The Anna Freud Center, once the Hampstead Child Therapy Course and Clinic, was established in 1947. Today the work of its eponymous founder continues as the basis for new initiatives.
Over a thirty-year period Anna Freud developed a technique of child analysis that became the transatlantic standard for this form of treatment. In addition to the influence of her writings, she exerted a strong personal influence over child care, as young clinicians from child mental health centers worldwide came to train with her in London and returned home to develop psychotherapeutic services based on the Hampstead model.
Today the Center has thirty full-time or part-time psychiatrists, psychologists, social workers, and child analysts on staff, as well as nine part-time clinical associates. In addition, it has three trained nursery teachers, a pediatrician, and an administrative staff of fifteen. The Center provides approximately ten thousand hours of treatment and consultation each year, and has more children in full analytic treatment than probably any other institution in the world. The Center also provides clinical consultation to families with special disadvantages—immigrant families, parents of deaf or blind children, and parents whose severe psychological disturbance puts the mental health of their children at risk. The advisory service includes a Well Baby Clinic and a Mother and Toddler Group. The Center's nursery school takes children between thirty months and five years of age. It has a high staff-child ratio and operates for the benefit of children from disadvantaged homes and children who are physically handicapped.
The Centers primary mission continues to be the provision of four to five times weekly psychoanalysis to children with severe psychiatric or developmental disorders, with a view to reducing the need for intervention later on. The Center has come to recognize that even less intensive therapy can be effective in containing a child's symptoms, preventing hospitalization or placement away from home, and maximizing the success of care and support within the family. However, clinical experience and cumulative data suggest that intensive treatment, particularly when offered before adolescence, has the potential for reversing pathological development. The Center's strategy for implementing its mission is to seek statutory reimbursement for nonintensive treatment, and to use voluntary contributions and its endowment to underwrite the additional cost of intensive care. This strategy is the only one viable in the absence of compelling evidence for the long-term cost-effectiveness of intensive treatment. At present, the Center's research is focused on collecting such evidence.
Psychoanalytic clinical work at the Anna Freud Center combines conflict-oriented interpretive treatment with “developmental help” based on the model of child psychopathology originally outlined by Anna Freud. The model assumes that emotional disorders in childhood arise in consequence of the arrest or distortion of one or more lines of normal development (emotional or cognitive processes, for instance). Such deviations may cause the child to develop maladaptive solutions that are viewed as risk factors for adult neurotic disorders.
It is not easy to distinguish analysis in the classical sense from the developmental help practiced by psychoanalysts at the Center. The interventions covered by the latter term pertain to pathologies traditionally defined as residing in the ego and thought to relate to the deviant development of ego functions and self- and object representations. Developmental help includes those aspects of the analyst's interaction with the child which (a) address ego functions (mental processes) via self- and object representations; (b) verbalize internal states and differentiation of affects; (c) break down unmanageable affects (anxiety) into smaller, more manageable entities the child can master; (d) develop internal representations of affects so that the child can master his or her feelings; (e) facilitate thinking by reducing anxiety and making links between different aspects of thought process; (f) facilitate the determination of cause and effect within an interpersonal context; (g) help the child separate internal from external, real from unreal, fantasy from reality; (h) set limits and explain them; (i) facilitate the creation of internal representations of self and other; (j) establish reciprocity (of giving and taking); (k) develop frustration tolerance and the capacity to delay gratification; (l) help to develop an “as if” attitude, the suspension of reality, and to encourage fantasy; (m) gradually confront the child with opposing ideas.
Under Anna Freud's guidance the Center developed a systematic approach to the collection of child analytic data. Material contained in the weekly written reports of therapists was subjected at regular intervals to a detailed categorization called indexing. The procedures for indexing a case, together with relevant categories and definitions, were outlined by Joseph Sandler in various of his works. After years of indexing work, over three thousand entries pertaining to the section on Treatment Situation and Technique were reviewed by three senior clinicians working with Anna Freud. A book summarizing this work described the essential features of the treatment technique of the Hampstead Clinic. The technique as now practiced has been further elaborated in A Manual of Psychodynamic Developmental Therapy for Children.
In addition to its prospective outcome studies of child analyses, the Center has recently completed a major retrospective study, in collaboration with the Yale University Child Center headed by Donald Cohen, of 763 cases treated in intensive or nonintensive therapy. The major findings of this study, currently being prepared for publication, indicate that child analysis is particularly effective with seriously disturbed children under twelve years of age, especially those suffering psychiatric disorders involving anxiety.
The Center has not abandoned its commitment to developmental studies. Much recent work has focused on the nature of mental representations of self and objects, and of object relationships. In collaboration with the MacArthur network, headed by Robert Emde, the Center has studied the impact of the parents' own childhood experiences on the child's developing relationship with them; the representations of these relationships in the child's mind; and changes in these representations during the course of analytic treatment. Another area of interest at the Center is distortions of mental representation occasioned by the experience of childhood abuse or neglect. This interest has been reinforced by leading experts in the field of developmental disorders and childhood maltreatment who have come over from the Tavistock Clinic to join the Center's staff.
In 1993 the Center became affiliated with the Department of Psychology, University College, London. The department, currently the largest in the UK, is also extremely strong in terms of research output, having been awarded the highest rating possible in a recent national peer review of university research. Making use of its new academic ties, the Center now offers a master's degree and has started a doctoral program linked to the Psychoanalysis Unit of the department. Five of the Center's staff are currently tenured faculty at the university.
Plans for the Center include expansion of its intensive treatment service and early intervention parent counseling program. The Center's diagnostic services are now available to statutory services in the UK, and plans are under way to include in the educational program a therapeutic
primary school facility for seriously disturbed children unable to cope with normal education.
In these projects and its other work, the Center continues its commitment to the work begun by Anna Freud. Applying and developing psychoanalytic principles in the care and treatment of children, the Center seeks also to influence government policy in the areas of health and education.