Psychotherapy.

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Psychotherapy.

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There is considerable tension within psychoanalysis regarding the place of social context in the individual’s inner life. In recent years, applications of psychoanalytic theory have extended to contexts outside of the therapeutic setting, and psychoanalytic scholars have increasingly attended to issues of race and culture within the therapeutic setting. The present article focuses on appli- cations of psychoanalytic theory in clinical and community contexts, with an emphasis on racial and cultural diversity. The author proposes an approach to clinical and community interventions that integrates multiple theoretical per- spectives (e.g., psychoanalytic, community, multicultural) to advance practitio- ners’ and consultants’ engagement with issues of diversity, and considers how practice with racially and culturally diverse populations can inform existing psychoanalytic theory. Two case examples, one from psychotherapy and the other from a community intervention, are presented to illustrate the ways in which psychoanalytic theory can benefit therapeutic work and consultation across sociocultural contexts. Implications of the experiences of minority indi- viduals and communities for psychoanalytic theory, research, practice, and education are discussed.

Psychotherapy.

Keywords: psychoanalytic theory, community, race, culture

In his paper “Wild Psycho-Analysis,” Freud (1910) cautioned against the loose interpre- tation of psychoanalytic theory and technique, as he offered a glimpse into a broader usage of psychoanalytic ideas by those not formally trained as psychoanalysts. Inherent in his critique was a cautionary statement about the analyst’s interpretation of psychoanalytic ideas, and an emphasis on self-discovery by the client without the analyst’s imposition. The notion of loose interpretation of psychoanalytic ideas is complicated. On one hand, psychoanalysis itself has been interpreted differently in some important ways within different schools of thought, such as ego psychology, the British school of object relations, and relational psychoanalysis. If psychoanalysis were not subject to interpretation and

This article was published Online First February 4, 2013. Correspondence concerning this article should be addressed to Pratyusha Tummala-Narra,

PhD, Department of Counseling, Developmental and Educational Psychology, Boston College, 319 Campion Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467. E-mail: tummalan@bc.edu

Psychotherapy.
modification, then these schools of thought would not have as much to offer as they do today. On the other hand, broader interpretations of psychoanalytic principles may still be experienced as precarious, particularly in the way that psychoanalytic ideas may be applied to understandings of diversity within clinical and nonclinical contexts (e.g., community-based interventions). In some cases, the integration of concepts from other perspectives, such as multicultural and community psychologies, in practice and consul- tation may be viewed as diluting psychoanalysis.

In a way, this dilemma concerning the looseness of interpretation raises questions about who decides what psychoanalysis should look like in theory and practice. I believe that this dilemma is especially relevant to contemporary times, as we have experienced unprecedented changes in demography in the United States and elsewhere, and global- ization characterized by rapid exchange of ideas through the media and Internet. This dilemma is also current in that psychoanalysis continues to face challenges to its scientific legitimacy, or at least the public awareness of this legitimacy, despite evidence for the effectiveness of psychoanalytic psychotherapy (Shedler, 2010). Additionally, questions about the elite status of psychoanalysis and its relevance to helping clients remain largely controversial.

Psychotherapy.

This article addresses some important ways in which psychoanalysis can be interpreted through broader and more inclusive lens as a way of moving toward a more complete understanding of racial and cultural diversity across clinical and community applications. This type of reshaping departs from the ways that psychoanalysis and other Euro-American theories have historically been applied to racially and culturally diverse communities, either through neglect of issues of diversity or through over- simplified modifications of existing psychoanalytic ideas. An example of the latter is the application of the concept of Oedipus complex to non-Western cultures that lacks a consideration of indigenous narratives of family dynamics (Tang & Smith, 1996). This has essentially been a colonizing approach (Altman, 2010), rather than an approach that considers multiple subjectivities and indigenous narrative. From the perspective of a 1.5-generation Indian American (born in India and immigrated to the United States as a child) female psychologist, the present article considers a psycho- analytic perspective that interfaces with multicultural psychology and community psychology frameworks, with the aim of addressing the complexity of racial and ethnic diversity within individual- and community-level interventions, and of consid- ering how practice across settings (e.g., psychotherapy, community work) informs how social context can be addressed in psychoanalytic theory.

Psychotherapy.

