This section offers historical and contemporary perspectives on indications for child psychoanalysis. It begins with Anna Freud's 1945 and 1968 papers, which reflect her evolving views on childhood psychopathology, the centrality of developmental principles in assessing and treating children, and the process of case selection for analytic treatment. The 1968 essay expresses optimism that future research will broaden theory, improve technique, and extend the effectiveness of child analysis to diverse populations. A paper by a contemporary child psychoanalyst concludes the section, responding to Miss Freud's hopeful predictions and examining the now-widened scope. Through theoretical discussion as well as a clinical presentation, this final paper demonstrates a complex, current approach to indications which emphasizes the following: comprehensive developmental assessment; relationship building and technical modifications for children with diverse needs and capacities; ongoing parent work; and collaboration with other professionals who support the child's learning, health, and overall developmental progression.
The world of child mental health has radically changed since Anna Freud's classic papers about the assessment of children's suitability for psychoanalysis. The field has been flooded with therapies, some influenced by psychoanalytic principles but many from other traditions, and the patient population is comprised of children with a greater range of psychopathology. This paper suggests that Anna Freud's Provisional Diagnostic Profile, which encompasses history, present circumstances, and current functioning, still serves as a useful guide to a thorough evaluation of patients and their potential for today's updated psychoanalysis. Contemporary analytic goals include not only the classic unconscious conflict resolution and symptom relief, but also an amelioration of the child's mental processes to facilitate affect regulation, mentalization, and insightfulness. The work thus addresses both pathogenic influences from the past and ongoing disturbances in mental functioning that impair the child's capacity to deal with the future.
After the sad death of our colleague Ilse Grubrich-Simitis, one aim of this paper is to revisit one of her groundbreaking works, "Drive or Trauma - Drive and Trauma" (1987) after almost 40 years. Grubrich-Simitis integrated drive and object relational aspects on the one hand and trauma-specific perspectives on the other in a creative way, as we discuss regarding some conceptual developments in contemporary psychoanalysis. A short case example illustrates the conceptual richness for treating chronically depressed patients with early trauma available to clinicians today. Considering both drive and trauma belongs to the strengths of modern psychoanalytic treatment techniques, which we would like to discuss alongside recent findings of the LAC1 depression study [Comparative outcome study of psychoanalytic and cognitive behavioral long-term psychotherapy with chronically depressed patients], indicating that these difficult-to-treat patients profit especially well from psychoanalysis.
Sibling relationships are formative and uniquely positioned within early social networks, not as authoritative as the parent-child relationships nor as optional as friendships. Psychoanalysis has incorporated assessments of sibling dynamics into practice, even as sibling relationships have received little formal attention in the literature. This article applies insights from the study of neural and cognitive development to help inform how sibling relationships may be formed, and in doing so offers a fresh perspective into the enduring influence of our earliest familial bonds. Specifically, the author argues that beginning in infancy, the sibling dynamic is shaped by a complex interplay of developing memory systems, changing schemas, and familial influences.
In presenting two sibling pairs observed as infants and toddlers during the Margaret Mahler separation-individuation research and followed for 60 years, this paper demonstrates how a sibling relationship contributes to the development of the inner world and sense of self, and it argues that these processes need to be more fully recognized in psychoanalytic theory and practice. With a focus on how the sibling relationship affects the development of self- and object mental representations, the lateral developmental trajectory of each sibling relationship is traced in the context of the developing vertical relationship to the parents. Analyses are drawn from detailed observations during the first three years of the mother-child and sibling interaction patterns and from follow-up interviews conducted periodically from latency through late middle age, when outside measures including the Adult Attachment Interview, Object Relations Inventory, the Structured Interview of Personality Organization, and projective tests also were administered. Although both sibling pairs experienced early adversity, one pair's AT classification was discordant, the other concordant. The concordant sibling relationship fostered separation-individuation and attachment, helping to move the attachment to the parents (and each other) to a higher level of differentiation and relatedness in later life. In the nonconcordant sibling pair, attachment to the parents was moved to a lower level of differentiation and relatedness later in life and to a lower level of differentiation in relationship to the sibling. The developmental trajectories of each sibling pair are considered in light of these classifications. The hypothesis-generating findings result in the articulation of specific areas for further research with greater numbers of subjects.
