Well... this is the last stop in my travels and this has been the hardest blog to write. There's definitely some unconscious thing going on ... Freud would have had a heyday with it. After two week's delay (jet-lag) I wrote a pretty decent account of my last days in San Francisco; only to accidentally delete the whole thing. Not sure what button I pressed but it was gone forever... despite every attempt to retrieve it. Oh well... perhaps that one was not meant to be. Five weeks later, having recovered from jet-lag and settled back into work and family routines, here's another attempt...
San Francisco Carnaval
It's Saturday 27th May and the start of the long holiday weekend of the famous San Francisco Carnaval (yes, they spell 'carnival' with an 'a' in the middle). We first heard about the carnival from a passer-by the previous morning, en route to my meeting with Kadija at the hospital. Walking gingerly down the steep Potrero Hill, I sought sympathy from a fellow traveller, asking, 'do you do this walk often?' 'Every day', she assured me, 'it gets easier after about 30 trips; and it's nothing compared to the stamina that is needed to dance in the parade at the carnival.' No sympathy there. She invited us to look out for her troop at the carnival parade on Sunday. We chit-chatted all the way to the hospital, where she works as a medical professional, and said goodbye, promising to check out the carnival.
I write all morning on Saturday, then in the afternoon Kofi and I make our way to 24th Street, the centre of all the carnival activity. Security is reassuringly tight as we pass through the barriers to the sound of music blasting from oversized speakers. The streets have been transformed and is now full of stalls, publicising hundreds of projects operating in San Francisco. There is an abundance of services for people who live on the streets, such as dental check-ups right there at the roadside. Kofi and I exchange our experience of working in the community with many of the stall holders and collect some of their publicity material.
As we progress along the street the stalls change from humanitarian projects to cultural artefacts, clothing and jewellery and other exotic items. Bands and singers man several stages along the way; attracting crowds of dancers and onlookers. Cultural food is available in abundance, straight off the barbecues, and I have never before seen such big bags of popcorn or fruit displays.
We treat ourselves to some delicious freshly roasted corn on the cob, then share a plate of barbecued chicken and rice (portions are so big in the USA). My mother would be horrified to see me sitting on the kerb tucking into my meal alongside other carnival goers. Before leaving the festivities I buy the smallest bag of popcorn (oversized in my opinion), which will last me a few days.
Sunday 28th May is the big day of the parade. The stalls from Saturday had disappeared overnight and the streets are crowded with spectators. Without inhibition, young and old dance and parade in their beautiful costumes. The preparation must have taken all year. We take a short cut through the side streets to the end of the parade to see the line-up of judges as they grade each troop. A very highly organised affair.
The holiday season continues on
Monday. We take a very long walk and a bus ride to Fisherman's Wharf, to explore the San Francisco Bays. Pier 39 is known for its large colony of sea lions . It was such a surprise to see these enormous creatures, just minding their own business and not bothered about the hundreds of people staring at them and taking pictures. I was also able to see the famous Alcatraz prison from this pier. We end the day with a quiet meal in a beautiful restaurant, before heading home.
The Infant Parent Programme in Action
It's Tuesday 30th May and time to get back to work. Today I'm scheduled to join the Infant Parent Programme (IPP) training seminar for post masters / doctoral students. I am keen to understand the training structure provided by the IPP. The seminar group; facilitated by Maria St John, deals with issues of clinical practice. Students alternate case reviews with intensive supervision.
The students see families once a week in their homes or at the trauma centre and the cases are taken to weekly supervision. In order to receive this service the families must qualify for Medicaid, therefore participating families are usually very stressed and traumatised. This work is not for the faint hearted as it requires that the clinician be able to focus on the parent-infant relationship amidst the family's stresses and strains of daily living, such as accessing medical care, legal help on immigration, asylum seeking, deportation preparation, domestic violence, etc.
As in Michigan, I notice that the students come from various professional backgrounds. The focus of today's class is on ending interventions with families, which is timely for the students, because many of them are soon to finish the course. Tessa Baradon's paper on endings from her book, 'Claiming The Baby', is the text under discussion. It can be found here: https://www.amazon.co.uk/d/Books/Practice-Psychoanalytic-Parent-Infant-Psychotherapy-Claiming-Baby/1583917616.
After the seminar I join Maria and her student who is preparing for a complex case review. We grapple with the material in order to help the student to find new ways of thinking about the family. Now I understand why the students receive such a high level of supervision; because the level of pathology being dealt with in the families referred to the trauma centre is very high.
My third session of the day is the supervisors' meeting, where I am able to discuss with the team about the different strands of the training offered by the university, i.e. perinatal mental health; infant parent programme; early childhood mental health consultations and direct services, which are offered as an extension of consultation. As a hospital that specialises in trauma, it is not an easy environment to work in and those drawn to work here have a strong motivation and passion to help this client group.
After the supervisors' meeting I take part in the supervision of a severe case. This mother and child have been receiving help for three years and still the mother is not responding well. We explore why it is that this mother is using the therapist so badly and not keeping appointments. How much can a therapist cope with at the hands of clients? When and how should she set limits and give back responsibility to the mother? How much of the team's time should be wasted waiting for a mother who repeatedly fails to attend, yet declares her need for the service.
