The Vulnerable Child Discussion Group has convened at Spring and Winter meetings of the American Psychoanalytic Association for 18 years. It originated in 1968, when Eleanor Pavenstedt started a study group called the “Committee on Social Problems”, changed, optimistically, since then, to the “Committee on Social Issues”. The roots go back even further.
In 1962, during their meeting in St. Louis, a group of concerned members of the American decided to focus some of their analytic attention on children disadvantaged by poverty, mental or physical handicaps, or who suffered from discrimination on the basis of race, ethnic background or sex. A joint Commission on Mental Health of Children had recently been established by the Federal Government with a need for greater understanding of the problems and remedial requirements of broad categories of children heretofore only inadequately considered: the blind, deaf, mentally retarded, brain damaged, and psychotic, as well as the poor, abused and delinquent. Those psychoanalysts felt that their knowledge could be important to people planning for the taking care of these children; conversely, they hoped that their research in this area might contribute to psychoanalytic theory. To relate psychoanalytic observations to the understanding of child development in general and method of treatment in particular has sound precedents in psychoanalytic history, as exemplified in Freud's Three Contributions and Little Hans.
Before, during and after World War II, Anna Freud and her associates treated and studied children. They formalized theories about those in concentration camps and those left orphaned, homeless, crippled or displaced by war, all undeniably vulnerable and high risk children. Normal and pathological lines of development have been painstakingly described. To this day, the Anna Freud Hampstead Center treats, studies and documents the developmental pathways of children of new immigrants to London and those rendered vulnerable by other causes, as well as the more classical psychoanalytic cases.
In 1963, a prevention project was started in St. Louis at the Advisory Conference on Research and Child Analysis. No research grant forthcoming, the project floundered. While then there was criticism of the term “prevention” because it carried with it the presumption that psychoanalysis could prevent mental illness, now it is commonly accepted that our findings have potential for preventative programs. In numerous psychoanalytic institutes both research and preventative programs abound with concurrent development of psychoanalytic theory and practice. Two examples are the Chicago Institute's Barr-Harris Parent Loss Center and Southern California Psychoanalytic Institute's Sexual Abuse Studies.
In 1968, Dr. Pavenstedt initiated a project on normal early child development with emphasis on the first three years of life.
In 1972, at the Dallas meeting of the American, the vulnerable child appeared on the program as an official discussion group under the sponsorship of the Committee on Social Issues. The original term, “disadvantaged child”, has evolved to “vulnerable and high risk child” to reflect the clearer understanding that the child is affected by the combination of risk related to external circumstances, and vulnerability determined by genetic and perinatal factors.
Over the years our discussion group has studied psychoanalytic aspects of many subjects, including children of divorce, foster children, sexually and physically abused children, sadomasochism in children, the special needs of blind children, and the development of narcissism.
Our research efforts have had the valuable support of many adult and child psychoanalysts. To name a few, E. James Anthony, Albert Solnit, Eleanor Galenson, Paulina Kernberg, Judith Kestenberg, Sally Provence, Kato van Leeuven, Anna Ornstein and Helen Beiser, all helped us to clarify thorny analytic theory; Brandt Steele and J. Alexis Burland reported and contributed insight into troubling subjects, such as, children who murder their parents and the vicissitudes of maternal deprivation. Theoreticians reflecting new and creative methods of observing child development such as followers of the theories of Kohut, have made valuable and welcome contributions. Raymond Raskin, the present chairman of the Committee on Social Issues (as well as past chairman of that committee), has given his resounding and welcome support to our sometimes controversial attempts to provide bridges between separation-individuation theory and the sense of self.
Finally, Anna Freuds's work, distilled through the expertise of Hansi Kennedy, has been a real spur to our examination of analytic treatment of children of psychotic parents, and to how a handicapped or chronically ill child affects siblings. Summaries of our proceedings which are carefully prepared by M. Hossein Etezady, following each meeting, have frequently been published in the Bulletin of the Southern California Psychoanalytic Institute and Society, edited by Sydney Lawrence Pomer and the Journal of Preventive Psychiatry, edited by Gilbert Kliman.
There are strong indications of a growing concern among psychoanalysts about the special ramifications for psychic structure among vulnerable and high risk children. Intertwined with expectable psychosexual pathways, these children often present severe disruption in the stability and efficiency of their ultimate mental equipment, their self-esteem, and their ability to relate to other people. The vulnerable and high risk child is more prone to suffer from developmental interruptions than from neurosis. A child entering the Oedipal phase handicapped by developmental problems is unlikely to cope adequately with the psychological stresses characteristic of that phase, so Oedipal neurotic
symptomotology is frequent and sometimes severe; however, as neurotic disturbance is more a by-product than the central core problem, therapeutic measures directed exclusively at resolving the neurotic conflict, even if effective, leave unmodified the significant underlying ego structural problems.
Anna Freud has said that analysis has a varied palette of techniques based on psychoanalytic knowledge, useful to understanding and supplying what the individual child needs; that the study of infantile urges, drives and development has been added to what we know from reconstruction; that applied child psychoanalytic work is of primary importance, a source of valuable insight and unsuspected findings in the course of developmental progression from immaturity to maturity.
The Vulnerable Child Discussion Group is dedicated to these insights. Throughout its evolution our discussion group and subsequent panels have focused on the psychoanalytic perspective of the ego, its strengths and weaknesses, and ways that analysts can promote growth of flexible, integrating, adaptive structures in the vulnerable child.
This year we have two meetings planned on the development of narcissism, a subject of great importance in the analysis of high risk and highly vulnerable children. As well, a panel on sexual abuse, December 21, 1986, put out work in a stormy area for analysts, but may help us with patient transferences and distortions.
As a by-product, twice a year we prepare a report on current developments in child analysis and child service available nationally, particularly those applicable to vulnerable children. This report, made initially to the Committee on Social Issues, is widely circulated and can be obtained by writing to this reporter. Since we are also a part of the program of the Association for Child Psychoanalysis and meet also as a part of the gatherings of the World Association for Infant Psychiatry and the International Association of Child Psychiatry, we sometimes have as many as four meetings a year, often with a continuing core of participants, so that there is a beneficial progression of understanding of the subject.
We believe that this active, thriving collaborative effort is of historical interest reflecting a continuing need in psychoanalysis.