The Psychoanalytic Study of the Child
ISSN: 0079-7308 (Print) 2474-3356 (Online) Journal homepage: https://www.tandfonline.com/loi/upsc20
The School Consultant as an Object for Externalization Kathryn Kris To cite this article: Kathryn Kris (1978) The School Consultant as an Object for Externalization, The Psychoanalytic Study of the Child, 33:1, 641-651, DOI: 10.1080/00797308.1978.11822994 To link to this article: https://doi.org/10.1080/00797308.1978.11822994
Published online: 07 Feb 2017.
Submit your article to this journal
Article views: 1
Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=upsc20
The School Consultant as an Object for Externalization KATHRYN KRIS, M.D.
IN
FORMULATIONS
OF
THE
FUNCTIONS
OF THE
PSYCHIATRIC
school consultant, the psychoanalytic concept of transference reactions has played an important part (Berlin, 1966; Hitchcock and Mooney, 1969). When applied to the consultation process in the original sense of a revived object relationship from the past, transferred to the therapist, who becomes the object of the patient's drives, it is misleading. On the one hand, in the practice of psychiatric school consultation, interpretations of such transferences, with their focus on individual past histories of consultees, rarely need be made, if ever (Babcock, 1949; Caplan, 1970; Coleman, 1947; Hitchcock, 1977; Maddux, 1950). On the other hand, as noted by Berlin (1966), management of transference along lines appropriate for the purposes of individual psychotherapy and psychoanalysis would promote unwelcome regression in the consultation process. The psychoanalytic concept of externalization, however, as a "subspecies of transference" (A. Freud, 1965, p. 43) does justice to the projective distortions that are regularly encounAssociate Attending Psychiatrist, McLean Hospital, Belmont, Mass.; Clinical Instructor in Psychiatry, Harvard Medical School. This paper is an expanded version of a contribution to the Skills in Consultation to Human Service Agencies Course, at the 130th meeting of the American Psychiatric Association, May 5, 1977, in Toronto.
Kathryn K ris
tered in the consultee's attitudes to the consultant and does not imply dynamics that call for technical management at odds with established experience in the practice of consultation. Further, the concept of externalization contributes a useful dimension to the formulation of the supportive functions of the consultant. The purpose of this paper is to apply the psychoanalytic concept of externalization to an understanding of the process of psychiatric consultation in schools. The paper will review the psychoanalytic concept of externalization. It will illustrate the use of externalization in several clinical examples and relate it to some published descriptions of school consultation. EXTERNALIZAnON
Anna Freud has distinguished externalization as a "subspecies" of transference from transference proper-the regressive displacement of an old object relationship onto the therapist. She writes: Not all the relations established or transferred by a child in analysis are object relations in the sense that the analyst becomes cathected with libido or aggression. Many are due to externalizations, i.e., to processes in which the person of the analyst is used to represent one or the other part of the patient's personality structure. So far as the analyst "seduces" the child by tolerating freedom of thought, fantasy, and action (the latter within limits), he becomes the representative of the patient's id, with all the positive and negative implications this has for the relationship. So far as he verbalizes and helps in the fight against anxiety, he becomes an auxiliary ego to whom the child clings for protection. Due to his being an adult, the analyst is seen and treated by the child also as an external superego. . . . The child thus re-stages his internal (intersystemic) conflicts as external battles with the analyst, a process which provides useful material. To interpret such externalizations in terms of object relationship within the transference would be a mistake, even though originally all conflicts within the structure have their source in earliest relationships [po 4lf.].
School Consultation
Externalization of one side of an inner conflict may also occur in instances where the conflict is principally intrasystemic, as between opposing drives or between two attitudes in conflict. Externalization provides a temporary solution to a variety of problems of indecision. Properly interpreted, it can lead to inner solutions. The term externalization, to be useful, must be reserved for readily clarifiable psychological events, not fully unconscious but closer to preconscious processes. Novick and Kelly (1970) distinguish it from the projection of an unconscious drive derivative onto an object. Externalization is of course related to, and in fact relies on, displacement, but is a more specific term in that it indicates the new location of internal content. Furthermore, externalization has some overlap with the concept of projective identification (for example, see Brodey, 1965; Giovacchini, 1967), but it is considerably broader in scope. On the other hand, as used here, the term externalization is not as broad as to refer "in general to the tendency to project into the external world one's instinctual wishes, conflicts, mood, and ways of thinking (cognitive styles)" (Moore and Fine, 1968, p. 45). Externalization, as I use it, occurs within the context of an object relationship and consists of the attribution of a part of the mental structures or their contents to the object. EXAMPLES OF EXTERNALIZATION IN SCHOOL CONSULTATION
The examples that follow are taken from the experience of the first four years of consultation in a large middle-class suburban school system. The McLean School Consultation Program 1 (M.S.C.P.) was hired by the School System's Director of Pupil Personnel. As a member of the M.S.C.P., I was assigned as the original and continuing consultant. The main tenets of the M.S.C.P. are: 1. Environment influences a child's emotional stability and development. I. I wish to thank Dr. Maurice Vanderpol, Director of the Program, for his support and wise counsel throughout the consultation.
