CMHC Outreach

A Program to Introduce Psychodynamic Consultation to Community Mental Health Centers

In keeping with our mission -- to explore ways in which psychoanalytic thinking and practice can be applied to the broader community – in January 2017 our Section launched a new initiative to provide pro bono, one on one psychodynamic clinical consultations to staff therapists in community mental health centers across the country.  A daylong onsite workshop is followed by twelve months of weekly individual clinical consultations between CMHC therapists and senior psychoanalysts who have volunteered their time. It is estimated that each consultant and therapist will have a total of forty sessions (by telephone, Zoom, Facetime, and sometimes in person) in the course of the twelve-month period.  

Supervisory support is essential in helping early career professionals in particular meet the daily challenges of their work:  developing clinical skills, maintaining job satisfaction, and minimizing burn-out.  At the same time, for those who work in the public sector, more often than not, agency supervisors are required to ensure that state and federal regulations are met, leaving little time to supervise the treatments themselves. Therapists and supervisors are constantly pressured to meet productivity and paperwork requirements, thus there is rarely an opportunity for therapists to discuss actual cases, to reflect on their experience with the patient, and to think about the patient's experience with them; skills that are among the basics of psychodynamic clinical training.

As the pressure to meet these regulations mounts, the emphasis on “evidence-based” and Cognitive Behavioral Therapies continues unabated, knowledge about and the ability to practice psychodynamically has all but disappeared.  With this intervention, we hope to demonstrate to the directors of CMHCs in the not-for-profit sector, regardless of discipline, that psychodynamic training and treatment are relevant to the populations they serve. We are aware that this latter goal is a tall order, however we have been encouraged by the enthusiastic welcome we have received from the Clinical Director at the Family Service League in Huntington, N.Y.  and the Director of Psychological Services at Clarity Child Guidance Center in San Antonio, Tx.  They are only too aware of the challenges facing their staff and the demoralization that threatens.  

The consultants, to whom we are eternally grateful and without whom we would not have a program, are members of the psychoanalytic community from across the country.  They are senior psychoanalysts who share our concern about the lack of interest in psychodynamic work in the public sector and share our hope that this program, and others like it, will start to reverse this trend.  They generously volunteered their time when this initiative was announced.

We have collected and analyzed data to measure the outcome of these interventions.  Quantitative measures gauging professional satisfaction and professional development were administered to each therapist at the beginning of the project, mid-way through, and at the conclusion of the twelve-month period.  While the number of subjects limits generalizability, preliminary findings from the Family Service League reveal significant changes in work satisfaction and self-perceptions of development as a therapist.  A paper describing these results can be found in the 2018 volume of the Journal of Applied Scientific Psychoanalytic Empirical Research (see reference below).

Qualitative data collected from both therapists and consultants in the month after the consultations ended have been analyzed and the results are being prepared for publication.  In concluding a verbal report on these findings at the 2019 annual conference of the Society for Psychoanalysis and Psychoanalytic Psychology, Dr. Boulanger commented: “It is poignant to see how eagerly the majority of the clinicians at describe their experiences during the year, and how they blossomed in the weekly consultations; but the sobering reflections from many of the consultants, as they became aware of just how difficult it is for most therapists working in the public sector, make it clear what an important role this initiative could play in community mental health.”

Since these were pilot studies, which we hope will be replicated in other sites, we have carefully documented this project as it has unfolded.  

If you are interested in volunteering to become a consultant or you would like to explore the possibility of undertaking an intervention like the one described here, please email:

Ghislaine Boulanger at Ghislaine242@gmail.com

or Larry Rosenberg at lmrphd@gmail.com