Buried on page 9 inside the Child Analysts and Child Psychoanalysis report derived from the 1993 Survey of Psychoanalytic Practice, Lee and Rima Brauer reported the following striking finding: “Two hundred sixty-six respondents to the survey were graduates of child [analytic] programs and comprise seventeen percent of the respondents who were active members.
“The majority of child graduates, 135 graduates of child programs, have no child patients currently in analysis.”
An analyst who has completed training in child analysis is a graduate of a child analytic program. They tend to have either small child analytic practices or none at all. However, as a group, the child analysts were successful analysts.
They had larger total analytic practices than non-child analysts. Most (63%) were also training analysts. The child analysts were more satisfied with their careers and more strongly identified with psychoanalysis than the non-child analysts. It might seem than the child analysts were successful despite the fact that the field of child analysis is not thriving from the viewpoint of the size of clinical practice. Let's look more closely at both child analysis and the child analysts and try to make some sense of these findings.
Two hundred sixty-six child analysts answered the survey. The mean number of child cases seen in analysis was 1.05. The distribution of cases is shown on graph 1 below, which shows more child analysts treat no cases than any other number of cases. In fact, more than half (135 of 266) of the analysts treat no cases!
Most affiliate members in child training have no child cases in analysis, and the mean number of child analytic cases for affiliates is 0.75. There was little statistically significant variation among all the societies in regard to child analysis! One larger society, with fifteen respondents, had a mean child analytic practice of 1.8, which exceeds the mean for all societies, 1.1. Statistically, this does exceed the incidence of child cases seen in several other societies. This society might warrant, with its consent, further study to see what it does to promulgate practice. Child patients are most commonly seen four times a week, but 29% are seen three times a week, the same percentage as adults seen at this frequency.
Although child analytic practices tend to be small or nonexistent for many child analysts, child analysts are an active and productive group in our membership.
Child analytic training is undertaken by approximately a quarter of the membership of The American. Over three quarters of those who graduate child programs are certified in child analysis. Women are one and a half times as likely to undertake child training as men. There are strong associations between being a child analyst and being a training analyst. Over one-third of the training analysts are also certified child analysts and almost two thirds (63%) of child analysts are training analysts.
Child analysts see 3.5 to 5 children a week in therapy and spend about a third of their clinical time with children. Child analysts are very strongly identified with the profession. Those who are also training analysts have patterns of identification and satisfaction similar to those of adult training analysts, while those who are not training analysts have identifications and satisfactions above those who are neither child analysts nor training analysts, but lower than training analysts. Completed child training is associated with higher income for both training and nontraining analysts, and is more significant for those who are nontraining analysts.
The crisis in child analysis is due to the small child analytic practices of child analysts. One might extrapolate and easily realize that there are under five hundred children in analysis in America with child analysts trained by The American. Given the small size of the child analytic practice, it cannot be expected to affect the lives of many as a direct result of service. One also questions the maintenance of skill and motivation in a field where the most child analysts treat no child analytic patients.
Yet there seem to be clear advantages to the analyst in becoming a child analyst. His work is much more informed by the developmental perspective, and the career path is likely to include becoming a training analyst.
General analytic practice is increased. It may be that the broad and varied background facilitates working with initial resistance and the recommendation for analysis. When the analyst superimposes
child clinical work on the child observational work, the theoretic and didactic class work and personal analysis on the work of adult analyses, he brings a tolerance, neutrality (in the interpretive sense), and wealth of intellectual and analytic experience to the analytic task at hand. He more keenly observes the broad developmental sweep as it interdigitates with theory and technique.
Why are so few children being treated by psychoanalysis? Although geography, social and economic factors exert their force, the disparity in levels of child practice within given cities suggest that attitudinal factors influence practice as well. These factors cannot be teased out in this questionnaire data, and will take careful thought, reflection, and investigation by other means to arrive at more conclusive answers.