Kathryn Kris
2. The consultant's influence on the child's school environment may provide an important measure of preventive psychiatry. 3. There is a consultative process and a progressive continuum in the uses made of the consultant, ranging from direct service to promotion of institutional change. 4. In-school consultation differs from office psychiatry in focusing on development rather than on pathology and in using consultation techniques rather than treatment techniques (Vanderpol, 1976; Vanderpol and Waxman, 1974). I was introduced to each of several schools within the system by the school's psychologist or social worker. The flexibility of approach, individual consultations around problems with children or with the institution, informal small group discussions with teachers, continuous seminars of eight to twelve sessions with psychologists and social workers and with high school counselors proved to be a particularly felicitous arrangement. The group process which developed in the continuous seminars heightened and led to verbalization of many of the silent prejudices or externalizations which accompanied involvement with each school or group. "Here comes the sex maniac." "Here comes the mind reader." These are two common initial greetings. Psychiatrists and psychoanalysts are likely to encounter them in many settings. Stereotyped and impersonal, they reflect a fearful anticipation, an anxiety engendered by the consultation. Characteristically they are experienced by the consultant as powerful and disruptive, impeding discussion and understanding. If one recognizes them as neither attributes of the consultant nor as expressions of deep regressive transference, they become manageable. They can best be seen as externalizations of one aspect of the consultee's personality; externalization of libidinal wishes in the first greeting, with the consultant as the seducer; externalization of superego aspects in the second greeting, with the consultant as critic. Do we always clarify these externalizations explicitly? Rarely. In fact, open verbalization of such externalizations does not occur in most instances of consultation with an indi-
School Consultation vidual. Usually it is sufficient for the consultee to meet us and to clarify the problem for consultation. It is my impression that the initial introductory phase in consultation, with collegial manner and explanations of purpose, offers a more or less silent confrontation with the consultee's prejudices or negative externalizations, as withholding mind reader, authoritarian critic, or irresponsible promoter of license (Berkowitz, 1975; Berlin, 1966; Bloch, 1972; Caplan, 1970; Hitchcock and Mooney, 1969). However, if the consultees are in a small group where irrational elements may be heightened, such externalizations are commonly verbalized. As a consultation progresses, one may be able to clarify the externalizations, thereby increasing the group's awareness of the specific conflict of which one side or the other, or both alternately, are externalized onto the consultant. A group of high school counselors was meeting with me for the second year, on a twice monthly basis. In the first meeting they established their agenda to be the sexual problems of the teen-ager. For their second meeting they requested a lecture by me. In the third meeting they became increasingly dissatisfied, unable to focus on any of their case material, misunderstanding one another and me. Jokingly they attributed the sexual behavior of their students to the students' sensing the psychiatrist was coming. At the same time they complained that I expected from them constant supervision, even 100 percent control of their students! Their group behavior oscillated between "can you top this" sexual exploits and silent withdrawal. The specific jokes and complaints might have been missed, but certainly no one could miss the feeling of discontent and frustration at that meeting. But the jokes and complaints about the consultant, recognized as externalizations, were helpful in showing the group their conflict over license and control. Clarification of the group's attribution to me of their own fears of inciting their students' sexuality and their demand of themselves for its total control helped them recognize their concerns. They could appreciate my suggestion that the students might be approaching sexuality in a similar manner. In subsequent sessions, perhaps in part because they felt sup-
Kathryn Kris
ported by the commonness of conflict, the group discussions included the still more delicate topics of their students' incestuous and suicidal fears, and finally recommendations to their principal for the management of a school tragedy. Such a sequence illustrates that when externalizations are clarified, understanding can be extended and problem solving can proceed. It should be noted that to recognize and clarify such externalizations of conflict between libidinal wishes and superego attitudes did not require my focusing on individual pathology or development. This is in keeping with the cautions of many authors in regard to consultation (Babcock, 1949; Berlin, 1966; Caplan, 1970; Coleman, 1947; and Maddux, 1950). Perhaps because it was a group of high school counselors one could clarify such externalizations within the group. With another group one might elect to clarify the externalizations in a displaced fashion, as recommended by Caplan (1970), Parker (1958), and Bindman (1959). A group of mature women professionals were complaining about the unresponsiveness of