Project Realize (formerly the Analytic Service to Adolescents Program)

Can now be found at www.project-realize.org

ASAP Receives AwardASAP in the New York Times

“Changing Lives, Creating Opportunity”

Project Realize (PR) is an in-school treatment and research project at Morton Alternative High School in Cicero, IL. Students have come to Morton Alternative High School after expulsion from the area high schools for violent and gang related behaviors. PR provides in-school psychoanalytic individual and group psychotherapy to students, and ongoing consultation with teachers, staff and parents.

Now in its 12 year, PR has treated over 100 students individually in psychotherapy, and approximately 300 students in group psychotherapy. In addition, each year parents participate in evening dinner programs that include a presentation and discussion of the challenges of parenting adolescents.

For more information about Project Realize, please contact Mark Smaller (marksmaller@gmail.com).

Project Realize Staff

Mark D. Smaller, Ph.D., Founding Director; Psychoanalyst
Dave Myles, M.A., Associate Director; Clinical Social Worker, Therapist
Sue Gass, M.A., Clinical Social Worker, Therapist
Matt Landa, M.A., Clinical Social Worker, Parent Coordinator
Nancy Marks, M.A.; Clinical Social Worker (Volunteer)

Supporters: The Arthur Foundation; The American Psychoanalytic Foundation; The Bari Lipp Foundation; individual donors

ASAP is funded through the generosity of foundation grant support and individual donors. To make a contribution, please contact Marty Laub, Ph.D., Executive Director, Chicago Institute for Psychoanalysis; or Mark Smaller, Ph.D. (marksmaller@gmail.com).

Publications

Smaller, M. (2007). “Psychoanalysis in the Streets: The Analytic Service to Adolescents Project.” The American Psychoanalyst, Volume 40, #4.

Upcoming and Recent Presentations

Smaller, M. (2009) “Self Psychology and the ‘Forward Edge’ Hits the Streets: The Analytic Service to Adolescents Program.” 32nd Annual International Conference on the Psychology of the Self; Chicago, October, 2009.

Smaller, M. (2008) “Keeping the Self Alive: Psychoanalytic Perspective on Self Destructive Behavior in Adolescents: Strategies for Teachers, Staff and Therapists.” Lorman Educational Services, Schamburg, IL.

DETAILED DESCRIPTION OF PROJECT (download in word)

Analytic Service to Adolescents Program (ASAP)
Chicago Institute for Psychoanalysis

Mailing Address: 122 South Michigan Avenue, Suite 1300, Chicago, IL 60603
Telephone: 312.922.7474
Fax: 312.922.5656
Website: www.chicagoanalysis.org
Founding Director: Mark D. Smaller, Ph.D.
Telephone: 312.447.0605
Fax: 312.922.5656
Email: marksmaller@gmail.com

PROJECT DESCRIPTION

The Analytic Services to Adolescents Project (ASAP) is a joint project of Morton Alternative High School in Cicero, Illinois, and the Chicago Institute for Psychoanalysis in downtown Chicago, Illinois. The central goal of the project, just finishing its 5th year of operation, is to foster the healthy psychological, social, and educational development of the high-risk student participants, with a specific focus of helping them to achieve graduation from high school. Also important is the goal to develop psychoanalytic methods can be replicated at other public and private high schools in the Chicago metropolitan area, or in other communities.

Morton Alternative High School, located in Cicero, Illinois, begins each academic year with approximately 40-50 high-risk students and provides a traditional high school curriculum as well as group therapy. The students attending Morton have been expelled from their public high schools because of severe behavioral problems, are burdened with multiple internal and external problems and have, by definition, not been effectively reached by any other interventions. These students know Morton is their “last stop” and that if they cannot “make it” at Morton, there is nowhere else for them to go.

To attain its goal of helping these adolescents progress psychologically, socially and academically, through a psychoanalytic perspective, the ASAP has five primary objectives. These are:

1) to provide 8 to 10 high-risk students at Morton Alternative High School with the opportunity to meet with two clinical social workers in individual psychoanalytic therapy sessions once each week.

