Child Analysis Today

Luis Rodriguez De La Sierra

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429911798
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Although there have been many other important contributions to the field of child and adolescent analysis, the major differences in theory and approach still bear the hallmarks of three of the most significant figures in the field: Anna Freud, Melanie Klein and Donald Winnicott. As well as providing an insight into these differences, this volume from the Psychoanalytic Ideas Series also portrays the state of child analysis today, whereby we need to reconcile and combine these differences to reveal a common ground from where we can move forward. This is represented by the sheer diversity of the perspectives in this volume, as they in turn show how they can influence the field of child analysis today.'This book represents an attempt to portray the state of child psychoanalysis in the British Psychoanalytical Society today. It offers a variety of clinical and theoretical perspectives, and attempts to demonstrate how they influence the world of child analysis in this country.

Chapter One
Developments in technique in Kleinian child psychoanalysis

Robin Anderson

It is now nearly ninety years since Melanie Klein first psychoanalysed a child, which led her to develop her special technique for analysing children. What is the Kleinian position now with regard to child analysis? Why and in what way does it differ from the technique originally described by her and restated by her in "The psycho-analytic play technique" (Klein, 1955)? In this chapter I look at Melanie Klein's technique of child psychoanalysis as it is practised now and consider some of the background to the changes in technique which have come about

At first intuitively, but later relying on clinically based conclusions, Klein took the view that child psychoanalysis was psychoanalysis in its fullest meaning, not a mere application of psychoanalytic techniques. Klein felt that any modifications of technique should therefore only take account of the different means by which children communicate with the analyst, i.e. through various kinds of play as well as the usual free association and dreams as in adult analysis. Klein found that despite their immaturity and limited capacity to express themselves verbally, children could form the essentials of an analytic relationship: the capacity to form a transference relationship, communicate unconscious information to the analyst, to process interpretations, and develop insight. She realized this once she had discovered that children's capacity to play fills the gap left by their inability to follow Freud's analytic rule of free association. This was refined into her concept of "play technique". To have an analysis, children require a setting that provides them with the means of communicating with the analyst: a playroom with suitable toys, and an analyst willing to accept the child's need to be mobile and to engage in various play activities, including those that involve the analyst.

Klein found that children form an intense transference relationship with the analyst irrespective of their intense relationship with their parents. They form this early, and it is through the interpretation of the transference that the child's anxieties decrease. She felt that the most important task for children in their development was the mastering of anxiety. This fundamental task underlies the capacity to manage all the other developmental tasks, such as dealing with the Oedipus complex. She found that children have to cope with more anxiety than adults and yet have less developed and less mature capacities to do so. She believed very strongly that the direct and deep interpretation of anxiety, describing their unconscious fantasies, most effectively relieves children's anxiety. She felt it important to interpret the negative transference, though she felt this should always be in the context of a positive transference that was best established by interpretation and not by extra-analytic means. Klein's writing abounds with examples of her technique with children (see especially The Psychoanalysis of Children, 1975a, and The Narrative of a Child Analysis, 1975b).

In "The psycho-analytic play technique" Klein states:

... my work with both children and adults, and my contributions to psycho-analytic theory as a whole, derive ultimately from the play technique evolved with young children. I do not mean by this that my later work was a direct application of the play technique; but the insight that I gained into early development, into unconscious processes, and into the nature of the interpretations by which the unconscious can be approached, has been of far-reaching influence on the work I have done with older children and adults. [1955, p. 122]

Thus, child analysis made possible new discoveries about the mind that benefited psychoanalysis in general and, for a period after the Second World War, it was regarded as the pace setter in developments in Kleinian psychoanalytic technique. However, in the past thirty years this situation has changed: the most important contributions from Kleinian psychoanalysts have come from their work with adult patients, and these discoveries have in turn led to changes in technique. Kleinian child psychoanalysts have been heavily influenced by these changes in the technique of adult analysis.

The psychoanalytic setting

In all the basic physical and psychological settings, modern Kleinian child analysts follow Klein's basic guidelines more or less unchanged. The room is simple, with furnishings that are as far as possible robust, and surfaces that are easily cleaned. This leaves the child free to play in as unrestricted a way as possible without the analyst having to intervene too much to protect the room (as well as, of course, the child and the analyst). The room is devoid of materials belonging to other children, which again would require the analyst to intervene, though Klein did encourage other children's toys to be kept in locked drawers, a fact that would give some reality to fantasies about the existence of other child patients, which in turn would have links with fantasies about siblings and mothers' babies.

