Review of Psychoanalysis at the Margins – Paul Stepansky


Stepansky, P.E. (2009) Psychoanalysis at the Margins.  Other Press, New York.

Psychoanalysis at the Margins is a ‘kid in the candy store’ experience for a historian of the psychoanalytic journey in America. Stepansky’s book is simultaneously a thoroughly sound – and enjoyable – analysis of the crisis, or ‘near crisis’ facing psychoanalysis and a penetrating examination of psychoanalytic publishing, training, and fractionation of the profession.  Had this reviewer read the last chapter first, the concern for the future of psychoanalysis might have been colored slightly more positively during the reading of this very detailed accounting. However, the reader will benefit greatly from the lead-up to the author’s last chapter because it provides the context to understand and to frame the recommendations. The forceful call to action for psychoanalysts of all schools, of all persuasions, of all national and local organizations is strenuously made in that final chapter. Stepansky elucidates the “unique opportunities” that are available for psychoanalysts to take hold of in saving the profession – and he does so in the manner of bringing the mainstream (of mental health care) toward psychoanalysis.  The ‘common ground’ so often looked for, written about, and discussed in conferences on psychoanalysis, is likely never to occur.  Rather, there are some basic understandings within psychoanalytic work that can be put to use in developing new – and different – relationships.  Small forays into these professional relationships have been made before. Freud advocated ‘free clinics’ that would offer psychoanalytic treatment in several cities in the time between the two wars.  August Aichhorn began homes for delinquent youth and used psychoanalytic techniques – quite successfully – in treating these troubled youngsters.  Anna Freud and her colleagues set up the War Nurseries during the London bombings (WWII), paving the way for the Hampstead Child Therapy Clinic (and the training program).  Since that time, what may be considered ‘applied psychoanalysis’ has been attempted, even advocated for, by numerous psychoanalysts to address the social and community problems faced in our country.  These efforts have been small, to be sure, especially as one compares these efforts to those that have occurred and succeeded in Europe.  There are documented efforts of bringing psychoanalytic knowledge to the school and educational setting, to family practice and internal medicine, corporations needing organizational understanding, parenting programs, racial, as well as terrorism concerns.  This reviewer is aware of small endeavors by psychoanalytically trained clinicians to bring clinical knowledge to police work with youth, ill children in the hospital setting, the reservations of American Indians and the therapeutic undertakings at crisis shelters for domestic abuse.  All of these attempts to form bridges to the community are enlightened ways of ensuring that the profession of psychoanalysis can indeed survive and perhaps re-find or establish its place in the mental health or health provision community.

The incommensurability of theory amongst the different ‘sub-communities’ of psychoanalysis have continued to fractionate the profession in America.  Stepansky suggests that we have a ‘plurality of theories,’ not ‘theoretical pluralism’ – the latter often being the way that our communities of psychoanalytic clinicians and the theories that these clinicians use in their work are characterized.  Indeed, Stepansky offers a fascinating account of this phenomenon by comparing the research cardiologist and the psychoanalyst in their respective attempt to reconcile or prove the accuracy of their theory and the underpinning of that theory.  In contrast to the road taken by the cardiologist and his “listening to the heart,” and reformulating the theory to meet the actual clinical reality, the psychoanalyst listens to the productions of a patient or client and listens through a ‘theoretical filter,’ translating the production – the sounds – into a “meaningful narratively embedded utterance.”  (p.162)  This filter includes both the analyst’s theoretical sensibility, as well as the analyst’s subjective hearing of the material or production.  That is, “…analytic listening is not merely theory-laden, it is theory embedded.”  The psychoanalyst’s values and commitment to a particular theory is integral to the actual act of listening.

Freud’s 1912 remarks on ‘evenly-suspended attention’ touches on this theme of listening, though perhaps connecting it to the review here may be an unfair extension.  Freud is discussing how the analyst begins to select from the material before him and how one’s expectations or inclinations may be followed.  Freud states that “…if he follows his expectations he is in danger of never finding anything but what he already knows…”  Like Freud, Keats’ remarks on negative capability may also be appropriate – for this capability speaks to one’s ‘being in uncertainty’ – living with the mysteries and the doubts, without ‘any irritable reaching after fact and reason.’  This is one of the traits that the psychoanalyst brings to the therapeutic endeavor – and there are ways to bring forth this quality, and to expand the application of this quality to the needs of our mental health community and of our society at large. By doing so, the profession of psychoanalysis may continue to exist.

Freud, S. (1912) Recommendations to Physicians Practicing Psycho-Analysis.  In The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: The Hogarth Press.

Rudy Oldeschulte trained in psychoanalysis at the Anna Freud Centre, London, and in law at DePaul University in Chicago. Currently in private practice in the San Antonio area.

The review is published at:



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4 responses to “Review of Psychoanalysis at the Margins – Paul Stepansky

  1. Eli

    Thanks for the review. I just ordered the book.

  2. we probably all have a tendency to confirm what we already know, therefore its so important to think about how we phrase what we ask about. Thank you for sharing:)

  3. I think it is also very important – given our tendency to confirm what we already know and like – to question the received wisdom, the theories…I think back to my ‘revised’ understandings of some of my early case work….moving on from instinctual drive theory and oedipal conflict to what may have actually occurred in the therapeutic relationship….

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