The Community Consulting Group, New York City - CCGNY
 BUILDING COMMUNITIES WITHIN COMMUNITIES
ARTICLE

Community Psychoanalysis: Developing a Model of Psychoanalytically-Informed Community Crisis Intervention

Mark B. Borg, Jr. PhD
[AUTHOR'S BIO]

Borg, Jr., M. B. (2010). Community Psychoanalysis: Developing a Model of Psychoanalytically-Informed Community Crisis Intervention. In N. Lange and M. Wagner (Eds.) Community Psychology: New Directions (pp. 1-66). Happague, NY: Nova Science Publishers.




Abstract

 

IN THIS CHAPTER I DEFINE and illustrate key concepts, practices and intervention strategies from the seemingly disparate fields of community psychology and psychoanalysis (specifically, relational/interpersonal psychoanalysis). Through a number of examples from my own work as both a clinical psychoanalyst and community practitioner, I hope to illustrate how a useful intersection has been, and can be, developed to cross-pollinate and enliven the practice of community crisis intervention (as well as how such work can also be usefully applied to clinical psychoanalysis itself). I present an overview of key psychoanalytic and community psychology concepts, such as transference, countertransference, enactment, empowerment and primary prevention, and show through a number of examples how these undergird the development of a psychoanalytic approach to community crisis intervention. I will present a number of new concepts — community character, point of impact, and project group methodology — which I will then use in describing the development of a model of psychoanalytically-informed community crisis intervention. I will also reverse the lens and utilize the community psychoanalytic concepts to illuminate clinical work with individual patients.


Introduction

 

Reverberations between Community Psychology and Psychoanalysis

 

The purpose of this chapter is to ask a series of questions that challenge the conventional wisdom that psychoanalysis and community psychology are necessarily divergent approaches to psychological intervention. There are, of course, commonly held distinctions between the activities of community practitioners and analysts. For instance, psychoanalytic patients generally initiate their own engagement in the analytic process, while governmental, academic, and social-philanthropic bodies are generally the initiators of community interventions, not the communities themselves. Community practitioners often participate in the daily lives of the community they are treating, while psychoanalysts do not participate with their analysands in such a way. Lastly, there is a component of didacticism to community treatment that would be considered very undesirable — in fact, boundary breaches — in psychoanalysis. How, therefore, can we consider community work psychoanalytic? In this chapter, I will propose a method of community analysis that retains a strong emphasis on the unconscious, on understanding group level coping and defensive strategies, and on the analysis of transference-countertransference enactments.

 

Over 2,500 years ago, Hippocrates suggested in Airs, Waters, Places that grasping the inherent disorder in any subject requires careful study of the subject's environment (cited in Potter, 1996). With this in mind, my colleagues and I have noted a significant absence of psychoanalytic thinking in contemporary community research and practice (Borg, 2002b, 2003a; Borg, Garrod & Dalla, 2001; Borg, Garrod, Dalla & McCarroll, 2009). However, further exploration has uncovered some significant contributions that psychoanalysts have made to social and community theory and practice over the years since its inception (e.g., Altman, 1995; Bion, 1959; Clarke, Hoggett & Sideris, 2006; Fromm, 1955; Jones, 1964; Hegeman, 1995; Miller, 1989; Miller & Gwynne, 1972; Milman & Goldman, 1979; Pines, 1998; Smelser, 1998, Sullivan, 1964; Volkan, 1988, 2009, and White, 2002).

 

Although psychoanalysts have traditionally shied away from direct community intervention, Freud (1921) himself acknowledged 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 individual's 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 word, is at the same time social psychology as well. (p. 69)

 

Freud is equivocal here as he was on many other topics — in fact, he seems to have been downright conflicted about where he stood on the issue.[1] Just nine years later, he described the normally functioning ego as an isolated atom of self-regarding consciousness that had no relational continuity with its surrounding physical world. He wrote,

 

Normally, there is nothing of which we are more certain than the feeling of our self, of our own ego. The ego appears as something autonomous and unitary, marked off distinctly from everything else . . . One comes to learn a procedure by which, through a deliberate direction of one's sensory activities and through suitable muscular action, one can differentiate between what is internal — what belongs to the ego — and what is external — what emanates from the outer world. In this way one takes the first steps towards the introduction of the reality principle, which dominates future development (Freud, 1930, p. 67; emphasis added).

 

That phrase "one comes to learn a procedure" encouraged generations of analysts to maintain a strict patrol of the boundary between the ego and the outside world[2] However, just a page later in the same article, Freud made an important concession when he suggested that "our present ego-feeling is only a shrunken residue of a much more inclusive, indeed, an all-embracing, feeling which corresponds to a more intimate bond between the ego and the world about it" (p. 68). This could be viewed as one of several remote origins of community psychology — a refusal to settle for the "shrunken residue" in favor of building upon "more intimate bonds" between ourselves and the world around us. Therefore, even on the heels of Freud's seemingly straightforward statement regarding the personal-social connection in his Group Psychology reference, the issue remained conflicted for him — as it does for many of us today.

 

Freud also recognized another important intersection between psychoanalysis and community psychology: a common concern about the effects of trauma. During the development of his drive model and the abandonment of his seduction theory, Freud emphasized internal conflict over interpersonal trauma and hardship as an 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 abandoned his original seduction theory, the notion of trauma as the progenitor of psychopathological processes and symptoms would have remained more in the foreground of theory and practice.[3]

 

The effort of many contemporary theorists and practitioners (e.g., Bose, 1998; Bromberg, 1998; Coates & Moore, 1997; Davies, 1996; Gartner, 1999; Stolorow, 2009; Tubert-oklander, 2007) are informed by an emphasis on the role of trauma in personality development and a shifting and more expanded view of causality — that is, many of the symptoms presented in treatment have etiologies that go beyond intrapsychic determinants solely representative of personal family dynamics. Clinicians are encouraged to pay greater attention to real aspects of interpersonal environments rather than attend solely to an individual's internalization and elaboration of interpersonal (and especially traumatic) events (Dohrenwend, 1978; Moos, 1984; Stokols, Misra, Runnerstrom, & Hipp, 2009; Tedeschi, Park, & Calhoun, 1998; van der Kolk, McFarlane, & Weisaeth, 1996; Wachtel, 2009). This enlarged attentional focus in the analyst requires a perception and understanding of environmental conditions that — due to their embedded and pervasive nature — often impede individual or community recognition of a need for treatment. In contrast to an individual's ability to acknowledge specific, ego-dystonic symptoms as signals of a need for treatment, the presence of chronic or acute trauma within targeted communities serves as a potent indicator of a need for intervention.

 

However, such situations are rarely cut-and-dried — it is often unclear whether symptoms are due to internal conflict, external trauma, or a mixture of both. This is especially true when we consider that so many traumas are the result of “friendly fire” — a military euphemism for the accidental killing or wounding of soldiers by their own comrades. I believe that psychoanalysis and community intervention can often be viewed as the treatment of friendly fire victims. Patients often resist believing that the people responsible for their safety — their family, their community — have let them down, and come to believe that their wounds have been inflicted by an "enemy" who exists outside of their nuclear families or circumscribed communities. This “let down,” on an unconscious level, targets how our families and our communities have not been able to sufficiently protect us from pain that we experience in the world outside of the boundaries of our safe (at least in fantasy) environments. There is a powerful taboo in our society against acknowledging these friendly-fire incidents within families and communities as they indicate systemic failures that are best left unspoken (due to their tendency to induce deep shame and anxiety in said systems, as well as to the intergenerational nature of such failures in our U.S. society). This taboo results in psychological wounds remaining hidden, battle dynamics becoming enactments (unconsciously acted-out), while suffering is symbolically expressed as physical and behavioral problems associated with mental distress or a wide array of rampant social ills in our society (Borg, 2003a). But what happens when those responsible for one's injuries consist of one's own family, community, or government?

 

From his interpersonal psychoanalytic perspective, Harry Stack Sullivan argued that psychiatric illnesses are caused by the collective action of constitutional, environmental, and cultural factors (Sullivan, 1953, 1956). He considered these causes as indigenous — that is, resulting from interactions among one's psyche, body, family, and society. He described how interactions with significant individuals (especially during early development) can lead to behaviors that appear to be medically rather than socially determined — for instance, strategic behaviors and rituals (often compulsive) that are unconsciously created to ward off anxiety. In such cases, emphasizing medical over social determinations supports the friendly fire taboo — patients come to believe that their conditions are the fault of their minds and their bodies, and not of their parents, or environments, or analysts.

 

Conscious or otherwise, pain, misery, and suffering enroll us in particular communities or societies. Perhaps this enrollment shows up most profoundly in our bodies as they are transformed through self-destructive practices (smoking, drinking, overeating) damaging conflict with others (e.g., wars, physical altercations), and interactions with environmental toxins (e.g., pollution, poisons).[4] Physical or psychological symptoms serve as expressions of personal life patterns and represent individual responses, reactions, and adaptations to interpersonal, familial, and cultural experiences. Psychiatric symptoms may also be used to enjoin ourselves with sanctioned patterns that mark what I have referred to as our palliative care system (Borg, 2005c), thus dissociating — and therefore keeping intact — the "friendly fire" wounds inflicted by our families and society at large. These patterns also play out in communities, especially between those in the center and those in the margins, and so many marginalized groups play the role of scapegoat for our social ills.[5] Symptoms such as crime, poverty, and various forms of discrimination represent this process on a larger scale. In many cases, psychoanalysts and community practitioners participate in this taboo, despite their sense of responsibility for challenging it.

 

Psychoanalytic Concepts

 

The Self-System, Dissociation, and Selective Inattention

 

From its inception, interpersonal psychoanalysis has maintained a focus upon problems in living, and upon the impact of coping mechanisms that, while reducing anxiety, may become entrenched in ways that impede growth (Sullivan, 1940, 1953). Sullivan focused on how we use these coping mechanisms or security operations in our interpersonal exchanges. They protect us from anxiety at the cost of limiting our ability to acquire information that might facilitate adjustment through what Sullivan referred to as the self-system. The self-system is a concept that Sullivan uses to describe the total set of security operations. The self-system maintains the agency and integrity of the self through monitoring and limiting one’s awareness of experiences that increase anxiety and/or decrease satisfaction and security. Brown (1995), following Sullivan (1954), describes the self-system as follows:

 

While self-system processes work to determine what is in and out of awareness, they are, nevertheless, always interpersonal operations in that they are always organizing self-experiences in the course of (real or imagined) interaction that (1) minimize disapproval and maximize approval and (2) are organized and internally consistent” (p. 873).

 

Similarly, Chrzanowski (1977) refers to the self-system as the master “anti-anxiety device” (p. 12).

 

Selective inattention is highly associated with the self-system’s natural tendency to actively exclude from awareness, not notice or inattend, certain obvious experiences that would cause us discomfort (i.e., anxiety) if we noticed them. Of course, we need a certain degree of selective inattention so as not to be stimulated — and overwhelmed — by every iota of experience that bomb blasts our perceptive system all day every day. Can you imagine being tuned in to every sound, every color, each smell that you encounter just, say, on the way to work this morning? Selective attention allows us to maintain a certain degree of focal awareness or concentration on the task at hand. However, Sullivan conceptualized this to be a security operation that maintains self-esteem and limits anxiety by means of truncating the scope of our conscious awareness of everyday life. Using selective attention, according to Sullivan (1953), is not without a price:

 

Selective inattention is, more than any other of the inappropriate and inadequate performances of life, the classic means by which we do not profit from experience which falls within the areas of our particular handicap. We don’t have the experience from which we might profit — that is, although it occurs, we never notice what it must mean; in fact we never notice that a good deal of it ever occurred at all (p. 319).

 

Dissociation, the more hardcore and close relative of selective inattention, has been a hot topic as of late. In fact, dissociation is the cornerstone of the contemporary evolution of Sullivan’s notion of me-you patterns (or personifications) — coined multiple self experience (Bromberg, 1994, 1998, Davies, 1996; Harris, 1996, 1998, 2009; Mitchell, 1993; Pizer, 1996, 2009). Dissociation is a primary operation (or defense) of the self-system that blocks from awareness any motives or sense of self that have been associated with an intense experience of anxiety (Sullivan’s uncanny emotions). At its most extreme, dissociation obliterates the integration of experience completely from a person’s ongoing sense of self — creating splits in the self-system, or personality, wherein there are as many selves as there are interactions, each self atomized and completely separated from all other selves in the overall system. Brown (1995) states that

 

The result of the [dissociative] process is that the experience of anxiety is diminished and security is enhanced. Dissociative processes include disturbances in awareness ranging from commonly occurring instances of selective inattention, to the more gross occurrences of automatisms. Since the details of the dissociated experience are not available in awareness for realistic perception and processing, dissociation interferes with the ability to learn successfully and adapt from experience [emphasis in the original] (p. 865).

 

Self-system processes, such as selective inattention and dissociation, are at the core of my description and use of the concept of character. I describe character as a primary defense against the anxieties of living in a state of chronic crisis, as are so many communities both in the U.S. and abroad.

 

Character

 

Though in her book, Remembering the Phallic Mother, Marcia Ian is speaking of character from the perspective of characters in novels, I think that her definition might serve as a provocative alternative definition of the dynamic defense system that I, and many others, refer to as character. Ian (1993) writes:

 

Novels may function as idealized worlds. Characters function as fetishes, which are “accretions,” of idealizations. Together they comprise an idealized psychological interiority extended through a makeshift duration. Effective characters resist even the most strenuous efforts to deconstruct them entirely because we cling more stubbornly to characters than to our verbal constructs (p 105).

 

Do we use our character in ways similar to the ways that an author might: To keep intact our own idealized version of ourselves and the world? Do we then crystallize and catalyze these ideal selves (representing character), worlds, and communities, and bring forth our own interiority solely through our engagements with the world, rather than through actual experience and reflection, and therefore simultaneously resist entering our lives fully.

 

That said, let’s go back to analysis. Like the interchangeability for Sullivan between personality and self-system, there is quite a bit of overlap between character and self-system — they both operate as defensive systems to minimize anxiety and maximize security and satisfaction at the expense of taking in actual experience with the world.[6]

 

There have been a number of contributors to the theory of character from the world of interpersonal psychoanalysis. For instance, David Schecter (1978), influenced by Guntrip’s (1968) work on schizoid processes, developed the concept of character detachment, which he saw as “a network of defenses and coping mechanisms that become relatively stable, structuralized and chronic in the personality” (p. 81). Joseph Barnett (1980) also developed a description of character; though his idea was that character is not solely defensive and that it is an overarching entity “and central structural phenomena in mental life” (p. 399), that organizes roles and functions, and determines which experiences can be incorporated into one’s overall sense of self.

 

Erich Fromm, however, is the interpersonal psychoanalyst most highly associated with the concept of character. Fromm (1941) stated that “Character É is the specific form in which human energy is shaped by the dynamic adaptation of human needs to the particular mode of a given society” (p. 305). Fromm (1947) based his, specifically social, definition of character on the assumption that “in the process of living, man relates himself to the world (1) by acquiring and assimilating things, and (2) by relating himself to people (and himself)” (p. 58). In summarizing Fromm’s description and definition of character, Brown (1995) states,

 

One can acquire by receiving, taking from someone, or producing through effort, but acquisition and assimilation are necessary in order to satisfy needs. In so doing, a person cannot live alone, unrelated to others. Thus, character is the relatively permanent, particular form with which we relate ourselves to the world. The child’s character is patterned by the parents and the society for which the parents are “psychic agents” (p. 863).

 

Invoking the specter of Fromm’s (1947) notion of social character (and viewing character itself as a kind of societal security system), Hegeman (1995) suggests that, within particular character formations, “successful adjustment to society could produce psychopathology” (p. 830). This being a society where some (e.g., the homeless, the mentally ill, other minority groups) suffer from an inability to adapt while others suffer from the compromises they have made in order to adapt (Fromm, 1955).

 

Freud developed his theory of character as a system of strivings that underlie, but are not identical with, behavior. Freud recognized the dynamic nature of character traits and that the character structure of a person represents a particular form in which energy is channeled in the process of living. Freud believed that the sexual drive was the source of energy of the character. He described character traits as “sublimations” of, or “reaction formations” against, the various forms of sexual drive — i.e., as defenses. Freud interpreted the dynamic nature of character as an expression of their libidinal source. For Freud the fundamental entity in one’s character is not the single character trait but the total character organization from which a number of single character traits follow, or represent. As such, Blos (1968) says,

 

Character structure renders the psychic organism less vulnerable than it has ever been before, and the maintenance of this structure is secured against any interference from any quarter, internal or external. If must be, one dies for it before letting it die (p. 190)

 

Fromm developed his definition of character to stand in sharp contrast to the traditional intrapsychic Freudian notion of character. For him, one’s character is an interpersonal event that is impacted and shaped by forces in the larger environment (i.e., politics, economics, and so forth). He analyzed specific cultural forces impacting the individuals in the U.S. society and delineated a number of character types specific to our culture; this includes the productive character orientation and four major types of nonproductive character orientations — receptive, exploitative, hoarding, and marketing. Fromm’s character orientations relate to the ways that individual’s assimilate resources from their environment. Ultimately Fromm (1941), perhaps not so different from Freud’s (1930) social analysis in his Civilization and Its Discontents, believed that “character is the basis for [our] adjustment to society” (p. 60)[7]

 

Wilhelm Reich (1933) elaborated Freud’s original conception of character and developed an elaborate means of analyzing character for its defensive purposes — likening character to “armor.” He believed that character was both a representation of person’s specific mode of existence as well as an expression of his or her entire past. Reich saw the character to be a “compact defense mechanism” against any and all efforts to change (e.g., analysis). Character, accordingly, serves as a defense against external stimuli, as well as a means of gaining mastery over internal impulses — libidinal and sadistic energies. Consistent with the contemporary notion of enactment, Reich believed that character manifests less in what one says, and more in what one does. Also, character is revealed less in the uncovering of dreams and fantasies, and more in how these are censored, distorted, and condensed. In summary, Reich sets the stage for my assertion throughout this chapter that character is made up of expressions of dissociated, inattended, and repressed unconscious content in specific communities that are then played out between practitioner and community participant. And that this, in turn, sets up a means for analyzing transference patterns that reveal themselves throughout the course of this work — through their dynamic interplay in circumscribed community settings.

 

A more contemporary interpersonal position regards character as multi-determined; with influences from significant interactions occurring during all eras in life (Cooper, 1991). The purpose of this character is primarily protection and defense. In the interpersonalized version of character, its function is specifically to protect self-esteem and diminish the experience of interpersonal anxiety. In essence, this means that all significant interactions experienced within the social context — family, peers, the community — have the potential to be influential in the development and maintenance of individual character structure. The purpose of this character is to protect the individual’s self esteem and diminish anxiety through maintaining an unconscious conformity with the “rules and regulations” of whatever social context — or set of interactions — we operate within. Within a contained context, these interactions themselves interlock to establish an overriding sense of character representing the mutually-developed, defined (and enacted), and protected structure and perpetuated by the interlocking interactive patterns sanctioned by community members (Cooper, 1987). Each facet of character must be understood in its own right, and then in relation to the environment as a whole (Cooper, 1987, 1989, 1991).

 

Transference and Countertransference Enactment

 

A perfectly acceptable definition of transference (and its enactment) comes from Freud’s description of the free-floating attention/free association technique (Freud, 1912, 1914, 1917). He states that “the patient remembers nothing of what is forgotten or repressed, but…he expresses it in action. He reproduces it not in his memory but in his behavior; he repeats it, but without of course knowing that he is repeating it” (Freud, 1914, p.150). Minus the fact that Freud considered this process part of the “armory of weapons” that the analyst must “wrest from [the patient] one by one” (ibid, p. 151), there are similarities between transference resistance and the notion of transference enactment. The main discrepancy, in fact, seems to regard how the transference/enactment is used. And 100 years of breaking taboos about the “appropriate” use of countertransference has opened the door for contemporary analysts to make much more use of our contributions to the enactment/repetition — that is, the contributions made through our own (counter-) transferential baggage.

 

Transference and countertransference in the broadest sense, refers to the unconscious transfer of experience from one interpersonal or environmental context to another; it results in the experience of reliving past interpersonal relations in current situations — for both patient and analyst (Blechner, 1992; Epstein & Feiner, 1979; Fiscalini, 1995; Gill, 1987; Ghent, 1990; Searles, 1975, 1979; Stern, 1994; Wolstein, 1975). In synchrony with this definition, Fromm-Reichman (1950) expressed the conviction that “the patterns of our later interpersonal relationships are formed in our early lives, repeated in our later lives, and can be understood through the medium of their repetition” (p. 4). It is possible that a person’s attitudes toward his or her environment inevitably represent transferential (or, in early interpersonal psychoanalytic parlance, parataxic) appraisals (Levenson, 1983 1991, 1996; Sullivan, 1953, 1964), and that familial as well as cultural contexts contribute to processes of introjection, internalization, and identification (Borg, 2003a, Borg et al., 2009; Freud, 1912, 1921, 1923; Fromm, 1955) underlying these appraisals.

 

There are important intersections between my use of transference and Sullivan’s (1953, 1954) notion of parataxic distortion. Brown (1995) describes this as follows:

 

Whereas the concept of transference refers specifically to the patient’s perception of the therapist, Sullivan uses the concept of parataxic distortion in the framework of interpersonal relations in general to indicate that an integrating tendency or mode of interpersonal relatedness is at play that is inappropriate to the [current] interpersonal situation” (p. 870).

 

An integrating tendency is Sullivan’s term for describing the dynamic that underlies a person’s seeking satisfaction or tension reduction through interactions with others, and involves the transfer of previous modes of interacting into contemporary interactions. Therefore, parataxic distortions are inclusive of a person’s history and methods of attempting to “fit in” to specific interpersonal context across time (especially those that were successful in a salient context). Janet Rioch, in support of Karen Horney’s (1939) repudiation of the pure instinct theory of the time, described transference in a way that captures the essence of parataxic distortion. She writes, “The particular character structure of the person requires that he integrate with any given situation according to the necessities of his character structure” (Rioch, 1943, p. 149). As important as this concept may be in expanding our understanding of transference, most interpersonal analysts currently use the term transference to both convey Sullivan’s earlier interpersonal meaning, as well as in ways similar to how transference is perceived and used across schools of psychoanalysis.

