The Handbook of Child and Adolescent Psychotherapy

Psychoanalytic Approaches

Monica Lanyado, Ann Horne, Monica Lanyado, Ann Horne

• Publisher: Routledge
• Year: 2009
• Print ISBN: 9780415463690
• eBook ISBN: 9781134041268
• Topic: Psicología
• Subtopic: Salud mental en psicología

This updated edition of The Handbook of Child and Adolescent Psychotherapy reflects the many changes in the profession. It includes:

• additional chapters on neuroscience, work with 'looked after children' and with foster parents, working in schools
• enlarged chapters on research, attachment theory, work with parents, and developments in child and adolescent psychotherapy around the world
• chapters on areas of specialist interest including violence, sexual abuse and abusing, trauma, parent-infant psychotherapy, autism, victims of political violence, delinquency and gender dysphoria.

The Handbook remains accessible and jargon-free. It will be a valuable resource for all who work in allied professions where the emotional well-being of children is of concern – health, education, social services – as well as trainee psychotherapists and experienced practitioners.

1
Introduction

Ann Horne and Monica Lanyado

The second edition of this handbook continues the tradition established in the first of offering an overview and explication of the profession of Child and Adolescent Psychoanalytic Psychotherapy. It is not, in any common sense, actually a handbook—there is no intent to train the reader who will not, in turn, emerge as a child psychotherapist from the reading. Rather, we would hope to broaden knowledge about the profession and the range of work with children and young people that this adaptation of psychoanalysis encourages; we would wish in addition to explore what a psychoanalytic understanding—in terms of theory, research and the implications for practice—offers in work with distressed and ‘stuck’ children and young people today.

It is thus designed for several types of reader. For those who are already training or working as child psychotherapists the value may well lie mainly in the chapters on work of specialist interest, although many of the other contributions will offer creative ideas and sparks to further thinking. For those contemplating a career in child psychotherapy—perhaps undertaking pre-clinical Masters courses—this is the volume that hopefully helps your friends and family understand what you want to be about. For the reader in allied professions, we offer an overview of the profession, its context and settings, and hope to clarify some of the assumptions about and insights of the psychoanalytic approach. Most chapters are therefore deliberately written to be accessible to a general audience and the authors have responded to that brief. Those seeking greater depth may find the suggestions for further reading helpful.

Our hope would be that the more generalised introduction will make accessible some of the excitement and potential in recent thinking about practice and research, and that the general reader will also find much in the more specialised chapters to enhance practice in other professions as well as to facilitate understanding of why and how the child psychotherapist is working in a specific field.

We have also included writers from a variety of theoretical backgrounds: Contemporary Freudian, Independent, Jungian and Kleinian. In general, these are experienced writers with proven interest and expertise in specific areas. This multi-authored approach should give the reader a sense of the diversity within the profession, and of a vibrant profession able to discuss, differ and develop, while sharing clear underlying principles.

Structure

The book is structured in four main parts but each chapter stands in its own right. The first part introduces the theoretical foundations of the work. While the first two chapters reprise the themes of the first edition, they have been updated—and the chapter on attachment theory has been rewritten and expanded to incorporate current knowledge and research. Neuro-science represents an important addition to the theoretical base and we welcome the clarity of Graham Music’s contribution. Finally, in the ten years since the first edition appeared, research has moved on considerably: we are most grateful to Nick Midgley for an erudite and measured exposition of the field. Throughout, authors have used straightforward language to introduce important ideas and concepts. These introductory chapters also provide plentiful references for those readers who wish to have more detailed knowledge.

The theoretical section is followed by three chapters about the child and adolescent psychotherapist in context—the cultural and racial context today; the most usual setting for the UK therapist working in the public sector (the multi-professional team); and as good an international overview of child psychotherapy as we could manage from colleagues abroad, encouraged by Lydia Tischler who was in 2005 celebrated for her work as co-ordinator of Central and Eastern European Networks for the European Federation for Psychoanalytic Psychotherapy in the Public Sector (EFPP). We are, of course, delighted that the first edition has already been translated into Czech and Italian; and that this second edition will appear in Japanese.

The third part of the book describes the diversity of treatment models offered by child and adolescent psychotherapists, beginning with the therapeutic setting and process. The tradition of intensive psychoanalysis (of four- or five-times weekly frequency) with which the profession began retains its rightful place; the principles, however, have become applied and developed in once-weekly work, probably the norm for most individual treatments. It is important that Part III then goes on to demonstrate the extent of work undertaken by the profession as many would assume individual psychotherapy to comprise the bulk of the child psychotherapist’s day. Not so. Brief interventions are explored, as is consultative work which applies psychoanalytic principles to enable colleagues in a variety of settings to make sense not only of the young people with whom they work but also of their own responses and feelings. Expanded chapters appear on work with parents and parent-infant psychotherapy. Both have generated a great increase in interest and engage child psychotherapists in most work settings. We are fortunate to have a child psychotherapist, also a group analyst, co-write the chapter on group work and have added a new chapter on working in educational settings, another growth area. The chapters on in-patient work and therapy and consultation in residential care remain as before.

The final section of the book describes areas of special clinical interest: autism, trauma, work with looked after children and foster carers, delinquency, violence, sexual abuse and sexually abusive behaviour, gender dysphoria, eating disorders, work with young people exposed to political violence. These chapters provide a mixture of an overview of ways of working with these specific problems as well as giving access to the theoretical thinking behind the interventions. They are rich in case illustrations and provide an intimate and impressive view of how far the profession has come in adapting classical psychoanalytic practice, originally developed for the treatment needs of mainly neurotic patients, to the more complex nature of a child and adolescent psychotherapist’s work today. Six chapters are new—or almost totally revised; four have been reviewed and updated.