I think of my own attempts to engage ambivalent clients back in London. The experience of working with emotionally unstable personalities equips you to know when to keep coming back and when to suggest to the unwilling parent that perhaps this is not the best time for them to engage and why not come back when it feels more convenient. For a zealous, enthusiastic trainee, eager to see change, this is not such a simple decision, especially when the therapist comes from a position of privilege. The feelings of guilt are overwhelming as the client dares the therapist to abandon her again. At what point does the patience of the therapist become the target for abuse and mitigate against the building of a healthy, trusting therapeutic alliance?
A burden is lifted from the shoulders of the therapist as she is given permission to also look after herself by setting limits for the client. Hopefully the client will understand that the therapist is also a human being with feelings, and will learn empathy and gratitude.
Is Psychoanalysis only for the Privileged?
On Wednesday 31st May I join the Fifth Wednesday Multicultural Gathering, where students and staff celebrate and reflect together on multicultural working. We watch a provocative film which asks many questions: Can Latin Americans only benefit from concrete interventions rather than psychoanalysis? Are Latin Americans analysable? Because they are poor does that mean that they are not curious about themselves; or are they only occupied with poverty?
The film discussed ways of adapting psychoanalysis to non-traditional patients; suggesting that the psychoanalytic tool will become relevant outside the consulting room when psychoanalysts start to write papers that more than five people understand. Can privileged psychoanalysts even bear to hear about poverty - what it's like not to have enough food or to be a victim of prejudice? Does the analytic setting produce the same pressures that the clients face in society - the privileged analyst's fear of contamination? Is the couch only for the wealthy?
We discussed some of these questions in small groups and I was humbled by the passion of group members, who had come to the end of their training, with great prospects ahead. Will they join the privileged or join those struggling within their cultural groups? What power do they possess to change the status quo? Tears were shed in my small group.
‘do unto others as you would have others do unto others’
After lunch I meet with Kristin Reinsberg, Director of Daycare Consultants at the Infant-Parent Program. The program aims to help the adults caring for the children to understand and respond to challenging behaviours appropriately, despite being overworked, underpaid and stressed. Many children spend more than 40 hours a week in day care, therefore the daycare staff spend more time with them than their own parents. The programme supports relationships between staff and directors, staff and staff and staff and parents; helping them to think about what they want for the children and creating a system where staff can have that also for themselves. Their motto is, ‘do unto others as you would have others do unto others’; therefore, through the experience of being held, heard, listened to, the staff are able to do listen to and hold fellow staff members, children and parents. Many of the systems in which the teachers exist are ones in which their voice is not heard. They are the unseen. Thankfully, things have changed from the 70s and the 80s. Wages and access to education have improved, and with the introduction of reflective practice there is a stronger emphasis on mental health consultation on a national level.
Homeless Families in San Francisco
It's Thursday morning, 1st June and today I am looking forward to meeting
Andrea Scott, an Early Childhood Mental Health Consultant at the Infant Parent Programme, whose role is to provide support to a variety of community based organisations. Andrea will take me to see some of the projects that work with homeless families. Her background in education and her work with victims of severe trauma has prepared her well for this role. We meet at the Asian Art Centre, where Andrea is a member.
From the art centre our first stop is the Hamilton Project for homeless families, where Diana meets us and shows us around the vast property which houses over 50 families each night and provides support for up to 25 families at high risk for chronic homelessness for 6 to 18 months. Families receive intensive social services to identify and address factors contributing to their homelessness. The aim is for families to find and retain permanent accommodation. Hamilton Children's Services also provides therapeutic support and enrichment activities to strengthen children's resiliency, promote academic success and enhance the parent-child bond.
Though just a block away from the main centre of town I feel slightly nervous as we walk past drug dependent individuals. The atmosphere is tense and Andrea seems to be watchful. She assures me that she is known in the area so we are relatively safe. However the area is known for its drugs and shootings. The tension in the air is because it's the last day of the month and money will be received and will be used on drugs to gain temporary relief from the miserable struggles of life.
In San Francisco, homelessness is no respecter of persons. Of the 8,000 known homeless people living in San Francisco, 25% are in families with infants and young children. The majority of San Francisco’s homeless families are transient, living in shelters, cars, in cheap by-the-night hotels in the city’s poorest neighbourhoods, or stay temporarily with friends or family. Because they are not visible they are often forgotten. From Hamilton Housing we go to meet Lihea at Compass Children's Centre, which is another project working with the homeless.
I have lunch with Andrea at the art centre before she returns to work and I take a taxi back home. I have one more meeting today with Maria St Johns and that will be the last appointment on my itinerary.
A Treasure From the Archives
Kofi and I walk to the hospital for the last time, to meet Maria. Together we stroll to 24th Street to find a place to eat and chat. The Dynamo Donuts and Coffee shop had already been recommended by Kadija and now by Maria, so we find a spot in the garden at the back of the shop. We reminisce about our time together and I say thank you to Maria and present her with the Winston Churchill Crown. I am surprised when she says that she also has a present for me. Reaching into her bag she handed me a small blue booklet from the archives of the university.
I feel overwhelmed to receive one of the original copies of the famous article, 'Ghosts in the Nursery' by Selma Fraiberg. I feel that I have received a piece of history. This will be a prized possession.
Goodbye San Francisco
I feel sad as we leave the coffee shop and walk in opposite directions; Maria to catch her train home and Kofi and me, back to our accommodation to pack for our departure.
What next? Well... I have a long report to write to summarise the learning from my travels. I will let you know when this is ready. It has been a fruitful journey and I am grateful to you for sharing it with me. And of course, thanks to the Winston Churchill Memorial Trust for making it possible.