2) to provide an additional 4 high-risk students with individual treatment sessions with a second year graduate student in social work (Loyola University) currently doing field work under the weekly supervision of program staff.

3) to provide support as needed to the families of students receiving individual sessions, through in-person or telephone contact with the program’s two clinical social workers.

4) to provide consultation to staff already seeing all students in once weekly group therapy as part of the curriculum.

5) to provide weekly consultation to Morton’s 6 teachers, 6 staff members and security personnel, so that they may better manage the stress and emotional demands of working with an intensely challenging adolescent population, and in this way enhance their ability to interact therapeutically with the students.

Through this comprehensive approach, the ASAP program strives to effect a community intervention which will reach beyond the individual students to provide powerful benefits for their teachers, their school community, their families and the larger community as a whole.

GEOGRAPHIC AREA

The Chicago Institute for Psychoanalysis, located in downtown Chicago, attracts students and patients from the city and surrounding suburbs.

The Analytic Service to Adolescents Program serves high-risk students, their families, teachers and school staff at Morton Alternative High School in Cicero, Illinois. Students at Morton Alternative are primarily Latino, but include some African American and Caucasin students and their families.

PURPOSE OF PROJECT

The Analytic Service to Adolescents Program (ASAP) is dedicated to providing effective psychoanalytic interventions that foster positive psychological, social and educational growth in a high risk adolescent population for whom other interventions have failed.

A unique feature of this project is that the treatment takes place at the school and act as a natural component of the school day. For the 8-10 students participating in individual ASAP sessions, these begin as a natural extension of the group therapy they are already receiving from Morton staff; each therapeutic element augments and supports the other.

Offering services at the school is critical to the program’s success. In the past, these very troubled students and their families were often referred to local mental health centers, but rarely followed through. Waiting lists at the clinics were a significant deterrent, and even if initial contact was made, students and parents rarely continued past a few sessions.

The major finding of ASAP has been that the majority of students have the capacity to progress emotionally, socially, behaviorally and academically when they are provided consistent, reliable, and predictable opportunities to talk about the difficulties confronting them at home and at school. Once engaged in an ongoing group process with an empathic adult who is sensitive to their needs both for psychological understanding and for appropriate limits, their aspirations and ambitions emerge, sometimes to their surprise.

When this therapeutic experience is expanded and enriched through engagement in the individual sessions provided through ASAP, the majority of these students make very productive use of that opportunity and begin to progress on several fronts. Goals and plans to achieve them are formulated, initial steps are taken and positive feedback received, setting the stage for further exploration and growth.

The benefits of these treatments are enhanced by the support offered to the parents and families of ASAP students receiving individual treatment. The consultation and support provided to the teachers, staff and security personnel at Morton are also invaluable in creating a therapeutic school environment. In addition, parents are invited for parent evenings, offering dinner, a brief presentation by ASAP staff, followed by discussion among parents of common difficulties raising adolescents. Strategies are developed to address those challenges. Attendance at these dinners has continued to climb since offered three years ago.

Through this comprehensive, collaborative approach, positive interventions are made that extend beyond individual students and their families to encompass the entire school community, and the larger community as a whole.

PROBLEMS AND ISSUES

The challenges facing the adolescents who end up at Morton Alternative High School can only be described as debilitating, and in many cases, life-threatening. Most of these students are Latino and come from impoverished communities marked by low levels of academic achievement, gang activity and crime. The family histories of Morton students are replete with dysfunction, trauma, violence, substance abuse and contact with the police. It is not surprising that these problems are mirrored in the adolescents’ own behaviors and that they are unable to envision a future different from their present reality. The severe recession, loss of jobs, and uncertainty about the future have, without question, exacerbated these problems and contributed to higher levels of anxiety and depression among the students at ASAP in the two years.

Something of what these children have to contend with is captured in what they report in group and individual sessions. A boy has a fist fight with his father and leaves home to stay with friends. Another suffers post-traumatic stress disorder both from witnessing violent attacks upon his mother by his father, and from his own participation in dangerous gang activities. The father of a 13 year old girl occupies an important position in a Chicago street gang and has been repeatedly jailed. Suffering intense anxiety and anger, she has experienced abuse, homelessness, neglect and has witnessed domestic violence and parental drug abuse. Another adolescent girl witnesses the murder of her dearest friend, only the latest blow in a life filled with loss, sexual assaults, and a volatile family life.