their male superior. They felt excluded by him and resented their own helplessness in regard to a piece of school policy. With them it was sufficient to question their attitudes and not necessary to spell out the externalization onto their superior of their own wish to exclude him from their intimate women's group or their wish to hold more power and be free of the uncertainties and anxieties produced by the need to negotiate. They decided to approach him, and they were surprised both by his immediate agreement to their administrative request and by his wish to attend their next meeting. No longer able to view themselves as helpless, they felt proud of their problem-solving ability. To have viewed this episode primarily in terms of a group transference, as a feeling of rejection by the father, as the castrated impotence of women, or the regressive homosexuality of oedipal failure would have been utterly without foundation in the data of the group consultation setting, and futile technically. As a consultant one often has the surprising experience of finding out that someone who seemed irredeemable is in fact
School Consultation
approachable. The consultant must be particularly alert to instances where such externalizations are focused on important administrators, fostering avoidance rather than contact and possible problem resolution. Where the personal contact is the least, the externalizations are likely to exert their greatest influence. In general we promote contact rather than avoidance, adhering to the precept that reality can be handled but irrational externalizations are self-fulfilling. Such externalizations are likely to occur at times of heightened anxiety, at the beginning or ending of a consultation, or with a new task, or when an opportunity arises for contact with a member from another group, for example, teachers with parents or consultees with their superior in the school system. Sometimes a state of helplessness and demoralization may be externalized onto the consultant. I have seen this when the consultation was coming to the end, both at the end of a school year, despite the possibility of continued contact in the future, and, in another school system, when the consultation services were being terminated because of a change in the chief administrator responsible for hiring. The danger here is that the consultant may feel helpless and demoralized rather than help the consultees to recognize their sense of helplessness and demoralization in the face of change. If the consultees can recognize their helplessness, they may begin to be able to master it. Berlin (1966), in particular, has delineated some of the consultant's difficulties in seeing a consultation to its end. Up to this point I have given examples of externalizations that interfere with the consultative or administrative relationship. I want to turn now to the way externalization enhances the relationship between consultant and consultee. As indicated by Anna Freud, the "auxiliary ego" functions depend upon externalization. The consultant in this sense becomes the representative of the consultee's ego. Several writers have referred explicitly or implicitly to externalization in the consultation process. Caplan (1970) speaks of the consultant functioning as a role model for the consul-
Kathryn Kris tee, as a superego and ego ideal (p. 92). Hitchcock and Mooney (1969, p. 355), in particular, have singled out the consultee's work difficulties leading to a temporary superego regression to a "preautonomous superego schema" with an externalization of superego functions onto the analyst as described by Sandler (1960). In what ways may the consultant be thought to function as an auxiliary ego? He may help the consultees verbalize their psychological observations or offer a conceptual framework for their observations, be it the psychology of character, principles of child development, or systems theory. In addition, he supports the consultees in the face of their anxiety. This may be done verbally, as when a consultant suggests an action or points to an aspect of avoidance on the consultee's part or indicates the basis for feelings of helplessness. Support may also be given by example, as when a consultant offers to present the first case to be discussed in a counselors' group where there is overt anxiety about being criticized in their first attempt at case discussions (Sarason et al., 1966; Parker, 1958). In another aspect of auxiliary ego functioning, the consultant offers himself to his consultees for identification with certain traits, in his problem solving and reality orientation, in withstanding tendencies toward helplessness, rebellion against authority, withdrawal from power, and intolerance of human limitation (Berlin, 1962, 1966). As consultants we also perform the function of valuing our consultee's work (Coleman, 1947; Sarason et al., 1966). This seems best conceptualized as supporting the function of the ego ideal, contrasted with the critical function of the superego (Lampl-de Groot, 1962). Often the consultee lacks not only a conceptual framework for what he does psychologically but also a recognition and esteem for his work. This may be the most immediately satisfying part of a consultant's job-to help the consultee recognize that he did something, that it made a difference, and that it may be conceptualized and thereby made applicable to other situations. This is not the same as fostering the consultee's dependence, compliance, or denial. It is support for his valuing of his psychological skills.
