Analysts in the Trenches: Streets, Schools, War Zones (Book Review)

Author:  Sklarew, Bruce, Stuart W. Twemlow and Sallye M. Wilkinson
Publisher:  Hillsdale, NJ: Analytic Press, 2004
Reviewed By:  Jeff Golland, Summer 2005, pp. 65-66

The title is true to its word. This book is about psychoanalysts working in mean streets from New Haven to New Orleans, plying their trade in violence-ridden public schools, and responding to casualties of war in Angola, Bosnia and the former Soviet Republic of Georgia. Other workplaces include municipal halls, police stations, earthquake damaged areas, and “ground zero” in Lower Manhattan. Racism, child abuse and homelessness are among the traumatic situations leading to the announcement of a new identity within our profession: the community analyst.

Twenty-three contributors describe their work in 12 essays, most with gripping clinical details. Some have practiced community work for decades. The editors contribute two chapters and an introduction that together provide a theoretical frame and general methodological considerations for community practice. The final essay, on mental health intervention and preventive approaches, addresses issues of research and policy. Those whose work has been limited to clinic and consulting room will be enlightened, impressed, and maybe a bit envious. These authors report impact in the larger world, while most of us treat fewer and fewer psychoanalytic patients.

What’s going on out there in the trenches? Isn’t psychoanalysis about intrapsychic and interpersonal psychology? Isn’t it our job to help people understand transference and resistance? Don’t we promote insight leading to personal agency and resolution of maladaptive compromises? Isn’t work in the trenches for the less well-trained psychologists, psychiatrists, social workers, nurses and paraprofessionals?

The term “applied psychoanalysis” has generally referred to non-clinical applications of our theory in the arts and humanities. Psychoanalytically-informed psychotherapies (also applications, though the term is not often used in this sense) have been considered distinct from the intensive, couch-centered treatment that Freud (1919) described as “pure gold” (p. 168). Along with the contributors to this book, I would use the word “applied” to cover all applications of psychoanalytic understanding, including the “pure” treatment method.

Freud’s abandonment of the seduction theory of hysteria is thought by many to have exchanged an external locus of motivation to an internal one. It is more accurate to say that a focus on fantasy life became central to his subsequent theoretical advances. Freud never rejected the importance of external influences on psychological functioning, and Hartmann’s adaptive point of view restored their status to the organized theory. This book has as its theme the effects of trauma and their management, both with individuals and with populations, and it provides several examples of the utility of a comprehensive psychoanalytic theory.

The editors’ introduction demonstrates how community analysts rely on understanding unconscious motivation to create methods that are active and group-based, and which aim to change (rather than interpret) transference and dynamics. A neutral posture is recommended for consulting on social conflict, but personal relationships and collaboration are core principles of the work. A flexible, helpful approach is advocated, eschewing both credentials and a posture of expertise. The history of this new specialty is traced to Anna Freud, August Aichhorn, John Bowlby, Erik Erikson, and Karl Menninger among others. The American Psychoanalytic Association (APsaA) endorsed community work in the 1970’s, but until the past decade, APsaA seemed to have dropped it from the agenda. Two of the co-editors, Sklarew and Twemlow, have led APsaA to a more activist stance, and support of this book’s publication is one result.

It is at this juncture that a review would typically provide brief summaries of the chapters of an edited compilation. An earlier draft had laudatory but inadequate words that failed to convey the richness of detail and clarity of presentation in what I consider to be exciting, even heroic efforts on the part of the contributors. This is a book that is not easily summarized. Like all compilations, chapter styles vary; unlike most, there is an overall coherence that is conveyed only by reading the entire book. The different voices comprise a consonant choir, not needing an editors’ summary.

I would be remiss, however, if I did not acknowledge Vamik Volkan, the pioneer (perhaps still lone) practitioner of international psychoanalytic intervention, who describes his work over three years on a once-in-five-months visiting schedule with an émigré family displaced by war to Tbilisi in the Caucasus. I need also to cite the exemplary William Granatir, who presents a memoir of his decade of volunteer work as a retired psychoanalyst in inner city schools, beginning at age 76 and ongoing.

I identify myself as a “classical Freudian” and my own institute teaching emphasizes the “standard” technique applied to intensive individual treatment using the couch. How can I heap praise on and express envy of the dramatically different methodologies of this book? I see psychoanalysis as a psychological theory, akin to evolution in biology, relativity in physics, and the big bang in cosmology. Although the discovery and creation of psychoanalysis took place in his consulting room with its data drawn from intensive couch-based psychotherapy, Freud was ambitious and saw its applications going beyond a mere method of treatment for neuroses. “Standard” clinical practice is, for me, our laboratory, the site where discoveries continue to be made to modify, extend and correct the theory. Its methodology is central to its advances, and it is unique in being simultaneously a research tool and a clinical application. A theory must also be useful beyond its laboratory or it will be elitist at best, or altogether irrelevant. Methods adapted for clinical situations different from the “standard” have led to the vast enterprise of psychoanalytically-informed psychotherapies.

This book is a landmark in defining newer methods for situations that cry out for psychoanalytic understanding. It does not read like typical analytic literature, and many names in its bibliography were unfamiliar to me. I reviewed it while also reading a series of papers in the Psychoanalytic Quarterly, a somewhat disjunctive experience. The Quarterly papers address intrapsychic conflict, delineating the ideas of outstanding theorists from several diverse psychoanalytic points of view. The abstractions and the clinical inferences were of a different order than those in Trenches. Psychoanalytic thought advances, though, from both metapsychology and phenomenology. Trenches provides the latter. Analysts may be committed to refining theory and the intensive individual analytic practice from which it evolves, while at the same time supporting social applications.

How can psychoanalysts engage in community psychoanalysis? Economics make it difficult. Fee-for-service models were the mainstay of practice, at least until insurance companies came to dominate health care. Like many of the contributors, community analysts often hold university faculty appointments, or they work for agencies. Grant support is needed to underwrite projects, and is not easy to come by. The larger society’s priorities do not emphasize mental health activities we psychoanalysts value.

I believe we can and must attend both to our practices and to the ills of the world. We can improve our methods in the laboratory in which psychoanalysis was discovered, and work to apply our knowledge beyond the consulting room. I have spent the last 35 years as a teacher educator. In the past decade I began more explicitly to connect my analytic thinking with my work in public schools. I have tried to develop communicable methodology for this application (Golland, 2002). Trenches has advanced my thinking. I can now more fully embrace the role of community analyst while I continue to practice intensive individual treatment.

Freud, S. (1919). Lines of advances in psychoanalytic therapy. Standard Edition, 17: 157-168.
Golland, J. (2002). What do teachers want (from psychoanalysts)? Journal of Applied Psychoanalytic Studies, 4: 275-281.

Jeff Golland teaches and is training and supervising analyst for the New York Freudian Society.

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