These adolescents suffer levels of chronic anxiety and depression, unmodulated anger and rage, impulsivity, hopelessness and low self-esteem that have derailed normal development, distorted their social relationships and eroded their ability to concentrate and learn. The behaviors to which these problems give rise elicit rejection from others and confirmation of their own negative self-perceptions. That so many of them do allow themselves to be engaged in the therapeutic process offered by ASAP is a testament both to the effectiveness of program methods and to the capacity for resilience of these students.

THEORETICAL AND CLININCAL PERPSECTIVES

ASAP has developed and utilized a “forward edge” (Smaller, 2011) approach to working with students. The approach grew out of both psychoanalytic, self psychological perspective (as created by the late Heinz Kohut, an internationally known psychoanalyst who developed his ideas at the Chicago Institute for Psychoanalysis, and clinical work with students.

Students, both in individual and group psychotherapy have made it clear that although they need an opportunity to share and discuss current and past trauma, they also are desperate for an opportunity to focus on normal adolescent desires, ambitions and goals. Therapeutic technique is organized around what responses (observations, interpretation, a concrete and practical assistance) will facilitate forward moving developmental strivings, rather than focusing on regressive behavior.

Such an approach has been very workable in this setting, and is also utilized in both consultation to teachers and parents. This perspective is also a dynamic one that continues to evolve in this particular school setting.

PROJECT PERSONNEL

Mark Smaller, Ph.D. – Director
David Myles, L.C.S.W. – Clinical Social Worker
Suzanne Gass, L.C.S.W. – Clinical Social Worker

RECENT PROJECT ACCOMPLISHMENTS

Overview of Activities
The fifth year of the Analytic Services to Adolescents Program (ASAP) at Morton Alternative High School began in August of 2010. As is always necessary, the first weeks were spent identifying the high-risk students who would be selected for weekly individual treatment with the project’s two clinical social workers. The ASAP staff consulted with school personnel in reviewing the 50 students in attendance at Morton, focusing specifically on the student’s degree of dysfunction, level of motivation, and general and psychological functioning as inferred from behavior in the classroom and in group sessions at Morton. As it is important to include both male and female students, gender also was a consideration.

Ten students (6 male, 4 female) were recruited to the project over the course of the school year and received various lengths of individual treatment. As expected, some students left the program before the end of the academic year and others were added. At any one time, 6 to 8 students were participating.

We are particularly pleased to report that the program was contacted by a graduate student in social work at Loyola University who had heard a presentation about the program at a professional conference and sought a fieldwork placement with the program. In response to her request, the program was reviewed by Loyola University and established as a fieldwork site for their graduate program in social work.

This second year graduate student began her placement in the fall of 2010 and was on site for 20+ hours per week. Her activities included individual work with 4 students in once weekly sessions, group work as a co-leader with program personnel, and consultation with teachers. In addition, she runs an afternoon basketball program (she is a former NCAA Division 1 basketball player) for a group of students (varying between 8-12).

Less heartening was the fact that the recession and the stock market losses in 2008/2009 continue to have a profound impact on the level at which foundations and other donors can support institutions and programs that carry forward their mission. Because of reductions in support for the ASAP program, it was necessary to eliminate the position of the family coordinator. Consequently, the program’s two clinicians became the source of contact for the parents of the students in the program. The good news was that this actually became a positive development. Previously, parents were extremely reluctant to allow the family coordinator into their homes, or to speak with him over the telephone. The open-ended availability of the social worker who was meeting individually with their child seemed to provide the parents with the reassurance and support they required to become more engaged.

Replication
The program has been replicated (Spring, 2010) and is in use at Saugatuk High School in southwestern Michigan. Great Expectations at Saugatuk High School had its first group last summer that has continued through the present. Psychoanalytic group and individual treatment has been the primary method in this program as well.

