EBSCOhost http://0-web.ebscohost.com.library.alliant.edu/ehost/delivery?si... EBSCO Publishing Citation Format: APA (American Psychological Assoc.): NOTE: Review the instructions at http://0-support.ebsco.com.library.alliant.edu/help/?int=ehost& lang=&feature_id=APA and make any necessary corrections before using. Pay special attention to personal names, capitalization, and dates. Always consult your library resources for the exact formatting and punctuation guidelines. References Javier, R. t., & Herron, W. G. (2002). Psychoanalysis and the Disenfranchised: Countertransference Issues. Psychoanalytic Psychology, 19(1), 149-166. <!--Additional Information: Persistent link to this record (Permalink): http://0-search.ebscohost.com.library.alliant.edu /login.aspx?direct=true&db=pph&AN=PPSY.019.0149A&site=ehost-live&scope=site End of citation--> Psychoanalysis and the Disenfranchised: Countertransference Issues Rafael Art. Javier, PHD, ABPP William G. Herron, PHD, ABPP This article examines basic psychoanalytic principles and their applications to the understanding and treatment of individuals not historically included in psychoanalytic formulations. It looks at the impact of culture, ethnicity, and class, but particularly poverty. The hope is to develop successful application of psychoanalytic theory and technique to the psychological problems of people living in poverty. Careful examination of their psychological reality may offer a unique opportunity to broaden vision of assessment to what constitutes dysfunctional condition, the concept of adaptation, the development of the working alliance, the nature of resistance and transference reactions, and the like. The analyst's personal discomfort, motivations, and stubborn adherence to specific theoretical and technical stances are considered the most damaging obstacles in this endeavor. Contemporary psychoanalysis has been extending its reach to understand the impact of culture on both theory and practice. Thus, significant consideration is beginning to be given to the roles of race, ethnicity, gender, and class in the formulation of psychoanalytic hypotheses and the practice of psychoanalytic principles. This is in contrast to a manifestly pancultural, but actually restrictive, attitude that had prevailed to limit both the population served by psychoanalytic work and the development of theory. Although the history of psychoanalysis was particularly attached to the idea of being a universal description of experience (Mayer, 1996), it was primarily a depiction of the developmental phases and descriptions of a relatively single homogeneous culture, a Western European-American identity that 1 of 16 10/13/13 7:45 PM EBSCOhost http://0-web.ebscohost.com.library.alliant.edu/ehost/delivery?si... emphasized middle-class, phallocentric, Anglo-Saxon attitudes and values. The ineffectiveness of such a view has become apparent through both a greater recognition of the subjectivity of the psychoanalytic enterprise and the therapeutic needs of a markedly multicultural patient population. Thus, the applicability of psychoanalysis in the United States to previously underserved groups is becoming more discernible (Altman, 1995; Javier & Herron, 1998; Leary, 1997). Our focus here is on one of the primary cultural forces, namely poverty, although it is clearly intertwined with other forces, particularly minority status. A Look at Poverty Through the Psychoanalytic Lens Our interest is in developing a way to successfully apply psychoanalytic theory and technique to the psychological problems of people who are living in poverty. “Poverty is less than the average expectable environment, and is relative to a given society” (Herron & Javier, 1996, p. 612). Thus, poverty refers to real limitations of choices due to economic scarcity. Disenfranchisement in the political, education, housing, health, and mental health delivery systems is a normal consequence of poverty (Herron, Javier, Warner, & Primavera, 1998). Specifically, individuals living in poverty are people who do not have enough economic resources to maintain a decent standard of living, and whose treatment options are generally limited to public or charitable institutions and whoever may be available as therapists. Educational opportunities are equally limited. Although strong dependency on public assistance or low-level manual labor to survive characterizes the lives of many of the poor, people who may have a steady and relatively reasonably paid job may still fall under the definition of poor. This is the case when their lives are entrapped in inescapable debts that keep their viable options extremely limited. The entrapment is more severe when confronted with an inability to find a better-paying job because of inadequate preparation to deal with the increasingly technology-driven job market. Patients with these types of life experience are now arriving at our offices through the managed care system that provides for only a limited number of sessions, and with no real options for continuing to pay for treatment on their own. The fact that many of these patients live in the slums and dilapidated areas of our land, and that their children are not protected against the worst of what our society has to offer, such as drugs, violence, alcoholism, and prostitution, demonstrates that the concept of poverty still applies to them. They are part of what has been referred to as the “underclass” (Wilson, 1990), and the poorest of all are unlikely to appear in the practices of most analysts. These features reinforce the idea that poor people have limited psychic resources and will not be able to do much for themselves, such as making use of insight (Javier, Herron, & Yanos, 1998). As a result, the psychoanalytic treatment of the poor is easily overlooked, creating a situation that is in dire need of remediation. Poverty limits the power of the individual in so many ways that it has become customary to designate poor people as disadvantaged, deprived, and disenfranchised. Although throughout history there have been repeated attempts to decrease poverty, the problem is that these attempts have been accompanied by programs that either maintain or increase poverty in these individuals. It would be a strong and contentious statement to conclude that social 2 of 16 10/13/13 7:45 PM EBSCOhost http://0-web.ebscohost.com.library.alliant.edu/ehost/delivery?si... forces have for centuries been engaged in a calculated balancing act, but poverty is notable as a tragic element in contemporary culture (Herron & Javier, 1996). Thus, the poor person is someone who is in need of psychological sustenance based on disruptions to the psyche that are part of the fabric of deprivation. But the poor person has not been well understood by psychoanalysis. The misunderstanding is rooted in the selectivity of who indeed can function as analytic patients and the use of valued psychodynamics that are most congruent with middle-class culture. Elliott and Spezzano (1996) noted the impact of the surrounding culture on psychoanalysis, in that revisions essentially have to occur. For example, Renik (1990) raised the possibility of changes in the stages of psycho-sexual development. Leary (1997) pointed out the need for revision of theories of family development given the variety of existing ethnic and racial styles. On a broader level, Samuels (1993) commented, The assumption that a good-enough environment is all that the innate potential of an individual requires to flower, and that this is determined within the nuclear family and in the first month of life, is hopelessly passive in the face of problematic social and political structures. (p. 583) It is useful to consider the problem in spatial terms. The mental content that has been the focus of theory and treatment has been only a part of the space that could be considered in the psychoanalytic endeavor. Now, it is time to consider the rest of the space, and to understand that the contents of all of the space are interactive, so the entire space becomes available for investigation. Of course, there has always been a recognition of an influential role of environmental and constitutional factors beyond the impact of the family or the strength of an instinctual urge, but the concerns of psychoanalysis have primarily reflected the intrapsychic content of the individual mind as though it existed in a relatively constant and limited space. The idea of constancy may seem questionable in light of the dynamic nature of the unconscious and the concept of psychic conflict, but the constancy lay in the repetitive action and form of the conflict, as for example, the possible and probable expressions of the Oedipal conflict. On the one hand, given that individuals create cultures and societies, it is helpful to begin with the individual. On the other hand, individuals are born into existing cultures that immediately affect them and in the developmental process have, for some time, a potentially greater influence on the individual than the individual can have on the culture given his or her developmental immaturity and the accompanying relative lack of power. Yet, the social and cultural diversity increase relativity and make generalities suspect in most instances. The point is that the poor person brings a particular set of characteristics to a therapeutic situation that are distinct from the patterns of the usual patient who has provided the clinical material for most of the existing psychoanalytic theory and technique. Thus, for most analysts who find themselves