 

Interpersonal psychoanalysts believe that experience and behavior take on meaning from the continuous series of interpersonal interactions that occur from the beginning to the end of our lives (Stern, 1997; Sullivan, 1953). It is through transference-countertransference interactions that a patient’s problematic intrapsychic and relational patterns are brought into the here-and-now of psychoanalysis and exposed for exploration, intervention, and understanding (Levenson, 1991; Pizer, 2009).

 

Enactment has become a hot topic in contemporary psychoanalysis. It is a concept that now includes the voices of analysts of various schools of thought, as it has been taken up by relational and interpersonal analysts (Bromberg, 2003; Hirsch, 1987, 1998, 2002; Levenson, 1991, 2009; Mitchell, 1997; Stern, 1997; Hoffman, 1983, 1998), Freudians (Jacobs, 1986, 2001; Boesky, 1990; Chused, 1991, 2003), and Kleinians (Feldman, 1997). Margaret Black (2003) states that “enactment suggests that the analyst receives information through the medium of felt experience” (p. 634). One exploratory approach to understanding transference-countertransference interactions is, therefore, the analysis of patient-analyst enactments, which Hirsch (1998) defines as

 

what happens when the analyst unwittingly actualizes the patient’s transference and, together with the patient, lives out [the] intrapsychic configurations . . . [enactment] is viewed as the patient’s unconscious effort to persuade or force the analyst into a reciprocal action: a two-party playing out of the patient’s most fundamental internalized configurations. (p. 78)

 

In 1933, Wilhelm Reich also offered a succinct definition of enactment, where he associated it with Freud’s repetition compulsion. Enactment, he said, is where “[a patient] behaves as they once did in analogous situations É [where] the conflict, which is no longer an internal one but one between patient and analyst, is thus brought to a head” (Reich, 1933, p. 19).[8] This makes transference, in Adam Phillips (1993) description, dependent upon “psychic mobility; by sitting still the analyst becomes a moving target” (p. 102) for the enactments that will inevitably blast their way into the treatment. Ferenczi (1932) addressed the importance of enactment as well, especially when working with traumatized patients, when he asserted that the analyst would unavoidably “have to repeat with his own hands the act of murder previously perpetrated against the patient” (p. 52).

 

Enactment can be used, in a clinically useful sense, to refer to the mutual and bidirectional unconscious influence of discrete and unique interactive events (Aron, 1996, 2003; Jacobs, 1986; Harris, 2009; McLaughlin, 1991; Pizer, 2009). However, the concept of enactment in its broadest sense can also be used to describe and address how all interactions — in analysis and in our daily lives — are tainted with, and make manifest, the unconscious dynamics of the enactor(s). Are enactments so ubiquitous in our daily lives so as to be made useless, as a special case of unconscious material, in the analytic setting? With this in mind, Lewis Aron (2002), therefore, states that “we are correct to ask, ‘What is not an enactment?” (p. 623).[9] However, Aron goes on to state his impression that

 

Enactments may well be a central means by which patients and analysts enter into each other’s inner world and discover themselves as participants within each other’s psychic life, mutually constructing the relational matrix that constitutes the medium of psychoanalysis (ibid., p. 629).

 

That said, contemporary interpersonal/relational theories focuses specifically on the transference-countertransference relationship as a means of addressing recurrent maladaptive ways of relating to others — unconsciously repeating in interaction, i.e., enactment — and the areas of conflict, deficit, and characterological problems in living that they engender (Bromberg, 1998; Cooper, 1991; Ehernberg, 1992; Figlio, 2008; Fiscalini, 1994; Levenson, 1991; Lionells, Fiscalini, Mann & Stern, 1995; Miller & Rice, 1967). Transference and countertransference, as I am using these concepts, refer to habitual, repetitive ways of perceiving and relating to others that are formed throughout development in one’s family and specific culture — creating patterns and routines that we simply follow (enact) as if by rote. A person’s attitude toward his or her environment is, inevitably, made up of transferential appraisals, initially formed and subsequently maintained in familial as well as cultural contexts (Drescher, 1998; Freud, 1921, 1927; Fromm, 1955; Layton, 1998). Sullivan (1953), in many ways, captures the culturally context-dependent nature of transference and countertransference that I am utilizing in this conceptualization of community intervention. He states that individuals “gradually learn ‘consensually validated’ meanings…These meanings have been acquired from group activities, interpersonal activities, and social experiences” (p. 28-29). These meanings, in other words, are in a state of being perpetually transferred into more contemporary contexts as we attempt to integrate ourselves into our surrounds by enacting our personal, familial, and community histories in the here-and-now.

 

I believe that through the transference-countertransference performances and empathic opportunities that are played out in the ongoing process of patient-analyst enactment, we are seeing through the eyes and experiences of others, while our experiences are also, and sometimes embarrassingly, seen by those others. In fact, I believe that many individuals in our society are highly invested in not seeing through other people’s eyes. I also believe that we use extremely powerful dissociative defenses to avoid empathizing with the suffering of others — a kind of “necessary ruthlessness” (Borg, 2007). We implement our necessary ruthlessness and so remain unaware of our part in, our collusion with, the society-level enactment of processes that result in the ongoing disenfranchisement and marginalization of others.

 

Working Through

 

Working through, as generally understood, implies the state of coming to terms with psychic hardship, anxiety and trauma, for example the death of a loved one (Freud, 1914, 1937a). For Freud, countering resistances was the task of working through. He states,

 

When the work of analysis has opened up new paths for an instinctual impulse, we almost invariably observe that the impulse does not enter upon them without marked hesitation É No stronger impression arises from the resistances during the work of analysis than of there being a force which is defending itself by every possible means against recovery and which is absolutely resolved to hold onto illness and suffering (Freud, 1937a, pp. 141-142).

 

One point that analysts of all bents agree upon is that the tough work of working through counters the resistances and resolutions of the forces which hold onto lost experiences and lost objects. The goal of these resistances and resolutions is, therefore, maintaining the status quo. And, I would imagine that community practitioners, should they peer through a psychoanalytic lens, might also agree that many of the problems faced in community intervention, are similarly (or seemingly) intractable.

 

Anita Tenzer (1995), in her chapter on “Working Through” in the Handbook of Interpersonal Psychoanalysis begins:

 

Working through in both classical and Interpersonal psychoanalysis involves repetitive, progressive, and elaborate exploration of resistance É and that the difference [in interpersonal psychoanalysis] is that the focus has shifted from pathology to the opening up of possibilities; the emphasis is not only on what impedes and constricts but also on what can enhance and mobilize É [in this process] there is a collaborative exchange in which both patient and analyst have a part. Together they may help the patient (and, coincidentally, the analyst) to develop new patterns of understanding and experience (p. 729) [emphasis mine].

 

Therefore, working through, from an interpersonal perspective, is the process of “countering the inertia of the familiar É raising tolerance for uncertainty, anxiety, and apprehension, and fostering the introduction and re-introduction of new experience within a variety of contexts” (ibid, p. 730).

 

Across all schools of analysis, repetition is the sin qua non of what one confronts in the process of working through. Freud (1914) believed that the repetition compulsion served as a mechanism for the active mastery of experience. However, he characterized it by its conservative nature and he considered it an expression of the inertia principle (i.e., the death drive). In contrast, the interpersonal psychoanalyst, Ernest Schachtel (1959) stated that “repetition is not due primarily to the inertia principle but, on the contrary, is essential for the productive work of exploring and assimilating the objects of the environment É objects of the cultural environment” (p. 259).

 

Repetition can take place across modalities (dreams, fantasies, memories, affects, and behavior) and in different contexts, both within and outside the analytic relationship/situation. Fromm-Reichmann (1950) suggested that any new piece of awareness, any new experience, if it is going to be taken in and made use of, has to be tested, re-tested, and re-conquered many times over. New experiences often cause anxiety (whether a new experience of self, other, or environment), calling for characterological defense to kick in and preserve a consistent sense of self across a changed/changing environment. Therefore, the working through process is very much about challenging the need to turn, to return, and to repeat the steps that lead the self back to the old and familiar processes. We utilize selective inattention and dissociation as self-protection which serves to thwart our experience of the new, the anxiety-provoking, or the overly stimulating.

 

Levenson (1972) writes, “The core of psychotherapy lies in the delineation of pattern” (p. 211). Therefore, of primary importance in the working through process is helping the analysand understand the ways that repetitive patterns (of defense specifically) are enacted — rather than experienced, taken in, and used in day-to-day life. Levenson (1983) later states that

 

Change does not come out of understanding the truth É but by “working through,” which from this perspective does not mean doing the same thing over and over, but, rather, recognizing a widening series of patterns of interaction and configurations of experience — always, I must emphasize, to some end point that is never achieved. It is an examination in great detail of the part to expand the whole. The therapist does not explain content; he [or she] expands awareness of patterning (p. 116, emphasis in the original).

 

Tenzer (1983) hypothesizes that in the course of working through, insight becomes elaborated, to a large extent unconsciously. And that it consists of two interrelated processes. One process assimilates an experience and registers it at a higher level of abstraction and consciousness. The other process organizes the experience — by means of differentiation and integration — so that it can be used to generate new kinds of behavior, understanding, and interaction with the world and others.

 

Therefore, working through consists of expanding intrapsychic and interpersonal frames of reference by witnessing and experiencing oneself and others in different ways in different contexts (e.g., analysis, community intervention). Tenzer (1995) states that this process “requires a tremendous amount of repetition, so that any new piece of awareness can be consolidated” (p. 738) — and integrated into one’s sense of self, or self-in-context.

 

John Fiscalini (1988) refers to the working through process as “living through.” He stresses that interpersonal psychoanalysts do not see the working through process in the abstract — it is a process that occurs within the context of the analytic relationship. This process is characterized firstly by the creation of a new interpersonal relationship wherein the analysand repeats old neurotic patterns and the analyst responds to them in new and different ways. Then, the analyst and patient “live through” their new interpersonal interaction repeatedly, consistently, and across a variety of different circumstances that arise in the patient’s life as well as in the analysis itself, with the analyst playing a vital role in validating the psychic re-patterning that takes place.

 

Finally, Donnell Stern (1983, 1997) has discussed how the repetitive experiences that go on unconsciously and are enacted in the analytic context represent a kind of “familiar chaos” that can be contrasted with “creative disorder,” where uncertainty can be accepted and previously unformulated experience is encouraged to surface through hitherto dissociated states of self. Stern’s conception of such creative disorder lends itself well to a way of viewing the working through process that encourages the expansion of self experience across all major domains — thinking, feeling, behaving, relating, and so forth.

 

Community Psychology Concepts

 

Empowerment Theory

 

Empowerment taps into — and makes use of — a community’s inherent resilience (Borg et al., 2009; McCormack, 2009). It has been suggested that when a community has undergone a process of empowerment, it has become “revitalized” (Bright, 2001; Revenson & Seidman, 2002; Seidman, 1983, 1988, 1991; Warren, 2001). Therefore, the terms empowerment and revitalization are synonymous when it comes to describing community interventions that are grounded in empowerment theory. Empowerment is both a value orientation for working in the community and a theoretical model for understanding the process and consequences of efforts to exert control and influence over decisions that affect one’s life, organizational functioning, and the quality of community life (Borg, 2002a; Perkins & Taylor, 1996; Perkins & Zimmerman, 1995; Rappaport, 1981; Zimmerman & Warschausky, 1998; Watzlawick, Weakland, & Fisch, 1974; Weick, 1984).

 

One could argue that there are empowerment processes going on in analysis quite often — whether or not we choose to refer to these processes as such. Working through the tyranny of unconscious id impulses and superego indictments, or breaking through the enacted traumas and the influence of the dissociated experience of the repetition compulsion is certainly empowering — leading to greater freedom to experience one’s life across domains of thinking, feeling, and relating to others and the world. This process, like empowerment in community theory, then results in a person’s ability to have more of a sense of conscious choice and volition in his or her life — which is the sine qua non of empowerment.

 

Empowerment theory describes the processes whereby communities develop their own self-defined, workable collaborative solutions to problems in living that account for contextual issues related to their specific environment (Bloom, 1996; Borg, 2002a, b, 2004a, b, 2006; Fawcett, Seekins, Whang, Muiu, & Suarez de Balcazar, 1984; Perkins & Zimmerman, 1995; Rappaport, 1977; Rappaport & Hess, 1984; Rappaport & Seidman, 2000). An empowerment-driven reading of social context, as opposed to an individual or a public health perspective, sees “disorder” less a function of specific disease processes, and more as the result of a transaction between efforts to make sense of one’s immediate world and the constraints of environmental factors, including responses to other people (Felner, Felner, & Silverman, 2000).

 

Empowerment theorists have traditionally focused on increasing the power and legitimacy of local communities, often through what are called mediating structures (Berger & Neuhaus, 1977; Mistry, Jacobs & Jacobs, 2009; Seeley, 1981). Mediating structures are small local agencies, institutions, and organizations that serve the local community residents, and provide a necessary function for them by helping to ensure that their needs and concerns are heard and met by large and often impersonal governing structures (Levins, 1995; Miller, 1993; Woodson, 1987). Mediating structures may include churches, service agencies, and other groups made up of community residents, and therefore sharing their concerns.[10] Often groups (or project groups) that form in the context of community interventions may themselves be transformed into mediating structures, grounded on the collaboration between intervention team members and local residents (Borg et al., 2009). Yet the long-term goals of such projects require that groups or organizations formed between residents and practitioners belong fundamentally to and reflect the needs and the perceptive legitimacy of the indigenous population (Mattessich & Monsey, 2001; Mondros & Wilson, 1994). They must be thought of as extensions of local communities, reflecting their own indigenous customs, practices, and tacit systems of accountability, rather than as rote instruments of distant government authorities, obeying abstract bureaucratic rules (Seidman & Rappaport, 1986).

 

Empowerment theory suggests that optimal functioning is a collaborative project between people and their environment. The experience of empowerment enhances people’s capacity to manage their own lives (Rappaport & Seidman, 2000). Accordingly, assessments of community functioning must take into account the relationships, social structures, and resources in which existing competencies operate (Townley & Kloos, 2009). Empowerment processes encourage the establishment of community- (rather than institutionally-) controlled solutions that can be responsive to the varying needs of different individuals, neighborhoods, and communities. Likewise, Mitchell (1993) has said that “Useful forms of meaning and hope do not lie preformed in the patient; they are generated when the analyst has found a way to inspire personally meaningful forms of growth and expansion from the inside out” (p. 225). This is as true of communities as it is of individuals. Treatment, intervention, and even social policy are empowering to the extent that they enable people to develop their own solutions to their problems, from the inside out — and that these are perceived as being legitimate solutions even if not implemented (i.e., imposed) by so-called “experts.”[11]

 

The ultimate goal of the community practitioner is to promote community members’ ability to define their community’s unmet needs and advocate for themselves and their community in the world at large (Albee & Gullotta, 1997; Bright, 2000; Zimmerman, 2000). The hallmark of empowerment is the functioning of collaborative processes. Empowerment processes have a way of shifting, multiplying, dissolving, and reappearing; most especially, they have a way of looking different to different residents and practitioners at different times throughout the course of the work. This is so because such processes reflect so many different facets of community life.

 

Participation, control, and critical awareness are essential aspects of empowerment. At the individual level of analysis, these factors include a belief in one’s ability to exert control (intrapersonal component), involvement in decision-making (behavioral component) and an understanding of causal agents (interactional component). At the organizational level of analysis, these factors refer to settings that provide individuals with opportunities to exert control and organizational effectiveness in service delivery and the policy process (Speer & Hughey, 1995). At the community level of analysis, these factors refer to the contexts in which organizations and individuals interact to enhance community living, and insure that their communities address local needs and concerns (Berger & Neuhaus, 1977).

 

Empowerment theory connects individual well-being with the larger social, economic, and political environment, and suggests that people need opportunities to become active in community decision-making in order to improve their lives, organizations, and communities (Zimmerman, 2000). Individual participants may develop a sense of empowerment even if wrong decisions are made because they may develop a greater understanding of the decision-making process, develop confidence to influence decisions that affect their lives, and work to make their concerns known. Organizations may be empowering even if policy change is not achieved because they provide setting in which individuals can attempt to take control of their own lives (Israel, Schulz, Parker & Becker, 1998; Pistrang, Barker, & Humphreys, 2008). Communities may enhance opportunities for residents to participate in the policy process even if some battles are lost. A community can be empowered because the citizens engage in activities that maintain or improve their collective quality of life.

 

“Given the nature of social problems,” Rappaport (1981) stresses, “there are no permanent solutions, no single this-is-the-only-answer-possible solutions…Problems must have many solutions that change with the currents” (p. 14). Both empowerment theory and interpersonal psychoanalytic theory implement this philosophy. Both seek to expand the options available for dealing with problems in living, and to support the agency of individuals in their efforts to find creative, health-promoting, collaborative, and sustainable approaches to the inevitable complexities and anxieties of everyday life. Interpersonal psychoanalysis and empowerment theory, at core, stress the importance of paradox: the need to sustain, rather than foreclose, the tensions among opposing and conflicting points of view (Mitchell, 2000; Rappaport, 1981).

 

Empowerment theory has been challenged. While critics commend those who seek to increase their own efficacy by gaining new skills (e.g., job training) or abstaining from self-defeating behaviors (e.g., substance abuse and crime), they lament the ubiquitous application of the much ballyhooed, yet often vaguely defined, empowerment nostrum to every problem imaginable (Ellsworth, 1989; Fetterman, 1994). Such critics claim that empowerment work at its worst may foster dependency by training people how to coerce or cajole benefits from governing bodies (Weissberg, 1999). Also, there is always a fine line between practitioners facilitating community revitalization programs in a framework of collaboration, and the possibility that these same “experts” might impose external or infantilizing measures. Therefore, the pragmatic focus on problems in living, mutuality, and pluralism that are highlighted in interpersonal psychoanalytic theory may provide an additional and important framework for community practitioners as they negotiate the potential pitfalls of empowerment practices. It is possible, as critics suggest, that the term has been expropriated beyond its intended use. It is the distinction between spontaneous empowerment activities occurring everywhere and the pragmatic use in dealing with real life problems that is fundamental (Riger, 1993).

 

Due partly to these problems with community empowerment, I believe than an interpersonal psychoanalytic perspective has something valuable to offer the theory and practice of community intervention. While interpersonal psychoanalysis and empowerment theory complement each other in their shared concentration on collaboration among individuals, I believe that interpersonal psychoanalysis can inform and improve upon how empowerment is conceptualized and implemented. From the psychoanalytic perspective that I am arguing in this chapter, community revitalization, like individual analysis, requires the working through of historically entrenched feelings of hopelessness, depression, and powerlessness (Borg, Garrod & Dalla, 2001). This is especially so in cases where chronic trauma, intensified by the defenses against overwhelming anxiety that are called up to deal with it, interferes with collaborative functioning. This community level process of working through historically entrenched problems in living, exacerbated by trauma, is enhanced by a working understanding of transference and countertransference enactments, just as in individual analytic work.

 

Primary Prevention

 

Primary prevention has historically been a philosophy and practice that attempts to see the acute in what is generally perceived as a set of chronic and intractable social problems (Morgan, 2008; Trickett, 1996). Prevention practitioners have used this information to develop methods of analyzing and intervening in social problems as early as possible, and prevention is considered primary if methods are developed to intervene in social problems before they begin (Albee, Joffe & Dusenbury, 1988; Price, Cowen, Lorion, & Ramos-McKay, 1988).

 

Yet there is an implicit level of “acceptable casualties” that we, as a nation, seem willing to absorb (Jencks & Petersen, 1991; Albee, 1996). Psychoanalysts are in a good position to witness and assess these casualties on an individual basis as they manifest in various patterns of behavior and sense of self (or selves) that our patients present in the consulting room — though, in prevention theory, psychotherapy is considered to be at the secondary level. That is, therapy and psychoanalysis are interventions that are generally implemented after a problem has already arisen. Nonetheless, I believe that there are potential incidents and problems that loom on the horizon of some of our patient’s lives that do meet the criteria for being “primary prevention,” the most dramatic examples may be when patients discuss, instead of act on, suicidal or homicidal ideations and impulses (Borg, 2004b; Goldston, Daniel, Erkanli, Reboussin, Mayfield, Frazier, & Treadway, 2009; Gullotta & Bloom, 2003a, b).

 

So back to “acceptable casualties.” There are alarming levels of highway deaths, homicides, substance abuse, infant deaths, child abuse, homelessness, school failure, preventable illnesses, unemployment, and other social problems that currently do not have crisis levels of resources allocated to them — these are among the “chronic crises” that I will highlight throughout this chapter. As a society, we operate from a core assumption that there is an acceptable or necessary level of casualties (call it “friendly fire”). This assumption appears particularly manifest when we view the levels of resources being directed (or, actually, not directed) to persons who have racial, socioeconomic level, gender, or other qualities that set them apart (Albee, 1982; Hage & Kenny, 2009; Mannarini & Fedi, 2009). This “setting apart” also includes a scapegoating process wherein marginalized individuals and groups, who the system can not or will not take care of adequately, are blamed for the very scarcity of resources that have and have not been made available to them (Albee, 1986; Britner, 2008; Goldston et al., 2009; Reich, 1995; Schorr, 1988) — what William Ryan (1971) originally referred to as a “victim blaming ideology” (p. 1).

 

Primary prevention has developed in response to this state of affairs — the state wherein many of our most multiply-marginalized have had to somehow adapt to the most horrid social conditions — chronic crisis — as if these could be in any way tolerated. It is this state of affairs, actually, that might help to make sense of the absolute need for powerful dissociative defenses in certain (many really) condition within which people in our country and around the world live.

 

There are two pertinent and similar definitions that I will utilize to define primary prevention. The first is offered by Felner and Lorion (1985):

 

[Primary] prevention applies to the enhancement, disruption, or modification, as appropriate, of the unfolding process [and conditions] that lead to well-being or to serious mental health or social problems. A primary prevention intervention involves the systematic alteration and modification of processes related to the development of adaptation and well-being or disorder, with the goals of increasing or decreasing, respectively, the rate or level with which these occur in the [target] population (p. 93)

 

And, the second, more concise definition comes from Gullotta and Bloom (2003b), the editors of the recent Encyclopedia of Primary Prevention, who define primary prevention as follows:

 

Primary prevention and health promotion encompass those planned actions that help participants prevent predictable problems, protect existing states of health and healthy functioning, and promote desired goals for a specified population” (p. 9).