Public Relation Efforts
In an effort to increase awareness about the program and its methodology, the work of the program was presented at the 32nd International Psychology of the Self Conference in Chicago in October, 2009, resulting in a published article (see listing of related publications below).
Also, at a symposium at the 2010 winter meeting of the American Psychoanalytic Association in New York clinical material was presented as it related to treating aggression and bullying.

At 100th Annual Meeting of the APsaA in San Francisco, presentations included topics of bullying at a symposium, and the impact of immigration reinforcement on families and children was presented at a Presidential Symposium, and a discussion of the Luis Bunuel 1950 film, “Los Olvidados (The Forgotten) which described gangs and violence in Mexico City.

This past June, 2011, the program and clinical material was presented by Dr. Smaller in Pittsburgh at a conference titled, “Reducing Youth Violence.”

And finally, in January of 2010 ASAP was featured in an article in the Chicago edition of the New York Times, and the New York Times Online (http://www.nytimes.com/2010/01/24/education/24cncmorton.html).

Publications

Two articles have been accepted and are awaiting publication, and one article was published this year:

Smaller, M.(2011), Psychoanalysis and the ‘forward edge,’ hit the streets.” Psychoanalytic Inquiry (in press)

Smaller, M. (2011), The plague of bullying.” Psychoanalytic Inquiry (in press)

Smaller, M. (2010), In the streets and out in the world: being a psychoanalyst in 2010. J. of Psychoanalytc Self Psychology

CLINICAL ANECDOTES

The following narratives describe examples of the impact the ASAP program has had on the students who become deeply engaged. Though statistical evaluation is utilized, the program’s best evidence of therapeutic effectiveness is often found in the observations of the teachers, families, peers, and therapists, and in the self-observations and reports of the students themselves.

K
K, an 18 year old Caucasian, had been with the Morton Alternative program for over two years. Her initial placement at Morton was a consequence of fighting with her peers. She was living with her mother, brother and maternal aunt in a household of volatile relationships. As a latency age child and early adolescent she suffered a great deal of physical and verbal abuse from her mother. She has described being pulled around her house by her hair (at 12 years old) to such an extent that her scalp became too painful for her to brush her hair. Her physical appearance was affected and she reports being teased by her peers because of the way she looked. With little or no support from extended family or from her father, she developed various symptoms of low self-esteem, anxiety and depression. Her most accessible emotion was intense anger, which she released in frequent fighting with her peers. She says of this period in her life, “I would fight anyone. I didn’t care, that’s all I knew how to do.”

When first in the program at Morton, she was self-conscious, anxious and depressed. Once involved in the ASAP program, she began to develop an understanding of thoughts, feelings and behavior resulting in improved relationships with her peers and more adaptive responses when conflicts arose. She spontaneously, and frequently, described how the school and the ASAP program had helped her. In one example, she said, “I know myself much better…I don’t get as anxious anymore.”
K graduated from Morton after completing summer school and plans to attend community college and work part-time. She envisions a future for herself that holds promise.

J
J was a 16 year old Hispanic adolescent who lived with her parents and her brother. She was placed at Morton in as a result of fighting with her peers and gang involvement.

J became involved in the ASAP program when she entered Morton, in part because she described herself as a “sex addict.” In addition to this struggle to develop appropriate relationships with boys, she was pulling out her hair and reported feeling extremely depressed. Her family life was difficult, with her mother suffering from heart disease and her father from alcoholism. She described not feeling loved by her father and desperately longing for his love and attention. She felt responsible for her mother’s health problems and was extremely anxious that she could cause her mother harm.

J made use of the therapeutic opportunity provided by ASAP to develop an understanding of her feelings, of the reasons for her self-destructive behavior, and of the relationships with family members. Actively engaged in the therapeutic process, J reports that her anxiety has decreased and her family relationships improved. She continues to use the therapeutic relationship to develop better regulation of her mood and to improve her behavior.
J will graduate next January.

A
A, a 16 year old Hispanic teen, came into Morton as consequence of fighting at her previous school. She became a participant in the ASAP program in early April of 2010 and was very slow to engage in the treatment relationship. She struggled to develop positive relationships with Morton staff and her peers.