Contemporary psychoanalytic perspectives hold the potential for privileging individ- uals’ and communities’ subjective experiences over theoretical principles that have been defined under a cultural lens that either diverges from or devalues individuals and communities that vary in significant ways from mainstream cultural context. This ap- proach is not counter, in fact, to the way that Freud and his contemporaries engaged in extending the practice of psychoanalysis to individuals and communities who were marginalized along social class lines. Such efforts culminated in the establishment of free clinics in Vienna and other parts of Europe, where psychoanalysis was made accessible to students, laborers, factory workers, farmers, domestic servants, and several others who were unable to pay for their treatment (Danto, 2005). As Elizabeth Ann Danto (2005) recognized in her notable book, “Freud’s Free Clinics,” many early psychoanalysts, such as Erik Erikson, Melanie Klein, Anna Freud, and Eric Fromm, although known today for their theoretical revisions of Freud’s theories, saw themselves as “brokers of social change” (p. 4) who challenged political conventions of their time.

Psychotherapy.

Psychoanalysis indeed has revolutionary roots, not to mention a history of persecution and exile. The history of exile that is part of the psychoanalytic movement in England and the United States has marked a retreat from these efforts centered on social justice. It is only recently that psychoanalysts have written about exile and its impact on the psychoanalytic movement outside of Europe (Danto, 2005). Just as this part of psychoanalytic history has been disavowed for decades, contemporary times demand that we reexamine history and social context and revisit the notion of social change when we conduct practice. In the following sections, I review recent developments in psychoanalytic theory concerning diversity, appli- cations of psychoanalytic theory in community intervention, and then describe two vignettes, one from psychoanalytic psychotherapy and one from a community intervention. This will be followed by a discussion of the applicability of psychoanalytic ideas across settings, and of how psychoanalytic theory can be informed by practice and consultation with racially and culturally diverse individuals and communities.

Psychotherapy.

Psychoanalytic Theory and Attending to Diversity

Over the past 15 years, psychoanalysts, particularly those using the lens of object relations theory and relational psychoanalysis, have written about internal representations of gender, race, culture, sexual orientation, and social class. For example, scholars have described the importance of the therapist confronting his or her own feelings of the racial other in order to address cross-racial and similar-racial interactions effectively (Altman, 2010; Bonovitz, 2005; Leary, 2006, 2012; Yi, 1998). Emotional insight in psychotherapy, within their perspectives, lies in the conceptualization of therapeutic interaction as co-constructed by the therapist and client, and the ability to tolerate ambivalence, anxiety, sadness, guilt, and shame as negotiated within the therapeutic dyad. These perspectives emphasize attachment, separation, and related mourning as essential components of the individual’s growth process, where the client and the therapist are changed by virtue of relating to one another (Mitchell, 1988; Stolorow, 1988).

Psychotherapy.

Psychoanalysts have also explored intrapsychic and interpersonal changes in the context of immigration. Akhtar (1999, 2011) described the many challenges of the mourning process for immigrants, including regression into earlier stages of development, culture shock and discontinuity of identity, disorganization, and a third separation- individuation process. Various aspects of immigrant adjustment and identity, such as bilingualism, pre- and postmigration character, challenges with acculturation, and the role of fantasy about country of origin and adoptive country, have been described in the psychoanalytic literature (Ainslie, 2009; Akhtar, 2011; Eng & Han, 2000; Foster, 2003; Tummala-Narra, 2009a). Additionally, in recent years, issues of spirituality (Aron, 2004; Roland, 1996; Tummala-Narra, 2009b), sexual orientation/identity, and gender identity (Drescher, 2007; Suchet, 2011) have been recognized as central to individual develop- ment. Indeed, there have been considerable advances in the psychoanalytic understanding of diversity within the context of the therapeutic relationship.

Psychoanalytic ideas on diversity have been further developed by scholars who would consider themselves as psychodynamic feminist thinkers. Scholars who integrate perspec- tives from psychoanalysis and multicultural psychology have approached psychoanalytic concepts such as culturally and racially based transference in the therapeutic relationship with an emphasis on the role of power, privilege, and social hierarchies in interpersonal and intrapsychic experience (Comas-Diaz, 2006; Greene, 2007; Tummala-Narra, 2007).

Psychotherapy.