Putting Psychoanalysis to Work

by James Henkhaus and Michael Birnkrant

BGSP recently interviewed Michael Birnkrant, Master’s graduate from BGSP and current doctoral candidate, about his experiences bringing his BGSP education into the workplace.

James Henkhaus: What were your reasons for enrolling in the Boston Graduate School of Psychoanalysis? Why BGSP?

Michael Birnkrant: Everyone has their own individual reasons for getting into this, and have used their degrees in various ways.  I started off as pre-med in college, and I actually went to medical school for a semester.  But, I remembered something a faculty member suggested to me my senior year which was that if I decided to leave medical school, I should come to this school.  That was always on the back of my mind during medical school, and I realized it wasn’t the right fit for me.  I was always a deeper, more abstract kind of thinker and I wanted to work one on one with people and understand what’s driving people, what made them tick, what’s going on inside?  I couldn’t find that in any of the psychology classes I took, even though I majored in psychology and did a senior thesis on social psychology.  Then in medical school everything was black and white.  Everything is already decided and determined, every step of every procedure….  So then I left and came here and enrolled in a Master’s [in Counseling] degree. I was very amazed at how interested I was consistently throughout the program.  It was the first time in my entire length of time studying where I wasn’t bored senseless in class, listening to lectures and whatnot.  So, I learned right away through the process learning style here how to work with other people, how to talk with other people, how to interact with other people.

JH: In what ways has BGSP prepared you to work in this field?

MB: It was only my second semester that I started fieldwork at a rest home in Lynn. I found myself face to face with schizophrenic, elderly folks and I learned very quickly how intense and tumultuous that can be and learned the basic skills of how to interact with them in a productive way.  After that, I began interning in the Boston Public Schools as a School Based Clinician. I had an amazing experience working with inner city kids in East Boston who had very little.  They mostly came from broken homes with no real support, most of them had no real boundaries at home, a lot had family members who were undocumented citizens and for that reason most of their families were afraid of engaging in the system to find extra help in school or other outside resources. I saw some very difficult cases that most people didn’t even want to go near.  I remember one time a student wrote a list of people in his class he wanted to kill.  Nobody wanted to work with this child and the thought was that he had to be medicated and sent out somewhere for evaluation.  Because of my training here, I wasn’t afraid of working with him. So I went right ahead and started working with him, built a rapport with him, joined him on his level, joined his world, understood where he was coming from. It was all due to a reaction formation for his feeling of being threatened by everybody.  He was told at a young age by his mother not to trust anyone outside of the family.  So he didn’t trust the teachers, none of the other students, and by forming that bond of trust with him, he became a whole different person. I continued working with him for another year or two after that and towards the end of our work he turned from being introverted and guarded young child to someone who was able to share with me the poetry he wrote, talk to me about politics and philosophy… Just a completely brilliant mind unfolded in front of me; it was amazing.

JH: That child seemed very troubled and your work with him had a profound impact on his life. How does this technique work with people with major mental illness?

MB: I [became] a doctoral student here after I finished my psychoanalytic Counseling Master’s degree.  …I also started doing per diem work at … a hospital doing group therapy on Sundays. …I was offered a job as inpatient group therapy coordinator at the hospital.  So I did that for a while and it was an absolute amazing experience working with some of the most acute psychiatric illnesses you’ll ever see.  I was calmly listening to patients who were feeling anxious or overwhelmed, they were having breakdowns or crisis and I just sat there and listened to them and didn’t try to tell them that they were wrong or that their delusions were fake and these behaviors were just symptoms of being schizophrenic and that they should take more medication.  So I listened to them and I just helped them feel more understood and comfortable and I contained a lot of their intense emotions.  There was always a noticeable difference after they interacted with me.  They always called me up to the units when there was a crisis.  I would always run up and they’d say, “We can’t do anything with this person. We’re going to restrain them and inject them with medication, that’s all we can do.”  I would say, “Let me just try first talking to them.”  It was a mix, the results, sometimes I would have great results from just talking to them.  Most modalities, from what I understand, there isn’t that intense training on how to handle the difficult feelings in the way that we learn here at BGSP, and it makes a drastic difference.  There was this one occasion in particular where there was this paranoid schizophrenic patient and everyone said, “You need to meet with him with two mental health workers….He’s too dangerous; you can’t be in there alone with him.” So we went in an office, with a nurse and a mental health worker and the guy is screaming at me, yelling at my face, calling me every name in the book, telling me that somehow I was involved in some conspiracy against him to inject his mind with whatever mind altering medication.  I just sat there and I listened to him and joined his feeling.  I used reflection, mirroring, joining, the basic techniques of modern psychoanalysis and he calmed down and he listened and he talked to everyone and the staff coherently and no one could believe it and I just thought nothing of it ….Afterwards I found out that the coworker who had seen this then went to the info session at the school here.

JH: What do other clinicians and your coworkers think of your style of working?

MB: Throughout my clinical experience, I gained a lot of “followers” if you will, coworkers who saw how I interacted with these patients. I was just doing what was second nature based on what I learned here. After finding out where I had been trained and seeing the success that I had had with various, difficult patients, a group came here [to BGSP] for an informational session. The training at the school helps us to process and think differently about our cases and patients and it’s so rewarding to see the results. A lot of the time we forget just how much of an impact we really have. It wasn’t until switching to private practice that more often I would start hearing a lot more positive feedback from people.  Within the hospital though, I was always called in as a last resort.  Each practitioner and clinician has their own style and tools that they use and many times there is no need for extra assistance, but some patients can be extremely non-compliant.  They saw me as a helpful resource. There was not a sense of competition to see who is the most “therapeutic” or “successful” with their patients. It is much more of a team atmosphere and the staff all knew that I was good at what I do, and even if I was unable to talk the patient off the edge, I was always willing to try. It can be detrimental to the physical and mental health of the patient to be restrained, injected and given up on.  Sometimes, there is nothing else that can be done. Sometimes, that is even what the patient is pushing for; to be left alone or to have the anxiety and stress alleviated via injections.

JH: We’ve touched on both ends of the spectrum, troubled children and schizophrenic elderly; tell me about an experience with someone in between these two cases.

MB: There was this girl I had been working with [in private practice] for a while. She was in her 30’s, had an extensive history of a serious anxiety disorder; she’d been in all kinds of programs. She said, “You’re the first person who hasn’t tried to get rid of me and send me to another person.  Every time I got to a new therapist they immediately tell me I need medication and to be hospitalized; and I refuse to take medication.” So I said, “What’s wrong with those other people?”  “I don’t know they just can’t handle me…” She replied, “I don’t know how you put up with me,” she always says.  I say, “Well let’s try this first before we decide if medication is a better option.”  So I listen to her. I just sit there, I don’t overreact, I know my own feelings — which is something you learn here: you don’t act on your emotions in a way that can be harmful to the treatment…. It makes a drastic difference.  Her tension levels have decreased, her frustration levels have decreased from just sitting there with me, being able to talk as much as she needs to.  I wait for her to contact me and I engage with her at that point.  The techniques we learn here make such a drastic impact that the patients are able to verbalize the difference; they feel so much more comfortable with the way that we work with them.