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Intersecting "Real Worlds": Community Psychology and Psychoanalysis

THIS PAPER CHALLENGES CONVENTIONAL divisions between community psychology and Interpersonal psychoanalysis. We challenge some common assumptions and practices of traditional psychoanalytic theory, including the view of the patient as the initiator of treatment; the neutral role of the analyst; and the distinction between psychoanalytic and psychoeducational practices. We focus on an intensive four-year community intervention in an impoverished, underserved area of South Central Los Angeles, and the community changes which occurred as a result of this intervention.

In his development of the drive model, Freud emphasized internal conflict, rather than interpersonal trauma, as the immediate basis for psychopathological processes and symptomatology. According to the drive model, it is the patient, motivated by the increasingly ego-dystonic experience of neurotic symptoms, who seeks psychoanalytic treatment. Had Freud not abandoned his original seduction theory, the notion of actual traumata as progenitors of psychopathological processes and symptoms are likely to have remained more in the foreground of theory and practice. A greater emphasis on the role of trauma in personality development, which informs the work of many contemporary theorists and practitioners, and the shifting view of causality which this emphasis creates, encourages the clinician to pay greater attention to real aspects of the interpersonal environment, rather than to attend solely to the individual's internalization and elaboration of interpersonal events. This broadening of attentional focus signals a need for psychoanalytic theory to perceive and understand deeply embedded and pervasive environmental conditions which may preclude the individual, or the community as a whole, from identifying a need for treatment. Rather than the individual's ability to distinguish specific, ego-dystonic symptoms from the ongoing experience of adapting to chronic distress, the presence of trauma itself, within specific, targeted communities, may prove a potent indicator of the need for psychoanalytic intervention.

In response to the "civil unrest" experienced in the South Central, Los Angeles community in 1992, a community mental health organization, The Community Health Realization Institute (CHRI), was contracted to implement an empowerment intervention. The intervention was to address such chronic issues as impoverishment, intra-racial violence, racism, unemployment, drug/alcohol abuse, and academic failure, and acute problems, related to the crisis itself, such as rioting, looting, arson, and inter-racial violence.

The CHRI intervention initially targeted community leaders, members of the Resident Advisory Council, teachers and other people in the community who were involved in the political and educational lives of the residents. Together, the members of the leadership team were responsible for 175 housing units in the Avalon Gardens Housing Project in South Central. Over the course of the project, 40 community leaders completed a year-long "Train the Trainer" program. These community leaders, after completing their own training, became "participant/ observers" in the intervention setting. These trained "staff" provided training in the program model, and consultation, to the majority of other community members in the general area.

The outcome data suggested that participants were able: 1) to increase their sense of security within their community; 2) to form and utilize social support; and 3) to feel more in control of their social, environmental and political lives, defined by their ability to sustain viable and mutually-developed and maintained empowerment. The assessment indicated that increased interpersonal functioning was the cornerstone of ongoing change. Residents' increased sense of security was directly reflected in reduced levels of anxiety (Borg, 1997).

Bringing community residents and service providers together to address chronic and acute trauma was an essential element in community empowerment. Participants explored how rigid, conditioned patterns of thinking and feeling work to maintain biases, prejudice, and negative assumptions about other individuals within the community. After training, residents reported increased ability to communicate needs among themselves. Residents also felt more respected and understood by community leaders and service providers, including outreach workers, building maintenance workers, teachers, police officers, politicians and rent collection staff. The participants reported increased trust in the community, enabling them to maintain a sense of responsibility toward the community and within their individual lives.

While empowerment training itself focused didactically on the personal empowerment of individuals, it was actually the relationships that formed within the program, and created a naturally supportive infrastructure, that had lasting results in increasing the community's ability to empower itself. Conversely, changes in the community were directly related to the increased interpersonal functioning of individuals, suggesting that personality and character structure are dynamic formations that are impacted by changes in the environment (Sullivan, 1953).

Interpersonal psychoanalytic theory describes the processes by which conditioned beliefs are created and maintained, through avoidance of anxiety. The social environment influences one's experience of anxiety (Sullivan, 1954). Therefore, an individual's perception of reality, and awareness of the potential for new experiences of self will be limited to the degree that one's community promotes and sustains anxiety. A community characterized by fear, distrust, secrecy, hostility and competition will engender chronic anxiety, calling for defensive maneuvers that distort perception.

