Prologue: Treatment of the Under-Five Child

Currently, there are many different parent–child psychotherapies that have evolved from the rapidly growing, sprawling field of infant mental health. At present, the field consists of applications or borrowings from well-known therapeutic concepts including neuroscience. Most often these approaches center on work with the parent and young child together, in what is often referred to as dyadic therapy. On closer examination, one becomes aware that psychoanalysis is poorly represented and is, in fact, often overlooked as the treatment of choice for very young children—even by child analysts themselves.

Psychoanalysts readily acknowledge the value and clinical relevance of treating latency-age and adolescent children analytically, but there is much less agreement about the proper age range within which patients are thought to be suitable for analysis. One purpose of this volume, then, is to provide case material so that the reader can examine the unfolding of the analytic process. This level of detail gives the reader the opportunity to observe the characteristics of the children and also samples of interventions of their analyses, so that one can become acquainted with the nature of the therapeutic action in treating under-five children.

There are numerous reasons that explain the reluctance of many analysts to treat very young children in psychoanalysis. One reason often heard is that the very young child may lack sufficient ego structure and sufficient precursors of the superego. The child may also lack adequate separately defined representations of self and other, sufficient to allow the child to participate in the analysis of intrapsychic conflict. A related argument brings up the question of whether the under-five child, who is still very dependent on his or her parents, has the capacity to supplement and structure his or her further development in interaction with the analyst as a new or developmental object, a transference object, or as an object for identificati