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Introduction to the Anna Freud-Hampstead Center Symposium held by the Michigan Psychoanalytic Society, November 11, 1978.
IN INTRODUCING THIS DISCUSSION I have a sense of inadequacy, since, during my whole working life as an analyst, I have never made the quality of "insight" my special subject of study. When working with adults, I shared the common opinion that the patient's acknowledgment of his psychic disorder and the desire to cure it are indispensable preconditions for his treatment. I also shared with my colleagues the common experience that, at least so far as the neuroses and the character disturbances are concerned, analysis tends to fail where such insight is missing and where entry into analytic therapy is due not to the patient's attitude in this respect but to familial or to social pressure.
When it came to children, I merely classed their lack of insight with the absence of the numerous other characteristics which, for the analyst, distinguish the immature from the mature patient and make child analysis such a hazardous and difficult undertaking. I refer in this respect to the child's inability or unwillingness to embark on free association; to the difference in his transference reactions; to his unreliable treatment alliance; to his diminished sincerity and frustration tolerance; to the preponderance of motor action over verbal expression; etc.