Informal survey and discussion among the members of the Committee on Child Analysis strongly suggest that when we refer to the “ecology” of an institute as far as child analysis is concerned, it is not the geography, not, to a large degree, the size of the community, nor even, in some cases, the “health” of the adult program that influences the tenor and health of child analysis. (As to the latter, some institutes with weak adult programs have strong, viable child programs.) When the senior child analysts in the community are actively involved in a child analysis practice, there appears to be no lack of child and adolescent patients. Although there are additional and important contributing factors that influence the health of child analysis in a community, it is upon the senior child analysts that so much rests. They are largely responsible for creating the “child analysis atmosphere” in which child analysis can flourish.
When senior child analysts have active child analysis practices, when they convey to analyst and non-analyst colleagues the importance of and indications for child analysis, when they themselves, convinced that child analysis is the treatment of choice where indicated, transmit this conviction to others, the senior child analysts ordinarily have more work than they can handle. They then, after consultation and evaluation, are able to refer cases to younger graduates and to candidates for their supervisory cases. When candidates move away from the heart of big cities where there is a great deal of competition and when they make their own professional contacts, they are less dependent on others for referrals. They, then, in turn, contribute to creating a “child analysis atmosphere,” which can only benefit that program and the other candidates.
In some communities senior child analysts, because they are leaders in child psychiatry training programs and are officers in national child psychiatry organizations, may have divided loyalties and responsibilities. I feel that these divided loyalties evolve, not from a lack of their interest in child analysis, but because senior child analysts are relatively few and are quite in demand. Therefore, they must wear many hats. Another reason for the seeming lack of patients for candidates devolves on what some of us call “the short half-life of the child analysts.” A study by Samuel Abrams of COPE will show, when it is released, what most of us have known for a long time: as child analysts age they take fewer young children in analysis. They tend to take more adolescents, and as they become training analysts, more adults. They get fewer children for referrals, may seem to the public to advocate child analysis less, and, once more, referrals to candidates suffer.
I have encountered fellows in child psychiatry, trained in my own psychoanalytically-oriented child psychiatry residency programs who feel that they are able to treat children who should be analyzed. I feel that we as educators should face, and help our trainees face these facts: 1.) child psychiatrists, although trained in child psychiatry by child analysts, are not child analysts. 2.) adult analysts, trained in child psychiatry are not child analysts. We must address these problems, not only for the benefit of the child analysis training programs, but for the benefit of children requiring child analysis.
Selma Kramer
Philadelphia