School Consultation
CONCLUSION
Viewing the consultant as an object for externalization enables one to understand many of the principles of consultation. Several generalizations about our tasks as consultants, what we should and should not do, are widely agreed upon. First, it is vital to approach our consultees as colleagues who share a common interest but have a different training (Berlin, 1966; Caplan, 1970). The danger of trying to be an expert on teaching or one who knows all the answers is all too familiar for those psychiatric and psychoanalytic consultants who have experienced the power of consultees in various settings to prove one's ineffectiveness. Second, our job is to act only as consultants. We do not replace our consultees at their jobs even when tempted by them to do so or criticized by them for not doing so. Consultees readily try to turn over their clients to us, promoting their own helplessness and externalizing onto us unrealistic expectations of omniscience. This does not mean, however, that we would not interview a child; we simply would not take over primary responsibility for teaching him. Third, we attempt to clarify explicitly the task with which the consultees want help and to formulate explicitly with them how we and they are to achieve the solution to the task. If the task cannot be defined or implemented, this alerts us to a problem, very frequently the result of externalizations interfering with the consultative working alliance. Each of these three general rules of procedure for consultants can be seen to protect the consultant from inadvertently accepting an omnipotent ego and superego role, defined by the consultee's externalizations, thereby deviating from the ego attitude of collaboration. It would be an error to suppose, however, that all transference reactions encountered in the consultation process are externalizations. For example, the externalizations of feelings of helplessness at termination are often accompanied by transference reactions based upon reactivation of past object losses. Nor will it then suffice to respond only to the externalizations. It has been my purpose here, however, to demonstrate the
Kathryn Kris
wide applicability and usefulness of the concept of externalization in the functions of the psychiatric or psychoanalytic school consultant.
BIBLIOGRAPHY BABCOCK, C. (1949), Some Observations in Consultative Experience. Soc. Servo Rev., 23: 347-357. BERKOWITZ, M. I. (1975), A Primer on School Mental Health Consultation. Springfield, Ill.: Charles C Thomas. BERLIN, I. N. (1962), Mental Health Consultation in Schools as a Means of Communicating Mental Health Principles.]. Amer. A cad. Child Psychiat., 1:671-679. - - - (1966), Transference and Countertransference in Community Psychiatry. Arch. Gen. Psychiat., 15: 165-172. BINDMAN, A. (1959), Mental Health Consultation.]. Consult. Psychol., 23: 473-482. BLOCH, H. S. (1972), Experiences in Establishing School Consultation. Amer. ]. Psychiat., 129: 63-68. BRODEY, W. M. (1965), On the Dynamics of Narcissism: I. This Annual, 20: 165-193. CAPLAN, G. (1970), The Theory and Practice of Mental Health Consultation. New York: Basic Books. COLEMAN,]. (1947), Psychiatric Consultation in Casework Agencies. Amer.]. Orthopsychiat., 17: 533-539. FREUD, A. (1965), Normality and Pathology in Childhood. w., 6. GIOVACCHlNI, P. (1967), Frustration and Externalization. Psychoanal. Quart., 36: 571-583. HITCHCOCK,]. (1977), Interventions by the Psychoanalyst in the Consultant Role.]. Philadelphia Assn. Psychoanal., 4: 45-49. - - - & MOONEY, W. E. (1969), Mental Health Consultation. Arch. Gen. Psychiat., 21 : 353-358. LAMPL-DE GROOT, J. (1962), Ego Ideal and Superego. This Annual, 17: 94-106. MADDUX, J. F. (1950), Psychiatric Consultation in a Public Welfare Agency. Amer.]: Orthopsychiat., 20: 754-764. MOORE, B. E. & FINE, B. D. (1968), A Glossary of Psychoanalytic Terms and Concepts. New York: Amer. Psychoanaly. Assn. NOVICK, J. & KELLY, K. (1970), Projection and Externalization. This Annual, 25: 69-98. PARKER, B. (I 958), Psychiatric Consultation to N onpsychiatric Professional W OThers [Public Health Monograph, 53]. Washington, D.C.: U.S. Public Health Service.
School Consultation SANDLER, J. (1960), On the Concept of Superego. This Annual, 15 : 128-162. SARASON, S., LEVINE, M., GOLDENBERG, I. I., CHERLIN, D. L., & BENNETT, E. M. (1966), Psychology in Community Settings. New York: Wiley. VANDERPOL, M. (1976), Mental Health Consultation in Schools. In: The Changing Mental Health Scene, ed. R. G. Hirschowitz & B. Levy. New York: Spectrum Publications. - - & WAXMAN, H. (1974), Beyond Pathology. Psychiat. Opinion, 11 : 18-24.
