Technique with Children, Psychoanalytic
TECHNIQUE WITH CHILDREN, PSYCHOANALYTIC
The psychoanalysis of children represents an area of research and practice whose definition and progressive formation, through the twentieth century, were not established without clashes, conflict, and polemics. There have been successive waves of interest, with competing views, sometimes resulting in fixed oppositional positions, depending on the period.
The psychoanalysis of children is perceived by some as heretical, difficult to practice, even fundamentally utopian or impossible; by others, it is seen as an informative and reflexive paradigm, capable of enriching the theory and the technique of adult psychoanalysis. On one hand, it has been presented as intrinsically impure, on the other, much more rarely, it has seemed to be a kind of unrealizable ideal, fecund but somewhat vague.
These debates relate of course to the status accorded the mind of the child viewed on its own terms, and not only insofar as it is evolving into the mind of an adult, but also involve inevitable modifications in technique, since it is obvious that the framework defined by Sigmund Freud for the adult (with the couch, the basic rule of free association, absolute priority accorded to language and so forth) cannot be applied as such to children, especially to very young ones.
In this connection, two remarks should be made: first of all, one must be very careful to distinguish the psychoanalysis of the child from various applications of psychoanalysis to the domain of childhood (psychoanalytically inspired psychotherapies, combined parent-child therapies, analytic observation of newborns, so-called psychoanalytic family therapies, psychodrama, group therapies—with analytical overtones—or even the application of psychoanalytic concepts in education, pedagogy, and social fields). Of concern here will be only the psychoanalysis of the child, in its strictest sense, and not any of its looser applications.
Furthermore, any science—and psychoanalysis has a legitimate claim to this status, scientific pretensions, even if that is not its only possible definition—defines itself at once by the presence of a framework, and also by its epistemological field. For psychoanalysis, there is a strict framework, and not only the formal appearance of one. In other words, as important as it is, merely having a framework is not enough to entitle something to be named a science; and the definition of psychoanalysis cannot be reduced to this feature. The essence of psychoanalysis is centered, at the minimum, on the dynamics of transference and counter-transference, on the concept of resistance and the function of interpretation, and it is reasonable to judge that there is no effective analysis possible, without real work on these different planes.
All the same it is quite possible to imagine that this work can be conducted in different settings and, notably, in settings adapted to the various ages of the children. The whole purpose of the psychoanalysis of children is to succeed in developing these different aspects; for so long as these are not addressed fully, the risk of conflict and misunderstanding between those who treat adults and those who treat children will remain, a risk that René Diatkine evidently was trying to parry when he said: "I am not a psychoanalyst of children, I am a psychoanalyst who treats children."
Regarded historically, the evolution of ideas concerning the technique of analysis of children has been marked by a some significant turning-points, linked to the work of the pioneers in this domain. Concurrently with the recommendations of Freud, who, from 1905, advised psychoanalysts to observe the psychosexual development of their own children, in an attempt to verify the reconstructed findings of the first adult treatments (Freud following his own advice, Karl Abraham observing his daughter Hilda, and Melanie Klein her youngest son), Herminie von Hug-Hellmuth was doubtless the first to undertake an authentic analysis of a child, in Berlin, during the First World War, recognizing the existence of transference and already utilizing, although in an unsystematic manner, games and drawings. Next was Eugenia Sokolnicka, in Warsaw, in 1919. In 1921, Klein settled in Berlin to practice the psychoanalysis of children, and Didier Houzel and Gilles Catoire remarked that "what can be considered as the prehistory of the psychoanalysis of children ended at the beginning of the 1920's" (1986).
Subsequently, one of the great debates in the history of psychoanalysis occurred between Anna Freud and Klein, precisely on technical aspects that were due to a basic theoretical-clinical divergence. Donald W. Winnicott eventually assumed an intermediary position in this debate, fairly close to the positions of Klein, especially on the question of the place of games in technique, but reproaching her, nevertheless, for what he saw as her insufficient attention, to the child's environment and particularly to the role of the real mother.
In France, a number of names should be mentioned, dividing, during the second half of the twentieth century, along the line of scission between Lacanian psychoanalysts and the non-Lacanian: Serge Lebovici, René Diatkine, Michel Soulé, among the latter; Françoise Dolto, Jenny Aubry, Rosine and Robert Lefort, among the former. These differences concerned theoretical references that were also reflected on the level of technique (the importance accorded to the child's wishes, and to the place of language, in particular). In the early twenty-first century the influence of the post-Kleinian movement is dominant in many countries in the conception and technical choices of child psychoanalysis (importance of counter-transference, exploration of archaic or primal levels of mental functioning, work on psychic boundaries, and so forth).
In 1926, in four lectures she gave at the Psychoanalytic Institute of Vienna, Anna Freud described an intermediary technique between the analytical and educational approaches. The limits she placed on the analysis of children were calculated on the basis of the following arguments: no transference neurosis is possible with the child (too great dependence on real parents); modification of the framework is required, having nothing in common with the free association technique of adults (absence of symbolic associations with games and drawings); there is need for a so-called preparatory phase during which the analyst "induces" the child by way of a certain charm to become involved in the treatment, by establishing a positive transference with the child, an educative role that is necessary if the analyst is to avoid the consequence of the lifting of repression and liberation of the drives.
In 1927, at a colloquium of the British Society, Klein refuted the propositions of Anna Freud, point by point. For her, analysis was incompatible with any educative attitude; the preparatory phase was in no way justified, because it was the interpretation of the anxieties in the transference which allowed the child to enter into the analytical process, the child being quite capable of developing an authentic transference neurosis.
