Sources and Management of Resistance in Child Treatment

In our attempts last year to elucidate and define the typical manifestations of transference which we encounter in the treatment of children, we made a number of comparisons and we drew some parallels between the life and treatment situations of children and adults in respect of both their psychic and their external reality. The phenomena of transference and resistance are, as has been said, the cornerstones of analytic psychotherapy, and it is probably no accident that we are following the symposium on transference with a symposium on resistance. In this way our previous discussions are in many respects very relevant to the theme of this year's conference. As I do not want to repeat what has already been presented and discussed this weekend, i.e. the definition of the nature of resistance and how the concept of resistance evolved in the history of psycho-analysis, I would like to precede my case report with another look at the child's situation vis a vis treatment.

Discussing the reasons which bring patients to treatment, Anna Freud writes: “The question whether or not an adult neurotic seeks treatment is in the last resort dependant on the amount of suffering which his neurotic symptoms cause him. For this reason neurotics undergo treatment more willingly than, for instance, perverts. A perversion disrupts normal life as much as a neurosis, but the perversion brings satisfaction, whereas neurotic symptoms are painful…” She goes on to say that distress usually outweighs the secondary gain the patient may derive through his illness and that the instinctual pleasure which the patient derives from the distorted gratification of repressed impulses, i.e. from his symptoms, is not experienced as pleasure by his conscious system. Neurotic suffering not only acts as a motive for seeking treatment but is probably also decisive for the patient's ability to sustain the difficulties and hardships of an analytic cure.

In the case of disturbed children, however, it is