According to Interpersonal psychoanalytic theory, individuals will protect themselves from anxiety by truncating their experience through the use of "selective inattention," or, under extreme conditions of trauma, "dissociation" (Sullivan, 1953). It is this defensive avoidance of anxiety that creates and maintains the conditioned beliefs that prevent community members from mutual understanding and effective collaboration. This defensive experience also keeps community members from actively identifying problems and seeking help. Significant, self-sustaining community empowerment requires changes in "community character," reflected in open, mutually supportive interpersonal exchanges which, over time, reduce the anxiety associated with assuming new beliefs, roles, and communication strategies.

Both neo-Freudian psychoanalysts and contemporary Interpersonalists have during the past 20 years considerably challenged the traditional view of the psychoanalyst as a neutral observer of the patient's process (Lionells, et al., 1995). An increasing emphasis on the essential use of countertransference to foster and explicate psychoanalytic change has become a ubiquitous aspect of dialogues between contemporary psychoanalysts. Interpersonal psychoanalysis, through Sullivan (1954), its founder, has consistently emphasized the participatory role of the analyst in his or her observational process: "there are no psychiatric data that can be observed from a detached position by a person in no way involved in the operation. All psychiatric data arise from participation in the situation that is observed – in other words by participant observation" (p.57). Contemporary Interpersonal analysts, such as Levenson, have deepened our understanding of participant observation. Levenson (1996) states that, "there is no such thing as unbiased listening…Cure, then, is an emergent and collaborative process of awareness" (p. 241). What creates analytic change, according to Levenson (1983), is the analyst's "ability to be trapped, immersed and participating in the system and then work his way out" (p. 174).

The South Central intervention required that community practitioner's roles be extremely flexible. Interventions included participation in family dinners, weddings, graduations, funerals, and numerous daily activities. In addition, practitioners assumed active roles within the community empowerment process, initially serving as representatives of smaller community groups and their concerns. These interactions provided a fertile ground for enactment of unconscious conflict. Interpersonal ideas about transference-countertransference dimensions of psychoanalytic treatment address enactment as an ever-present dimension of the process. Levenson (1983) states that "the transference becomes a highly intensified replay of the material under discussion" (p. 11). As a part of the empowerment process, longstanding conflicts among members of the Avalon Gardens community were highlighted, and, through their enactment in the transference-countertransference matrix, were made amenable to intervention.

For instance, a small group of men formed an organization to represent the community's needs to their political representatives. The women in the community felt that this was a good idea and decided to form an organization of their own. Emotionally heated debates ensued over which group would be recognized by community practitioners as the community's primary and legitimate representative body. In discussion among themselves, a male practitioner involved with the men's group and a female practitioner involved with the women's group began to enact a longstanding community conflict. The male practitioner argued that the men in the community had historically experienced a heightened sense of disenfranchisement in the community, due to overshadowing and marginalization by the women. The female practitioner argued that the men were not able to follow through with their commitments in their personal lives, and that there was no reason for the women to expect them to be responsible within this context.

In allowing themselves to identify with the parties in conflict, to the degree of affectively embodying their respective positions, the community practitioners were able to empathize with community members' feelings of anger at being misunderstood, and having their efforts thwarted and motivations maligned. Gradually, the practitioners, from their respective positions of gender-based identification, were able to work through initial reactions of denial and projection and, through identifying mutual underlying feelings of helplessness and sorrow, to form a common bond. The experience of becoming embedded and gradually emerging from this "enactment" enabled the community practitioners to articulate the depth and nature of one significant longstanding area of community conflict, thereby increasing community members' awareness and flexibility with respect to this conflict.

Although traditional psychoanalysis has eschewed psychoeducational approaches to individual or group problems as forms of nonanalytic engagement or "acting out," the traditional model of analytic technique, with its emphasis on the development of observing ego, has always had an educational component. Freud's (1930) injunction, "Where id was, there shall ego be" (p. 80) speaks directly to this educative process. What distinguishes psychoanalysis from other educational experiences is its emphasis on bringing heretofore unconscious aspects of experience into conscious awareness, primarily through the process of transference. Community interventions which emphasize more didactic approaches to group interaction, may still retain and develop opportunities for unconscious experiences to become manifest through transferential processes. In the Avalon Gardens intervention, for example, we believe that an initial didactic focusing of attention on interactive processes between group members facilitated, rather than precluded, participants' ability to become increasingly aware of their engagement in transferential distortions with one another, and the underlying motives that fueled these distortions.