 

There are three levels of prevention:

 

1.  Primary Prevention: To take action before some untoward set of events occurs so as to preclude, delay, or reduce its occurrence. For instance, lowering the rate of new cases of mental disorder in a population over a certain period of time by counteracting harmful circumstances before they have a chance to produce illness.

2.  Secondary Prevention: The most succinct definition of secondary prevention is early recognition and prompt treatment, or early intervention. For instance, reducing the disability rate due to a disorder by lowering the prevalence rate of the disorder in the community (lowering the number of new cases, shortening the duration of existing cases).

3.  Tertiary prevention: This level of prevention is associated with treatment of disorders or problems that have already been incurred by individuals or groups. For instance, rehabilitation is a common form of tertiary prevention — actions that assist people in regaining the highest level of functioning possible after the onset of serious illness, disorder, or disorganized community existence.

 

Studies of the adaptive impact of a wide array of developmental circumstances have shown that there are common developmental antecedents, such as family resources and interaction patterns, economic and social deprivation, other life stresses, powerlessness, and an array of non-specific protective resiliency factors (social support, sense of self-efficacy, hope), that all relate to the probability that persons in a population will develop an extraordinary assortment of mental and physical disorders (Felner, Farber, & Primavera, 1983; Kellam & Brown, 1982; Perkins, Larsen & Brown, 2009; Senge & Scharmer, 2001; Shure & Spivack, 1982), and that certain communities themselves will be “disordered” (Kellam, Brown, Rubin, & Ensminger, 1983; Sameroff & Fiese, 1989)

 

Contemporary primary prevention models emphasize the dynamic, reciprocal interactions between the individual and their context, with bi-directional influence being a fundamental element (Henggeler, Schoenwald, Bourduin, Rowland, & Cunningham, 1998; Mistry, Jacobs, & Jacobs, 2009; Sarason & Doris, 1979). Consistent with such a dynamic perspective, primary prevention becomes an ecological model which holds that developmental trajectories are shaped by “Progressive, mutual accommodation between an active, growing human being and the changing properties of the settings in which the developing person lives” (Bronfenbrenner, 1979, p. 21). Such an ecological framework also provides for the consideration of critical additional elements of human contexts. It offers a comprehensive and integrative means of viewing the interactions between the various parts of total ecological and psychological systems, as well as between individuals and their proximal environments (Baltes, 1987; Benard, 1991; Latkin, German, Hua, & Curry, 2009; Walderdine, 2008).

 

It is possible that intersections can be developed to account for similarities between primary prevention and interpersonal psychoanalysis. Through its implementation of security operations, the self-system tends to perpetuate its isolation within the personality. Hence, the person tends to seek means of maintaining safety, tending to develop solutions to problems in living which serve this purpose, albeit often in an indirect and not always understandable fashion. The “me-you” patterns, which become the basis for habitual distortions in experience, are always, according to the interpersonal perspective, derived from actual, if improperly understood, experiences with real others, in which the self has experienced some security or control, and which has become misapplied in the face of anxiety.

 

From the perspective of this potential as a foundation for prevention, Sullivan’s (1953) self-system can be viewed as a metaphor for the potential for personal, and interpersonal, primary prevention. The self-system can be translated, through theories of empowerment and primary prevention, to suggest the human capacity to protect oneself from the debilitating impact of anxiety and insecurity. The existence of the self-system (while traditionally viewed from the perspective of its pathological implications), therefore, indicates the human potential for an internalized primary prevention system in that a person is able to adapt to environmental stressors, through psychological defense mechanisms. This is done in such a way that the person is able to maintain security. Yet the sacrifices and concessions that one makes to maintain this sense of security underlie Sullivan’s (1956) notion of psychopathology. However, the system itself remains indicative of the health-preserving potential inherent within the individual. It is my assumption that this system can be expanded within the context of interpersonal and community relationships. Interpersonal psychoanalytic theory would hypothesize that it is anxiety that disrupts the continuity of experience and, therefore growth.

 

On the other hand, if an experience arouses curiosity, strengthens initiative, and sets up desires and purposes that are sufficiently intense (along the gradient of anxiety), it can be a motivating force. The value of an experience, therefore, can only be based on what it moves us toward and into. Of course, the value in this is in bringing experience into conscious awareness — to prevent repetition of destructive patterns. Gill (1987) states that “making explicit what is seen is inherent to the psychoanalytic praxis” (p. 232). This takes active listening in the process of interpersonal collaboration, framed in the development of a safe relationship that perhaps was preserved through the initial anxiety-reducing machinations of the self-system — qua primary prevention mechanism. Combined, these validate a person’s sense that his or her experience of the world is worth attending to, and that he or she has something to contribute to interpersonal processes. Levenson (1996) states that “there is no such thing as unbiased listening…Cure, then, is an emergent and collaborative process of awareness” (p. 241). The breakdown of the established order, the temporary chaos that is created when the traditional rules of interaction are challenged, may be vital to a creative process, a reorganization of experience into more complex and flexible patterns (Borg et al., 2009), hence setting up on ongoing internal/interpersonal primary prevention process.

 

Taken together, the previous ideas insinuate that rigidified systems of psychological defense (i.e., self-system) can be manifest in the overall character structure of a community (Borg, 2005b). Also insinuated, however, is the notion that a breakdown of established order (perhaps at the level of trauma, disaster, crisis) in a community, may be vital to the reorganization of experience — setting up opportunities for more functional approaches to prevention and empowerment.

 

A Psychoanalytic Approach to Community Work

 

Community interventions challenge many accepted assumptions and practices of contemporary — and more so traditional — psychoanalysis. For instance, community practitioners often initiate the treatment (that is, the intervention), expand the "frame" by working — and working through — in the context of the day-to-day life of the client, and by making use of the educational opportunities of the work. Nevertheless, community work can retain a strong psychoanalytic sensibility. Martin Bloom (1996), a major figure in the primary prevention field, has argued that

 

Because we now know that traumatic reenactment is a central dynamic in the development and adjustment of traumatized individuals, we must consider the possibility that traumatic reenactment is a strong possibility for traumatized groups as well . . . Therefore, personal and group trauma must be converted into a community asset, not just a personal asset or catastrophe. (pp. 180-181).

 

In all of the examples of crisis intervention that I will explore in this chapter, trauma was the initiating factor; in retrospect, trauma could in fact be viewed as a "community asset" — a point of impact, an acute spike in a state of chronic crisis, which ultimately served as a cry for help. It was only in response to the South Central Los Angeles riots, for example, that city officials began to address manifestations of both acute and chronic trauma; the riots catalyzed their search for a community-based mental health organization to work with old issues of impoverishment, intra-racial violence, racism, unemployment, drug/alcohol abuse, and academic failure, as well as the riot-associated issues of looting, arson, and inter-racial violence (see Borg et al., 2009). The trauma of the riots led, therefore, to unprecedented reparation in the community. Unlike individual psychoanalytic work, which takes place at carefully delineated times and places, community work requires the active participation of practitioners in the daily lives of residents. This kind of personal involvement surpasses even the most progressive psychoanalytic models. While these dramatic departures from the traditional boundaries of analytic work might seem radical, I believe that such intimate contact does fall within the bounds of a contemporary, interactive view of psychoanalysis.

 

Although traditional psychoanalysis generally eschews the didactic approach as "non-analytic" ("acting out"), community work often involves teaching — and it absolutely requires the willingness to be taught. For me, Freud's injunction that "Where id was, there shall ego be" speaks directly to the educative process that underlies psychoanalytic practice. Furthermore, interpersonal psychoanalysis takes directly into account the ongoing educational component of psychoanalytic interaction wherein the reduction of dissociative processes allows for greater learning from experience (Bromberg, 1998; Eisold, 1994; Ehrenberg, 1992; Fiscalini, 1988, 1994; Stern, 1983, 1994, 1996, 1997; Sullivan, 1953, 1954). What distinguishes psychoanalysis from other educational experiences is its use of transference to bring unconscious aspects of experience into conscious awareness. A psychoanalytic approach to community work uses the same approach for the same reason — transference offers the best access to the unconscious material whose potential can improve everyday conditions. Asking questions such as what does a particular interaction between myself and a particular community member or among community members themselves mean about the unconscious dynamics at play in the community itself has been an imperative part of each of the interventions that I have been involved in to date. Dealing with, and then making use of, transference and countertransference enactments in the community eventually allows decisions to be made with an increasing sense of support and hope, as new access has developed to previously ignored community resources for developing ideas, implementing action plans, and working them through them in a collaborative — and more conscious — manner. I cannot emphasize enough the degree to which chronic oppressive conditions in a community truncate the capacities of individual members to simply experience day-to-day life. In fact, such conditions interfere with what the educational philosopher John Dewey (1991) described as the key factor in all types of learning:

 

Every experience influences in some degree the objective conditions under which further experiences are had . . . when [a person] executes his intention he thereby necessarily determines to some extent the environment in which he will act in the future. He has rendered himself more sensitive and responsive to certain conditions, and relatively immune to those things about him that would have been stimuli if he [sic.] had made another choice. (p. 20).

 

The way that the issue of gay marriage was taken up by one of my patients might highlight how when societal conditions are felt to be oppressive it can, and does, make it difficult for some of its members to fully experience their life and to take in (i.e., learn from) experience. During the week in which the gay marriage issue hit the media (the controversy over states like Massachusetts issuing marriage licenses to gay couples, and the ensuing protest, including George W. Bush’s sacralization of sanctity of male-female coupling), Jerry, one of my patients, who is a gay, African American postal worker, attended his session in what seemed to be a state of panic. He was confused and scared. He said, “I feel as if I am being picked on. And I cannot figure out why.” He spoke in a highly pressurized manner for the first twenty minutes of our session as he described being pervasively preoccupied with this sense of being picked on — he could often think of almost nothing else. In reaction to this feeling, he had initiated a number of conflicts with his co-workers and his supervisor. He knew he was being picked on and was determined to find out who was responsible.

 

During a very brief pause, I questioned the timing of his feeling of being picked on. In a hostile tone he said, “What do you know?” He then commented that I had no idea what I was talking about. I could feel his rage and resentment in my gut as I recalled his previous interest in the gay marriage issue. “Well,” I said, “I am interested in what you meant when you said that you’d been thinking of ‘almost nothing else’…I am wondering about the issue of gay marriage. You spent the last few sessions discussing it, and now that it is getting so much media attention you are silent on the issue and I myself am feeling a knot in my stomach” Jerry then said that he had been thinking about this issue all week — that, in fact, his “gut was in a knot” — but it did not occur to him to discuss his feelings and thoughts about the issue in therapy or with anyone else (even though he had been obsessively following the stories, and the outcome of what he considered a Civil Rights issue since it first arose). When I questioned this, he said, “It’s hopeless, a dead issue, anyway.” He went on to discuss his experience of the gay marriage issue for the rest of the session and said that he could see how this had been a major component of his preoccupation with being picked on during the week.

 

In this example we can see how when a social condition is experienced as being oppressive it can lead to a preoccupation that truncates other ways of experiencing ourselves. Jerry’s behavioral acting-out at work and his hostile attitude toward me formed his unconscious protest against the ways in which he personally felt oppressed. His usual interests and general ways of interacting with friends and colleagues were not available to him during the preceding week, only one aspect of his experience was felt by him to be sanctioned and therefore able to be expressed, a hostility that he wielded against all who he encountered, including his analyst. In fact, his “What do you know?” — and the subsequent emotional gut-punch that landed in me — was his way of aligning me with the system of oppression; only then could we feel what it was like from within our shared experience and work our way out together.

 

What I have been discussing as truncated experience in this example relates to the role of dissociation in oppressed communities. In my experience of working with oppressed communities I have seen a very common dynamic at play. This dynamic is so common, in fact, that I have developed a formula for approaching my interactions in community work. The formula is thus: Intolerable oppressive conditions create the need for individuals and groups living in these conditions to dissociate certain aspects of their experience — the “dead” and “hopeless” aspects. These aspects are then enacted in interactions within circumscribed communities. In the above example, aspects of my patient’s truncated experience — links between his feelings and the oppressive social condition he associated with the gay marriage issue, as well as strong expectations that others in his social environment (including his analyst) will reinforce this oppression — are dissociated and enacted as we can see in the antagonistic exchanges that he had with others during the week, and this often occurs in a physical sense (the knot in our guts).

 

Arriving at a point at which this patient and I could have this discussion, and were able and willing to experience the fullness of our interaction and the ways that pertinent issues played out between us related to the wider context of his life took time and the development of a sense of safety and trust. The fact that we could learn from it was based on a number of years of developing a relationship that could contain the expression and enactment of such experience. Similarly, in my experience, community interventions that emphasize didactic approaches to group interaction in their early stages often facilitate later-stage opportunities for unconscious processes to become manifest through the analysis of these dissociated and enacted experiences. Simply, such analysis, which we can be thought of as analyzing the transference-countertransference of community interaction, is also educational.

 

Levenson (1972) believed that change in a system is created through a practitioner's "ability to be trapped, immersed, and participating in the system and then work his [sic.] way out" (p. 174). This statement is to my mind the definitive description of the constructive use of enactment. The experience of becoming embedded in, and gradually emerging from, an enactment — as was the case with Jerry in the previous example — allows a community practitioner to articulate the nature and the depth of significant longstanding areas of community conflict. For me, working through transference-countertransference enactments has consistently been the most effective way to help community members increase their awareness of, and thus their ability to address and change, areas of community conflict and crisis; enactment, therefore, is a powerful means of making a community aware of its patterns of previously inattended or dissociated thinking, feeling, relating, and behaving.

 

In Creative Evolution Henri Bergson said, "Our intellect is intended to secure the perfect fitting of our body to its environment, to represent the relations of external things among themselves — in short, to think matter" (Bergson, 1911, p. ix). Bergson suggests that our biological heritage makes us kin to the world around us. Therefore, the tools, artifacts, and social structures that we create to navigate our way through this world become unconscious enactments of our interconnections with each other, our history, and the world itself. Experience and conduct are shaped by a continuous series of interactions with the social-cultural-economic-political-geographical environment.[12] In fact, dynamic systems theory suggests that all living beings receive a vast array of inputs from the physical environment and the numerous experiences, especially inter-human experiences, that we encounter in daily living (Ghent, 2002; Prigogine & Stengers, 1984; Thelen & Smith, 1994). In other words, the same input that makes up our experience of ourselves and our world are always immersed in dynamic interchange with the environment. Transference — the analyst's, the patient’s, the community practitioner's, and the community member’s — is the result of how one's sense of self and other has been unconsciously shaped and molded by that environment. It is through the exploration of transference and countertransference that the patterns of living created through interactions with the environment are brought into the here-and-now of analysis and made amenable to collaborative exploration and understanding.

 

As we now proceed to the section where I will be describing the actual process of developing and implementing community psychoanalysis, I will be most primarily setting out to explore the sense of self, other, and context. This exploration, of course, has to take place somewhere, and that somewhere is most often imagined as the analyst's consulting room. But much of the data that we consider significant — the autobiographical self-experience, the biographical experience of others, and the geographical experience of context — is brought into the consulting room by the patient. The community is where all of these experiences of self, self-other, and self-context are developed and repeatedly played out. There are many ways and places to approach and engage these aspects of experience — both as they are enacted between patient and analyst in the consulting room, as well as what they convey about the patient’s environment/community — so as to enhance analytic and community intervention processes.

 

Developing and Implementing Community Psychoanalysis

Community Character

 

Community can be conceptualized as a defense against the overwhelming sense of isolation and alienation that is increasingly part and parcel of modern life in most Western cultures. The French philosopher Jean-Luc Nancy (1991) suggests that “community, far from being what society has crushed or lost, is what happens to usin the wake of society” (p. 11, original emphasis). Thomas Pynchon (1961), similarly, stressed such a use of community to combat our forlorn, and often objectified status when he wrote in V., “Community may have been the only solution possible against such an assertion of the Inanimate” (p. 289). Accordingly, I believe that communities, like individuals, develop unique characters that make use of unique constellations of psychological defense systems (Borg, 2002a). Also like individuals, community responses to trauma are frequently marked by rigid and repetitive modes of interaction (Garland, 1998; Ursano, McCaughey & Fullerton, 1994)[13] For instance, in many communities that have been traumatized by oppressive conditions — and unjust treatment — from the wider society, patterns of interaction are marked by suspicion and hostility. As I use the term, community character describes group-level self-protective mechanisms (or group-level self-system operations).[14]

 

To sum up, community character is a typical style of interaction that reflects the unconscious, unwritten, unstated, but ever-present laws that decrease group anxiety by governing and limiting the ways that people interact with each other within a community (Borg, 2004, p. 155). These implicit laws grow out of the actual historical events, circumstances, and experiences to which the community has had to adjust. They give communities their distinctive characters, similar to the ones found in individuals. Indeed, there is a direct connection between community and individual character; individuals are formed in part by the character of their communities, and experiences and behaviors that are not consistent with the community character must be dissociated and enacted. For example, gang violence can be seen as an enactment of a prohibited protest against injustice (Borg, 2005b; Borg & Dalla, 2005). The community may acknowledge the injustice, but the act of protest is prohibited, out of fear that protest would mark the community for more oppression. The gangs hold and enact the protest for the community, partly due to their willingness to violate the standard rules and regulations of the community, and partly as a displacement of repressed/dissociated community concerns.

 

In communities that have experienced significant trauma, as in individuals, character tends to become inflexible, impinging upon individual members in ways that are overt and often intractable. Rigid patterns of relating within communities are partly the enactment of the community character (Borg, 2004a).

 

Community character is organized into patterns of social interaction, relations, and connections — essentially the sum total of the unconscious enactments of a particular community’s stakeholders (Borg, 2004b). Through repetition, these enactments lead to the establishment of rules, regulations, taboos, and stereotypes, implying that any character formation based on acclimation to a pathological society can produce psychopathology (Fromm, 1941, 1955, 1956, 1968, 1976, 1998; Fromm & MacCoby, 1970; Hegeman, 1995; Mead, 1934; Menzies, 1960; Revenson & Seidman, 2002; Richardson, Fowers, & Guignon, 1999; Schultheis, 2004). Taking Fromm’s position regarding what he facetiously called our “Sane Society,” we can see that symptomatic compromises, borne of this acclimation, are currently visible in the loss of corporate ethics, a growing tolerance of cruelty, and the tendency to target and scapegoat criminals without accounting for the criminogenic environments that sustain them (Borg & Garrod, 2003). The ultimate pathological compromise is the acceptance of such behaviors as the norm.

 

Community represents interaction patterns among individuals who respond and react to each other and to the outside world according to their sense of security within the context that they have inherited and that they themselves sustain. This is what Kurt Lewin (1935) meant when he argued that a natural relationship exists between “the character of a given situation and the character of the group which dominates the behavior of the individual in the situation” (p. 109). First and foremost, the rules and prohibitions of a community and the repetitive interactions they shape protect a tentative sense of security. This function encompasses all the feelings, thoughts, belief systems, passions, longings and other facets of those embedded within a particular community character. The developmental and interaction patterns of a community are specific to it, making it essential for community practitioners to collect a considerable amount of community-specific data so as to understand as clearly as possible the assets and deficits of community life.

 

Although it is tempting to make generalizations and to organize troubled or traumatized communities into certain types, every community ultimately requires a unique intervention, just as do individual patients in analysis. This recognition supports an empowerment philosophy that encourages community members to “work from the inside” to develop new ways of interacting that support a growing sense of security based on expanding interactional options — hence creating opportunities for primary prevention as new crises arise in the community. Generalities about “primary causes” and beliefs about “universal dynamics” are not helpful in this regard; in fact, they can obscure the unique reality of a particular community and often create powerful resistance to actual change.

 

This was particularly true in a consultation that I was involved in with a research and treatment substance abuse center in East Los Angeles. The center had a tendency to see their clientele in very general terms — as “junkies.” They did not treat them as collaborative partners in their own treatment. They treated them in an authoritarian manner, as if by having a drug addiction they were children, and this set up a powerful relational dependency in the clientele. This worked fairly well so long as the state was uncritically funding the treatment of such individuals; in fact, since a major component of the center’s business was methadone maintenance, the “junky” was a highly valuable resource. In my work with the center, its directors were attempting to develop a program to help their clients who were on methadone maintenance recover from their addictions to both heroin and methadone itself. This program innovation, however, was born of mixed motives — and, therefore, highly resistant to change. Recent changes in California’s Medi-Cal insurance policies had resulted in a large number or people in the program being unable to pay for the services. Since ethically the program could not just drop these clients, they had begun to float (i.e., provide pro bono treatment) a large percentage of their population. This set up a rather desperate financial crisis in the center. The program innovations ultimately failed, because regardless of the crisis, they were unable to change the ways that they perceived and interacted with their clientele: as junkies receiving the mythical free lunch and not as individuals in need of recovery. Unconsciously the center’s character was built upon general “universal dynamics” of the junky (especially their chronic dependency in which the staff colluded). This dependency cycle, in fact, became the primary cause for the clinic’s existence. To shift that way of thinking and perceiving would destroy this clinic’s identity — ultimately, it would rather perish than face that.

 

It is important to develop inferences about themes underlying community psychopathology, but we must do so without letting formulas obscure crucial community issues or entangle us in the medical model by which an “expert” (in many cases, a representative of the dominant society) seeks to prescribe and impose a treatment plan, as in the case above. Approaches of that kind may undermine a community’s efforts to develop an empowering means of relating to each other and to outsiders. Expanding the field of inquiry so that community members and outside sources of support can examine together the various aspects of character facilitates the likelihood that improvements in living experiences will be created. A common alternative — a behavioral modification plan imposed by some well-funded intervention program — often carries harsh iatrogenic consequences.[15] For example, imposed community modification plans institute dependency on external (and generally transitory) resources, and so can actually erode the capacity for self-advocacy and reliance that they purport to be strengthening, as in the case where the treatment of heroin through methadone becomes the illness itself.

 

My view of community character is similar to how Erich Fromm (1941) and Allan Cooper (1987, 1991) view individual character. That is, character is multi-determined, multi-faceted, and has the capacity to be altered for better and for worse by interpersonal experience. For instance, one of my earliest consultations was at an adolescent psychiatric hospital that served also as a long-term residential treatment center. During the time of the consultation, the character of the community was profoundly impacted by dramatic and sudden changes in financial resources. This treatment center had once been a cohesive community founded on attention to consistent and progressive treatment, good communication, appropriate boundaries, and a strong sense of collaboration among staff, patients, and the patient’s families. The hospital administration supported this environment both philosophically and financially.

