Psychoanalysis at Work in the Community

Vincent Panetta, Ph.D., decided early in his career that if his patients would not come to him, he would go to them.

Through his work at mental health clinics in Boston and on the South Shore, Dr. Panetta and his staff use home-based therapy to “stop that revolving door that is so typical of mental health services,” working with a very challenging population of families, children, and adolescents, mostly in their homes and other community settings. “Eventually, you want your patients to come to the office, of course,” Dr. Panetta says, “but I immediately observed when I first worked as a psychotherapist in an outpatient clinic in Boston how much need there was for home visits.”

Dr. Panetta developed outreach programs at multiple outpatient counseling services south of Boston, with his staff seeing as many as 300 people a week, including referrals from the state Department of Mental Health, the Department of Children and Families, and the Department of Developmental Services. Their patients include many children from foster homes, developmentally disabled adults, and patients from group homes and workshops.

Dr. Panetta and several of his clinicians studied at the Boston Graduate School of Psychoanalysis (BGSP), where he is now on the faculty. He considers his training at the school essential in his work with difficult cases. “We see young children who have already lived two lifetimes, in terms of abuse, loss, and emotional damage,” he explains. “Some of our patients are flagrantly psychotic, paranoid, or bipolar. We have kids who have been in and out of DYS (Department of Youth Services) and suffer from oppositional defiant disorders and explosive disorder.”

“Without my psychoanalytic knowledge, this would be like operating in the dark, knee-deep in the mud,” he continues. “What I got from BGSP provides that guiding light and the tools I need to work with people.  Psychoanalysis teaches you that human emotions are very contagious. When you are working with kids who have a good reason to feel angry, self-destructive, and aggressive; you quickly become infected with those feelings. My training at BGSP helps me navigate those feelings, to study them until I have enough information to make an intervention. It’s like a puzzle. I intervene based on what I feel, know, study, and observe.”

“Without this kind of training, clinicians often get burned out,” he adds. “They get tangled in their own emotions and the emotions of the patient.”

The proof is in the results, Dr. Panetta points out. “We hold onto our patients,” he says. “Before working with us, some had been to several therapists, were periodically hospitalized, medicated, living in group homes without jobs. They weren’t making any progress. Today some of our patients have graduated from college, hold jobs, are living independently, and are off medication. Thanks to my BGSP training, we have really been able to help our patients.”

Dr. Panetta now teaches the Fieldwork Seminar at BGSP, helping students navigate their placements working with people with psychosis in the community. For people who have never been exposed to psychosis, there’s a great deal of anxiety when they begin, a lot of uncertainty, and fear that they won’t know what to do.  Trepidation.  As they begin to do it, they report what they observe and experience, through the process of talking, they feel more and more comfortable being at these places. Over the course of time, some people really enjoy it. They experience first hand what it’s like to be sitting with someone who is narcissistic, psychotic, or delusional, which is good preparation for entering the field.