The Anna Freud Tradition

Lines of Development - Evolution of Theory and Practice over the Decades

Norka T. Malberg, Norka T. Malberg, Joan Raphael-Leff

• Publisher: Routledge
• Year: 2018
• Topic: Psychology
• eBook ISBN:
  9780429920080
• Subtopic: Education in Psychology
• Index: Psychology

This book introduces the birth and development of the Anna Freudian Tradition from a perspective of developmental lines, by addressing the early development of this tradition and the conflicts and innovations arising from the interaction between the internal and external world of the organization.

PART I

ANNA FREUD: HER WORK AND LEGACY

Overview

CHAPTER ONE

The Anna Freud Centre today

Mary Target

It is an honour to write this brief introduction to such a welcome and timely book. I am highly aware of how much the Centre has changed, in some important ways almost out of recognition. This is especially true in relation to child psychotherapy and child psychoanalysis, and to a lesser extent in relation to the kinds of research and training which are carried on now, and their integration or otherwise with clinical activity.

Strong cohesion had, in the days of the Hampstead Child Therapy Course and Clinic, been created by an overriding commitment to psychoanalytic theory and treatment, by unquestioned loyalty to Miss Freud as the Centre’s leader and founder, and by nearly all professional staff participating right across the Clinic’s domains of treatment, research, and training, so that all staff knew each other and worked together continually. And, very importantly, by the presence of the Centre’s young patients and their families, together with their therapists, the Centre’s own symbolic “children”: every cohort of trainees labouring away full-time for four to five years, with nearly all the training on site, Maresfield Gardens, a home for this international group of committed young people.

The atmosphere of the Hampstead Clinic and the early Anna Freud Centre are movingly revived each year at the AFC November Colloquium, where a group of alumni gather. For them I imagine Tuesday and Wednesday may perhaps always somewhere be tinged with the anxiety and excitement of presenting or hearing a new profile or paper!

That was how the Centre was when I arrived in 1988 to do some research on the outcome of child psychoanalysis. It was roughly the same place I read about in the copious material (800 files of assessments, weekly reports of the analytic process and of the painstaking parent work, research group minutes, and hundreds of Wednesday papers), which I felt privileged to absorb as I prepared my PhD. This was a retrospective study of child psychoanalytic outcomes at the Centre, enabled by George Moran and Peter Fonagy, which we continued after George’s tragic death. George, who liked people to keep busy, also got me to sort out a lot of archive materials relating to the early history of the Centre, and it was this material which made very real to me what I had begun to understand from analytic publications and biographies. In the painstaking notes, minutes, observations, and correspondence, there were principles and priorities forming a backbone for the Centre’s work.

* * *

I would like to introduce this book by naming what seemed to me some central enduring principles. However, first it is important to acknowledge the great gap in the Centre’s earlier identity left by the closure of the four to five year full-time training in psychoanalytic psychotherapy for children.

Closure of the training:

In 2003 Anna Freud Centre’s board reluctantly took the decision that heavily subsidizing the training was taking a large proportion of its income, raised with difficulty for other purposes, treatment, and research, and that as most trainees by then went on to work in the NHS, the NHS should meet its responsibility to fund the training. The incoming directorial team of myself, Linda Mayes, and Peter Fonagy set about first trying to negotiate with the NHS to provide secure funding on a new basis, then when that proved impossible, to establish a collaboration with the British Association of Psychotherapists to provide a joint training and clinical psychotherapy service. For different reasons, the intensive work on both initiatives was unsuccessful. We are currently very hopeful about the possibility of contributing to a new child psychoanalytic training in collaboration with the Institute of Psychoanalysis and other psychoanalytic child or adolescent centres in London. Ideally, although this is a distant goal, this could eventually lead to the fulfilment of one of Anna Freud’s hopes, to have child analytic training (without requiring prior adult analytic training) recognized by the IPA as a route to membership, and the AFC could play a part in that. One of the Centre’s many distinguished alumnae, Dr Jill Miller of Denver, has laid a vital foundation for this possibility through her successful work to create such a “child only” route to membership of the American Psychoanalytic Association.