 

Drastic cutbacks in insurance reimbursement radically altered the makeup of this community. The residential treatment wing lost its independent status and instead had to share the same living space as the acute psychiatric ward. The experienced and well-trained clinical staff was drastically cut. That staff had run “community groups” that met twice every day. These groups were the backbone of the community’s functioning. These groups focused on and explored the ongoing group process [15a] among staff and patients. This dynamic information was then used to monitor the goings-on on the unit, with follow-through where needed, to help the community maintain and improve safety and trust on the unit. After the budget cuts, the community groups were no longer as capable of facilitating group process or containing the hectic emotions of day-to-day life on the unit. Psychiatric nurses and direct care staff no longer had a sense of the overarching clinical goals, and were expected to run the unit with only the pragmatic guidelines of basic physical safety and bare-bones behavioral management. Staff-to-patient ratios were not increased to accommodate the population of the combined wards nor the increased acuteness of the patients who were now in the care of the staff members. Even behavioral management became increasingly difficult as the community character deteriorated into one of hostility, paranoia, non-communication, and non-collaboration. The physical safety of patients and staff members was increasingly at risk. The character of the community was being transformed as the support — financial, clinical, emotional — was being drained from the system, and as the administrators decreased their investment in the hospital itself. When a decision to sell the hospital, essentially to “give up” on the staff and the patients, was arrived at (and, interestingly, no one told the staff or the patients), an eight-hour riot erupted, during which time patients locked staff in their offices, barricaded the outside doors to the facility, and proceeded to demolish the unit. The situation was contained only when a fire broke out that required the intervention of the fire department and the police.

 

Before the cutbacks, the community character of this treatment center had been governed by the preconscious expectation that self-destructive behavior would be a target of intervention (a self-sustaining primary prevention model unconsciously sustained by many an adolescent; see Borg & Dalla, 2005) — after all, almost every patient on the ward had ended up there as a result of uncontrollable self-destructive behaviors (cutting, substance abuse, gang affiliation, suicidal and homicidal gestures/attempts, eating disorders, and so on). The unspoken law of the community rendered these destructive behaviors intolerable, and no longer hidden and colluded with. When the resources were available, this law was upheld with relative consistency and reliability.

 

Once resources became scarce, the overtaxed staff could no longer be consistent and reliable, however much they wished otherwise, and trust began to wear thin. As it did, the community character devolved into one of hostility, paranoia, and non-communication. The hostility reflected the patients' anger at having had a safe environment yanked out from under them (again). The paranoia reflected a return to a previous state of existence in their homes before coming to the treatment center: an environment where their own behaviors could not be controlled and their emotional life was neglected. After having learned to communicate their needs in the established trust that they would be responded to appropriately, the patients were in a sense forced to give up on this hard-earned expectation and the reverted to previous styles of self-destructive behavioral acting out — a familiar and desperate cry for help. Community character was now operating according to a new set of unnoticed or unformulated assumptions. This character implicitly mandated that needs should no longer be communicated because they would not be reliably responded to or adequately met. Since needs do not disappear, though, they merely became dissociated and enacted. It seems that many of the incidents of anarchic community functioning were similar to those that were enacted in some of the individual patients’ families, and resulted in behaviors similar to those had gotten these patients hospitalized in the first place. All of this created enormous anxiety in both the staff and the patients reflecting/enacting also the dread in the administrators who were trying to keep — and then gave up on keeping — the hospital alive.

 

Furthermore, this community was replete with trauma. All of the patients had come to the hospital with histories of profound abuse and neglect, and the trauma of their own self-destructive behaviors. Before the cutbacks, this treatment center, with its ten-year history of dedicated staff and program development, had been able to meet successfully the challenges of this traumatized population. But once financial constraints made adequate intervention impossible, the patients' traumatic histories only made the deteriorating community character more rigid as the need to defend against disappointment and despair became more and more pressing. Patients' enactments of their dissociated desires to have their needs met became their only means of communication as the new community character became less and less flexible. The hopelessness of the riot foreshadowed the eventual collapse and closing of this facility.

 

Sick Societies, Facilitating Environments, and Community Character

 

Erich Fromm (1941) believed that many contemporary — at least Western capitalistic — human societies fail to facilitate the full development of individual lives; instead, they are designed develop capacities and technologies for material production. In his view, societal structures tend to breed a consumer mentality:

 

Societies become structured so that individuals are drawn into a view of the world and their place in it which enables them to want to do the work which their particular society at its particular point of history requires. The subjective function of character for the normal person is to lead him to act according to what is necessary for him from a practical standpoint
(p. 310).

 

Fromm thought that all societies selected for some characteristics and obscured others. He thought that humanity had a potential which was carved into particular shapes by culture, and that sick societies were the ones that prohibited (or derailed) the actualization of human potential. Fromm thought that people are shaped in Western society to think of themselves and other people as commodities, to be valued according to the conditions of the marketplace. According to Fromm, our essential aloneness and helplessness predispose us to accept whatever the price is for belonging, such as the roles offered to us by society (e.g., our role as a marketplace commodity). This need for belonging in a particular society also predispose parents (who operate out of social necessity by virtue of their own character structures) to introduce socially fashioned solutions to their children. Repression in this case derives its power from the fear of ostracism, not merely from the fear of punishment.

 

In the same manner that Winnicott (1958) believed that proper analytic holding environments do not exert social influences on patients beyond the facilitation of maturational processes, Fromm believed that in an ideal society the psyche is not damaged by social forces. Instead, he viewed such a society as a facilitating environment for achieving our inherent psychic maturational potential. Fromm (1941) introduced awareness of an element in the human psyche that encourages individuals to collude with or opt for social arrangements that inhibit their development — namely, the anxiety that arises from the uncertainties of existence, or existential anxiety. To avoid this anxiety, Fromm suggested, most people are willing (or compelled) to escape from freedom — that is, to make life more certain even if it means accepting limited or symptomatic self-reflections through the eyes of authority. The payoff is the illusion of being taken care of by god-like figures who serve as buffers between individuals and the hazards of daily living. Fromm felt that we exist in conflict between existential anxiety and the inherent tendency to grow emotionally and spiritually. This conflict is manifested and enacted through what Fromm (1941, 1955) called social character.

 

There are some important differences between the community and social character concepts. Fromm (1941) thought that social character was “the essential nucleus of the character structure of most members of a group which has developed as the result of the basic experiences and mode of life common to that group” (p. 305). In contrast, the community character concept provides a means for understanding and working with group-level transference and countertransference and for describing interactions between and among individuals from different groups. Unlike social character, community character is enacted and exists on a local scale, according to the laws and mores of a specific local community. Two individuals may belong to several overlapping communities, with the enactments that they participate in being dependent upon the dynamics of the combined communities that each one belongs to (or which they perceive each other belonging to).

 

The concept of community character allows practitioners to view community intervention through an interpersonally-oriented psychoanalytic lens, by which character is seen as a series of repetitive ways or patterns of relating to self and others. At the most basic level, these adaptive/defensive patterns form a stable personality structure for addressing security needs in the face of anxiety. They are reinforced according to the degree that such needs are threatened in a given relationship (e.g., between parent and child), in a specific community (e.g., by local beliefs, prejudices, and taboos), or within society (e.g., by formal laws, sanctioned rules of conduct, or cultural norms).

 

Point of Impact

 

A disaster or crisis that shakes a community system can be viewed as a shared focus through which individuals and groups can explore their chronic concerns (Borg, 2002a). To describe such experiences I use the term point of impact, defined as the “emotional
epicenter where pain and anxiety become manifest and where the immediate trauma and longstanding difficulties and conflicts converge” (Borg, Garrod & Dalla, 2001, p. 19).

 

The point of impact is the place where defenses break down and the individual and/or community is flooded with overwhelming anxiety. This often manifests as an experience of acute crisis that is related to something going on in the real world — an interpersonal event. Furthermore, such interpersonal events are always embedded in a context of personal, cultural, economic, racial, and political meanings. The community character is that which protects the community from experiencing its own chronic crisis (i.e., anxiety stemming from chronic hardship and trauma). The point of impact is a break down in the community character’s capacity to defend against (dissociate/enact) such anxieties.

 

At times of crisis, a community’s traditional defense patterns are jolted and sometimes loosened, thus offering new opportunities for learning and change. There is also a corresponding potential that defensive patterns of relating may gain strength, and become more rigid, but the fact that they are in flux provides a window of opportunity for intervention. Community character defenses that are transmitted across generations — for instance, racism and other forms of prejudice, xenophobia, and stereotyped communication — evolve to manage the pain and anxiety of chronic trauma. Yet they create emotional and behavioral climates that may congeal into perpetually repeating manifestations of the trauma. A community system that is resistant to change is likely to enact a widespread dissemination of emotional (including depression, alienation, and paranoia) and behavioral (including violence, isolation, and crime) symptoms.[16] For example, in traumatized communities a common way of relating is through exaggerated stereotyping and scapegoating. This way of relating often results in the mistreatment of virtually everyone in the community at one time or another, thereby creating an environment in which people are repeatedly traumatized — and effectively distracted from the underlying traumatic causes.

 

A psychoanalytic patient’s presenting problem often comes in the form of an acute crisis — the recent dissolution of a long-term relationship, a relapse into substance abuse, or an episode of extreme anxiety or psychosis. Another patient may be present with an acute flare-up within what is otherwise a chronic state of crisis — a history of relationships with abusive partners, long-term substance abuse, or extended depressive symptomatology. In my experience, these flare-ups represent threats to characterological defenses that protect against overwhelming chronic and unrecognized anxiety. Such defenses are so entrenched that they have become synonymous with how these people are experienced by others (as well as by themselves) across time. As Siegal (1987) put it, symptoms are, after all, “attempts at solutions” (p. 289).

 

I will use the term point of impact to refer to crisis flare-ups that exist within and manifest more entrenched, chronic states of community crisis. As in psychoanalytic treatment, it is often the eruption of an acute crisis within a well-defended state of chronic crisis that initiates a request for community intervention. Because the point of impact is essential to each of the examples in this chapter, whether community or clinical, I will in this section, present four examples (two community and two clinical) to exemplify this concept.

 

What is the Point of Kendra’s Law?

 

Usually a chronic crisis remains hidden during an initial community assessment, with an acute crisis serving as the point of impact indicating a more chronic condition. For instance, in January of 1999, Kendra Webdale was pushed in front of a Manhattan subway train by Andrew Goldstein who suffers from schizophrenia and was later convicted of second-degree murder. The subway killing raised a huge public outcry and resulted in the passage of “Kendra’s Law” in New York, which calls for forced treatment for the mentally ill (AOT: assisted outpatient treatment). The irony is that prior to the killing, Mr. Goldstein repeatedly sought treatment, only to be denied. Another irony is that the State, which considered Mr. Goldstein mentally ill when it passed the Kendra’s Law, argued in court that he was perfectly sane when he pushed Ms. Webdale in front of the train. A final irony is that, as a murderer, Mr. Goldstein is getting the treatment he had begged for. This tragedy (point of impact) ultimately served to highlight a state of chronic crisis in the community mental health system and the need for ongoing assessment of how well it does (and does not) serve its target population. Initially, however, this killing just seemed to be yet another random tragedy in a large contemporary city.

 

So let’s back up to describe this process. What does this example — this point of impact — say about our response to social problems in our contemporary Western society? In the last century, the pace of urbanization and industrialization in the West has outstripped the development of life-sustaining infrastructures in support of urban residents. We in the United States are now witnessing a backlash wherein deindustrialization, corporate downsizing, unemployment, and the dismantling of the welfare state are adding to the already considerable pressure on our support structures (Blackwell, 2003; Giroux, 2003; Zizek, 1989, 2006, 2008a), and, in turn, on our legislation and social policies that address these structures (Gilbert & Etzioni, 2002; Huber & Stephens, 2001; Swank, 2002). Epidemiological studies are showing that increasing numbers of physical and mental health impairments are resulting from exponential growth in urbanization and industrialization and their decompensatory effects (Price-Smith, 2001). Researchers working on the Global Burden of Disease Project (GBD) have projected future causes of deaths and impairments using a measure they call disease burden — though we might read this as a more ominous and extended version of what I am calling the point of impact. They believe that by 2020, the leading causes will be heart disease, depression, and traffic accidents (Murray and Lopez, 1996, 2004). Furthermore, these and other researchers are predicting that five of the top ten leading causes of “disease burden” by 2020 will be associated with “psychiatric conditions” (Duckett, 2004; Hacker, 2002; Haagsma, Haavela, Janssen, & Bonsel, 2008; Lee, 1999). If true, it is imperative that we evaluate our service provision infrastructure for these conditions, the social policies that support this infrastructure, and the cultural and political implications of such services, including oppression and social justice in the institutions we are creating to address our growing psychiatric disease burden (Mathers & Loncar, 2006; World Health Organization, 2008). The Webdale/Goldstein tragedy may be the kind of point of impact that can draw our attention to the insufficiency in the infrastructure that we use to address a potential psychiatric apocalypse. This being the case, we need look to our contemporary times to evaluate the point of impact(s) that are being enacted now and setting up the very conditions that will result in psychiatric disturbances on such a grand and overwhelming scale.

 

My four-year tenure on the executive board of a community health center in New York City gave me the opportunity to observe and participate in a group attempt to develop an effective community mental health approach and supportive infrastructure to address the Webdale/Goldstein tragedy as a point of impact. The group process focused primarily on how this tragedy called the New York service-provision community to address and implement needed changes in social policy that addresses the needs of the population it serves. During that time I also worked with an ongoing community development project managed by the Coalition of Voluntary Mental Health Agencies, a social policy and advocacy organization representing over 100 nonprofit community mental health agencies in New York City. This group worked at what might be considered the intersection between the civil rights and community mental health movements. It became apparent that the philosophies underlying these movements both have and have not been enacted in contemporary social policy in the U.S. specific to addressing the needs of people with disabilities. Specifically, it became apparent that the ways in which the system (specifically made manifest in social policy) alternately resists, repeats, and colludes with power operations under the guise of unexamined assumptions referred to as ableism or disability oppression (Casteneda & Peters, 2000; Fanon, 1967, 1968; Foucault, 1978, 1980; Freire, 1970; McClintock & Rauscher, 2007). These terms refer to the institutional discrimination that serves to exclude individuals with physical and mental disabilities from full societal participation.

 

The current policy of deinstitutionalizing mentally ill individuals in the U.S. was 50 years in the making. The combined population of residents in state and county mental hospitals in this country has dropped from more than 500,000 in 1950 to approximately 50,000 today (Monahan, Swartz, & Bonnie, 2003; Shelton, Taylor, & van den Bree, 2009). However, the total population of mentally disabled prison inmates has increased to the point that a person with a serious mental illness is almost five times more likely to be incarcerated than admitted to a psychiatric care facility. This juxtaposition of declining treatment and increasing incarceration rates suggests a point of impact that has increasingly attracted considerable attention from deinstitutionalization critics, who note that most governments have consistently failed to establish promised community-based treatment programs (Swanson, 2000; Tam & Law, 2007). However, there are signs that the tide is turning in this area. Backed by research asserting that treatment can reduce violence in people with major psychiatric disorders and fueled by high-profile cases of violent crimes committed by people suffering from severe mental illness, community-based treatment approaches are slowly gaining attention in this drama (Bell, Adams & Griffin, 2007; Korn, 2004; Perlin, 2000; Swanson, 2003). The issue remains controversial, since it pits public safety concerns against individual rights.

 

Researchers in the Global Burden of Disease Project (GBD) have predicted that five of the top ten “disease burdens” the world must address by 2020 will be related to mental disabilities (Murray & Lopez, 1996; Newton, Lee, Goodman, Fernández, & Yeung, 2009). However, it seems that a point of impact that has already been predicted is a point of impact that can, at least potentially, be prevented. The tendency to reduce the complex circumstances, multiple identities, various etiologies, and personal struggles associated with people with mental illness make them easy targets for fearful projections (e.g., breakdowns, violence, instability) within the general population. Scapegoating such as this makes the very idea of developing preventative strategies impossible because the very use of the scapegoating process serves a defensive process wherein causes and conditions remain hidden. The tendency of GBD and similar discourses to lump together mental disability categories that reduce them to a societal burden underscores the similarities of the ableistic perspective and other discriminatory practices — especially the way we use certain groups as scapegoats for societal malfunctions. In its worst form, this process represents a “victim-blaming ideology” (Ryan, 1971) that casts doubts on the legitimate rights of oppressed groups and supports cutbacks in or the elimination of institutions meant to provide services for them.

 

Henry Giroux (2000) argues that “Domination is never total in its effects; contradictions arise within all public spaces, even those that appear most oppressive” (69). It seems as though the further we move from social investment, the closer we come to the politics of domination or social containment, in which state services are reduced to the repressive functions of discipline, control, and surveillance (Aronowitz, 1996; Foucault, 1975; Price-Smith, 2001; Said, 1993). By addressing the circumstances that erupt at the point of impact — a symptom of such oppressive and reductive strategies for dealing with epidemic social problems — we can create responsive communities and policies to address the unique circumstances of those individuals in need of mental health services is an important focus for challenging the effects of domination. This is especially true when we go beyond the language of individual pathology to the more threatening issue of how we treat our marginalized populations. Working at the point of impact, we might be able to expose the degree to which marginalized individuals in our society still lack the security and resources required for their safety, well-being, and empowerment.

 

By working at the point of impact — specifically, the Webdale/Goldstein tragedy — this group was able to describe certain processes at play in the service-providing system, changing the community character of this system, and the ways that mentally-ill people are treated in New York. This has been the main task of the Coalition, and the ongoing development and implementation of Assertive Community Treatment — a treatment modality consistent with empowerment and prevention praxis, in that it includes a treatment team approach from various community resources that encourages and requires the full participation of the client in his/her own treatment — has increasingly been accepted as a primary form of care for psychiatric patients at risk.

 

When Getting Well is Not, Actually, the Point

 

Intervening at the point of impact always produces unexpected results. For instance, at the time that protease inhibitors — the first effective treatment for HIV — were being introduced into the national healthcare system, I was consulting to a Southern California AIDS/HIV clinic developing, implementing, and evaluating programs to serve people with HIV and their families. While the drugs signaled hope for HIV/AIDS patients worldwide, it also created daunting challenges for the patients who suddenly had a future again. Many of the patients I worked with were middle class and well educated, but had not worked for several years. Quite a few of them were supported by Social Security Disability Insurance (SSDI) benefits that they could only obtain when they were symptomatic, could no longer work, and had gone through every shred of personal savings that they had once built up. Furthermore, many of these individuals had resigned themselves to the fact that they were going to have a very early death. As the patients got better in response to the new medications, their SSDI benefits were halted — both the actual health insurance, which paid for extremely costly prescriptions and frequent doctor’s appointments, and monthly cash benefits.

 

Though the prospect of having a longer life was hopeful in many respects, many of these individuals confronted the stark reality that they would not be stepping into their old lives — and began to detect characterological behaviors and feelings that had been established in them related to the ominous character of the very community they had, often for years, been turning to for help. They had not worked in several years which made them unattractive job candidates; their skills were often outdated and noncompetitive. Instead, many realized that they would have to adjust to the stresses of not only poverty, but of working-class poverty (e.g., low wages, entry-level employment, lack of health benefits, and so on), brought on by the withdrawal of their disability benefits. This often propelled these individuals into new situations that taxed their functioning to the utmost. In these situations, the clinic clients often found themselves working in a context where they felt undervalued compared to their previous middle class occupations: long hours for low wages in positions incommensurate with their education. Therefore, adjusting to this circumstance was nearly catastrophic for many of the clinic’s patients. The one advantage to thinking that they were going to die was believing that they only had to deal with the ways in which the disease had taken their lives away for a limited time. Having their death sentences rescinded meant that they would have to figure out how to both grieve a life lost while simultaneously developing a new life of increased hardship. Thus the introduction and the effects of the protease inhibitors became a point of impact in this community, ushering in the trauma of a return to physical functioning and ability to work with restricted access to the middle class lives they once enjoyed. Having HIV/AIDS for many of these individuals had already brought with it a status of feeling like a disenfranchised person, the acute crisis laid this bare by the very fact that these individuals would now be bringing this sense with them into their renewed engagement with the social world.

 

Ironically, it was the disease itself that made this community (i.e., clinic) necessary. The HIV/AIDS clinic had served as a defense against the chronic sense of anxiety, loneliness, and dread of being HIV-infected, disenfranchised, and often ostracized. The protease inhibitors, qua point of impact, would save (at least extend and make more productive) many lives, but would ultimately kill the clinic itself. Over the years, many of the patients at this clinic had grown much invested in the sense of community and solidarity that they had formed at and through the clinic. Now that an effective treatment had been introduced to combat the disease, the community was quickly losing its reason for existing as such. At a time where many of the patients would need the kind of support and care that they had been receiving — and had learned to trust — over the years, the community itself was being dismantled due to the fact that the patients were “getting better. However, due to a consistent effort to restructure their reason for existing (what psychoanalytic organizational consultants refer to as primary task), we were able to work together to develop a holistic treatment program focused prevention and health promotion — as opposed to primarily medical care — that was ultimately funded, and the clinic and its programs continue today.

 

In analytic work, it might be possible to identify a point of impact for every patient. I will give two striking examples that add to the community dynamics explored above from the clinical setting. Although, the point of impact is primarily a community concept, I am presenting these clinical examples because they address dynamics that are similar to the processes that might be encountered when we are addressing the point of impact in community work. In the first example, the case of Tim, we can see that, given adequate time and resources, an understanding of what the point of impact is, as well as the chronic crisis that underlies it, can become manifest in the transference-countertransference encounter. Within this framework, the chronic crisis underlying the point of impact can then be worked through and integrated into the patient’s understanding of him- or herself in the context of his or her history. This work can then be used to improve the patient’s functioning and well being in their daily life. Often, however, as in the second example, the case of Jolie, the point of impact is so overwhelming that it manifests (as an acute symptom or symptom constellation) only for a brief time period. Sometimes, during this brief encounter with the point of impact, the minimal and incomplete understanding of the chronic crisis that it taps into can backfire (i.e., trigger powerful defenses), leading to an abrupt termination of the treatment or intervention. The end result in that case (as in the second example) is a return to a status quo of functioning wherein the chronic state of crisis is (once again) thoroughly dissociated.

