Flexibility in the treatment situation, the need to negotiate with parents, the directness of children, the visibility of emotional conflicts not yet buried under layers of displacements and disguises: these are the recurrent themes in observations on child analysis submitted by Dr. Lester H. Friedman, Mrs. Kerry Kelly Novick and Dr. Jack Novick, and Dr. Martin A. Silverman.
Reflecting on nearly twenty-five years in practice, Dr. Lester Friedman comments that his child patients have enabled him to better understand the childhoods of his adult patients. “From my firsthand experience with young children in analysis I was more fully able to appreciate as clearly a well defended adult woman attempting to enact one aspect of an intense sadomasochistic love relationship that she had with her father. My work with young children enabled me to realize that she must have had a very intense positive love relationship with her father. I could recall the intensity of the transference with a young girl patient and this was extremely helpful in appreciating the complexity of the adult woman's early childhood. I could see how her current behavior in the transference was largely the result of a regression to the anal-sadistic phase. The intense transference resistance of one girl, which was marked by silence and reading, appeared in her analysis to ward off the disappointment she experienced in the face of her powerful libidinal transference. As a result of this child analytic experience I could more clearly recognize the often subtle shifts in my adult patients who reacted to their unspoken and warded-off libidinal transference with a regression to an earlier libidinal phase and ego functions. On occasion a child has manifestly expressed a predominantly negative transference through the course of a successful analysis. This seemingly negative transference in one young girl served to defend against a love for her father. This appeared perhaps most clearly when once during her analysis I had to miss a week abruptly without the usual advance notice. When her father asked aloud, “I wonder why Dr. Friedman had to miss a week,” she responded by saying, “Maybe his wife died.” An adult patient who maintains for a long time a predominantly negative transference is often warding off an unacceptable positive or negative oedipal transference.
“On occasion an adult patient will, in the “heat of the transference,” express starkly his or her sexual lust. A man once said, “Screw me,” and at another time a woman said, “You rejected me,” or “Let's fly off and get married.” These powerful longings expressed a libidinal wish and served as a defense. My work with children has enabled me to understand that the expression of such longings in such a stark, blunt way is a revival of wishes from the prelatency period of childhood, and a result of the ego's relative incapacity to control and moderate the drive derivatives (Scharfman, 1978).
“Child analytic work has helped me to understand how parents' conflicts affect their children. Recently a young woman who felt anxious said she wanted to “have fifty men.” She had told me how in mid-latency her father had left for a few days, saying he might not return. I noted how depressed, scared, and guilty she must have felt then. She now wanted to have a different man every night and then reject him to gain revenge on her father, who she felt had rejected her. This readily led to her recalling the hurt and rejection she felt from her mother, who blamed the patient for her father leaving. In her mind her mother cared more about her father than about her. We could now understand her need for a woman to encourage her. This soon led to her reviving the way she felt as a young girl, namely that her father belonged to her, and then how devastated she felt when he sent her off to school at age four and in effect told her “to get lost.” What enabled this complex to emerge with such intense affect was my sensitivity to her sense of rejection in the paternal transference. Because of my increased insight gained from my years of experience as a child analyst, her affects of early childhood, latency, and adolescence have been revived more fully and with a mutative effect.
“Another aspect of child analysis is the increased necessity to acknowledge and work with one's countertransference. I say ‘increased necessity’ because children often evoke more powerful reactions with a suddenness that is not commonplace in adult analysis. This experience of first acknowledging and then analyzing one's countertransference is of utmost
importance in successful analytic work with adults, as Ted Jacobs has taught us.”
Kerry Kelly Novick and Dr. Jack Novick of the Michigan Psychoanalytic Institute relate their experience with first year candidates who assumed child analysis would be vastly different from work with adults. “In our clinical work with children and adolescents, we identified three features which seemed particularly salient. First, there is in child analysis no ‘standard technique.’ Each case, each day demands invention and flexibility. In the course of one week, a nine-year-old girl talked about wanting to stop her treatment, lay on the couch and discussed her displacement of anger from her father to her analyst, snuggled with her teddy bear in the chair, lay on the floor doing aerobic stretches, ‘accidently’ kicking the analyst, and ended the week playing cards with talk about her wish for a twin.
“Second is the unavoidability of intense counterreactions and the usefulness of understanding them in the service of the analysis. Instead of experiencing our feelings as interferences or obstacles, we have to learn to use them as part of the process.
“The third important feature is the narcissistic sensitivity of children, parents and analysts in the course of the work. When children want to hurt your feelings, they rarely hesitate. Equally, their immediate reactions help the analyst to learn to be sensitive and tactful. Parents come to a child analyst at a time of extreme vulnerability. Our experience has made us feel that separate diagnostic categories and different theories and techniques to deal with narcissistic issues are not necessary.