The toys should be small and simple to allow the child's own fantasy to be expressed in the play rather than the toys themselves suggesting too many fantasies to the child. The fact that each child has his or her own set of toys, which are kept in a locker or drawer, encourages a sense of continuity between the play in separate sessions. It also makes an analogy between the idea of an internal world containing internal objects, and the box or drawer containing the child's toys.

A boy of four in analysis because of disturbance arising from serious illness in his family systematically broke his toys into tiny pieces and tried to flush them down the sink. It seemed that this was an expression of his desperate wish to rid his mind of all ideas because their presence provoked distressing and disturbing feelings about his family. He was able to convey by his actions that he wanted his mind to be quite empty. Later, when he began to recover, his toys once more became a means of playing and expressing himself symbolically in a more peaceful way.

Frequency of sessions

In child psychoanalysis there are generally four or five sessions per week, to allow close contact and effective analysis. However, Melanie Klein did acknowledge to Esther Bick when she was developing the child psychotherapy training at the Tavistock Clinic that children do develop transference, which can be worked with analytically, even if they are seen only once a week. Nowadays, we would describe this as psychoanalytic psychotherapy rather than psychoanalysis, although the technique is very similar.

Parents

The analyst's relationship with the parents and their place in the analysis of their child is very important. As far as work within the sessions themselves is concerned, a child's comments about its parents would be considered like any other communication, much as an adult patient's references to their spouse would be analysed. Of course, a child depends on the parents to allow the analysis to take place, and often uses them to carry part of himself as, for example, when the child does not wish to come for sessions, leaving the parents to carry the motivation for analysis against which the child may vigorously protest. It is very important that these splits are fully analysed, particularly when they relate to negative transference, to avoid the parents carrying negative feelings of the child, which belong in the analysis. The parents must be regarded as the analyst's allies and it is important for both patient and analyst that contact is maintained. The usual arrangement would be to meet once per term, with an understanding that other contact, usually by telephone, would be made when necessary.

The problem of the parental contribution to the child's disturbance would not be regarded as something the analyst could or should attempt to influence directly. Of course, understanding the impact of this on the child, and managing the parents' transference to the analyst, can make a positive contribution to the parents as well as helping their child, but if this is not sufficient then the solution would be to seek additional help for the parents from elsewhere, leaving the analyst as free as possible to engage with the child. However, the management (rather than the analysis) of the relationship is crucial and the analyst does need to consider privately the nature of the relationship the parents have with the analyst.

Transference and interpretation

These two categories are considered together because how we understand the transference so much influences how we interpret to the patient.

Elizabeth Spillius (1983, 1988) has described how Kleinian technique in adult analysis had changed in the preceding thirty years, and noted the following four trends.

1. Destructiveness is being interpreted in a more balanced and less forceful way.
2. The use of part-object language describing the bodily expression of unconscious phantasy has been approached differently due to a shift of emphasis towards a greater interest in how part-objects function in the mind. In other words while the anatomical process—"You are putting your faeces into me" or "You experience me as a good feeding breast"—are present as ideas/hypotheses in the analyst's mind, he is much more likely to talk about what the patient is doing or experiencing in terms of the patient's conscious language. For example: "You are trying to relieve yourself by filling me with your confusion", or "You feel I have become more benign and helpful to you." The analyst may go on to connect this with the anatomical part-object processes, although often does not do so. This is described by Edna O'Shaughnessy as a concern with psychological rather than anatomical part-objects.
3. The concept of projective identification is being used more directly in analysing the transference and counter-transference.
4. As a result, there has been an increasing emphasis on acting in the transference and on the pressure experienced by the analyst to join in.

Spillius (1983, 1988) sees these changes as arising from several causes:

1. Bion's understanding of projective identification as a normal process of infancy and its use as a fundamental form of communication between infant and mother, patient and analyst.
2. Rosenfeld's development of this approach.
3. Betty Joseph's emphasis on the total transference situation and the way analysts can be powerfully drawn into subtle unconscious collusions with the patient.

I would add Hanna Segal's detailed work on symbolic functioning to the list.