 

Tim as Toxic Agent

 

I met “Tim” when I was working at a community mental health center in New York’s West Village. He was a forty-seven year old, Caucasian, gay man who was living with his elderly mother, as he had been for most of his life. During his initial intake he described an almost unbelievable history of psychiatric hospitalization. From the time that he was in his early twenties, he said that he had been hospitalized over 100 times. He had been diagnosed with paranoid schizophrenia, was taking a wide array of anti-psychotic medications, and had been released from his most recent hospitalization just that morning. And that, for him, was the problem: he was going home. I asked him why he was afraid of going home. He was afraid, he said, for the same reason that he had, a month previously, been hospitalized: he was terrified that something about him, something inside him, something dangerous though indescribable that he carried within him, was toxic. So toxic, in fact, that he believed that it had the potential to either kill or drive his mother or anyone else close to him insane. He was in a panic, sweating and shaking, and had a hard time staying until the end of the intake session. We scheduled an appointment for later that week, but he did not attend. In fact, he went straight back to the hospital. Later that day I received a strange phone call at the clinic’s front desk — an “emergency.” I picked up the line, stating my name, and all Tim said was, “Good, you’re still alive.” And thus began the sputterings of what would become a many-yeared analysis.

 

Over the next six months he would exit the hospital, reinitiate treatment for up to a month, and return to the hospital repeatedly. Tim referred to the hospital as his “Home Away from Home,” but it felt more like home to him than his actual home. Despite the fact that the hospital felt like home to him, Tim nonetheless felt that his numerous stays there meant that he was an outcast of society and that these stays interrupted the possibility of him “having a life.” I was, of course, extremely skeptical about the possibility that our work would contain him. But something about that first session, the intensity of what I would later consider the manifestation of a point of impact in that session and his subsequent phone call, held my curiosity and sustained my hope during that first phase of treatment. While a point of impact represents an acute manifestation of a more chronic crisis, it was difficult to tell what the chronic crisis in Tim’s life was. That is, both his hospitalizations and his living situation with his mother seemed equally problematic to Tim, and both resulted in him feeling as if he “had no life.” Though my curiosity and concern was engaged by our interaction in the first session, the subject of his toxicity never came up again during the first six month phase of treatment, and he seemed to have no ability or desire to engage with me on the topic. After six months I told him that the current situation of repeated hospitalizations interrupting his treatment was unmanageable and we terminated his treatment.

 

Two years later, Tim resurfaced. He had called the center, found out that I was no longer employed there, found my number, and gave me a call. I told Tim that I would be unable to work with him under the previous conditions. He assured me that that would not be the case. He told me that was terrified of returning to the hospital again, as his most recent stint lasted for six months instead of the “usual” week to month. In fact, he said that this was the first trip in a long time where the hospital staff were speaking of “institutionalizing” him indefinitely. He told me that he felt certain that things had changed. He said that he was willing to comply with his medication regimen (and sign a consent so that I could talk to his psychiatrist), that he had quit drinking, and that he was wholly invested in continuing our work. He believed that he would be able to “refrain” from re-entering the hospital, and that he would be able to attend analytic sessions regularly. And so he did!

 

Over the next six months, Tim attended his three-times/week analysis without missing any sessions, surprising even himself. During this time, he would begin to put together a history of what seemed to be crisis after crisis beginning with the separation of his parents when he was age three. He revealed how, at that age, when his parents were both but twenty-two, and already had three children, a sixteen-year old girl came to the door and revealed to Tim’s mother that she had been impregnated by Tim’s father. The results of this incident were that Tim’s parent’s divorced, his mother suffered a “psychotic break” and was psychiatrically hospitalized for the next three years, and Tim and his brother were sent to an orphanage (while his sister stayed with the mother’s parents). Tim was never to see his father again.

 

This series of events was key in setting up what Tim and I began to refer to as the “Tim as Toxic Agent” scenario. That is, Tim had developed a deeply held belief that somehow it was he who caused the total annihilation of his family: His parents divorce, his mother’s breakdown, the banishing of himself and his brother to the orphanage, and the disappearance of his father. One of the ongoing effects of Tim feeling responsible for the breakdown of his family is that Tim has taken up the care of his psychotic mother. Tim revealed that, as a result of his care for his mother and his hospitalizations he essentially “has no life.” Even worse were his perpetual wishes and dreams that he actually was toxic so as to be able to kill his mother who had, in many ways, “stolen my life.”

 

However, this did not come into our treatment relationship until Tim had begun to piece together the circumstances of his first psychiatric hospitalization. When he was twenty years old, he was at a bar with a group of his friends and a male friend of his had stabbed and killed his own impregnated girlfriend. Tim had been standing beside her when this event occurred and was unable to stop the murder. Soon thereafter, Tim was subpoenaed to testify on the matter; instead he was hospitalized psychiatrically — the first of many hospitalizations. Tim believed that rather than being called in as a witness to the murder, he was being indicted to stand trial for his own crimes. An important part of that story is that at the time none of these friends knew that Tim was gay, and he had been in love with the man who murdered his girlfriend. This caused Tim, once again, to wonder if his desire to “get rid of her” might have compelled this man to kill her under the influence of the “Toxic Agent.”

 

On the evening that Tim revealed this incident, I received a series of frantic emergency messages on my voice-mail. “Are you OK?” Tim cried, “Please call…” When I called Tim he was in a state of panic and could not believe that I was still alive. “I was absolutely certain that you were dead,” he said, “that you jumped out of your (seventh story) window as soon as I left.” Similar to our very first session three years earlier, once again, Tim brought a point of impact into the transference, into our relationship. He had, in his fantasy, driven me crazy and killed me — by inducing me to commit suicide under the influence of his toxicity. The fear (and the wish) of driving his mother crazy (as he believed he had done at an early age) and killing her came full force into our relationship.

 

Tim’s acute anxiety that he had driven me out the window was the acute crisis of the point of impact. It was present in our very first session too, but we did not have the data that we needed to make sense of it. Tim’s belief that he had destroyed his family now became one of his central transference concerns with me. On occasion, this transference theme would become so overwhelming that it would erupt into an acute crisis, a point of impact. However, these acute crises were always shadowed by chronic, but less pressing, concerns that he would damage me in ways similar to that which he believed he had damaged his family.

 

Tim’s chronic state of crisis was quite pervasive — and had much to do with his sense of being an outcast, and an orphan, in both his family (having poisoned them all) and his community (being a closeted gay man in a very conservative Bronx neighborhood). After the eruption of Tim’s fear that he had caused me to jump out the window, he began to reveal the full scope of his delusional system. He had come to believe and develop fantastic conceptualizations that he was culpable for virtually all of the pain and suffering in the world — that it was not his world, his community that was dangerous, it was he. His hospitalizations were generally triggered by his belief that the only way to save the world, his mother, and his family, was to lock himself, and the toxicity that he incarnated, away.

 

The dynamics associated with “Tim as Toxic Agent” continue to come up in his day to day life, as well as in his analysis. Understanding certain events, such as his fantasied destruction of me, as manifestations of his most salient point of impact has been essential for the ongoing process of working through. This process, through addressing the point of impact, has helped us understand the effects of the family traumas in Tim’s life and the chronic state of crisis associated with his own psychiatric history and his relationship with his psychotic mother. In the repetition of the acute states of crisis in the transference, we have been increasingly able to make sense of the chronic crisis that stultified Tim’s sense of being alive. We have been able to use this information and experience to consistently challenge the “Toxic Agent” identity that had been lurking in and wreaking havoc upon Tim since early childhood. In fact, in the last four years Tim has been hospitalized just twice, each time related to someone being hurt near him and him feeling culpable, and both times for 72 hour periods, and both times adding considerable insights to our ongoing work.

 

On the Periphery of the Point of Impact

 

Often a state of chronic crisis is so deeply embedded that all we can glean from an analytic interaction is a point of impact that triggers powerful defenses and leaves us with a series of unanswerable questions. One afternoon the clinic secretary called to tell me that there was a woman there who needed to see me right away. The woman, Jolie, was not one of my patients. When I met with her she told me, between heaving sobs, that she did not know why she was in my office, how she got there, or who had sent her. However, from the story we eventually pieced together, Jolie recalled that she had been waiting outside the emergency room of a local psychiatric hospital when she met an ex-patient of mine who suggested that she leave the hospital and see me instead. During the two-hour session in my office she repeatedly stated that her appearance here at the clinic “made no sense,” that she had always been “just fine,” and that whatever was going on with her “would pass.”

 

Jolie was a thirty-seven-year-old woman who had immigrated from India with her parents when she was eight; she told me that her family was “good” and “intact,” and that she herself was single, an actress, a dancer, a poet, and a screenplay writer who had misplaced a project about her life that she had been working on for five years. Unable to find the manuscript over the course of a week, she had become increasingly paranoid and angry. She told me that she had suddenly lost track of time and had found herself in several strange places — including my office — without knowing how she got there. After a while she regained some of her bearings and sense of self. She asked me to escort her back to the hospital for an evaluation, and requested an appointment with me. Later that night she called to tell me that she had not been admitted to the hospital, and that she wanted to see how things worked out before she scheduled an appointment. I never heard from her again.

 

I have seen her, however, in various public situations over the past five years — walking down the street, talking with friends, holding hands with a lover, reading scripts in coffee bars, and hailing cabs in what look like costume for an acting or dancing gig. In fact I saw her on the street just before I began writing this chapter. Although we have made eye contact on a few occasions, she has never given the slightest hint that she recognizes me. From what I can see, she has not seemed distressed. I wonder whether she is working, loving, and doing well. Had she experienced an acute flare-up of a chronic crisis on the day we met? Had her own point of impact had suddenly erupted into her awareness? Or had she been living in a dissociated state of chronic crisis connected to some deep sense of having been robbed of her identity, history, and bearings, with the experience constantly lurking on her horizon? Had she lost some core of her sense of self when she left India? Did her family and community support her artist identity, not to mention her immigration to New York City? And like so many of the acute crises that we face in day to day life, when left unexplored, I will never know the answers to any of these questions.

 

The reason why I think that these clinical examples are important is because, frequently in community intervention, encountering a point of impact is an intense experience that can be used to either legitimize the work (as in Tim’s case) or can lead to an abrupt termination (as in the case of Jolie). Working at the point of impact is a process that brings to light previously dissociated crises that are then amenable to intervention. This is, however, a delicate situation in that a person (or a community) is engaged in a process where they are confronted by anxieties and experiences that may verge on breakdown. At the point of impact, a whole history of dissociated anxiety and crisis is brought into awareness. Therefore, the clinician or practitioner needs to understand how much is at stake, and also that experience at the point of impact is a rare opportunity that, depending on the strength of one’s defenses, may be inaccessible under any other conditions. And even then, as in the second clinical case, such opportunities are generally fleeting, and that such windows of opportunity are often short-lived.

 

I use the point of impact concept to describe the emotional epicenter of any crisis (clinical and community) where pain and anxiety are manifested and where immediate trauma converges with longstanding issues and conflicts. In this manner, acute trauma can unlock a community’s history of chronic trauma (Borg et al., 2009). Intergenerationally transmitted character defenses (such as prejudice, stereotypical communications, in-group insularity) and ritualized communicative and behavioral taboos (such as implicit prohibitions against cross-ethnic or interracial communication) are created to manage the anxiety and pain associated with chronic trauma. These defenses can result in the perpetuation of trauma by means of the emotional tone, behavioral symptoms, and the interactive patterns they sustain. As the emotional and behavioral symptoms mentioned at the end of the preceding section are repeatedly enacted in a community, crisis or disaster may be required to disrupt them. The point of impact is an acute crisis that serves as a focus through which groups and individuals can explore chronic conflicts, differences, and dissatisfactions (Borg, Garrod & Dalla, 2001).

 

A point of impact is an emotional entrance through which many of the communities and analysands with which I have worked have relaxed their borders to let the outside world in. They may also serve as portals for community crisis interventions. This may be what Freud was hinting at in Analysis Terminable and Interminable (1937b) when he suggested that the stronger the trauma, the better the chances for a cure.[17] On a community level, acute trauma can unearth histories of conflict, anxiety, and pain experienced in relationships among residents and service providers across generations. In the South Central Los Angeles intervention mentioned previously, inquiries into the history of relationships between residents and service providers (especially law enforcement authorities) led to a forum in which longstanding patterns of stereotyping, prejudice, inter-group suspicion, paranoia, hostility, aggression, and violence could finally be given voice and not only enacted.

 

As practitioners, it is our goal to develop community interventions that transform these fixed points into expanding spaces of awareness. Such spaces can provide access to emotional experiences that in turn allow for negotiable and collaborative solutions to characteristic hardships and problematic interaction styles.

 

Creating a Psychoanalytic Community Context: Project Groups

 

In some of the interventions I have been involved in, residents and community stakeholders worked with community practitioners to develop project groups[18] comprised of community residents and practitioners to focus on and intervene in a specific community problem (Borg & Lynch, 2005). I pose that we can view such groups as a type of action research methodology.[19] Following Stringer’s (1999) description of action research methods, these groups formulated an agenda of defining community problems to be addressed, exploring problem contexts and sustaining or initiating environmental factors, analyzing the problems’ component parts, and developing strategies for resolution. Project groups are forums in which residents make commitments to work collaboratively with practitioners to identify problems to be addressed, to develop inquiry processes, and to develop explanations leading to better understandings of community problems (Borg & Magnetti, 2004).

 

Project groups develop means for planning, implementing, and evaluating the projects and programs they create in the context of each intervention. As such groups collect additional data, they invite community leaders and other interested people involved in their political and educational lives to participate. Eventually, residents and practitioners become participant/observers (Sullivan, 1954) capable of consulting with and training other community members regarding the action research methods they themselves had created, practiced, and sustained.

 

What we have come to call “project group methodology” grew out of the post-riot South Central Los Angeles intervention that we were involved in for some years, where we learned that bringing community residents and service providers together to address, explore, and intervene in the oppressive conditions that fostered trauma was an essential element in community empowerment (Albee et al., 1988; Borg et al., 2009; Nebbitt, Lombe, & Williams, 2008; Rappaport & Seidman, 2000). Since then, each time I have seen this methodology used I have also seen how rigid, conditioned patterns of thinking and feeling are explored by project group participants, and how members are able to experience en vivo how these processes serve to maintain biases, prejudices, and negative assumptions about other community members. In most cases, residents reported an increased capacity to communicate needs among themselves as well as more respect and understanding on the part of community leaders and service providers (including outreach workers, teachers, police officers, and rent collection staff). This resulted in higher levels of trust and increased feelings of responsibility about community needs.

 

My observations persuade me that this methodology can also be used in organizations and communities that have clearly identified problem areas or areas requiring increased development. For instance, a disaster intervention organization that I belong to formed what might be called a “project group” to enhance its outreach efforts, increase funding, develop progressive tracking methods, and create ways of becoming “authorized” for crisis activation. While establishing a formal project group is not considered a standard practice in all interventions or consultations, less formal groups with different names are often created to serve similar functions.

 

The "action research" component of project groups is generally focused on exploring community dynamics through examining enactments, and understanding them as manifestations of dissociated experience in the community. My colleagues and I have repeatedly noted that the relationships formed within project groups and the emergence of naturally supportive group processes result in increased levels of community empowerment as well (Borg, 2004a). I therefore believe that by understanding and working our way out of the enactments engaged in within the project groups, members are better able to address problems in living in their community. In many ways, expanding on this process is the primary task of project groups.

 

Enactments within project groups, especially those between community stakeholders and the practitioners, are microcosms of the enactments that take place in the communities these people come from (and between their communities and other communities, or between their communities and outsiders). Project group enactments, therefore, offer the same kind of therapeutic leverage in community work that transference/countertransference enactments offer in individual work.

 

Transference/Countertransference Enactments in Community Interventions

 

I suggest that individuals within the same community develop common transferences and transference-related enactments based on their shared experiences. One common expectation of the South Central LA residents, for example, was that interactions with outsiders would ultimately become hostile and neglectful, whatever the stated intentions (Borg, 2004a). The idea that communities collectively develop common transferences has greatly helped me understand the community work in which I have participated. Knowing that individuals in communities will develop similar transferences may also be helpful to analysts working with individuals from specific communities.

 

In community work, transference is a phenomenon in which community members’ experience and play out their community’s underlying and disavowed conflicts (Borg, 2003b). I generally use the transference and countertransference concepts to refer to the transfer of internalized relational patterns from personal, familial, historical, and cultural contexts to an individual's current experience of self and other (Borg, 2005a). Along these lines, then, enactment is best described as the behavioral playing out of unconscious transference and countertransference themes that represent the unconscious dynamics of community character. From this perspective, enactment is a vehicle for experiencing, expressing, and ultimately understanding transference themes and the ramifications of repetitive relational and current functioning patterns within the community.

 

A central premise of the contemporary interpersonal psychoanalytic perspective is that both participants (analyst and analysand) are involved in processes that invariably affect and are affected by an interpersonal field (Bromberg, 1998; Levenson, 1991; Mitchell, 2000; Stern, 1997, 2003). Transference shapes countertransferential relationships and is revealed in them; reciprocally, one’s countertransference shapes and is revealed in the transferences of the other. Sullivan (1940, 1953) described the analyst’s role in this process as that of a participant-observer who attends to and appraises his or her participation in the analytic process. This is almost always the case for community practitioners, who participate in the daily life of the community and then must take stock of that participation.

 

In communities, persistent modes of thinking and feeling are often reinforced in important ways by daily interactions that are established, sustained, and reinforced by its members. As Bauer (1993) notes:

 

A person’s distrust for others . . . may result in a manner of relating (e.g., guardedness, defensiveness) that actually creates a malevolent or rejecting environment, leading to further guarded, defensive behavior. By behaving in a particular fashion, a person may actually create an environment that provides continued validation for the behavioral stance that supports the original premise. (p. 176)

 

When member involvement becomes crucial (e.g., when practitioners use project group methodology), transference and countertransference issues can serve as the raw material out of which community change is crafted. Interactions and confrontations between members and practitioners almost always mirror community issues that require attention. Formal and informal meetings in which problems are re-enacted in front of and with practitioners are vivid demonstrations in microcosm of larger community patterns. As in individual work, the concrete experience of transference enactments carries a kind of conviction that exposition, or even interpretation in the abstract, seldom do.

 

I will present a more extended case study to exemplify these concepts in community work.

 

The Women’s Prison Council

 

Since 1980, the number of incarcerated women in state and federal prisons has increased fourfold (Borg & McCarroll, 2004; Women’s Prison Association, 2009). Much of the increase has been attributed to the national trend in sentencing drug offenders to prison instead of probation or treatment programs (Belknap, 2001; Gilliard & Beck, 1998; Lochart & Scott, 2009; Van Wormer & Bartollas, 2000).[20] During the 1980s, the number of women arrested for drug violations more than tripled — twice the rate of increase for men (Bloom & Chesney-Lind, 2003; Greenfield & Minor-Harper, 1991; Women’s Prison Association, 2008). Today, the typical incarcerated woman is young, single, non-white, has children, has few job skills, has little (if any) work experience, and has a significant substance abuse problem (Borg & Garrod, 2003; Dittman, 2003; Moore, 1995; Women’s Prison Association, 2009; Young, 2000). Though there are few community organizations designed specifically to address this crisis, the Women’s Prison Council of New York City (WPC) is a nonprofit organization established in 1844 that has a long-term history of working to create opportunities for change in the lives of women prisoners, ex-prisoners, and their families. The recent changes mentioned above in the criminal justice system have had a direct impact on the WPC’s ability to perform its primary task: to help women make the transition from prison back into their communities.

 

During an intervention with the WPC, a female colleague and I noted how patriarchal societal dynamics associated with the oppression of women — specifically, female prisoners — were enacted in interactions between WPC staff and their clients, as well as between WPC staff and us. We also saw that this dynamic played out in subtle and overt ways both within the WPC and between WPC and the numerous institutional settings that they were connected to (especially the criminal justice system). While the mission of the organization is to help women (especially women of color, lower-income women, and women with health and mental health problems) integrate back into the community after a prison sentence, we found that some of the more pernicious aspects of the ways in which our society treats women were also at play between the staff and the clients, as well as between the leaders of the organization and the field staff.

 

Something odd had been happening in the ways in which the WPC staff — especially the clinical directors and their teams — were dealing with WPC’s clients. As many of the changes in the criminal justice system had resulted in greatly increasing the caseload of the individual staff members, the staff members had begun to change their tactics in dealing with their clientele. We began to think that the WPC had changed its organizational structure as a means of dissociating the overwhelming environmental conditions and changes in policy that were effecting their population. It seemed likely that some of the conflicts that were going on among individual members of the staff could be translated into organizational (system-level) conflicts as they faced the changes in the wider system.

 

It had always been a strict policy at the WPC that actual police intervention would be the very last measure taken in dealing with the women that it served. The only times, in fact, that police were called to intervene had been in overt cases of child abuse. However, recently it was becoming increasingly clear that individual staff members had been turning to the police for minor infractions perpetrated by the women they served. This set up an ironic situation wherein the very people who were ostensibly working to help women transition back into their communities from prison were actually helping them to return. For example, one woman client was charged with a parole violation and sent back to prison because she did not show up for a meeting with her WPC counselor. It turned out that the reason for this absence was that the client could not find child care (it also turned out that the client had called to inform her caseworker of the circumstance). Though this had been noted in staff meetings, none of the actual staff members had been confronted on this behavior. Instead of addressing this behavior directly, the executive director had decided that she would set up a kind of subtle surveillance system that would be enforced in the heavy-handed treatment of the WPC clientele by the executive team. It would then be the executive team’s task to confront this issue — on a one-to-one basis — with staff members and decide how it should be dealt with. This task included vesting the executive team members (only one of whom was involved in clinical matters) with the authority to terminate staff members who did not desist from this behavior.

 

So, rather than address how this behavior might represent a desperate attempt at dealing with the massive and oppressive changes in the how the criminal justice system treats women, the WPC authorized members of its staff to quash any and all symptoms of this (i.e., the acting-out of the anxiety that system-level changes in the criminal justice system were creating in the interaction patterns being enacted between WPC staff and its clients as well as between WPC staff themselves) as they were made manifest in the WPC itself. And the degree of secrecy that the program manager, Ms. Vick (who had initiated our consultation), stressed regarding this issue was particularly disturbing to us in our consulting role. In fact, it seemed as though the executive team had been empowered to enact a role very similar to that of the criminal justice system itself, to seek out the rule-breakers and to punish them — without any consideration of the ways in which certain problematic behaviors might be — both real and transferential — reactions to problems in wider social context.

