A Closer Look

Every Thursday afternoon, Philadelphia psychoanalytic psychologist Deborah Luepnitz, PhD, closes her Philadelphia practice to volunteer with one of the 11 homeless shelters that make up Project H.O.M.E., an innovative program that offers the city's homeless permanent housing and counseling services.

Through the program, Luepnitz facilitates one-hour sessions with the shelter's eight case workers to talk out the frustrations that surround their daily challenges. They might discuss, for example, how to handle the emotions that come with residents' often challenging behavior, which on bad days can include leaving lit cigarettes around, smearing bodily fluids on walls or screaming at case workers.

"People who work with homeless adults have to contain an enormous amount of [residents'] split-off rage and psychotic anxiety on a daily basis," says Luepnitz, who has worked pro bono at Project H.O.M.E. for six years. "I see my role as providing a holding environment for staff so they can provide the same for the res idents."

Luepnitz also connects other psychoanalytically oriented mental health professionals who want to work pro bono one-on-one with residents of the shelters. She has made about 20 successful matches in the past year and her 10-year plan includes finding a clinician therapist who will consult for each of the 11 shelters, and a clinician for every homeless resident who wants treatment.

"This kind of in-depth work is not for the wealthy only," she says. "To be human is to struggle with unconscious conflicts, and that includes people who live on the corner by the convenience store."

Luepnitz is one of many members of APA's Div. 39 (Psychoanalysis) volunteering their services or offering low-cost treatment to underserved or vulnerable populations, such as the elderly, trauma victims and rescue and emergency personnel. In fact, the division has created a Web site at www.Div39outreach.org to highlight their work and encourage its members interested in volunteering to network, brainstorm new opportunities and imitate each others programs.

Indeed, promoting and encouraging its socially conscious side is one of the ways Div. 39 is trying to educate the public--and psychology--about what modern-day psychoanalysis looks like and to change misperceptions that it's an "austere and formal therapy" for the upper-class only, says division secretary Marilyn S. Jacobs, PhD, a Los Angeles psychoanalyst. The division is also working to emphasize how its members--who have diverse backgrounds in psychoanalysis and psychoanalytic psychology--have contributed to the shaping of modern psychoanalysis through a rich range of research and scholarship. The division is also fostering the next generation of members by including graduate students on every division committee and task force.

"Psychoanalysts are much different now--they are more active in the consulting room, and they are more socially active," says Div. 39 member Marylou Lionells, PhD, a psychoanalyst at the White Institute in New York City.

A theoretical shift

Psychoanalysis has shifted in the last 30 years from a hierarchical, medically based therapy to a more socially conscious, therapist-as-participant approach, says Lewis Aron, PhD, a New York City-based psychologist. The change is in part a return to its roots: Pioneer European psychoanalysts of the early 20th century supported women's rights, gay, lesbian and bisexuality concerns, and sex education, among other progressive ideas at the time, he says.

But the psychoanalysis that caught hold in America became known as a socially conservative, elitist therapy geared to the wealthy, says Aron. Additionally, trained psychologists interested in the techniques were excluded from the field since training institutes were only open to medical applicants. It wasn't until the 1980s--when four psychologists backed by APA and a newly formed Div. 39 won an antitrust lawsuit against the American Psychoanalytic Association--that training in psychoanalysis was available to nonmedical applicants such as psychologists and social workers.

With the beginning of Div. 39 and psychology's formal entrance into psychoanalysis, "less conservative folks now had an audience," Aron says. In addition, contemporary theories of psychoanalysis that viewed therapy as a two-person process entered the mainstream. In fact, psychologist members of Div. 39 have pioneered some major theoretical systems of modern psychoanalysis: Stephen Mitchell, PhD--who died in 2000--broke ground with his theory of relational psychoanalysis, which emphasizes how motivation stems from experience and relationships rather than biology, as Freud's theories suggested. Likewise, psychologists Robert Stolorow, PhD, George Atwood, PhD, and Donna Orange, PhD, influenced the field with their intersubjectivity theory and its emphasis on context and how patients and therapists influence each other during therapy.

Indeed, today's psychoanalysis reflects their contributions and is more about a "dynamic interaction between two people" than a "blank screen therapist who doesn't speak," adds Jacobs. But, to modern psychoanalysts' and psychotherapists' chagrin, the image of the authoritarian therapist seems stuck in the minds of most of the American public and many psychologists.

"We're perceived as having narrow interests and quirky ideas of Freud's and that's it," explains Ramirez. "The desire to have a more accurate identity is important to us."

Giving psychoanalysis away

Despite such opinions, Div. 39 has continued to emphasize its outreach programs to the underserved and diverse populations and to support cultural competence and other multicultural issues, say its leaders.

Outreach efforts swelled last year in particular when then-Div. 39 President Jaine Darwin, PhD, made outreach her No. 1 presidential initiative and challenged every section and division member to start at least one new project aimed at bringing psychoanalysis to the public. The division has supported and encouraged programs for the homeless, firefighters who were involved with 9/11, families of 9/11 victims and veterans returning from Iraq who don't have mental health insurance.

One pro bono program in particular, Strategic Outreach to Families of All Reservists (SOFAR), offers individual or family therapy to families of reservists and National Guard members who are stationed in or returning from Afghanistan, Iraq and Kuwait. SOFAR volunteers also lead support groups targeted for families, mothers and parents on such topics as stress management or general coping.

And at APA's Annual Convention in Washington, D.C., in August, the division teamed with APA's Div. 19 (Society for Military Psychology) to co-sponsor a panel on providing pro bono psychoanalytic services to military and reservist families.

"The military is one of the best representations of diversity in our country," notes Ramirez. In fact, the division's convention program reflected its members' broad range of scholarly interests, with topics including sexuality and gender, traumatic brain injury, emergency room care and adolescent coping.

Yet with all of these efforts, psychoanalysts and division leaders agree they still have a long way to go toward debunking the myths that surround modern-day psychoanalytic psychology. But Ramirez, for one, feels up to the challenge. He says one of his greatest joys as division president is watching psychologists' surprise when they come to realize--through interactions with psychoanalysts or educational sessions--that today's psychoanalysis isn't what it once was or see similarities to their own practices.

"It's fun when people say, "Oh, I do that too!" says Ramirez. "We stop being someone 'other' and we start being kin."

Further Reading

  • Auld, F., Hyman, M., & Rudzinski, D. (2005). Resolution of Inner Conflict: An Introduction to Psychoanalytic Therapy. Washington, DC: American Psychological Association.