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To summarize briefly, challenges to the analyst working with this age group fall into several categories:
Rapid shifts in the functioning of young children make diagnoses less useful than in older patients.
Obtaining cooperation and alliance from parents of young children is especially important.
The under-five children, although willing to engage, tend to require immediate gratification, rather than the elusive long-term goals of mastery of their suffering over time.
The analyst is left with all kinds of challenges, including her own countertransference. For instance, the analyst has to struggle with her own feelings of competition with the parents and anger at terminations that she judges to be often premature. Her rescue fantasies in response to the intense suffering of young children have to be managed. Putting herself in physical and emotional danger, the analyst has to be able to remain objective and yet engaged.
This volume was intended as a broad invitation to consider offering analysis for the prelatency child. It conveys vividly the complexity and the many facets of how young children can present for intensive treatment. Given the depth of the five cases, the reader has occasion to see the details of the analytic work. He can examine the unfolding of the interventions by the five analysts and to contemplate the nature of the therapeutic action in these diverse cases. Even if we do not always understand the exact nature of what was useful at a given moment, developmental assistance or interpretation, the material shows how much change can be accomplished at this young age relatively quickly.
We hope that this issue will be read both by child analysts and by those working with adults who are looking for illustrations of psycho-dynamic conflicts of young children close-up.
Anna Balas, M.D.
Ruth Karush, M.D.