The Avalon Gardens intervention began as a series of workshops within which principles of the CHRI model were taught to community members who chose to attend. As the intervention was fraught with publicity and political endorsement, community members were initially drawn to the workshops by curiosity. Soon, it became apparent that many people attending the workshops were actually the unacknowledged leaders of the community. However, the residents themselves overtly disavowed this. These apparent leaders, through their endorsement, increased other members' receptivity to the program. It became evident that these members, despite their disavowals, were the "gatekeepers" of the community and that they were, at best, deeply ambivalent about the intervention itself.

Practitioners began to notice that unconscious efforts to sabotage the program were being enacted by these "leaders." At one point, an important meeting had been scheduled and one of the perceived "leaders" had agreed to pass out flyers for the meeting. On the day of the meeting, no one showed up. Upon exploration, it was discovered that, somehow, the resident had "forgotten" to hand out the flyers. When questioned, the resident expressed anger that he had been "chosen" (even though he had volunteered) to deliver the flyers.

When this was explored in the group setting, other leaders supported the resident in his anger. Previously unexpressed negative emotions began to surface. Community members then described their shared experience of hope and disappointment in previous community interventions. Although it was not overtly articulated in the group process, it became apparent that residents' unconscious wishes to be passively gratified, and fear of abandonment and disillusionment of these wishes, were the underlying determinants of the negative emotions. This was revealed through an increase in concrete demands for tangible services (such as building repairs, salaried positions, and cable TV), and overt expressions of anger and disappointment as demands remained unfulfilled. There were clear expressions of distrust and hostility toward program practitioners as "outsiders" who, like all previous "outsiders," would tantalize community members with hope that would, ultimately, lead to disappointment. The airing of these negative emotions provided the first opportunity for community members and practitioners to have a real dialogue with each other about their respective hopes, plans, resources and limitations. Community members experienced themselves and the practitioners in a new way when, upon voicing anger and fear, rather than expressing it through sabotaging behavior, their feelings were met with attention, interest and respect. For the first time, when practitioners began to explain the empowerment process, and their roles as facilitators rather than "fixers," community members began to have some genuine, experiential understanding of what was actually being offered. Strategies for communication that began as didactic informational offerings, from practitioners to residents, became enacted modes of interaction between practitioners and residents and, through the integration of cognitive, affective and interpersonal experience, took on new dimensions of meaning.

The theory of empowerment, similar to Interpersonal theory, emphasizes the cyclical nature of growth in which, ideally, change spirals in an ever-expanding and deepening process. Empowerment theory describes the process whereby people in communities develop collaborative solutions that work for them (Rappaport & Seidman, 2000). Community solutions grow through a process in which the work itself, involving increasing individual experiences of assertiveness, self-efficacy and self-esteem, supports the outcome. Consonant with Interpersonal psychoanalytic theory, empowerment is a dynamic concept that describes a process of a community, and its individual members, moving toward greater satisfaction and security.

The practice of actively seeking expansion of self-experience seems to be in synchrony with the goals of community psychologists and Interpersonally-oriented psychoanalytic practitioners. If we, as analysts and community practitioners, keep in mind that our roles intersect upon the ground of meeting the needs of our shared communities, we may be able to find ways of increasing our ability to work together with diverse populations within numerous settings. The intersection of values between these apparently divergent fields occurs when community psychologists and psychoanalysts are able openly to acknowledge a commitment to meeting the perceived needs of our clients and to utilizing the perceived strengths of communities and their members as a guiding force for developing and supporting ongoing approaches to health and empowerment.

References

Borg, M. B. (1997). The Impact of Training in the Health Realization/Community Empowerment Model on Affective States of Psychological Distress and Well-Being. Ann Arbor, MI: UMI.
Freud, S. (1930). Civilization and its Discontents. New York: Norton.
Levenson, E. (1983). The Ambiguity of Change. New York: Basic Books
Levenson, E. (1996). Aspects of self-revelation and self-disclosure. Contemporary Psychoanalysis, 32, 237-248.
Lionells, M.; Fiscalini, J; Mann, C.H & Stern, D. (1995). Handbook of Interpersonal Psychoanalysis. NJ: Analytic Press.
Rappaport, J. & Seidman, E. (2000). Handbook of Community Psychology. New York: Kluwer Academics/ Plenum Publishers.
Sullivan, H. S. (1953). The Interpersonal Theory of Psychiatry. New York: Norton.
Sullivan, H. S. (1954). The Psychiatric Interview. New York: Norton.