Child analysts have been heavily affected by these changes, particularly in relation to methods of interpreting to children. Since they address the very fundamentals of the analytic relationship, which we hold applies just as fully to children as to adults, perhaps this is not surprising.

Analysing children places special demands on the analyst, demands that in many ways are more extreme than those which relate to most adult patients. It is often necessary to be able to process complex material quickly—to interpret under fire, to use Bion's phrase. To do this, the analyst is required, often very rapidly, to observe manifest behaviour, to consider personal feelings and their possible relevance to the child's behaviour, to come to a view about the underlying meaning of this in the child, and to respond by interpretation, sometimes at the same time as physically restraining the child.

If these pressures can be withstood and the analyst is able to remain open to the patient's projections and their meaning, as well as other material, it is possible to build up a three-dimensional picture of the object relationships of the child's internal world. Interpretations must take this into account since an interpretation is an action. If its potential meaning to the patient has not been understood, then the patient may experience it not as understanding but rather as some kind of enactment of an existing unconscious constellation. Another way of putting this is that we must consider who we are in the transference and whom the patient experiences the interpretation as coming from. These kinds of states are prominent in the paranoid-schizoid position and rapid fluctuations between paranoid-schizoid and depressive levels of functioning during a single session are relatively common.

I would like to illustrate some of these issues by presenting some material from an analytic session of an eight-year-old boy. This boy, whom I will call John, is the same child that I described earlier as destroying his toys. John had come to analysis at the age of four because, following the serious illness of a much loved older brother, he had become very angry and negative and had given up all positive aspects of his emotional and cognitive development. This included giving up all play. After entering analysis there were some distinct improvements, but he then became very negative again and I had noticed myself becoming very demoralized and rather weak with him. In exploring the possible meaning of my counter-transference at that time, I had concluded that what had been enacted between us and within me was a projection of a total transference situation, which was closely related to the crisis that had initially brought him to analysis. Something anti-developmental, which had led him to give up on himself and his creative development, had happened when he felt so despairing about the affliction of his brother. It was as though he had equated his illness with the triumph of hate over love. I thought that this despair had now lodged itself in me and that I had to struggle to deal with this first by understanding it and then interpreting, rather than by enacting the situation with him.

Once I had understood this and managed to strengthen my work with him, John seemed to come back to life and, although there were fluctuations in the quality of contact, there was a more hopeful and lively atmosphere. He was intermittently able to use the toys and to play, although at other times he engaged in a high degree of enactment with me. At times he resembled a child playing like an adult and free associating. At other times he was much more interested in doing things to me which seemed to mobilize feelings in me that he wished to disown, or demoralizing me as though to fill me with depression and hopelessness. In this way he seemed to be creating a situation in which he was like an affliction, perhaps the illness his brother suffered from, while I was left like the brother (i.e. that part of himself which was identified with the brother and projected into me) in a state in which I had to struggle hard to remain analytically alive.

A Tuesday session

As usual recently John presses the buzzer continuously, and the noise reverberates throughout the whole house. As I open the door he is looking up triumphantly at his au pair, who has brought him, and she is laughing but in an embarrassed way. He says to her "Oh, sorry, I forgot" but quite insincerely. I remove his hand from the buzzer gently but firmly and say "Hello John." At the door of the playroom he asked if I would please wait outside as he has a surprise for me. I agree, somewhat reluctantly. I hear a noise that could possibly be striking matches and I open the door. He is not striking matches and although I cannot see what he is doing I wait before entering the room. When I do go in after about a minute he has arranged some sheets of drawing paper on the floor and there is obviously something under them. He treads on the pieces of paper and then shows me that he has "secretly" placed some peanut shells all over the floor under the sheets of paper. He says nothing to my enquiry as to what the purpose of this is, although I assume he intended me to wa...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• ACKNOWLEDGEMENTS
• CONTRIBUTORS
• Introduction
• CHAPTER ONE Developments in technique in Kleinian child psychoanalysis
• CHAPTER TWO Child analysis: when?
• CHAPTER THREE Anna Freud—child analyst
• CHAPTER FOUR Being Frankenstein: a youth's solution to psychosis
• CHAPTER FIVE How come your house never falls down?
• CHAPTER SIX On interpretation and holding
• INDEX