Although siblings are ubiquitous in our lives and the lives of our patients, there has been no theory of sibling impact on the development of the mind and character. In an effort to encourage the development of such theory, this paper will review the major ideas that have been proposed thus far about the role of siblings on the development of the mind, including impacts of ordinal position, identity formation, sibling loss, sense of embodied self, and capacity for intimacy. The role of resistance in exploring sibling impact will be suggested, and how this may create a blind spot for analysts identifying and interpreting sibling transference and countertransference. Some ideas and case material will be presented in an effort to initiate such a theory-building process.
Sibling bonds are often central in children's everyday lives, but they remain underrepresented in developmental and clinical research. This article reviews the developmental and clinical significance of sibling relationships through the lens of attachment theory and presents some original research on siblings that were participants in the London Parent-Child Project. We examine how sibling relationships contribute to children's social, cognitive, and emotional development. We highlight the bidirectional and ambivalent nature of sibling interactions, the moderating effects of parental differential treatment, and the predictive role of attachment representations within the sibling subsystem. We further explore cross-cultural perspectives, sibling dynamics in adoptive placements, and findings from the Friends and Family Interview administered to siblings.
(1968). Indications and Contraindications for Child Analysis. The Psychoanalytic Study of the Child: Vol. 23, No. 1, pp. 37-46.
(1945). Indications for Child Analysis. The Psychoanalytic Study of the Child: Vol. 1, No. 1, pp. 127-149.
Working through is a concept that is well suited to increased understanding of therapeutic action, particularly when examined from the perspective of child analysis. The work of child analysis makes it clear that an important aspect of the working through of psychological problems involves not only transference interpretation of conflict, but also other forms of intervention. Clarifying distortions due to defense, or to cognitive delay or immaturity, is a common part of child analysis. The analysis of children can function as a model for understanding the value of such noninterpretive interventions for both child and adult psychoanalytic technique. This paper provides an illustration of working through over the course of a child analysis to exemplify various forms that working through can take.
The argument in this paper is that the most long-sighted opportunity we possess to protect the future of our profession is to apply and invigorate basic pedagogic practice by ensuring that learners are first provided knowledge of foundational analytic constructs that, only when reasonably mastered, are built upon with the introduction of subsequent ideas in historical context and sequence. Using architectural imagery, unless the deliberations and debates that led to the evolution of ideas are taught to each generation, learners will be disadvantaged by the inheritance of upper floors detached from their foundation, posing the risk that the practice of future generations will, analogously, become detached from a foundation we would recognize as analysis.
Dropout and premature termination are not uncommon in child and adolescent treatment. We present a several-year analysis of a school-age boy whose treatment involved a prolonged impasse that could have led to early termination. Drawing on Ferro's (1999) psychoanalytic field theory, the analyst describes how this perspective helped him endure and make sense of the shared predicament, culminating in what we term an analytic crucible - an intense transformative process that reshaped the analytic space, the analyst's stance, and the child's sense of self. From the perspective of many years later, with deeper immersion in field theory, the analyst reflects on additional aspects of the treatment illuminated by the theory. The case illustrates key concepts from psychoanalytic field theory, how they relate to and build on other psychoanalytic ideas, and their relevance to understanding impasse and promoting shifts in child analysis by expanding the analyst's capacity to remain engaged, open, and curious.
This paper examines psychosomatic disorders in adolescents through the psychoanalytic treatment of a teenage girl. Initial findings indicate that symptoms may stem from self-punitive and critical internal dynamics. The author explores the concept of the "psychosomatic paradox," proposing that physical ailments may offer unconscious advantages, thereby perpetuating the cycle of illness. The clinical material highlights psychoanalytic techniques, focusing on consistent availability, attentive listening, and interpreting psychosomatic symptoms within the context of the transference. Supported by psychoanalytic literature, the discussion builds a framework for understanding the mind-body connection in these disorders. The paper concludes by highlighting the potential of psychoanalytic treatment to foster emotional and psychological growth in adolescents with psychosomatic conditions.
This essay explores the impact of immigration on children of the next generation through the 2021 film Minari. Specifically, the experiences of the children in the film are utilized to examine how immigration heightens and resurfaces aspects of the melancholic experience, as conceptualized by Freud in his 1917 essay "Mourning and Melancholia." The author discusses the challenge of mourning in a hostile cultural climate, losses that are specific to the next generation, and protective factors for children of immigrants.
