Over the past twelve years, a group of clinicians at the Institute for Psychoanalytic Training and Research (IPTAR) has been developing and refining a psychoanalytically informed model for working with a range of inner-city children who struggle with complex histories of trauma and loss. From the beginning, we recognized that our challenge was to find a practical way to offer treatment that would be intensive enough to be effective. We hoped that by embedding our service within the school setting, we could provide convenient access to services for multiply stressed families. In addition, inspired by Bruno Bettelheim’s writing about his work at the Orthogenic School in Chicago, we wanted to help students to use the school as a therapeutic milieu. In 2013, the IPTAR On-Site School Program was awarded the American Psychoanalytic Association’s Educational Achievement Award, which honors outstanding psychoanalytically informed work with educators and schools.
In the past 10 years, we have forged partnerships with five schools that strive to use education to break cycles of intellectual, emotional and economic poverty. In a time when testing students’ academic performance is emphasized everywhere, these schools also maintain a focus on working with the whole child and on the idea that learning takes place best in a supportive community. Cognizant that emotional and behavioral problems interfere with students’ capacities to take advantage of their opportunities, the school administrators were interested in working with us. By buttressing and expanding their psychological services, we have, together, been able to help students to use their relationships with therapists, teachers and peers to learn to interact in new and meaningful ways.
The students we have treated range in age from kindergarten through twelfth grade. Some require special education, while others are intellectually gifted. In addition to struggling with the stresses of inner city life, they cope with a variety of genetically based concerns.
We offer psychodynamically oriented individual and group therapy on-site during the school day, tailored to the needs of each school and its students. Therapists integrate treatment, available at whatever frequency is clinically indicated, with regular consultations with parents, teachers, and administrators. Each school has a site supervisor, an IPTAR graduate, who works with the educational staff to design and evaluate programs. Over the years, in addition to our regular clinical services, we have run groups for parents, teachers and for pregnant or parenting adolescents. We have provided therapeutic tutoring, case management, and organizational consultation. We have also offered psychoeducational workshops for adolescents, parents and faculty members on such subjects as child development and recovery from trauma. We have instituted a continuity of care policy for children who have graduated or changed schools and we offer free or low-cost therapy to interested family members at the IPTAR Clinical Center. Since 2002 we have treated over 700 students and provided training to 124 therapists.
Systematic Learning and Research
Since the program’s inception, IPTAR has supported our work in ways that have led to a deeper understanding both of individual students and of the issues involved in working with this population. The therapists working in the schools are candidates in, or graduates of the IPTAR Child and Adolescent Program, Adult Analytic Program, Externship/Internship (Pre-Analytic) Program or Respecialization Program. In addition to attending regular team meetings with the IPTAR site supervisors, each therapist is individually supervised on a weekly basis by an IPTAR graduate with expertise in child and adolescent treatment. Curriculum and course sequencing have been sensitive to the needs of trainees in the school program. Senior members of the institute have run workshops on such topics as working with cultural diversity and psychotherapy with traumatized individuals. Candidates from the Child and Adolescent Program have given accounts of intensive courses of psychotherapy both as lectures for IPTAR and for the wider community.
We have found that the combination of psychoanalytically oriented psychotherapy and participation in a strong academic community makes a significant difference in students’ working effectively to meet both academic and personal goals. We have described our work at conferences and in published papers (see below). Our next step will be to develop research studies to further understand our clinical observations. We have one study addressing changes in object relations and self image after several years of individual and group therapy in a middle school, and another which studies the impact of narcissistic mentation on object relations.
Presentations and Publications
Rentrop, C.B. (2005), Transformations of Trauma and Loss: Report of the IPTAR School-based Psychotherapy Project. Presented at the Tavistock Center’s First European Conference on Child and Adolescent Mental Health in Educational Settings Conference, Paris, France.
Evert, E.C. (2005). Cycles of Denial and Awe: Working with Trauma through the IPTAR Clinical Center’s School-Based Service. J. Infant Child Adolesc. Psychother., 4:310-320. Also presented at IPTAR’s Child and Adolescent Program’s Visiting Lecture Series
Rentrop, C.B. (2005). The IPTAR Clinical Center’s School-Based Service: Children Who Have Children—Case Report of a School-Based Intervention with Adolescent Parents. J.
Infant Child Adolesc. Psychother., 4:321-33. Also presented at IPTAR’s Child and Adolescent Program’s Visitning Lecture Series.
Shaffer, R. (2011). The Case of D: A four times a week pscyoanalysis of a ten year old boy over the course of five years. Presented at The New York Freudian Society.
DeLardemelle, C. (2012). I didn’t destroy you, we have survived: A young girl’s revelations about psychotherapy and lessons for her therapist. Presented at IPTAR’s A Child Therapist at Work.