A note on history

A full history of developments in psychoanalytic work with children and young people, leading to the establishment of training schools, is contained in the Introduction to the first edition of this handbook, to which the curious reader is directed.

Although the lasting impetus to the establishment of the profession of Child and Adolescent Psychotherapy comes from the theoretical interest and practice of both Anna Freud and Melanie Klein (Daws 1987), other influences helped found the structure for psychoanalytic work with children and young people. In Vienna, Hermine Hug-Hellmuth (or Hug von Hugenstein) combined her experience as a teacher with her growing interest in psychoanalysis, publishing her first monograph in 1912 and a paper on child analysis in 1921 (MacLean and Rappen 1991). Geissman and Geissman conclude: ‘Her work, buried for sixty years, is being unearthed at last: and that work was the invention of child psychoanalysis’ (Geissman and Geissman 1998:71).

In the 1920s the child guidance movement, begun in the USA, reached the UK. The first specially trained psychodynamic workers with children in the child guidance multi-professional teams were the psychiatric social workers (PSWs). Following the establishment of the first child guidance clinics in the UK (by Emanuel Miller and Noel Burke in London and the Notre Dame Clinic in Glasgow) the ‘Mayflower ladies’—the first PSWs— went out to the USA to be trained by colleagues there. This interest in gaining particular expertise in work with children and young people grew amongst the early professions in the new clinics—psychologists, psychiatrists (originally specialists in Psychological Medicine) and social workers. Although there was a stimulating ethos of interest in applying psychoanalytic and child development understanding to children, many clinics remained voluntary, reliant until the advent of the National Health Service in 1948 upon jumble sales and donations to keep going. This picture of committed enthusiasm by professionals, yet a backcloth of it being difficult for society to take seriously child mental health issues, remains with us.

At University College, London, the 1920s saw the first courses in child development and observation, run for social workers and teachers. It was during this period of early enthusiasm that Dr Margaret Lowenfeld established in 1928 the Children’s Clinic for the Treatment and Study of Nervous and Delicate Children:

Here Lowenfeld’s wartime experience and research observations had already led her into the belief that, in addition to environmental considerations, there were processes inherent in children themselves which would enable them to find more adaptive solutions. For Lowenfeld the key to these possibilities was play.

(Urwin and Hood-Williams 1988:42–3)

This developed in 1931 into a one-year training course and, in 1935, into a three-year ‘training in psychopathology and psychotherapy with children and leading to a diploma’ (ibid.: 89). The first child psychotherapy training was thus established at Lowenfeld’s Institute of Child Psychology.

Melanie Klein’s move to England in 1926 greatly influenced the British psychoanalytic world not only through her theoretical exploration of the internal world of the infant and the very early mother-infant relationship but through her practice of child psychoanalysis and her belief in the availability of very young children to psychoanalysis through the analytic play technique that she developed (Klein 1955). Klein’s influence led the Psychoanalytic Society to develop its own criteria for training in child analysis, beginning with the supervised analysis of two adult patients, and followed by supervised work with a pre-latency, a latency and an adolescent, all while the candidate was in full analysis.

Notable at this time was the work in applied psychoanalysis undertaken in Vienna by Anna Freud, Sigmund Freud’s daughter, and colleagues: the establishment of the Jackson Day Nursery (forerunner of the Hampstead War Nurseries) and the use of systematic, detailed observation of children; two child guidance clinics in Vienna for children and for adolescents; work with Aichhorn on juvenile delinquency; the establishment of a school, run by Eva Rosenfeld, to give disturbed children an appropriate learning environment; lectures for teachers and the development of a growing relationship between teaching and psychoanalysis.

The final scene in the pre-war setting for post-war developments in child psychotherapy, therefore, was that of the Freud family’s arrival in London in 1938. Daws gives a singular insight: ‘It is characteristic of Anna Freud’s directness and the practicality of her interest in children that her luggage included 10 little stretcher beds—a foreshadow of the War Nursery she later helped create’ (Daws 1987).

Anna Freud and Melanie Klein, as psychoanalysts, provided a rare combination of the close observation of children with psychoanalytic theory. Despite important theoretical differences, harshly disputed in the Psychoanalytic Society’s ‘Controversial Discussions’ (King and Steiner 1991), these two principles remained central in the development of that application of psychoanalysis which was child psychotherapy.

Multiple influences arose from the experiences of the Second World War: evacuation of children which, for the first time, probably alerted the middle classes to the conditions of the poor and especially of the inner-city child; loss of parents in war; the work of John Bowlby on maternal deprivation and on separation, foreshadowing his thesis on attachment (Bowlby 1969); an Army Medical Corps, influenced by leadership from the Tavistock Clinic, taking seriously issues of war neurosis, mental health and trauma; and the influence of the child guidance movement on the establishment of the National Association for Mental Health. Together with the climate of change heralded by the Beveridge Report and the advent of the Welfare State, it seemed an atmosphere in which development could be nurtured.

In 1947 Anna Freud established at the Hampstead Clinic (now the Anna Freud Centre) a child psychoanalytic training based on her approach and accepting lay and analyst candidates. The foll...

Table of contents

• Contents
• Contributors
• Acknowledgements
• 1 Introduction
• Part I Theoretical foundations
• Part II Context
• Part III Diversity of treatments and settings
• Part IV Areas of special interest
• Index