ISSN: 0079-7308 (Print) 2474-3356 (Online) Journal homepage: https://www.tandfonline.com/loi/upsc20
The School Consultant as an Object for Externalization Kathryn Kris To cite this article: Kathryn Kris (1978) The School Consultant as an Object for Externalization, The Psychoanalytic Study of the Child, 33:1, 641-651, DOI: 10.1080/00797308.1978.11822994 To link to this article: https://doi.org/10.1080/00797308.1978.11822994
Published online: 07 Feb 2017.
Submit your article to this journal
Article views: 1
Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=upsc20
The School Consultant as an Object for Externalization KATHRYN KRIS, M.D.
IN
FORMULATIONS
OF
THE
FUNCTIONS
OF THE
PSYCHIATRIC
school consultant, the psychoanalytic concept of transference reactions has played an important part (Berlin, 1966; Hitchcock and Mooney, 1969). When applied to the consultation process in the original sense of a revived object relationship from the past, transferred to the therapist, who becomes the object of the patient's drives, it is misleading. On the one hand, in the practice of psychiatric school consultation, interpretations of such transferences, with their focus on individual past histories of consultees, rarely need be made, if ever (Babcock, 1949; Caplan, 1970; Coleman, 1947; Hitchcock, 1977; Maddux, 1950). On the other hand, as noted by Berlin (1966), management of transference along lines appropriate for the purposes of individual psychotherapy and psychoanalysis would promote unwelcome regression in the consultation process. The psychoanalytic concept of externalization, however, as a "subspecies of transference" (A. Freud, 1965, p. 43) does justice to the projective distortions that are regularly encounAssociate Attending Psychiatrist, McLean Hospital, Belmont, Mass.; Clinical Instructor in Psychiatry, Harvard Medical School. This paper is an expanded version of a contribution to the Skills in Consultation to Human Service Agencies Course, at the 130th meeting of the American Psychiatric Association, May 5, 1977, in Toronto.
Kathryn K ris
tered in the consultee's attitudes to the consultant and does not imply dynamics that call for technical management at odds with established experience in the practice of consultation. Further, the concept of externalization contributes a useful dimension to the formulation of the supportive functions of the consultant. The purpose of this paper is to apply the psychoanalytic concept of externalization to an understanding of the process of psychiatric consultation in schools. The paper will review the psychoanalytic concept of externalization. It will illustrate the use of externalization in several clinical examples and relate it to some published descriptions of school consultation. EXTERNALIZAnON
Anna Freud has distinguished externalization as a "subspecies" of transference from transference proper-the regressive displacement of an old object relationship onto the therapist. She writes: Not all the relations established or transferred by a child in analysis are object relations in the sense that the analyst becomes cathected with libido or aggression. Many are due to externalizations, i.e., to processes in which the person of the analyst is used to represent one or the other part of the patient's personality structure. So far as the analyst "seduces" the child by tolerating freedom of thought, fantasy, and action (the latter within limits), he becomes the representative of the patient's id, with all the positive and negative implications this has for the relationship. So far as he verbalizes and helps in the fight against anxiety, he becomes an auxiliary ego to whom the child clings for protection. Due to his being an adult, the analyst is seen and treated by the child also as an external superego. . . . The child thus re-stages his internal (intersystemic) conflicts as external battles with the analyst, a process which provides useful material. To interpret such externalizations in terms of object relationship within the transference would be a mistake, even though originally all conflicts within the structure have their source in earliest relationships [po 4lf.].
School Consultation
Externalization of one side of an inner conflict may also occur in instances where the conflict is principally intrasystemic, as between opposing drives or between two attitudes in conflict. Externalization provides a temporary solution to a variety of problems of indecision. Properly interpreted, it can lead to inner solutions. The term externalization, to be useful, must be reserved for readily clarifiable psychological events, not fully unconscious but closer to preconscious processes. Novick and Kelly (1970) distinguish it from the projection of an unconscious drive derivative onto an object. Externalization is of course related to, and in fact relies on, displacement, but is a more specific term in that it indicates the new location of internal content. Furthermore, externalization has some overlap with the concept of projective identification (for example, see Brodey, 1965; Giovacchini, 1967), but it is considerably broader in scope. On the other hand, as used here, the term externalization is not as broad as to refer "in general to the tendency to project into the external world one's instinctual wishes, conflicts, mood, and ways of thinking (cognitive styles)" (Moore and Fine, 1968, p. 45). Externalization, as I use it, occurs within the context of an object relationship and consists of the attribution of a part of the mental structures or their contents to the object. EXAMPLES OF EXTERNALIZATION IN SCHOOL CONSULTATION
The examples that follow are taken from the experience of the first four years of consultation in a large middle-class suburban school system. The McLean School Consultation Program 1 (M.S.C.P.) was hired by the School System's Director of Pupil Personnel. As a member of the M.S.C.P., I was assigned as the original and continuing consultant. The main tenets of the M.S.C.P. are: 1. Environment influences a child's emotional stability and development. I. I wish to thank Dr. Maurice Vanderpol, Director of the Program, for his support and wise counsel throughout the consultation.