Principles and applications of the Anna Freud Centre’s work in the twentieth and twenty-first centuries

The Hampstead Clinic and Anna Freud Centre’s dedication to the emotional well-being of children has several strong branches—theoretical, educational, therapeutic, research, all extending into social involvement and international collaboration. Let us look at some of these, past and present:

Theoretical tradition: In Anna Freud’s day the Hampstead nurseries and Clinic were founded on a psychoanalytic model of normality and pathology, including theoretically based clinical assessments such as the developmental lines and profile which mapped each child’s pattern of emotional growth. The uniqueness of these diagnostic methods lay in the development of systematic ways of observing and integrating the interaction of internal and external influences, framed by a strong metapsychological framework.

Education and training: was always at the heart of the Centre. During the war, training the staff of the War Nurseries began the creation of a whole generation of future child psychoanalysts. With the inception of the Hampstead Child Therapy Course a series of training and post-qualification activities developed in order to satisfy what Anna Freud felt were important professional development requirements. The clinical groups and the Wednesday meetings connect us to those activities even in such different times. The annual colloquium was and is a time for clinicians to discuss clinical work and explore common ground.

Therapeutic tradition: Child analytic thinking took many forms at the Hampstead Clinic: intensive and non-intensive psychotherapy with children and parents, and collaboration with allied professionals such as teachers and medical personnel in order to support children and their families. I would particularly like to mention the work of the social workers: all the hundreds of reports I read by Nicky Model and Barbara Grant impressed me by their penetrating delineation of what would now be thought of as systemic factors, and by their unsentimental but evident compassion. Research groups studied work with borderline, adopted, blind, or chronically ill children, and other special groups challenging and extending classical analytic principles. Preventive measures such as early intervention with toddler and nursery age children and their parents were also an important aspect of the clinical work at the Hampstead Clinic. All the clinical work went hand in hand with intensive study and discussion.

The research tradition was, as stated above, rooted in the understanding of specific disorders or conditions affecting development, and through conceptual research, especially the massive Hampstead Index (it must be admitted that “indexing” tends to be referred to as though an example of intergenerational trauma).

Social involvement and collaboration: There are numerous examples of this principle, through the decades, from work with war trauma; judicial and legislative consultation work to advocate the best interests of the child (Yale University); collaboration with child psychiatry services in very impoverished east London; work with paediatric patients on the wards of the Middlesex Hospital.

Today in the Anna Freud Centre many of these strong traditions continue, in twenty-first century incarnations:

The psychoanalytic model of normality and pathology is taught and adhered to as a broad framework, but it has become more interdisciplinary, incorporating contemporary thinking and evidence. For instance, the concept of mentalization posits a developmental line in the ego psychology tradition of Anna Freud, and I believe connects directly with the technique of developmental help, but is influenced by the work of Bion, the French psychosomatic school, Winnicott, Bowlby, as well as research in developmental and clinical psychology. It therefore offers bridges within and beyond psychoanalysis. The theoretical model of stages of early self-development, affect representation, experience of psychic reality, personality functioning and the family are underpinned by many theoretical and clinical psychoanalytic papers and an ongoing interdisciplinary discussion group (areas of exposition include: social cognition and attach-ment; personality disorder; aggression; violence; development of psychic reality; normal and neurotic development; relationship to other psychoanalytic theories and to research findings; mental experience as embodied, and new ideas on psychosexuality). Special clinically based groups in the Centre are developing their own models of parent–infant psychotherapy, work with toddlers and work with disordered and so on.

Theory based assessments include many measures developed for clinical and research work in areas such as parent–infant interaction, affect regulation, attention, coding of play and attachment narratives, etc.

The Anna Freud Centre now promotes a new, wider intellectual framework for psychoanalytic and related research, which includes developmental studies (identifying psychological and neural mechanisms underlying disturbance); therapeutic techniques specifically designed to address a developmental dysfunction, different age groups, and diagnostic problems; and a developmental neuroscience lab straddling psychodynamic developmental ideas, empirical psychology, and neuroscience.

Similarly, current programmes of education and training include popular short courses and workshops for clinicians and researchers in the field, covering a very wide range of areas. Some of the courses are delivered in association with UCL or to implement government priorities for professional training. Although far from psychoanalysis, they bring other professionals, young trainees, and older policy makers into the Centre, and connect us strongly with the world of child and family mental health today.