Describing her family relationships as full of turmoil, she stated that she was chronically belittled by her parents and siblings. She has no subjective experience of feeling loved or of being a part of her family, and in fact, when her mother was hospitalized, was blamed by her family for her mother’s hospitalization.

As more details of an extremely traumatic childhood emerged, including sexual and physical abuse, A has become more engaged and productive in school. With a significant connection with her therapist, A’s self esteem has dramatically improved, and she reports real connections with friends at school.
A will graduate in June of 2012.

E
E was 15 years old when he arrived at Morton, was living with his mother and sister. He had been placed in a school for juvenile defenders where many of his difficulties worsened. He shared with the social worker that his father had abandoned the family when he was a toddler, stating, “I never knew my father, I still don’t, even though I see him once in a while. He lives in Chicago.” E’s father has a history of gang involvement, drug abuse and physical attacks on E’s mother.

Not wanting her son to “turn out like his father,” E’s mother was over-protective and inflexible in her parenting of E. Although her desire to protect her son was understandable, by limiting E’s opportunities to establish some independence, she inadvertently was encouraging him to regress.

In the school setting, E initially was unable to “filter” his remarks to his peers, teachers or the staff. In his own estimation, E feels he is being “honest,” but his remarks are perceived by others as provocative and immature, and hindered his attempts to be liked and accepted by his peers.

Through his individual therapy, E has become better able to listen to feedback from others, and is developing a greater capacity to modulate his own emotions. In a parallel development, he became less emotionally reactive to what he perceives as put-downs, or as kindly meant, mild teasing from others.

Beginning to explore relationships with girls, he reported this year his first “real girlfriend.” Of that relationship, he remarked, “We talk alot, and I’m getting pretty good at listening to her.” The positive identification with his therapist and of E’s emotional and psychological development has emerged.
E is proudly working for the park district this summer while attending summer school in the morning, and will graduate in June 2012.

M
A student at Morton and a part of the ASAP program for nearly 3 years, M’s progress represented the kind of success we wish every child at Morton could experience. M was on the fringes of a gang, smoked a considerable amount of marijuana every day, and had such a conflict filled relationship with his father that physical fights sometimes erupted, with punches exchanged. His older brother is a high school dropout and drug dealer, his parents have a strained relationship, but smoke marijuana together in the home. M himself was on the radar of the local police, who frequently stopped him on the streets or in cars. As a protective adaptation to his environment, M reported his belief that, “On the streets, the best defense was a tough offense – strike first and never apologize.”

Underneath his tough guy bravado, his therapists, teachers and staff recognized the “charming little boy” who wanted to be cared for and admired. A vulnerable side of himself that he rarely revealed began to emerge in group and individual work. Through his productive use of individual and group treatment, M began to envision having a materially successful life gained without the risks of going to prison or being shot by rival gang members. From envisioning a positive future for himself, M worked toward graduating from high school, possibly going to college, and even business school! He proudly obtained a job at a major brand paint store, decreased his marijuana use substantially, began getting straight A’s, became a student leader. In his final group session, M reported in his final group session “No one ever thought I’d become anything good, no one ever thought I’d graduate from high school – well, I proved them wrong!”
M graduated during the summer of 2010. He is missed.

QUANTITATIVE FINDINGS (SEE ATTACHED)

CONCLUSION

The primary mission of the Analytic Service to Adolescents Program is to help students better understand the relationship between their personal history, often replete with trauma, and their underlying emotions in order to help them develop great capacity for self observation and self regulation resulting more adaptive social, personal and academic skills. In providing comprehensive therapeutic services to adolescents in a “last stop” educational setting, the program seeks to reduce the risks of poor academic performance, substance abuse, and incarceration; lessen vulnerability to affective disorders, particularly anxiety and depression; and to ameliorate the intense distress associated with violence and trauma.

Overall, the project seeks to improve the psychological functioning, educational performance, likelihood of graduation and social behavior of these adolescents. The qualitative and, to a somewhat lesser degree, the quantitative data sets collected over the last five years of the project indicate that the program’s services are having a life-altering, and at times, life-saving, impact on students at Morton Alternative High School.


Leave a Reply

Your email address will not be published. Required fields are marked *