Kathryn Kris
2. The consultant's influence on the child's school environment may provide an important measure of preventive psychiatry. 3. There is a consultative process and a progressive continuum in the uses made of the consultant, ranging from direct service to promotion of institutional change. 4. In-school consultation differs from office psychiatry in focusing on development rather than on pathology and in using consultation techniques rather than treatment techniques (Vanderpol, 1976; Vanderpol and Waxman, 1974). I was introduced to each of several schools within the system by the school's psychologist or social worker. The flexibility of approach, individual consultations around problems with children or with the institution, informal small group discussions with teachers, continuous seminars of eight to twelve sessions with psychologists and social workers and with high school counselors proved to be a particularly felicitous arrangement. The group process which developed in the continuous seminars heightened and led to verbalization of many of the silent prejudices or externalizations which accompanied involvement with each school or group. "Here comes the sex maniac." "Here comes the mind reader." These are two common initial greetings. Psychiatrists and psychoanalysts are likely to encounter them in many settings. Stereotyped and impersonal, they reflect a fearful anticipation, an anxiety engendered by the consultation. Characteristically they are experienced by the consultant as powerful and disruptive, impeding discussion and understanding. If one recognizes them as neither attributes of the consultant nor as expressions of deep regressive transference, they become manageable. They can best be seen as externalizations of one aspect of the consultee's personality; externalization of libidinal wishes in the first greeting, with the consultant as the seducer; externalization of superego aspects in the second greeting, with the consultant as critic. Do we always clarify these externalizations explicitly? Rarely. In fact, open verbalization of such externalizations does not occur in most instances of consultation with an indi-
School Consultation vidual. Usually it is sufficient for the consultee to meet us and to clarify the problem for consultation. It is my impression that the initial introductory phase in consultation, with collegial manner and explanations of purpose, offers a more or less silent confrontation with the consultee's prejudices or negative externalizations, as withholding mind reader, authoritarian critic, or irresponsible promoter of license (Berkowitz, 1975; Berlin, 1966; Bloch, 1972; Caplan, 1970; Hitchcock and Mooney, 1969). However, if the consultees are in a small group where irrational elements may be heightened, such externalizations are commonly verbalized. As a consultation progresses, one may be able to clarify the externalizations, thereby increasing the group's awareness of the specific conflict of which one side or the other, or both alternately, are externalized onto the consultant. A group of high school counselors was meeting with me for the second year, on a twice monthly basis. In the first meeting they established their agenda to be the sexual problems of the teen-ager. For their second meeting they requested a lecture by me. In the third meeting they became increasingly dissatisfied, unable to focus on any of their case material, misunderstanding one another and me. Jokingly they attributed the sexual behavior of their students to the students' sensing the psychiatrist was coming. At the same time they complained that I expected from them constant supervision, even 100 percent control of their students! Their group behavior oscillated between "can you top this" sexual exploits and silent withdrawal. The specific jokes and complaints might have been missed, but certainly no one could miss the feeling of discontent and frustration at that meeting. But the jokes and complaints about the consultant, recognized as externalizations, were helpful in showing the group their conflict over license and control. Clarification of the group's attribution to me of their own fears of inciting their students' sexuality and their demand of themselves for its total control helped them recognize their concerns. They could appreciate my suggestion that the students might be approaching sexuality in a similar manner. In subsequent sessions, perhaps in part because they felt sup-
Kathryn Kris
ported by the commonness of conflict, the group discussions included the still more delicate topics of their students' incestuous and suicidal fears, and finally recommendations to their principal for the management of a school tragedy. Such a sequence illustrates that when externalizations are clarified, understanding can be extended and problem solving can proceed. It should be noted that to recognize and clarify such externalizations of conflict between libidinal wishes and superego attitudes did not require my focusing on individual pathology or development. This is in keeping with the cautions of many authors in regard to consultation (Babcock, 1949; Berlin, 1966; Caplan, 1970; Coleman, 1947; and Maddux, 1950). Perhaps because it was a group of high school counselors one could clarify such externalizations within the group. With another group one might elect to clarify the externalizations in a displaced fashion, as recommended by Caplan (1970), Parker (1958), and Bindman (1959). A group of mature women professionals were complaining about the unresponsiveness of