Progressively, Anna Freud drew closer to the Kleinian positions, but for a long time there remained serious differences between the two schools as a legacy of this early opposition. It wasn't until 1990 that the first joint colloquium took place, between the Anna-Freudian Hampstead Clinic and the Kleinian Tavistock Clinic (this colloquium was to have been presided over by John Bowlby, who, in fact, died a few months before the event). These two institutions have remained, through 2005, very important centers for reflection on the subject of child psychoanalysis, certain names deserving mention, among many others: Anne-Marie and Joseph Sandler, Peter Fonagy, Hansi Kennedy, George Morane, of the Hampstead Clinic; Hanna Segal, Esther Bick, Martha Harris, Donald Meltzer, and Juliet Hopkins, of the Tavistock Clinic.
Given that there is no such thing as a purely technical problem, but that technical problems always refer to underlying theoretical-clinical issues (hence, the historical survey, above), it can be said that the question of psychoanalytic technique with children is based on four main elements: the place of parents in the process, the framework, the transference-counter-transference dynamic, and the function of interpretation.
Working with parents should be distinguished from the treatment, properly speaking, but it conditions it, in great part. Depending on the age of the child and the technique of each practitioner, positions vary as to the analyst's role in the family. In most cases, the work is effectuated by a consultant, not by the child's analyst, so that the child's "mental space" is better respected, but some technical variations are possible in this respect.
As far as the framework is concerned, a point in common with adult analysis concerns the number of sessions per week, which should be enough for a veritable analytical process to be begun (all the more so with psychotic, as opposed to neurotic children). Three visits a week seems to be the generally accepted frequency, alas not very often realized in practice. The question of payment has been also the source of much reflection, the notion of "symbolic payment" having been particularly developed by Françoise Dolto, in France, and by other authors influenced by her.
In addition, the place of the body and of preverbal communication, have attracted much attention, and have caused some changes in the way children are treated, compared to adults. In the early twenty-first century, means such as games, drawings, or modeling clay are in very wide use, and usually considered as analogous to the adult's words, and as a basis for the practice of free association.
The counter-transference and corporal involvement of the child analyst is often more intense than that of the analyst of adults, which is why, unfortunately, analysts rarely continue until an advanced age to treat children, as Donald W. Winnicott was able to do. The difficulty of the task should not, however, be reduced to rationalizations as to its basic impossibility. The child, just like the adult, is living in "deferred action" from the very beginning, even if current developments in psychoanalysis of the very young might cause some modifications in the Freudian theory of deferred action; for example, by diffraction over a number of generations.
The major difficulty connected to the framework of analysis of children has to do with the role of the analyst himself, who has to find a balance between the freedom children are given to express themselves and the limits one must at the same time impose on them to avoid colliding with infantile omnipotence.
As to transference, particular attention deserves to be paid to the therapeutic alliance, already mentioned, which lies at the very heart of the controversy between Anna Freud and Klein. This is a particularly difficult notion when it comes to children: some authors see it as a precondition for the later development of the transference dynamic; others as a preliminary but conscious and ego-like version of the transference, properly speaking. It is clear, in any case, that with the child, in most cases, the therapeutic alliance depends in large measure on what kind of bond has or has not been established with the parents.
Interpretations can be metonymical, metaphorical, historical, or flatly transferential, as with adults, but should have, over time, a containing effect, which gives them their therapeutic value, and this because the children treated are, mostly, those whose capacity for containing is defective, and whose psychic boundaries are still in the process of being formed. The kernel of this problem is knowing how to create for such children, while their internal framework is still in formation, an external structuring framework, one specifically derived and internalized from the framework of the treatment. The analysis of children's resistance has proven to be wholly indissociable from the analysis of the fantasy-contents and of the transference.
As with adults, many positions, often quite opposed to each other, have been taken regarding the conclusion of the child's analysis, it being understood that ideally the child should be the one to decide, even beyond the eventual disappearance of the symptoms that motivated the analysis—which would make sense, obviously, only in relation to the existence of suffering and intrapsychic conflicts obstructing the development of the child.
Following authors such as Hanna Segal and Donald Meltzer, the post-Kleinian movement has contributed much to the discussion of the technique of analyzing children. Meltzer (1967) even suggested describing the therapeutic process in five successive phases: gathering the elements of transference, sorting through confusions of place, sorting through confusions of bodily zones and modalities, [passing] the threshold of the depressive position, and, finally, the process of separation. Such a description, of course, risks being overly schematic, but it has had the virtue of being able to account for the dynamic of the process, as well as to allow the articulation of a certain number of technical approaches.
At the end of this introduction, it is fitting to recall, with Antonino Ferro (1997), that psychoanalysis is basically a single entity; and that there is really nothing to be gained by dividing the psychoanalysis of the child from that of the adult. Each is in a position to enrich the other, notably by way of a calm, comparative meditation on the various technical problems that are posed in the two fields.
See also: Child analysis; Children's play; Controversial discussions; Flower Doll: Essays in Child Psychotherapy ; Psychoanalytical Treatment of Children ; Richard, case of; Squiggle; Transference in children; Transitional phenomena.
Freud, Anna. (1946). The psychoanalytical treatment of children. Technical lectures and essays. London: Imago.
Houzel, Didier, and Catoire, Gilles. (1986). La psychanalyse des enfants. Encyclopédie médico-chirurgicale. Psychiatrie. Paris: E.M.-C.
King, Pearl H. M., and Steiner, Riccardo. (1991). The Freud-Klein controversies, 1941-45. London and New York: Tavistock-Routledge.
Meltzer, Donald. (1967). The psychoanalytic process. London: Heinemann Medical.
Sandler, Joseph, Kennedy, Hansi, and Tyson. Robert L. (1980). The technique of child analysis. Discussions with Anna Freud. London: Hogarth and the Institute of Psychoanalysis.