Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

I.F.A

Name of Innovative Program: 
Insight For All: A Psychoanalytic Project for Homeless Adults and Families
Sponsoring Organization
I.F.A
Name of Innovative Program Lead: 
Deborah Anna Luepnitz
E-mail Address of Innovative Program Lead: 
dalue@webtv.net
Project Description: 
Two million Americans experience homelessness in a given year, and roughly half struggle with mental illness. The only treatment considered relevant to such individuals when they move into shelters has been anti-psychotic medication--sometimes with supportive counseling. Our project has attempted something different. Based on research by Dr. Bert Karon and others, we believe that people who have been severely traumatized--even those labeled psychotic--can benefit from psychoanalytic therapy. Our program consists of 12 analysts who work pro bono with homeless men, women and families who have agreed to live indoors at Philadelphia's Project H.O.M.E. Since 2005, we have left our offices to meet with homeless people onsite. What appears to be helpful is both the insight gained by the exploration of the patient's history and dreams--and the internalization of the caring relationship with the therapist. Some of our patients become able to hold jobs, do creative art work, and feel more fully engaged in the Project H.O.M.E. community.
Creativity and Innovation: 
Creative work is often ignited by the inspiration of history. This is true for our project.  Although most people think of psychoanalysis as an elitist practice, the fact is that Freud wanted talking therapy to be accessible to rich and poor alike. Elizabeth Danto's book, FREUD'S FREE CLINICS describes the development of 10 free psychoanalytic clinics in 7 European countries from l918-1938. Far from being some wild variation from tradition, our project is part of this beautiful but little-known history. On the other hand, given that there are no books as yet on the subject of psychotherapy with homeless people, we have had no choice but to innovate. Our therapists have done art and play therapy with adults. We have met our patients in conference rooms, in their private quarters, and in tents at Occupy Philly.  A few homeless patients have even asked to be seen in our offices where they have preferred using the analytic couch.
Leadership: 
Members of I.F.A. are encouraged to learn about homelessness outside the clinical context. Over the years, we have served food at churches, distributed blankets and water during "code blue" nights, and participated in the midnite street count. I.F.A. has also endeavored to share experiences with others working with underserved populations, and given interviews to groups in the U.S., Norway and Australia. I.F.A. members have presented our work at the following conferences: Psychoanalysis, Culture and Society (Rutgers); APA's Division 39 ( San Antonio and NYC; The World Conference on Psychotherapy ( Sydney, Australia); NY Department of Homeless Services annual conference; New Directions in Psychoanalysis (D.C.); Appalachian Psychoanalytic Society (Knoxville). There are presentations scheduled for Vermont and North Carolina for 2013.
Sustainability: 
I.F.A. has run for 7 years on a budget of zero. The only adjustment we've had to make in the interest of sustainability is to stop accepting doctoral students. The problem was not quality of service; young clinicians can do excellent work. The problem was that they might see a patient for 2 years and then leave town for a new job. We did our best to find replacements, but such changes can re-traumatize patients with a history of abandonment. We now accept only experienced therapists who are committed to remaining in Philadelphia. We would prefer to stay small in number, and offer maximum clinical consistency. There are various ways that we could use funds to expand our services. Without funds, however, I.F.A. will continue because of our devotion to promoting the dignity of the most fragile of our fellow citizens. I like to think we are "too small to fail." 
Replicability: 
A number of groups have studied our structure and methods and claimed I.F.A. as an inspiration. Of these, the most successful has come out of another psychoanalytic group—the Women's Therapy Center Institute (WTCI) in NYC. In 2005, the WTCI invited I.F.A. to give a presentation, and decided to copy us. They chose to focus on homelessness prevention, however, and developed a relationship with a local domestic violence shelter. (Taking time to develop a relationship with the referring agency is key. Barging in as experts is a big mistake). The moment of leaving a DV shelter is when many women become homeless. The WTCI calls its pro bono project "Connect and Change." They have received funding for several years from the FARR foundation. Like I.F.A., Connect and Change has patients who have barely missed a session in 3-5 years, and have used the treatment to extricate themselves from destructive relationships, and stop the cycle of violence, poverty, and addiction.
Results/Outcomes: 
We are a young project offering long-term therapy. Thus, we don't expect to have "graduates" after only 4-5 years. If we include the individuals seen in group, family and individual therapy, we have touched roughly 100 lives.  Many have used the treatment to face medical problems for the first time (e.g. ulcers, cancer, HIV) to  re-connect with family; to move within Project HOME to more independent accommodations; to live more comfortably as a gay, lesbian  or transgender person;  to  land part-time employment; or to develop--and sell--their art work. (One woman even had her own art show).  What this description can't demonstrate is the number of involuntary mental health commitments that were averted, the drug and alcohol relapses prevented, the  (all too common)  amputations due to frostbite that didn't need to occur. Existing behavioral metrics aren't well suited to the population we care for.  It can take years for a patient who has lived out of shopping carts and trusts no one to admit she hears voices. 
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