their male superior. They felt excluded by him and resented their own helplessness in regard to a piece of school policy. With them it was sufficient to question their attitudes and not necessary to spell out the externalization onto their superior of their own wish to exclude him from their intimate women's group or their wish to hold more power and be free of the uncertainties and anxieties produced by the need to negotiate. They decided to approach him, and they were surprised both by his immediate agreement to their administrative request and by his wish to attend their next meeting. No longer able to view themselves as helpless, they felt proud of their problem-solving ability. To have viewed this episode primarily in terms of a group transference, as a feeling of rejection by the father, as the castrated impotence of women, or the regressive homosexuality of oedipal failure would have been utterly without foundation in the data of the group consultation setting, and futile technically. As a consultant one often has the surprising experience of finding out that someone who seemed irredeemable is in fact
School Consultation
approachable. The consultant must be particularly alert to instances where such externalizations are focused on important administrators, fostering avoidance rather than contact and possible problem resolution. Where the personal contact is the least, the externalizations are likely to exert their greatest influence. In general we promote contact rather than avoidance, adhering to the precept that reality can be handled but irrational externalizations are self-fulfilling. Such externalizations are likely to occur at times of heightened anxiety, at the beginning or ending of a consultation, or with a new task, or when an opportunity arises for contact with a member from another group, for example, teachers with parents or consultees with their superior in the school system. Sometimes a state of helplessness and demoralization may be externalized onto the consultant. I have seen this when the consultation was coming to the end, both at the end of a school year, despite the possibility of continued contact in the future, and, in another school system, when the consultation services were being terminated because of a change in the chief administrator responsible for hiring. The danger here is that the consultant may feel helpless and demoralized rather than help the consultees to recognize their sense of helplessness and demoralization in the face of change. If the consultees can recognize their helplessness, they may begin to be able to master it. Berlin (1966), in particular, has delineated some of the consultant's difficulties in seeing a consultation to its end. Up to this point I have given examples of externalizations that interfere with the consultative or administrative relationship. I want to turn now to the way externalization enhances the relationship between consultant and consultee. As indicated by Anna Freud, the "auxiliary ego" functions depend upon externalization. The consultant in this sense becomes the representative of the consultee's ego. Several writers have referred explicitly or implicitly to externalization in the consultation process. Caplan (1970) speaks of the consultant functioning as a role model for the consul-
Kathryn Kris tee, as a superego and ego ideal (p. 92). Hitchcock and Mooney (1969, p. 355), in particular, have singled out the consultee's work difficulties leading to a temporary superego regression to a "preautonomous superego schema" with an externalization of superego functions onto the analyst as described by Sandler (1960). In what ways may the consultant be thought to function as an auxiliary ego? He may help the consultees verbalize their psychological observations or offer a conceptual framework for their observations, be it the psychology of character, principles of child development, or systems theory. In addition, he supports the consultees in the face of their anxiety. This may be done verbally, as when a consultant suggests an action or points to an aspect of avoidance on the consultee's part or indicates the basis for feelings of helplessness. Support may also be given by example, as when a consultant offers to present the first case to be discussed in a counselors' group where there is overt anxiety about being criticized in their first attempt at case discussions (Sarason et al., 1966; Parker, 1958). In another aspect of auxiliary ego functioning, the consultant offers himself to his consultees for identification with certain traits, in his problem solving and reality orientation, in withstanding tendencies toward helplessness, rebellion against authority, withdrawal from power, and intolerance of human limitation (Berlin, 1962, 1966). As consultants we also perform the function of valuing our consultee's work (Coleman, 1947; Sarason et al., 1966). This seems best conceptualized as supporting the function of the ego ideal, contrasted with the critical function of the superego (Lampl-de Groot, 1962). Often the consultee lacks not only a conceptual framework for what he does psychologically but also a recognition and esteem for his work. This may be the most immediately satisfying part of a consultant's job-to help the consultee recognize that he did something, that it made a difference, and that it may be conceptualized and thereby made applicable to other situations. This is not the same as fostering the consultee's dependence, compliance, or denial. It is support for his valuing of his psychological skills.