“Experience in child analysis alerts the analyst of adults to the operation of the parenting function in adult patients, which may often be sequestered outside the analysis as the repository of perverse pathology. A six-year-old boy suffered from night terrors, annihilation anxieties and preoccupation with death. It emerged in work with his parents that they did not provide ordinary protection for the child, for instance, that no one wore seat belts regularly in the car. These issues had never been brought into their analyses, but this area of inadequate parental functioning represented the operation of a sadistic perversion.”
Dr. Martin Silverman reminisces about the choices he had available for the final year of his residency in psychiatry at the University of Rochester Medical Center. Deciding to embark on a child psychiatry fellowship, he found the child psychiatry supervisors, all child
analysts, to be excellent. He simultaneously attended excellent didactic courses and research seminars with George Engel and Sandor Feldman. “To my unexpected delight I found that I was entering a domain that was at least as fascinating as that of adult psychiatry, if not more so. After a stint as an army psychiatrist, I returned to New York, where I underwent a second year of child psychiatry fellowship and enterd the psychoanalytic training which had been my principal goal since early in medical school. Now convinced of its importance I added child analytic training.
“Children are still close to and more often than not still in the midst of the genesis of their neurotic conflicts when they are brought to a psychoanalyst. They tend to present their concerns, their struggles, and their efforts at effecting a solution with an urgency and directness that is rather different from their adult counterparts. Usually there is nowhere near the degree of displacement, disguise, filtering and layering that has to be painstakingly peeled away and excavated through in psychoanalytic work with adults.
“A grown man enters analysis unhappy in his relationships with women and inexplicably failing to progress in his work. Through the analysis of manifold, layered resistances and the subtlest of transference-countertransference enactments, the analyst is able eventually to help the patient reconstruct a group of traumatic events early in his childhood.
“How dramatically different is the analysis of a six-year old boy whose behavior, at first understandably affected by his mother's early divorce, grew very much worse after the recent birth of a child to his mother and her new husband. Here, rather than subtle expressions of complex derivatives of the internal reverberations of events from the long buried past is the prompt, efflorescent emergence of what in the adult patient had to be slowly and carefully chipped and tapped out of the rock as a paleontologist might uncover minute fossil traces that enable him to make an educated guess about past occurrences.
“The little boy launches immediately into excited and nervously restless misbehavior that has to be controlled. He then shifts promptly into a wildly competitive baseball game. He uses a big dinosaur as a baseball bat with which he can propel a little dinosaur “pitched” his way as far as he possibly can across the room. When this behavior is interpreted as an expression of his feelings about the arrival of a baby sister, he shifts his interest to hide-and-seek games in which he excitedly desires to include his mother. On the two or three occasions when she agrees to participate in this for part of a session, he makes it clear that his beaming, child's delight is to set things up so that he and his mother can huddle together in a hiding place difficult for me to find. When, two years later, his mother again becomes pregnant, he organizes us once again into competitive ball games in which he is impelled to outdo me and to obtain my help in besting him as a ballplayer. Behind this, we soon discover, is the wish, increasingly clearly expressed but now under sufficient control, to smash my ‘balls.’
“Between these episodes, we play out and analyze the tangled, ambivalent feelings within my young patient related to the loss of his first father and to his hopes and dreams—humiliatingly impossible to realize—of replacing him in his mother's affections and in her life. They also, like a time machine, project us back to the early years, to guilty wishes and fears of being castrated and turned into a female. These we come to understand have served unconsciously to punish him for, in his fantasies, causing the divorce and fantastically are supposed to enable him to compete with his father's new wife, his mother's baby girl, and with his mother so that he might make a more secure place in his stepfather's heart than he was able to make in the heart of his real father. He has had to misbehave, in fact, to prove he is not a girl.
“Not all psychoanalysts are comfortable working with children. In many instances it is a matter of preference for the comfort that affords to the analyst from all the filtering, layering and distancing mechanisms which the adult has built up by the time he or she has gotton to the analyst's office. The use of the couch, daily sessions, regularity of schedule, precise starting and ending times, analytic anonymity, and relative silence and nonparticipation on the analyst's part are useful in promoting withdrawal of attention from the outer world to the inner world, temporal and topographic regression, and loosening of inhibitions against self-revelation. They also serve, however, to protect the analyst working with an adult from more than indirect or much-removed contact with the excitement and agitations, the powerful hungers and longings, the inopportune and frightening maddeningly sexual urges and wishes, the devastating disappointments, the terrifying rages, and the scourging feeling of shame and guilt in head-on confrontation with which the analyst working with a child is repeatedly drawn.
“Child analysis strips away, or at least greatly lessens, the opportunities available to the analyst to obtain distance from the patient's and therefore one's own emotional intensities. One does not sit comfortably behind the patient out of view and in command. One does not quietly remove oneself behind a mask of inscrutability. One is not protected from the intrusion of the actual world; family members move in and out, on and off the analytic stage.”
Child analysis enriches and facilitates one's work with adult patients in innumerable ways. It demands physical and mental ingenuity and considerable emotional resilience on the part of the analyst, but it is very rewarding.