Introduction: Attention Deficit Hyperactivity Disorder in Children and the Psychoanalytic Process

“The child can use the analyst as a new love object, an auxiliary ego, a new object of identification, or an object of externalizing inner conflicts and the splitting of ambivalence” (Sandler, Kennedy, and Tyson, 1980, p. 107).

This statement made by Anna Freud reflects Freud's belief that the emergence of psychopathology is influenced by multiple factors, including an underlying neurobiological vulnerability, that complicate the ubiquity of unconscious conflicts throughout the stages of personality development. In calling attention to the analyst's divergent roles with a child, she also cautioned against the danger of maintaining a developmental orientation to psychopathology which is unidimensional by commenting, “I criticize above all the lack of data to support the concept of the unempathic mother as the pathogenic agent” (Anna Freud, 1983, p. 385).

Anna Freud's recommendation that the analyst can become both an active presence in children's lives and a new object in their inner world remains a cornerstone of contemporary psychodynamic treatment approaches. Her identification of the analyst as a potential, auxiliary ego for the child whose aim is to promote ego development underlies the principles of child psychotherapy. If the therapeutic process is understood as an emotional experience involving unconscious communication that fosters comprehensive ego development in the child and psychological growth in the family, then a psychoanalytic orientation is not in any way mutually exclusive with cognitive-behavioral and psychopharmacological efforts at symptom reduction.

Two essential goals of psychoanalytic psychotherapy with children and adolescents consist of establishing a therapeutic alliance that broadens and deepens the child's emotional communication and formulating interventions which address the child's particular developmental immaturities and adjustment problems