Circles of Change: Volume I An Adventure in Self Transformation and Therapeutic Community at Atascadero State Hospital by Joseph Abrahams, M.D.

From the preface by the author:

Circles of Change represents the culmination of Dr. Abrahams’ seven decade career as a psychoanalyst. In this two volume book he comes full circle from his roots as one of the creative leaders of American institutional psychiatry starting at Fort Knox Military Prison and St. Elizabeth’s Hospital in Washington D.C. to return from a  long sojourn in private practice in Southern California to Atascadero State Hospital from 1990 through 1996, which is the subject of this study.

During his unique and varied career, Dr. Abrahams’ studied with, was in analysis and interacted with luminaries of American psychoanalysis such as Frieda Fromm Reichmann, Harry Stack Sullivan, James Rosen, Edith Weigert and Karl Menninger. He truly deserves a place, as this book demonstrates, as one of their peers. He has made singular contributions to psychoanalytic theory and practice, particularly with respect to the treatment of those patients who have been considered least accessible to traditional psychoanalytic therapy. Long before the seminal works of Kernberg and Kohut, which are referenced  in the annotated bibliography, he developed successful models and techniques for treating patients with narcissistic and psychopathic personalities as well as psychosis and mood disorders.

Group therapy is a sine qua non for treatment of many of these individuals in which a Therapeutic Community develops, obviating the resistances, complications with dream analysis and thought disorganization which interfere with developing a stable working transference relationship in individual therapy. The psychiatrist becomes a facilitator, who relinquishes the more authoritarian role assumed by the analyst in traditional psychoanalysis. As individuals progress, they become amenable to individual work with analysis of the transference as the final project. Dr. Abraham’s group work has been successful with very large groups, families, mother and daughters, professional identity groups, the severely regressed and psychopathic inpatients. This also includes his patients on two different wards and programs at Atascadero State Hospital. In both his group and individual therapy he has co-led with and trained various other therapeutic disciplines including pastoral counselors, which is consistent with diffusing and mitigating transference issues as well as getting at core ‘spiritual issues’ as patients transact at the level of their souls.