 

We established a project group consisting of the five members of the executive team and began an analysis of the dynamics that were at play both in the organization and in the larger criminal justice system within which the WPC operated. We found that by addressing the most problematic circumstances that the executive team was dealing with as if they were solely “in-house” issues, set up an impossible (seemingly futile) task. Therefore, the theme of the consultation seemed to revolve around the enactment of trying to do the impossible and to do so by dissociating and losing track of the primary task of the organization itself. This was so because some of the ways in which the WPC served women were becoming impossible in the system of oppression that the criminal justice system was increasingly becoming. So taking on societally-influenced problems as if they were solely “in-house” issues was an enactment of the WPC’s inability to deal with, develop, and integrate measures to address such hopeless issues as recidivism and changes in the criminal justice system’s treatment of women (especially zero tolerance laws that increasingly targeted the often minimal roles of women in the more severe crimes of their male partners). As the criminal justice system burgeoned under the pressure of increasing female inmates (with needs that the system itself was not equipped to deal with), the female inmates became increasingly overwhelmed (and oppressed). Simultaneously, the WPC became increasingly overwhelmed by their sense of decreasing their efficacy in performing their primary task. When the staff members of the WPC lost their sense of efficacy (and their sense of certainty as to the nature of their primary task) there was a breakdown of the boundary that existed between the WPC and the wider hostile environment within which it operated.

 

While this was clearly a desperate situation, we increasingly felt as if we were intruding into areas where we were not welcome. In fact, we often felt as if we were involved in some kind of struggle between the executive team’s need for more understanding of the complex dilemmas that they were caught up in and what we perceived as the executive director’s covert need to keep us out (she refused to meet with us throughout the consultation). As we had already become quite invested in doing a decent job ourselves, we were struck with a sense of humiliation at not being clear about what it was that we were trying to accomplish at and for the WPC. Perhaps we, like the members of the executive team, did not really want to know what we were facing. When we asked what we could do for them, it seemed as if they perceived this as a question of what we were going to do to them (i.e., what we planned on perpetrating against them). The transferential message that we kept hearing was something like: You say you want to help, but we know you want to indict and charge us with wrongdoing.

 

Perhaps the members of the executive team, desperate to figure out a way to be effective in what felt like (and was) a hostile and forbidding criminal justice system, did actually invite us in to do something. But we increasingly felt as if the system itself — the WPC — would not allow us to do our job. Was this how it felt to be on the executive team? Take care of our problems for us, but do so by getting rid of them, and, whatever you do, do not let us (or at least the executive director) know anything about it.

 

After the first six months of our consultation, we decided to hold a meeting to address (i.e., confront) what we were seeing as the more problematic aspects of the functioning of the WPC, especially the enactment of mistreatment perpetrated upon their clientele that resembled the criminal justice system’s increasing mistreatment (i.e., making the accomplishment of the WPC’s primary task increasingly difficult if not impossible) of the WPC itself. And in doing so, we stepped right into an enactment wherein we brought to life their transference fears about being charged with wrongdoing. We mentioned the criminal justice system’s increasing oppression of women, and how the WPC staff were behaving, against their best intentions, in very similar ways. In our countertransference stance, we had taken up an authoritarian, as opposed to collaborative, position vis-a-vis the executive team. We found ourselves enacting the same kind of role that their executive director had taken up with the staff. By relegating the power to the clinical directors to terminate to the clinical staff, the executive director was able to distance herself–dissociate the hopelessness in the system — with a sense of righteous indignation. Like the executive director, we felt thoroughly authorized and untainted in taking up the authoritarian position where we could dissociate and enact our sense of hopeless (regarding gaining actual entry into the inner workings of the organization — and, hence, being able to accomplish our primary task) and we began to feel justified in our rather harsh feedback — i.e., criticism — of the organization’s overall functioning. Perhaps this was because we, like the executive director (and on down the line), were feeling ineffective in our roles (still related to the trickle-down effect of the increased harshness with which the criminal justice system was treating those at the lowest end of the treatment totem pole: the female prisoners themselves)?

 

After we completed the presentation of our conceptualization, Ms. Vick became visibly upset, questioning our authority to make such hurtful comments, especially in our doing so in a way that allowed us to distance ourselves from this dilemma with such critical and harsh judgment. After all, weren’t we there to help them work through these dilemmas rather than solely pinpointing the problem and then leaving them to fend for themselves? We believed that the very circumstance of making progress, while ostensibly hopeful, had been underlining the resistance that we experienced in the organization (especially regarding our sense that we were not fully able to do our job) since the beginning.[21] That to make such progress also meant that the WPC would have to acknowledge how it had been colluding with a wider system of oppression, and that this was extremely painful to its core staff. We realized that what we were enacting with them was mirroring the community (character) issues that we were trying to call attention to. We openly discussed how the community problems were being played out between the staff and the clients as well as between ourselves and the staff. We were then able to use this information to begin to help the executive team re-strategize their approach to dealing with their field staff, and to focus on helping them provide adequate service to their clientele. The executive team was able to develop ways of engaging with their staff with an increased understanding of how they were being affected by changes in the wider system that had been impacting their work, and had, prior to this, been dissociated and enacted throughout the WPC.

 

Working through in Community Crisis Intervention

 

Applied to community interventions, working through is the process of coming to terms with the loss of a familiar and predictable environment, and the acceptance of a new state of affairs. Donnel Stern (1983, 1997) expressed the same idea as giving up “familiar chaos” for “creative disorder.” Such exchanges generally entail new experiences of uncertainty, ambivalence, and anxiety.

 

The working though process takes into account interactive repetition and the role that repetition plays in establishing familiar and predictable experiences in living. It also addresses the tendency that we have to resist experiencing ourselves in novel ways, and instead to repeat historical patterns in all of our current experiences (Fromm, 1955; Schachtel, 1959; Sullivan, 1953). The primary goal of the working through process is to become more aware of how one’s history of embeddedness in social contexts has shaped one’s current experiences, and then gradually to increase one’s capacity to tolerate new experiences across the domains of thinking, feeling, relating, and behaving. Successful working through permits increased awareness of alternative ways of experiencing oneself in interactions with other individuals and the wider environment; it is reflected in more flexible, functional and communicative interactions.

 

The character concept is intimately tied to the working through process. In work with individuals, working through refers to resolving intrapsychic conflict, addressing anxiety to allow for a fuller interpersonal experience, and the revelation and change of character. When working with communities, working through is a collaborative process of exploring and understanding the dynamics that underlie and reveal the community character (Borg, 2003b, c, 2004b, 2005c, d). These dynamics are brought to life through transference-countertransference enactments that highlight their development and use (Levenson, 2009). Working through in community intervention, most specifically, is a process wherein the rigidity of the community character is confronted and intervened in — hence expanding experiential and practical options in community members (Borg & Lynch, 2005).

 

Throughout the working through process the primary focus of the practitioner is on how community members experience themselves, others, and their everyday interactions in the community. Despite countless examples of conflict, confusion, and contradiction, members function at various levels of competence within their respective community’s psychic organization. However, rather than causing undue anxiety while working through, it is important to recognize the assets (not solely the deficits) in a community’s functioning — such as how the operations of the community character allows for their ability to sustain a sense of cohesion. Regardless of how hostile or non-supportive an environment appears (whether or not the environment is welcoming), practitioners must assess how individuals maintain their sense of cohesion and how they have maintained relationships in the past (averting the possible narcissistic injuries implicit in solely focusing on pathological aspects of their functioning). Once a more holistic picture of the community begins to cohere, accounting for both the assets and the problems in the community character, the information can be utilized to determine how security and esteem can be developed and maintained in a more conscious manner, and be expanded to encompass the operations of the community as a whole. Similar to their clinical counterparts, community working through processes eventually bring up issues of mourning, loss, anxiety, and fear. But as we know from clinical experience, these are best countered by a sense of hope, and this sense of hope needs to be present in community work too, even where it is considered a taboo experience because of the dread associated with it (Kristeva, 1989; Mitchell, 1993).

 

Practitioners of the interpersonal psychoanalytic position accept that change takes time, is difficult, and requires strong motivation and collaboration, both to sustain changes and to establish new ones. Community practitioners must focus on how community members relate to significant people in their personal and public lives. Whether in analysis or community intervention, change is difficult because abandoning familiar patterns (which preserve a sense of security) will often produce the very anxiety that stereotyped relational patterns have been developed to evade. The new anxiety can manifest in a disruption in the general sense of community, and this may persist until new ways of interacting are integrated into the community’s character.[22] Such a shift requires sufficient flexibility to allow community members to experience new feelings, maintain new perceptions, and learn new skills (Kretzmann, & McKnight, 1993). As inherent security operations permit the expansion of personal and interpersonal awareness, members will note an increased sense of flexibility in their own characters as well as in their interactional capabilities which will then be reflected in the community character.

 

In the interventions I have been involved in, a guiding question has been, "How can we facilitate and help community members sustain a wider array of options for relating to each other?" The working through process in the community setting facilitates members’ learning new ways of relating to each other, and experiencing themselves and their environment.

 

Conclusion

 

Bringing It All Together/Apart

 

Alfred Bester (1957) begins his classic science fiction novel, The Stars My Destination, as follows:

 

This was the Golden Age, a time of high adventure, rich living, and hard dying É but nobody thought so. This was a future of fortune and theft, pillage and devastation, culture and vice É but nobody admitted it. This was an age of extremes, a fascinating century of freaks É but nobody loved it (p. 7).

 

This Golden Age was sparked by the invention of a process called jaunting — teleportation, the transportation of oneself through space by an effort of the mind alone. However, there were some limitations; the most severe of these being that one could not just jaunt out into an unknown space. All who had tried had either died or disappeared. And perhaps enactment is itself a kind of reciprocal jaunting into the private and unknown space of the other’s experience.

 

Yes, jaunting into unknown space has always been, and Bester suggests will always be, treacherous — and sustained by a profound fantasy of what the future, our next destination, the self and the community that awaits us there, will be. And yet we do it every day. Many, if not all, of the interventions that I have been involved in have been sparked and sustained by dreams of the future, the coming community. And although each of the interventions that I have described might represent this process, I would like to conclude with a brief story that I think supports this notion — that all interventions begin and end on fantasy and the degree to which we are capable of bringing (or not bringing: resisting) that to life.

 

A Brief South African Dream

 

Some years ago, my group — the Community Consulting Group — was contracted to consult to one of the technical educational institutions, known as Technikons, in South Africa. We were sought because a colleague, Mr. Zunkel, then living in Durban, had informed the Dean of the local Technikon that we had previously been involved in a number of community revitalization consultation projects. The Dean had sent a representative to New York who worked with our team to establish a set of goals and strategies for addressing the upheavals and stormy seas that his particular Technikon campus in Durban was attempting to navigate. The representative, Dr. Narismulu, wanted us to help his institute become more effective at accomplishing their primary task: developing, from the raw materials of the student body, a viable professional work-force for a new South Africa. Little did we know at the time that Dr. Narismulu was essentially attempting to do something quite grander than neither what he had been mandated to accomplish by the Technikon system — nor, how both myself and Mr. Zunkel would be drawn into the enactment of that experience as we engaged with Dr. Narismulu and the Technikon system. It was also interesting to note how by calling in two foreign consultants — myself and Mr. Zunkel — this intervention reenacted the colonial position in which valued knowledge is seen as belonging to powerful institutions on other shores, while the indigenous peoples experience themselves as lacking in knowledge and authority, voiceless and disenfranchized (Said, 1993; Sardar, 1997). By consulting to Dr. Narismulu and inadvertently training him to consult to his own organization — and later, other linked institutions — we may have been, like him, unconsciously challenging this system from the start. After all, moving from a colonial to a post-colonial position is not solely about having access to previously thwarted knowledge and power, but is more related to the struggle to make that knowledge and power useful in local contexts (Desai & Vahed, 2007).

 

During the initial consultation in New York, in the ongoing e-mail and telephone communication over the next six months, and with Mr. Zunkel providing one-to-one consultation to Dr. Narismulu in South Africa, we collaborated with Dr. Narismulu to develop an elaborate project that would help his institution reach out to, and collaborate with, under-served communities and institutions, and service agencies in the region. We developed internship and outreach programs that would serve to recruit residents of the Zulu communities and members of the numerous shanty-towns and we then collaboratively formulated a mediation program that would link the Technikon institution with other service agencies already operating in the area (including the South African Police Service).

 

Little did we know, at this stage that Dr. Narismulu’s mandate had been, instead, to find ways of helping this particular Technikon join forces with their historical competitors, the other Technikons in the Kwa-Zulu Natal region and beyond. Nor did we know that the consultation itself had begun to reach epic proportions in the mind of our consultee (Dr. Narismulu, that is, not the Technikon system itself). The competition among the Technikons had been hotly sustained by a deeply engrained — and quite realistic — sense of scarcity that permeated the South African society, and played out dramatically among the educational institutions (Desai, 1999). There was a major merger going on in the Technikon system, and Dr. Narismulu, in many ways, represented a fierce resistance to forming such “unholy alliances” with the historical rivals of his circumscribed academic community. When we found out about the system-merger, we thought that the project that had already been set in motion (the one that we had helped Dr. Narismulu construct and implement) could be expanded to include the other tertiary institutions. That was not, however, part of the initial plan — in fact, we ascertained that the plan that we had been working to develop was meant as a means of countering the need for the Natal Technikon to collaborate on the more wide-scale project.

 

So, Dr. Narismulu was mandated to take on a task, he rebuked the task and took up a maverick project to counter the dreaded merger/alliance. We joined him on this task, unaware of the actual situation and of his mandate from on high. Though I met with Dr. Narismulu, visited South Africa, and maintained regular communication with him throughout the project, it is Mr. Zunkel who, after thirty years as an international banker, volunteered to help out in the South Central project, moved to South Africa, and wound up being the point person in this project.

 

In some ways, both Dr. Narismulu and Mr. Zunkel were being asked to mediate between and among certain key positions, stances, solutions, and understandings within vast and complex systems — political, educational, professional, institutional, and theoretical, to name but a few. However, as the project had been appropriated to fit the structure of Dr. Narismulu’s fantasy life, and not the primary task of the organization that he represented, it was not authorized, and doomed to fail (at least in terms of his own enacted desires).

 

Many in South Africa had struggled through years of oppression to finally achieve a position in their own community of status and a sense of being personally valuable in the context of the ubiquitous sacrifices that had been made in the years of perpetual struggle. In many ways our intervention served as a confrontation of the system of scarcity that had been developed and sustained in order to support a means of allowing people to navigate their way through the day to day riptides associated with living within a system of massive — ubiquitous — oppression. The idea of a merger among the Technikon institutes represented a dramatic shift from scarcity to synergy — a shift that would have been unthinkable under the apartheid system. In fact, a synergistic system was unthinkable in regards to how the apartheid system had been, and remained, internalized in many of those who had spent their entire lives embedded in it.

 

The first elections to be held in a fully democratic South Africa took place in April 1994. This was made possible by a new constitution, approved in 1993, which provided for universal suffrage of the South African people. The new constitution was the manifestation of a voluntary relinquishment of power (with internal violence and outside economic pressures acting as potent incentives) by the white minority (Faure & Lane, 1996; Turner, 2000). This then signified the end of over forty years of apartheid. One commentator noted that, in this act, “South Africa emerged from the shadow of apartheid badly injured, but alive” (Welsh, 1999, p. 509).

 

The results gave a substantial majority — over 62 percent of the votes cast, in a high turnout — to African National Council (ANC) candidates, of which Nelson Mandela was a member, of all races. Over the next six years, the ANC, initially headed by Mandela and then by Thabo Mbeke, would struggle with many issues related to the revitalization of an economic, institutional, political, and educational system that had suffered many harsh blows over the preceding years (Elbadawi & Hertzenberg, 2000). This endeavor was complicated, as well, by the need to help many people (blacks, Indians, colored) make the transition from holding a “non-entity” status (Asmal, Asmal, & Roberts, 1997), to attaining, for the first time ever, a sense of empowerment and of their own value as the social capital of a newly emerging government.[23]

 

It must be noted that there was some suspicion as to why the National Party (NP) had “voluntarily” acceded to the vote of 1994, knowing that this would, most likely, result in the end of their rule. Many have justifiably heralded this as a great victory over the South African system of oppression (Braude, 2009; Welsh, 1999). Yet others have, more pessimistically, noted how the NP government shrewdly abandoned the franchise at a time when South Africa faced a national debt, impoverished economy, and depleted work-force that were essentially insurmountable (Desai, 1999; Harris, 1994; Lodge, 2009). Thus leaving the newly established ANC government “holding the bag” on an economic and political environment that had developed seemingly intractable problems.

 

South African president Thabo Mbeki (1998) said,

 

We must, by liberating ourselves, make our own history. Such a process by its nature imposes on the activist the necessity to plan and therefore requires the ability to measure cause and effect; the necessity to strike in correct directions and hence the requirement to distinguish between essence and phenomenon; the necessity to move millions of people as one man to actual victory and consequently the development of the skill of combining the necessary and the possible (p. 9)

 

But there is a sharp counterpoint to this sentiment posed by sociologist Ashwin Desai, who targeted the darker, and less effective, components of the new government’s struggle to liberate South Africa. Regarding post-apartheid conditions, especially in the Townships, Desai (2000) writes:

 

Echoes of the apartheid past were heard in the neo-liberal present. Evictions, relocations and disconnections vied with promises of housing, water and a culture of human rights É Against a new democratic government, implicit and ineffective boundaries to struggle had to be observed. As a style of struggle, counter-violence was out, lobbying was in. The rhetoric of human rights hindered as much as it helped. There was a constitution that enshrined a multitude of rights. But these were rights over the multitude; facilitating governance, enshrining property, observing process, and always subject to financial limitation É Liberation did battle with emancipation, empowerment with equality É [We saw that] human rights interventions could also be converted into defensive weapons and important tactical adjuncts to mass mobilization. Victory [over the NP government] demarginalized rather marginal subjectivities (the indigent, the consumer, the unemployed, the illegal), forcing these half-hidden and degraded personalities to be examined in context
(p. 5).

 

These statements, in many ways, set the pace for the contemporary South African situation. The South African economy had survived the impact of sanctions, disturbances and disinvestment; battered but essentially intact, there had been negligible damage to the industrial infrastructure or the functioning of the markets (Desai, 1999). But it was in the deformed labor force that forty years of “Bantu education” and many years of school disruption had brought about the worst results of job discrimination and apartheid were felt (James & Van De Vijver, 2000; Williams, 2009)). Skilled labor was in short supply, exacerbated as disenchanted whites emigrated, and a threateningly large number of unemployed — and nearly unemployable in a modern economy — needed to be trained and/or retrained. It would be the primary task of the tertiary education system, the Technikons, to develop the means of educating and re-educating the people, the country’s newly established social capital.

 

In essence, what this meant was that the Technikon system had been placed in a position wherein they were faced with the unprecedented task of mediating between an amalgam of systems that had been, historically, not only disconnected, but also in opposition to one another. Most importantly, the individual Technikons did not consider themselves to be part of a “system.” Rather, these institutions considered themselves to be relatively autonomous organizations whose history of interaction with other Technikons had been characterized by fierce rivalry, fueled by their struggles for scarce educational resources, financial support, and student bodies that could be considered educable.

 

Suddenly, these institutions were chartered with the daunting task of churning out a functioning work-force comprised, for the most part, of peoples who had so recently been ineligible participants of the (seemingly) same work-force. Education itself became increasingly politicized. The institutions comprising the tertiary educational system suddenly found themselves in need of establishing new identities, and creating means of collaboration, not only with each other, but also with the very governmental systems that had so recently discovered the value, the necessity, of what it was that they were doing. And, it seemed that Dr. Narismulu was “holding” (had internalized and taken up the task) this darker part, this daunting task, that was ushered in by breaking the NP stronghold on South Africa. A task for which it would, and will, take many years to work through.

 

Merging the institutions in the Technikon system was an important first step in this process. In retrospect, we can see that the deal was going down — the merger within the Technikon system — with or without Dr. Narismulu’ acceptance, or even his participation, in the process. Ultimately, the intervention that we were involved in turned out to be far more personal than the community-oriented program that we developed originally accounted for. We joined Dr. Narismulu in his grand (and perhaps grandiose) fantasy of building systems, shoring up the defenses of a community that had survived traumatic oppression, and real scarcity. A huge burden had befallen Dr. Narismulu and his institution, and he certainly did want to help. However, when push came to shove, the work that we conducted — and especially the work that we did not — was based on a dream that seemed so absolutely essential that Dr. Narismulu (perhaps as an important representative of the system he wanted to support) did not feel that he could stand allowing the process of recovery to develop endogenously; that, in fact, he had to have an active hand in helping move it right along. This problem of “fixing” rather than joining a process and allowing it to unfold in its own creative ways has been a problem we have seen along the way as we, in the Community Consulting Group, have been developing this model.

 

The Technikon system was, after all, heading toward an uncertain future with or without our help. It seems that in many ways we were there — for a brief while — to sustain very powerful, at times seemingly omniscient, fantasies about the kind of resources that this institution would need to acquire and sustain if it was going to make the transition into its post-apartheid identity, to prevent, at this primary level, a repetition of its oppressive history. Both we and Dr. Narismulu wanted to believe that we could be at the central core of this grand process. But the reality was that this process — this process of working through toward empowerment at a much larger level — had already undertaken a life of its own, and that it would take years to work through the crises and the trauma of South Africa’s history. And so, after a brief intervention, perhaps a daydream that had us caught up in years of national trauma, the dream that we had joined for a brief while, continues as the Technikon system continues its task of helping South Africa recover from its apartheid years.

 

Post-Conclusion Synthesis

 

No matter what our previous training, experience, and expertise, each time we encounter a new patient (and often those who have been coming in for years), a new consultation opportunity, or a new community intervention we are inevitably being propelled into the unknown space of the other — as well as a whole history of environmental factors and influences that the person brings with him or herself. How much we allow ourselves to actually experience this is, of course, quite another question. For when we experience these dangerous places, we might realize that these are also the worlds that each of us lives in, consciously and unconsciously, privately and collectively. As we know from both analysis and community work, not to mention daily life, these are worlds of living and dying, fortune and theft, pillage, devastation, and, of course, extremes. And when we travel into these worlds part of us does disappear, to be forever transmogrified by the experience of being touched and impacted by the other — treacherous business indeed. This is the case whether these experiences are minutely explored and analyzed as in psychoanalytic treatment, whether this happens more incrementally in community work, or when it occurs simply by living out one’s life in our embeddedness in human culture. What we choose to do with it, to what degree we experience vs. dissociate these processes, is of course a personal matter. I, following the lead of others, have suggested that these processes are enacted ubiquitously throughout each of our existences here.