In addition, we run several high quality and popular University College London graduate programmes, developing the strong affiliation between our institutions started under the directorship of Mrs Anne-Marie Sandler. They include four master of science degree programmes (one taught 50% at Yale), a professional doctorate and a psychoanalytic PhD programme. The strong link to Yale Child Study Center is a vital and growing part of the Centre’s identity and activity.

The annual Child Psychoanalytic Colloquium continues to be held at the Anna Freud Centre, now very ably organized by three child psychoanalysts who trained at the Centre, and the staff organize and present at many other international professional conferences.

The clinical orientation of the Anna Freud Centre is now more multidisciplinary, and multi-modal. Treatments offered at the AFC still include both intensive psychoanalysis for children, and non-intensive therapy parent work, and therapeutic applications for specific disorders or populations (e.g., the parent–infant project, adolescents in crisis, maltreated fostered and adopted children, family relationship problems, and children undergoing dialysis). Developing and offering a range of evaluated treatments recognizes that children and families need a variety of treatments, and meets the challenge of the current policy agenda to widen access to psychological help for those most in need. Furthermore, integrative approaches may be important particularly for special clinical groups with complex problems such as families with severe adversity and/or very poor parenting. Studies show that common factors in the therapeutic process underlie the effectiveness of all talking therapies. A psychoanalytic model of the mind and of the therapeutic relationship can be extended through broader concepts such as “mentalization”: all psychotherapies develop an interactional matrix in which the developing mind becomes a focus. In the area of prevention, the AFC has expanded outreach in the form of toddler groups in areas of great deprivation, school-based groups, work in prisons and hostels for homeless mothers and infants, and training of practitioners working with teenage parents and their children.

The AFC has burgeoned as a research centre studying a wide range of phenomena, including basic research on infant social-cognitive development; neuroscience of development and maltreatment; outcome research and systematic reviews (e.g., process-outcome of psychotherapies, evaluation of routine clinical effectiveness, Parent–Infant Project [PIP] Randomised Control Trial, and a very large study of the treatment of adolescent depression); and a range of studies of attachment: infancy, child, and post-adoptive placement. The Anna Freud Centre builds our wider scientific credibility and impact on policy by combining academic and clinical leadership with developmental psychopathology research.

Finally, in terms of contemporary social involvement and collaboration, most of the AFC’s clinical projects now operate in the community, many in collaboration with other leading state and voluntary services (e.g., Great Ormond Street Hospital, the Marlborough Family Service, the Tavistock Clinic, Kids’ Company, Islington CAMHS and Local Authority, the Brandon Centre). Our strong and growing academic links with Yale and UCL extend the clinical collaborations to research, training, and educational opportunities.

In sum, the Anna Freud Centre has lost a central plank of its original identity through no longer having the intensive psychoanalytic training, but it has gained in range and impact in other respects and across a much wider sphere. The original classical child psychoanalytic focus has broadened, and the developmental understanding of normality and pathology cuts across treatment models and reaches a much wider professional audience. Our research intersects with work on behavioural genetics and social/affective neuroscience, all the time focusing on aspects of parent-child relating, and its effects on the child’s growing internal world. There has been great change, but also continuity, and the Centre remains a place where people come from all over the world to think about how to understand and help children and families. We continue to draw strength from thinking about their complex developmental problems in depth, respecting complexity and being ready to find new solutions—in theory and in practice—to improve and extend what can be offered.

CHAPTER TWO

Anna Freud: the teacher, the clinician, the person

Elisabeth Young-Bruehl

Very seldom in the history of psychoanalysis has a contributor appeared who could be and do everything to the highest level—and wear all the hats so beautifully. An adult and child clinician; a training analyst, supervisor, and mentor; both a theorist in and a historian of psychoanalysis as a science and a profession; an institution founder and builder, and an institution director; an expert extending “applie...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Series Editors’ Foreword
• About the Editors and Contributors
• Preface
• Prologue
• Part I: Anna Freud: Her Work and Legacy
• Part II: Clinical Work and Applications of Anna Freud’s Developmental Tradition
• Part III: Specialized Work in the Anna Freudian Tradition: Past, Current, and Future
• Part IV: Personal and Theoretical Reflections from Clinicians Trained at the Anna Freud Centre
• Appendix Biographical cameos
• Subject Index
• Author Index
• Personae