissociated trauma to conscious recognition of trauma, and from a sense of entrenched and oppressed isolation to increased social connections among community members as well as to the outside world.
For a community practitioner dealing with crisis, being an observer is not enough. In order to experience the fullness of an interaction we must understand the significance of what we see, hear, feel, and touch. This requires active participation in the interactive process as the community develops its own empowering strategies for dealing with trauma and crisis. The practice of actively seeking expansion of self-experience seems to be in synchrony with the goals of community psychologists and interpersonally-oriented psychoanalytic practitioners. If we, as analysts and community practitioners, keep in mind that our roles intersect upon the ground of meeting the needs of our shared communities, we may be able to find ways of increasing=2 0our ability to work together with diverse populations within numerous settings. The intersection between these apparently divergent fields occurs when community psychologists and psychoanalysts are able to openly acknowledge a commitment to meeting the perceived needs of our clients and to utilizing the strengths of communities and their members as a guiding force to developing and supporting ongoing approaches to health and empowerment.
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