 

Throughout this chapter I hope that I have allowed the reader to experience the world of the other — that a kind of enactment has occurred wherein the reader has been able to enter these worlds and experience him or herself as a participant in the process. After all, one of the most essential healing ingredients in the recovery of trauma is the witness (Herman, 1992; Manzo, 2002; Poland, 2000) — and in your reading you have taken up that role vis-a-vis the examples I have presented, their protagonists, and the one who is reporting them. My hope that the reader might take up the participant-observer position with and in these stories is best captured by a statement made by Sandra Buechler (1999) in her description of the analyst’s position in psychoanalytic treatment, “Perhaps the analyst must find, with each patient, an optimal balance between being neutral enough to serve as a transference object and vividly new enough, as an object, to inspire sufficient hope” (p. 219).

 

In each of the cases that I have presented, both clinical and community, the results — whether success, failure, or, more generally, somewhere in-between — have had repercussions that go well beyond the scope of simply presenting a case study. In each case that I have presented I was involved with an exchange of time, energy, commitment, emotional investment, and much tough work — and for this I am exceedingly grateful. I have traveled through, and been offered access to, some extremely intimate experiences often (at least emotionally) right where the people whom I have introduced live. Not only that. The experience of closeness and mutuality created in the process of being involved in these projects and treatments has left me with a sense of having been “on the front lines.” Each of the crises that these communities, groups, and individuals either live with, have lived with, or have lived/worked through has given me a deep respect for the nature of crisis — both in its acute and chronic states — and great hope in the possibility that community-building, even in individual analysis, can be a major force in the working through process.

 

Through these examples I have attempted to locate individual and collective human processes in the real world with its multiple levels of influence, acknowledge that our world includes groups diverse both in resources and culture, and suggest that learning about and being effective and validated in that real world involves creating authentic relationships that are inclusionary, negotiated, and involve the development of trust and reciprocal commitments. In both community psychology and interpersonal psychoanalysis the primary task is to create a way of working with groups, communities, and individuals that is built on new ways of thinking, new targets for intervention, new conceptualizations of our professional roles and of our cherished concepts and tools for doing so, and most importantly, fostering and sustaining new hopes for collaborating with people and communities.

 

References

 

Albee, G. W. & Gullotta, T. P. (1997). Primary prevention works. Thousand Oaks, CA: Sage.

Albee, G. W. (1986). Toward a just society: Lessons from observations on the primary prevention of psychopathology. American Psychologist, 41, 891-898.

Albee, G. W. (1996). Revolutions and counterrevolutions in prevention. American Psychologist, 51, 1130-1133.

Albee, G. W., Joffe, J. M. & Dusenbury, J. S. (1988). Prevention, powerlessness, and politics. Beverly Hills, CA: Sage.

Altman, N. (1995). The analyst in the inner city. Hillsdale, NJ: Analytic Press.

Arlow, J. A. & Brenner, C. (1964). Psychoanalytic Concepts and the Structural Theory. New York: International Universities Press.

Aron, L. (1996). A meeting of minds: Mutuality in psychoanalysis. Hillsdale, NJ: Analytic Press.

Aron, L. (2003). The paradoxical place of enactment in psychoanalysis. Psychoanalytic Dialogues, 13, 623-632.

Aronowitz, S. (1996). The death and rebirth of American radicalism. New York: Routledge.

Asmal, K., Asmal, L. & Roberts, R. S. (1997). Reconciliation through truth: A reckoning of apartheid’s criminal governance. Cape Town, SA: David Philip Publishers.

Baltes, P. B. (1987). Theoretical propositions of life-span developmental psychology: On the dynamics between growth and decline. Developmental Psychology, 23, 611-626

Barnett, J. (1980). The interpersonal process, cognition, and the analysis of character. Contemporary Psychoanalysis, 16, 397-416.

Bauer, G. (1993). The analysis of transference in the here and now. Northvale, NJ: Aronson.

Belknap, J. (2001). The invisible woman: Gender, crime, and justice. Belmont, CA: Wadsworth Group.

Bell, L. A., Adams, M. & Griffin, P. (2007). Teaching for diversity and social justice. New York: Routledge.

Benard, B. (1991). Fostering resiliency in kids: Protective factors in the family, school, and community. Portland, OR: Western Center for Drug-Free Schools and Communities.

Berger, P. L. & Neuhaus, R. J. (1977). To empower people: From state to civil society. Washington, DC: American Enterprise Institute.

Bergson, H. (1911). Creative evolution. New York: Henry Holt and Company.

Bion, W. R. (1959). Experiences in groups. London: Tavistock.

Black, M. J. (2003). Enactment: Analytic musings on energy, language, and personal growth. Psychoanalytic Dialogues, 13, 633-656.

Blackwell, D. (2003). Colonialism and globalization: A group-analytic perspective. Group Analysis, 36, 445-464.

Blechner, M. (1992). Working in the countertransference. Psychoanalytic Dialogues, 2,
161-179.

Bloom, B. & Chesney-Lind, M. (2003). Women in prison: Vengeful equity. In R. Muraskin (Ed.), It’s a crime: Women and justice (175-195). Upper Saddle River, NJ: Prentice Hall.

Bloom, M. (1996). Primary prevention practices. Thousand Oaks, CA: Sage.

Blos, P. (1968). The adolescent passage. New York: International Universities Press.

Boesky, D. (1990). The psychoanalytic process and its components. Psychoanalytic Quarterly, 59, 550-584.

Borg, Jr., M. B. & Garrod, E. (2003). Criminal behavior, adulthood. In M. Bloom, & T. Gullotta (Eds.) The encyclopedia of primary prevention and health promotion (366-372). New York: Kluwer/Plenum.

Borg, Jr., M. B. (2002a). The Avalon Gardens Men’s Association: A community health psychology case study. Journal of Health Psychology, 7, 345-357.

Borg, Jr., M. B. (2002b). The psychoanalyst as community practitioner. Psychologist-Psychoanalyst, 22, 26-34.

Borg, Jr., M. B. (2003a). Atrocity touring psychoanalysis: A Case Study in Traumatic Enactment. Mind and Human Interaction, 13, 132-144.

Borg, Jr., M. B. (2003b). Community group-analysis: A post-crisis synthesis. Group-Analysis, 36, 228-241.

Borg, Jr., M. B. (2003c). Observations from a World Trade Center disaster intervention. The Community Practitioner, 2, 21-25.

Borg, Jr., M. B. (2004a). Community intervention as clinical case study. Clinical Case Studies, 3, 250-270.

Borg, Jr., M. B. (2004b). Venturing beyond the consulting room: Psychoanalysis in community crisis intervention. Contemporary Psychoanalysis, 40, 147-174.

Borg, Jr., M. B. (2005a). Community analysis: A case study examining transference and countertransference in community intervention. International Forum of Psychoanalysis, 14, 5-15.

Borg, Jr., M. B. (2005b). Superblind: Supervising a blind Therapist with a blind analysand in a community mental health setting. Psychoanalytic Psychology, 22, 32-48.

Borg, Jr., M. B. (2005c). A zombie storms the meathouse: Approximating living and undergoing psychoanalysis in a palliative care culture. Psychoanalysis, Culture, and Society, 10, 1-22.

Borg, Jr., M. B. (2006). Engaging diversity’s underbelly: A story from an immigrant parish community. American Journal of Community Psychology, 37, 191-202.

Borg, Jr., M. B. (2007). Just some everyday examples of psychic serial killing: Psychoanalysis, necessary ruthlessness, and disenfranchisement. In B. Willock, R. Curtis, & L. Bohm (Eds.) On deaths and endings: Psychoanalyst’s reflections on finality, transformations and new beginnings (180-195). London: Routledge.

Borg, Jr., M. B. & Dalla, M. R. (2005). Treatment of gangs/gang behavior in adolescence.
In T. Gullotta, & G. Adams (Eds.) Handbook of adolescent behavior
(519-542). New York: Kluwer/Plenum.

Borg, Jr., M. B. & Lynch, M. (2005). A collaborative and consultative approach toward understanding and change in an immigrant Catholic parish: A case study. Consulting Psychology Journal: Practice and Research, 57, 142-152.

Borg, Jr., M. B. & Magnetti, E. (2004). The diva is/in the organization: Exploring personal/interpersonal/organizational dynamics and their enactment. Psychodynamic Practice, 10, 221-247.

Borg, Jr., M. B., Garrod, E. & Dalla, M. R. (2001). Intersecting ‘real worlds’: Community psychology and psychoanalysis. The Community Psychologist, 34, 16-19.

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 (193-207). Madison, CT: International Universities Press.

Borg, Jr., M. B. & McCarroll (2004). At the prison-community boundary: The Women’s Prison Association of New York City. Women’s Studies Quarterly, 32, 86-101.

Bose, J. (1998). The inhumanity of the other: Treating trauma and depression. The Review of Interpersonal Psychoanalysis, 3, 1-4

Braude, C. B. (2009). Commissioning, community, and conscience. Journal of South African and American Studies, 10, 77-90.

Bright, E. M. (2000). Reviving America’s forgotten neighborhoods: An investigation of inner city revitalization efforts. New York: Garland.

Britner, P. A. (2008). Prevention process. Journal of Primary Prevention, 29, 461-463.

Bromberg, P. M. (1994). “Speak! That I may see you”: Some reflections on dissociation, reality, and psychoanalytic listening. Psychoanalytic Dialogues, 4, 517-547.

Bromberg, P. M. (1998). Standing in the spaces: Essays on clinical process, trauma, and dissociation. Hillsdale, NJ: Analytic Press.

Bromberg, P. M. (2003). One need not be a house to be haunted: On enactment, dissociation, and the dread of “not-me” — A case study. Psychoanalytic Dialogues, 13, 689-710.

Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32, 513-531.

Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.

Brown, L. O. (1995). A glossary of interpersonal psychoanalytic concepts and terms. In M. Lionells, J. Fiscalini, C. H. Mann, & D. B. Stern (Eds.), Handbook of Interpersonal Psychoanalysis (861-876). Hillsdale, NJ: Analytic Press.

Buechler, S. (1999). Searching for a passionate neutrality. Contemporary Psychoanalysis, 35, 213-227.

Chesney-Lind, M. (1997). The female offender: Girls, women and crime. Thousand Oaks, CA: Sage.

Chrzanowski, G. (1977). Interpersonal approach to psychoanalysis. New York: Gardner Press.

Chused, J. (1991). The evocative power of enactments. Journal of the American Psychoanalytic Association, 39, 615-639.

Chused, J. (2003). The role of enactments. Psychoanalytic Dialogues, 13, 677-687.

Clarke, S., Hahn, H., Hoggett, P. & Sideris, T. (2006). Psychoanalysis and community. Psychoanalysis, Culture & Society, 11, 199-216.

Coates, S. W. & Moore, M. S. (1997). The complexity of early trauma: Representation and transformation. Psychoanalytic Inquiry, 17, 286-311.

Coles, E. R. (2009). Intersectionality and research psychology. American Psychologist, 64, 170-180.

Cooper, A. (1987). Transference and character. Contemporary Psychoanalysis, 23, 502-513.

Cooper, A. (1989). Working through. Contemporary Psychoanalysis, 25, 34-62.

Cooper, A. (1991). Character and resistance. Contemporary Psychoanalysis, 27, 721-731.

Cummings, T. (2006). Handbook of organization development. Thousand Oaks, CA: Sage.

Danto, E. A. (2005). Freud’s free clinics: Psychoanalysis and social justice, 1918-1935. New York: Columbia University Press.

Davies, J. M. (1996). Linking the “pre-analytic” with the postclassical: Integration, dissociation, and the multiplicity of unconscious process. Contemporary Psychoanalysis, 32, 553-576.

Desai, A. & Vahed, G. H. (2007). Inside indenture: A South African story, 1860-1914. Durban, South Africa: Madiba Publishers.

Desai, A. (1999). South Africa still revolting. Johannesburg, SA: Impact Africa.

Desai, A. (2000). The Poors of Chattsworth: Race, class and social movements in post-Apartheid South Africa. Durban, SA: Madiba Publishers.

Dewey, J. (1991). Education and experience. In J. A. Boydston (Ed.), John Dewey: The later works, 1925-1953 (1-62). Edwardsville, IL: Southern Illinois University Press.

Diamond, M. A. (1993). The unconscious life of organizations: Interpreting organizational identity. Westport, CT: Quorum Books.

Dohrenwend, B. S. (1978). Social stress and community psychology. American Journal of Community Psychology, 6, 1-14.

Drescher, J. (1998). Psychoanalytic therapy and the gay man. Hillsdale, NJ: Analytic Press.

Duckett, P. (2004). It’s war, and it’s official: Repositioning impairment and disability into the society for community research and action. The Community Psychologist, 37, 10-14.

Ehrenberg, D. B. (1992). The intimate edge: Extending the reach of psychoanalytic interaction. New York: Norton.

Eisold, K. (1994). The intolerance of diversity in psychoanalytic institutes. International Journal of Psycho-Analysis, 75, 785-800.

Elbadawi, I. A & Hartzenberg, T. (2000). Development issues in South Africa. New York:
St. Martin’s Press.

Ellsworth, E. (1989). Why doesn’t this feel empowering? Working through the repressive myths of critical pedagogy. Harvard Education Review, 59, 297-324.

Epstein, L. & Feiner, A. (1979). Countertransference. New York: Jason Araonson.

Fanon, F. (1967). Black skin, white masks. New York: Grove.

Fanon, F. (1968). The wretched of the earth. New York: Grove.

Faure, M. & Lane, J. E. (1996). South Africa: Designing new political institutions. Thousand Oaks, CA: Sage.

Fawcett, S. B., Seekins, T., Whang, P. L., Muiu, C. & Suarez de Balcazar, Y. (1984). Creating and using social technologies for community empowerment. In J. Rappaport & R. Hess (Eds) Studies in empowerment (145-172). New York: Haworth.

Feldman, M. (1997). Projective identification: The analyst’s involvement. International Journal of Psychoanalysis, 78, 227-243.

Felner, R. D. & Lorion, R. P. (1985). Clinical child psychology and prevention: Toward a workable and satisfying marriage. Proceedings: National conference on clinical child psychologists. New York: Haworth.

Felner, R. D., Farber, S. S. & Primavera, J. (1983). Transitions and stressful life events: A model for primary prevention. In R. D. Felner, L. A. Jason, J. N. Moitsugu, & S. S. Farber (Eds.), Preventive psychology: Theory, research, and prevention (191-215). New York: Pergamon.

Felner, R. D., Felner, T. Y. & Silverman, M. M. (2000). Prevention in mental health and social intervention. In . J. Rappaport, & E. Seidman (Eds.), Handbook of community psychology (9-42). New York: Kluwer/Plenum.

Ferenczi, S. (1932). The clinical diary of Sandor Ferenczi. Cambridge, MA: Harvard University Press.

Fetterman, D. (1994). Empowerment evaluation. Evaluation Practice, 15, 1-15.

Figlio, K (2008). The citizen psychoanalyst and the psychoanalytic social activist. Psychoanalysis, Culture & Society, 13, 71-74.

Fiscalini, J. (1988). Curative experience in the analytic relationship, Contemporary Psychoanalysis, 24, 125-142.

Fiscalini, J. (1994). The interpersonally unique and the uniquely interpersonal. Contemporary Psychoanalysis, 30, 114-134.

Fiscalini, J. (1995). Transference and countertransference as interpersonal phenomena. In M. Lionells, J. Fiscalini, C. H. Mann, & D. B. Stern (Eds.), Handbook of interpersonal psychoanalysis (603-616). Hillsdale, NJ: Analytic Press.

Foucault, M. (1975). Discipline and punish: The birth of the prison. New York: Vintage Books.

Foucault, M. (1978). The history of sexuality, Vol. 1: An introduction. New York: Vintage Books.

Foucault, M. (1980). Power/knowledge. New York: Pantheon.

Freire, P. (1970). Pedagogy of the oppressed. New York: Continuum.

Freud, S. (1912). The dynamics of transference. Standard Edition, 12, 99-108. London: Hogarth.

Freud, S. (1914). Remembering, repeating and working though. Standard Edition, 12, 145-156. London: Hogarth.

Freud, S. (1917). Mourning and melancholia. Standard Edition, 14, 237-258. London: Hogarth.

Freud, S. (1920). Beyond the pleasure principle. Standard Edition, 18, 3-64. London: Hogarth.

Freud, S. (1921). Group psychology and the analysis of the ego. Standard Edition, 18, 67-144. London: Hogarth.

Freud, S. (1923). The ego and the id. Standard Edition, 19, 3-66. London: Hogarth.

Freud, S. (1927). The future of an illusion. Standard Edition, 21, 5-56. London: Hogarth.

Freud, S. (1930). Civilization and its discontents. Standard Edition, 21, 57-145. London: Hogarth.

Freud, S. (1937a). Constructions in analysis. Standard Edition, 23, 255-269. London: Hogarth.

Freud, S. (1937b). Analysis terminable or interminable. Standard Edition, 23, 209-253. London: Hogarth.

Fromm, E. (1941). Escape from freedom. New York: Holt, Rinehart & Winston.

Fromm, E. (1956). The sane society. New York: Rinehart.

Fromm, E. (1968). The revolution of hope. New York: Harper & Row.

Fromm, E. (1976). To have or to be. New York: Harper & Row.

Fromm, E. (1998). The art of listening. New York: Continuum.

Fromm, E. & MacCoby, M. (1970). Social character in a Mexican village. Englewood Cliffs, NJ: Prentice-Hall.

Fromm-Reichmann, F. (1950). Principles of intensive psychotherapy. Chicago: University of Chicago Press.

Garland, C. (1998). Understanding trauma: A psychoanalytical approach. New York: Routledge.

Gartner, R. (1999). Betrayed as boys: Psychodynamic treatment of sexually abused men. New York: Guilford.

Ghent, E. (1990). Masochism, submission, surrender. Contemporary Psychoanalysis, 26,
108-136.

Ghent, E. (2002). Wish, need, drive: Motive in light of dynamic systems theory. Psychoanalytic Dialogues, 12, 763-808.

Gill, M. M. (1987). The analyst as participant. Psychoanalytic Inquiry, 7, 249-259.

Giroux, H. (2000). Stealing innocence: Corporate culture’s war on children. New York: Palgrave Macmillan.

Giroux, H. (2003). The abandoned generation: Democracy beyond the culture of fear. New York: Palgrave Macmillan

Goldston, D. B., Daniel, S. S., Erkanli, A., Reboussin, B. A., Mayfield, A., Frazier, P. H. & Treadway, S. L. (2009). Psychiatric diagnoses as contemporaneous risk factors for adolescents and young adults: Developmental changes. Journal of Consulting and Clinical Psychology, 77, 281-290.

Greenfield, L. & Minor-Harper, S. (1991). Women in prison. Washington, DC: U.S. Department of Justice.

Greenson, R. R. (1970). The exceptional position of the dream in psychoanalysis. Psychoanalytic Quarterly, 39, 519-549.

Gullotta, T. P. & Bloom, M. (2003b). Evolving definitions of primary prevention. In T. P. Gullotta, & M. Bloom (Eds.), Encyclopedia of primary prevention and health promotion (9-15). New York: Kluwer/Plenum.

Gullotta, T. P. & Bloom, M. (Eds.) (2003a). Encyclopedia of primary prevention and health promotion. New York: Kluwer/Plenum.

Guntrip, H. (1968). Schizoid phenomena, object relations and the self. New York: International Universities Press.

Haagsma, J. A., Haavelar, A. H., Janssen, M. F. & Bonsel, G. J. (2008). Disability adjusted life years and minimal disease: Application of a preference-based relevance criterion to rank enteric pathogens. Population Health Metrics, 6, 345-368.

Hage, S. M. & Kenny, M. E. (2009). Promoting social justice approach to prevention: Future directions for training, practice, research. Journal of Primary Prevention, 30, 75-87.

Harris, A. (1996). The conceptual power of multiplicity. Contemporary Psychoanalysis, 32, 537-552.

Harris, A. (1998). Psychic envelopes and sonorous baths: Siting the body in relational theory and clinical practice. In L. Aron, & F. Anderson (Eds.), Relational perspectives on the body (39-64). Hillsdale, NJ: Analytic Press.

Harris, A. (2009). You must remember this. Psychoanalytic Dialogues, 19, 2-21.

Harris, G. (1994). The organization of African unity. New Brunswick, NJ: Transaction.

Hegeman, E. (1995). Cross-cultural issues in interpersonal psychoanalysis. In M. Lionells, J. Fiscalini, C. Mann, & D. B. Stern (Eds.), Handbook of interpersonal psychoanalysis (823-846). Hillsdale, NJ: Analytic Press.

Henggeler, S. W., Schoenwald, S. K., Bourduin, C. M., Rowland, M. D. & Cunningham,
P. B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents
. New York: Guilford.

Herman, J. (1992). Trauma and recovery. New York: Basic Books.

Hirsch, I (1998). The concept of enactment and theoretical convergence. Psychoanalytic Quarterly, 67, 78-101.

Hirsch, I. (1987). Varying modes of analytic participation. Journal of the American Academy of Psychoanalysis, 15, 205-222.

Hirsch, I. (2002). Beyond interpretation: Analytic interaction in the interpersonal tradition. Contemporary Psychoanalysis, 38, 573-587.

Hoffman, I. Z. (1983). The patient as interpreter of the analyst’s experience. Contemporary Psychoanalysis, 19, 389-422.

Hoffman, I. Z. (1998) Ritual and spontaneity in the psychoanalytic process: A dialectical-constructivist view. Hillsdale, NJ: Analytic Press.

Huber, E. & Stephens, J. D. (2001). Development and crisis in the welfare state. Chicago, IL: University of Chicago Press.

Ian, M. (1993). Remembering the phallic mother: Psychoanalysis, modernism, and the fetish. Ithaca, NY: Cornell University Press.

Illich, I. (1976). Medical nemesis: The expropriation of health. New York: Pantheon.