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CONCLUSION
Viewing the consultant as an object for externalization enables one to understand many of the principles of consultation. Several generalizations about our tasks as consultants, what we should and should not do, are widely agreed upon. First, it is vital to approach our consultees as colleagues who share a common interest but have a different training (Berlin, 1966; Caplan, 1970). The danger of trying to be an expert on teaching or one who knows all the answers is all too familiar for those psychiatric and psychoanalytic consultants who have experienced the power of consultees in various settings to prove one's ineffectiveness. Second, our job is to act only as consultants. We do not replace our consultees at their jobs even when tempted by them to do so or criticized by them for not doing so. Consultees readily try to turn over their clients to us, promoting their own helplessness and externalizing onto us unrealistic expectations of omniscience. This does not mean, however, that we would not interview a child; we simply would not take over primary responsibility for teaching him. Third, we attempt to clarify explicitly the task with which the consultees want help and to formulate explicitly with them how we and they are to achieve the solution to the task. If the task cannot be defined or implemented, this alerts us to a problem, very frequently the result of externalizations interfering with the consultative working alliance. Each of these three general rules of procedure for consultants can be seen to protect the consultant from inadvertently accepting an omnipotent ego and superego role, defined by the consultee's externalizations, thereby deviating from the ego attitude of collaboration. It would be an error to suppose, however, that all transference reactions encountered in the consultation process are externalizations. For example, the externalizations of feelings of helplessness at termination are often accompanied by transference reactions based upon reactivation of past object losses. Nor will it then suffice to respond only to the externalizations. It has been my purpose here, however, to demonstrate the
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wide applicability and usefulness of the concept of externalization in the functions of the psychiatric or psychoanalytic school consultant.
BIBLIOGRAPHY BABCOCK, C. (1949), Some Observations in Consultative Experience. Soc. Servo Rev., 23: 347-357. BERKOWITZ, M. I. (1975), A Primer on School Mental Health Consultation. Springfield, Ill.: Charles C Thomas. BERLIN, I. N. (1962), Mental Health Consultation in Schools as a Means of Communicating Mental Health Principles.]. Amer. A cad. Child Psychiat., 1:671-679. - - - (1966), Transference and Countertransference in Community Psychiatry. Arch. Gen. Psychiat., 15: 165-172. BINDMAN, A. (1959), Mental Health Consultation.]. Consult. Psychol., 23: 473-482. BLOCH, H. S. (1972), Experiences in Establishing School Consultation. Amer. ]. Psychiat., 129: 63-68. BRODEY, W. M. (1965), On the Dynamics of Narcissism: I. This Annual, 20: 165-193. CAPLAN, G. (1970), The Theory and Practice of Mental Health Consultation. New York: Basic Books. COLEMAN,]. (1947), Psychiatric Consultation in Casework Agencies. Amer.]. Orthopsychiat., 17: 533-539. FREUD, A. (1965), Normality and Pathology in Childhood. w., 6. GIOVACCHlNI, P. (1967), Frustration and Externalization. Psychoanal. Quart., 36: 571-583. HITCHCOCK,]. (1977), Interventions by the Psychoanalyst in the Consultant Role.]. Philadelphia Assn. Psychoanal., 4: 45-49. - - - & MOONEY, W. E. (1969), Mental Health Consultation. Arch. Gen. Psychiat., 21 : 353-358. LAMPL-DE GROOT, J. (1962), Ego Ideal and Superego. This Annual, 17: 94-106. MADDUX, J. F. (1950), Psychiatric Consultation in a Public Welfare Agency. Amer.]: Orthopsychiat., 20: 754-764. MOORE, B. E. & FINE, B. D. (1968), A Glossary of Psychoanalytic Terms and Concepts. New York: Amer. Psychoanaly. Assn. NOVICK, J. & KELLY, K. (1970), Projection and Externalization. This Annual, 25: 69-98. PARKER, B. (I 958), Psychiatric Consultation to N onpsychiatric Professional W OThers [Public Health Monograph, 53]. Washington, D.C.: U.S. Public Health Service.
School Consultation SANDLER, J. (1960), On the Concept of Superego. This Annual, 15 : 128-162. SARASON, S., LEVINE, M., GOLDENBERG, I. I., CHERLIN, D. L., & BENNETT, E. M. (1966), Psychology in Community Settings. New York: Wiley. VANDERPOL, M. (1976), Mental Health Consultation in Schools. In: The Changing Mental Health Scene, ed. R. G. Hirschowitz & B. Levy. New York: Spectrum Publications. - - & WAXMAN, H. (1974), Beyond Pathology. Psychiat. Opinion, 11 : 18-24.