Israel, B. A., Schulz, A. J., Parker, E. A. & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202.

Jacobs, T. (1986). On countertransference enactments. Journal of the American Psychoanalytic Association, 34, 289-307.

Jacobs, T. (2001). On unconscious communication and covert enactments. Psychoanalytic Inquiry, 21, 4-23.

James, W. & Van De Vijver, L. (2000). After the TRC: Reflections on truth and reconciliation in South Africa. Athens, OH: Ohio University Press.

Janet, P. (1889). L’automatisme psychologique. Paris: Alcan.

Janet, P. (1894). Historie d’une idee fixe. Revue Philosophique, 37, 121-163.

Jencks, C. & Peterson, P. E. (1991). The urban underclass. Washington, DC: The Brookings Institution.

Jones, E. (1964). Essays in applied psychoanalysis. New York: International Universities Press.

Kellam, S. G. & Brown, C. H. (1982). Social, adaptational and psychological antecedents of adolescent psychopathology. Baltimore, MD: Johns Hopkins University Press.

Kellam, S. G., Brown, C. H., Rubin, B. R. & Ensminger, M. E. (1983). Paths leading to teenage psychiatric symptoms and substance abuse. In S. E. Guze, F. J. Earls, & J. E. Bartlett (Eds.), Child psychopathology and development (126-134). New York: Raven.

Kohut, H. (1984). How does analysis aure? Chicago: University of Chicago Press.

Korn, M. L. (2004). Approaches to assertive community treatment. Medscape <http://www.medscape.com/viewarticle457029>.

Kretzmann, J. P. & McKnight, J. L. (1993). Building communities from the inside out: A path toward finding and mobilizing community assets. Evanston, IL: The Asset-Based Community Development Institute.

Kristeva, J. (1989). Black Sun. New York: Columbia University Press.

Lacan, J. (1977). The four fundamental concepts of psychoanalysis. London: Tavistock.

Lacan, J. (1991). The seminars of Jaques Lacan: Book II. Cambridge, England: Cambridge University Press.

Latkin, C. A., German, D., Hua, W. & Curry, A. D. (2009). Individual-level influences on perceptions of neighborhood disorder: a multilevel analysis. Journal of Community Psychology, 37, 122-133.

Layton, L. (1998). Who’s that boy? Who’s that girl? Clinical practice meets postmodern gender theory. Northvale, NJ: Jason Aronson.

Lee, S. (1999). Is poverty violence? In D. Curtin, & R. Litke (Eds.) Institutional Violence
(5-12). Atlanta, GA: Rodopi.

Levenson, E. (1972). The fallacy of understanding. New York: Basic Books.

Levenson, E. (1983). The ambiguity of change. Northvale, NJ: Jason Aronson.

Levenson, E. (1991). The purloined self. New York: Contemporary Psychoanalysis Books.

Levenson, E. (1996). Aspects of self-revelation and self-disclosure. Contemporary Psychoanalysis, 32, 237-248.

Levenson, E. (2009). The enigma of the transference. Contemporary Psychoanalysis, 45, 163-178.

Levins, R. (1995). Beyond democracy: The politics of empowerment. In A. Callari (Ed.), Marxism in the Postmodern Age (246-259). New York: Guilford.

Lewin, K. (1935). Psycho-sociological problems of a minority group. In . G. W. Lewin (Ed.), Resolving social conflicts: Field theory in social science (107-115). Washington, DC: American Psychological Association.

Lewin, K. (1936a). Some social-psychological differences between the United States and Germany. In G. W. Lewin (Ed.), Resolving social conflicts: Field theory in social science (15-34). Washington, DC: American Psychological Association.

Lewin, K. (1936b). Cultural Reconstruction. In G. W. Lewin (Ed.), Resolving social conflicts: Field theory in social science (35-39). Washington, DC: American Psychological Association.

Lewin, K. (1946a). Behavior and development as a function of the total situation. In G. W. Lewin (Ed.), Resolving social conflicts: Field theory in social science (337-381). Washington, DC: American Psychological Association.

Lewin, K. (1946b). Action research and minority problems. In G. W. Lewin (Ed.), Resolving social conflicts: Field theory in social science (143-152). Washington, DC: American Psychological Association.

Lin, N. (2003). Social capital: A theory of social structure and action. Cambridge, UK: Cambridge University Press.

Lionells, M, Fiscalini, J., Mann, C. H. & Stern, D. B. (Eds.) (1995). Handbook of interpersonal psychoanalysis. Hillsdale, NJ: The Analytic Press.

Livert, D. & Hughes, D. L. (2002). The ecological paradigm: Persons in settings. In T. A. Revenson, A. R. D’Augelli, S. E. French, D. Hughes, D. E. Livert, E. Seidman, M. Shinn, & H. Yoshikawa (Eds.), A Quarter Century of Community Psychology (51-63). New York: Kluwer/Plenum.

Lockhart, M. J. & Scott, J. (2009). Women in prison: Where do we draw the line? Dissident Voices, 3, 138-176.

Lodge, (2009). The South African developmental state? Journal of South African Studies, 35, 253-261.

Mannarini, T. & Fedi, F (2009) Multiple senses of community: the experience and meaning of community. Multiple senses of community: the experience and meaning of community. Journal of Community Psychology, 37, 211-227.

Manzo, J. (2002). Community organizing: “community” as a discursive resource in a youth social services agency. Journal of Mundane Behavior, 3, 1-15.

Mathers, C. D. & Loncar, D. (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine, 3, 1-5.

Mattessich, P. & Monsey, B. (2001). Community building: What makes it work. Saint Paul, MN: Amherst H. Wilder Foundation.

Mbeki, T. (1998). Africa: The time has come. Cape Town, SA: Tafelberg Publishers.

McClintock, M. & Rauscher, L. (2007). Ableism curriculum design. In M. Adams, L. Bell, & P. Griffin (Eds.), Teaching for diversity and social justice (198-229). New York: Routledge.

McCormack, C. (2009). The wee yellow butterfly. Glendaruel, Scotland: Argyll.

McLaughlin, J. (1991). Clinical and theoretical aspects of enactment. Journal of the American Psychoanalytic Association, 39, 595-614.

Mead, G. H. (1934). Mind, self and society. Chicago: University of Chicago Press.

Menzies, I. (1960). A case-study in the functioning of social systems as a defense against anxiety. Human Relations, 13, 95-121.

Miller, E. (1989). The Leicester model: Experiential study of group and organizational processes. Occasional paper no. 10. London: Tavistock.

Miller, E. (1993). From dependency to autonomy: Studies in organization and change. London: Free Association Books.

Miller, E. & Gwynne, G. V. (1972). A life apart: A pilot study of residential institutions for the physically handicapped and the young chronic sick. London: Tavistock.

Miller, E. & Rice, A. K. (1967). Systems of organization. London: Tavistock.

Milman, D. & Goldman, G. (1979). Psychoanalytic contributions to community psychology. Dubuque, IA: Kendall-Hunt.

Mistry, J., Jacobs, F. & Jacobs, L. (2009). Cultural relevance as program-to-community alignment. Journal of Community Psychology, 37, 487-504.

Mitchell, S. A. (1993). Hope and dread in psychoanalysis. New York: Basic Books.

Mitchell, S. A. (1997). Influence and autonomy in psychoanalysis. Hillsdale, NJ: Analytic Press.

Mitchell, S. A. (2000). Relationality: From attachment to intersubjectivity. Hillsdale, NJ: Analytic Press.

Monahan, J., Swartz, M. & Bonnie, R. J. (2003). Mandated treatment in the community for people with mental disorders. Health Affairs, 22, 28-38.

Mondros, J. B. & Wilson, S. M. (1994). Organizing for power and empowerment. New York: Columbia University Press.

Moore, M. H. (1995). Public health and criminal justice approaches to prevention. In M. Tonry, & D. P. Farrington (Eds.), Building a safer society: Strategic approaches to crime prevention (237-262). Chicago: University of Chicago Press.

Moos, R. H. (1984). Context and coping: Toward a unifying conceptual framework. American Journal of Community Psychology, 12, 5-36.

Morgan, (2008). Psychology in the Community. Journal of Prevention and Intervention in the Community, 35, 29-43.

Mullahy, P. (1967). The contributions of Harry Stack Sullivan. New York: Science House.

Murray, J. L. & Lopez, A. D. (1996) The global burden of disease: Comprehensive assessment of mortality and disability from disease, injuries, and risk factors in 1990 and projected into 2020. Cambridge, MA: Harvard University Press.

Murray, J. L. & Lopez, A. D. (2004). The global epidemiology of noncommunicable disease. Cambridge, MA: Harvard University Press.

Nancy, J. L. (1991). The inoperative community. Minneapolis, MN: University of Minnesota Press.

Nebbitt, V. E., Lombe, M. & Williams, J. H. (2008). Assessing the moderating effects of anxiety sensitivity on antisocial behavior among urban African American youth. Journal of Health Care for the Poor and Underserved, 19, 277-293.

Newton, P. N., Lee, S. J., Goodman, C., Fernández, F. M. & Yeung, S., (2009) Guidelines for Field surveys of the quality of medicines: A proposal. PLoS Medicine, 6, 1-55.

Paradis, E. K. (2000). Feminist and community psychology: Ethics in research with homeless. American Journal of Community Psychology, 28, 839-858.

Pasmore, W. (2001). Action research in the workplace: the socio-technical perspective. In P. Reason, & H. Bradbury (Eds.), Handbook of action research (38-47). Thousand Oaks, CA: Sage.

Perkins, D. D. & Taylor, R. B. (1996). Ecological assessment of community disorder: Their relationship to fear of crime and theoretical implications. American Journal of Community Psychology, 24, 63-107.

Perkins, D. D. & Zimmerman, M. A. (1995). Empowerment theory, research, and application. American Journal of Community Psychology, 23, 569-579.

Perkins, D. D., Larsen, C. & Brown, B. B. (2009). Mapping urban revitalization: Using GIS spatial analysis to evaluate new housing policy. Journal of Prevention and Intervention in the Community, 37, 48-65.

Perlin, M. (2000). The hidden prejudice: Mental disorder on trial. Washington, DC: American Psychological Association.

Phillips, A. (1993). On kissing, tickling and being bored. Cambridge, MA: Harvard University Press.

Pines, M. (1998). Circular reflections: Selected papers on group analysis and psychoanalysis. London: Jessica Kingsley Publishers.

Pistrang, N., Barker, C. & Humphreys, K. (2008). Mutual help groups for mental health problems: A review of effectiveness studies. American Journal of Community Psychology, 42, 101-121.

Pizer, S. (1996). The distributed self: Introduction to symposium on “the multiplicity of self and analytic technique.” Contemporary Psychoanalysis, 32, 499-507.

Pizer., S. (2009). Inside out: The state of the analyst and the state of the patient. Psychoanalytic Dialogues, 19, 49-62.

Poland, W. S. (2000). The analyst’s witnessing and otherness. Journal of the American Psychoanalytic Association, 48, 17-34.

Potter, P. (1996). Hippocrates. Cambridge, MA: Belknap Press.

Price, R. H., Cowen, E. L., Lorion, R. P. & Ramos-McKay, J. (1988). 14 ounces of prevention: A casebook for practitioners. Washington, DC: American Psychological Association.

Price-Smith, A. (2001). Plague and politics: Disease and international Policy. New York: Palgrave Macmillan.

Prigogine & Stengers, (1984). Order out of chaos. New York: Bantam Books.

Pynchon, T. (1961). V. New York: Viking.

Rappaport, J. & Hess, R. (Eds.) (1984). Studies in empowerment. New York: Haworth.

Rappaport, J. & Seidman, E. (Eds.) (2000). Handbook of community psychology. New York: Kluwer/Plenum.

Rappaport, J. (1977). Community psychology: Values, research and action. New York: Holt, Rinehart & Winston.

Rappaport, J. (1981). In praise of paradox. A social policy of empowerment over prevention. American Journal of Community Psychology, 9, 1-25.

Reason, P. & Bradbury, H. (Eds.) (2001). Handbook of action research. London: Sage.

Revenson, T. A. & Seidman, E. (2002). Looking backward and moving forward: Reflections on a quarter century of community psychology. In T. A. Revenson, A. R. D’Augelli, S. E. French, D. Hughes, D. E. Livert, E. Seidman, M. Shinn, & H. Yoshikawa (Eds.) A quarter century of community psychology (3-31). New York: Kluwer/Plenum.

Richardson, F. C., Fowers, B. J. & Guignon, C. B. (1999). Re-envisioning psychology: Moral dimensions of theory and practice. San Francisco: Jossey-Bass.

Riger, S. (1993). What’s wrong with empowerment? American Journal of Community Psychology, 21, 279-292.

Rioch, J. M. (1943). The transference phenomena in psychoanalytic therapy. Psychiatry, 6, 147-156.

Roszak, T. (2001). The voice of the earth: An exploration in ecopsychology. Grand Rapids, MI: Phanes Press.

Ryan, W. (1971). Blaming the victim. New York: Vintage.

Said, E. (1993). Culture and imperialism. New York: Vintage.

Sameroff, A. J. & Fiese, B. H. (1989). Conceptual issues in prevention. In D. Schaffer, I. Phillips, N. B. Ezner, M. M. Silverman, & V. Anthony (Eds.) Prevention of mental disorders, alcohol, and other drug use in children and adolescents (23-54). Washington, DC: U.S. Government Printing Office.

Sarason, S. B. (1971). The culture of school and the problem of change. Boston: Allyn & Bacon.

Sarason, S. B. (1974). The psychological sense of community: Prospects for a community psychology. San Francisco: Jossey Bass.

Sarason, S. B. (1978). The nature of problem-solving in social action. American Psychologist, 33, 370-380.

Sarason, S. B. (2000). Barometers of community change: Personal reflections. In J. Rappaport, & E. Seidman (Eds.), Handbook of community psychology (919-929). New York: Kluwer/Plenum.

Sardar, Z. (1997). Postmodernism and the other: The new imperialism of western culture. London: Pluto Press.

Schecter, D. E. (1978). Attachment, detachment, and psychoanalytic therapy. In E. G. Witenberg (Ed.), Interpersonal psychoanalysis: New directions (81-104). New York: Basic Books.

Schorr, L. B. (1988). Within our reach: Breaking the cycle of disadvantage. New York: Doubleday.

Schultheis, A. (2004). Regenerative fictions: Postcolonialism, psychoanalysis and the nation as family. New York: Palgrave Macmillan.

Searles, H. (1975). The patient as therapist to his analyst. In P. Giovacchini (Ed.), Tactics and Techniques in Psychoanalytic Therapy: Countertransference (95-151). New York: Jason Aronson.

Searles, H. (1979). Countertransference and related subjects. New York: International Universities Press.

Seeley, D. S. (1981). Education through partnership: Mediating structures in education. Cambridge, MA: Ballinger.

Seidman, E. & Rappaport, J. (1986). Redefining social problems. New York: Plenum.

Seidman, E. (1983). Handbook of social intervention. Beverly Hills, CA: Sage.

Seidman, E. (1988). Back to the future, community psychology: Unfolding a theory of social intervention. American Journal of Community Psychology, 16, 3-24.

Seidman, E. (1991). Growing up the hard way: Pathways of urban adolescents. American Journal of Community Psychology, 19, 173-205.

Senge, P. & Scharmer, O. (2001). Community action research: Learning as a community of practitioners, consultants and researchers. In P. Reason, & H. Bradbury (Eds.), Handbook of action research (238-249). London: Sage.

Shelton, K. H., Taylor, P. J., van den Bree, M. (2009). Risk factors for homelessness: Evidence from a population-based study. Psychiatric Services, 60, 465-472.

Shure, M. B. & Spivack, G. (1982). Interpersonal problem-solving in young children: A cognitive approach to prevention. American Journal of Community Psychology, 10,
341-356.

Siegal, L. (1987). Sullivan’s contributions to child psychiatry. Contemporary Psychoanalysis, 23, 278-298.

Smelser, N. J. (1998). The social edges of psychoanalysis. Los Angeles, CA: University of California Press.

Speer, P. W. & Hughey, J. (1995). Community organizing: An ecological route to empowerment and power. American Journal of Community Psychology, 23, 729-748.

Stern, D. B. (1983). Unformulated experience: From familiar chaos to creative disorder. Contemporary Psychoanalysis, 19, 71-99.

Stern, D. B. (1994). Conceptions of structure in interpersonal psychoanalysis. Contemporary Psychoanalysis, 30, 255-300.

Stern, D. B. (1996). The social construction of therapeutic action. Contemporary Psychoanalysis, 16, 265-293.

Stern, D. B. (1997). Unformulated experience: From dissociation to imagination in psychoanalysis. Hillsdale, NJ: Analytic Press.

Stokols, D., Misra, S., Runnerstrom, M. G. & Hipp, J. S. A. (2009). Psychology in an age of ecological crisis: From personal angst to collective action. American Psychologist, 64, 181-193.

Stolorow, R. D. (2008). The contextuality and existentiality of emotional trauma. Psychoanalytic Dialogues, 18, 113-123.

Stringer, E. T. (1999). Action research. Thousand Oaks, CA: Sage.

Sullivan, H. S. (1940). Conceptions of modern psychiatry. New York: Norton.

Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: Norton.

Sullivan, H. S. (1954). The psychiatric interview. New York: Norton.

Sullivan, H. S. (1956). Clinical studies in psychiatry. New York: Norton.

Sullivan, H. S. (1964). The fusion of psychiatry and social science. New York: Norton.

Tam, C. & Law, S. (2007). Best practices: A systematic approach to management of patients who refuse medications in an assertive community treatment team setting, Psychiatric Services, 58, 457-459.

Tedeschi, R. G., Park, C. L. & Calhoun, L. G., (1998). Posttraumatic growth: Positive changes in the aftermath of crisis. Mahwah, NJ: Lawrence Erlbaum.

Tenzer, A. (1983). Piaget and psychoanalysis: Some reflections on insight. Contemporary Psychoanalysis, 19, 119-132.

Tenzer, A. (1995). Working through. In M. Lionells, J. Fiscalini, C. H. Mann, & D. B. Stern (Eds.), Handbook of interpersonal psychoanalysis (729-747). Hillsdale, NJ: Analytic Press.

Thelen, E. & Smith, L. B. (1994). A dynamic systems approach to the development of cognition and action. Cambridge, MA: MIT Press.

Townley, G. & Kloos, B., (2009). Development of a measure of sense of community for individuals with serious mental illness residing in community settings. Journal of Community Psychology, 37, 362-380.

Trickett, E. J. (1996). A future for community psychology: The context of diversity and the diversity of contexts. American Journal of Community Psychology, 24, 209-234.

Tubert-oklander, J. (2007). The whole and the parts: Working in the analytic field. Psychoanalytic Dialogues, 17, 115-132.

United States Department of Justice (1999). ADA Legal Documents: Public Law 101-336. Washington, DC: U.S. Department of Justice.

Ursano, R. J., McCaughey, B. G. & Fullerton, C. S. (1994). Individual and community responses to trauma and disaster: The structure of human chaos. Cambridge, UK: Cambridge University Press.

van der Kolk, B. A., McFarlane, A. C. & Weisaeth, L. (1996). Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York: Guilford

Van Wormer, K. S. & Bartollas, C. (2000). Women and the criminal justice system. Boston: Allyn and Bacon.

Volkan, V. D. (1988). The need to have friends and enemies: From clinical practice to international relationships. Northvale, NJ: Jason Aranson.

Volkan, V. D. (2009). Large-group identity” ‘Us and them’ polarizations in the international arena. Psychoanalysis, Culture & Society, 14, 4-15.

Wachtel, P. L. (2009). Knowing oneself from inside out, knowing oneself from outside in: The “inner” and the “outer” worlds and their link through action. Psychoanalytic Psychology, 26, 158-170

Walderdine, V. (2008) Contextualizing debates about psychosocial studies. Psychoanalysis, Culture & Society, 13, 341-345.

Warren, M. R. (2001). Dry bones rattling: Community building to revitalize American democracy. Princeton, NJ: Princeton University Press.

Watzlawick, P., Weakland, J. H. & Fisch, R. (1974). Change: Principles of problem formulation and problem resolution. New York: Norton.

Weick, K. (1984). Small wins: Redefining the scale of social issues. American Psychologist, 39, 29-48.

Weissberg, R. (1999). The politics of empowerment. Westport, CT: Praeger.

White, K. P. (2002). Hating and being hated: Some personal thoughts about racism from a psychoanalytic perspective. Contemporary Psychoanalysis, 38, 401-422.

Williams, J. M. (2009). Legislating ‘tradition’ in South Africa. Journal of South African Studies, 35, 191-209.

Winnicott, D. W. (1958). Through pediatrics to psychoanalysis. Madison, CT: International Universities Press.

Wolstein, B. (1975). Countertransference: The psychoanalyst’s shared experience and intimacy with his patient. Journal of the American Academy of Psychoanalysis, 3, 77-89.

Women’s Prison Association (2009). Mentoring women in reentry. New York: Institute On Women and Criminal Justice.

Women’s Prison Association (2009). Women’s voices: Advocacy by criminal-justice involved women. New York: Institute On Women and Criminal Justice.

Woodson, R. L. (1987). On the road to economic reform: An agenda for black progress. Washington, DC: Regenery Gateway.

World Health Organization (2008). Primary health care: Now more than ever. Geneva, Switzerland: World Health Organization.

Young, M. (2000). Five faces of oppression. In M. Adams, W. J. Blumenfeld, R. Castaneda, H. W. Hackman, M. L. Peters, & X. Zuniga, X. (Eds.), Reading for Diversity and Social Justice: An Anthology on Racism, Antisemitism, Sexism, Heterosexism, Abelism, and Classism (pp. 35-49). New York: Routledge.

Zimmerman, M. A. (2000). Empowerment theory: Psychological, organizational, and community levels of analysis. In J. Rappaport, & E. Seidman (Eds.), Handbook of Community Psychology (43-64). New York: Kluwer/Plenum.

Zimmerman, M. A. & Warschausky, S. (1998). Empowerment theory for rehabilitation research: Conceptual and methodological issues. Rehabilitation Psychology, 43, 3-16.

Zizek, S. (1989). The sublime object of ideology. London: Verso.

Zizek, S. (2006). The parallax view. Cambridge, MA: MIT Press.

Zizek, S. (2008a). In defense of lost causes. London: Verso.

Zizek, S. (2008b). Violence. New York: Picador.

 

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