May I repeat the well-known? Child psychoanalysis is facing very serious challenges. Fewer families are seeking psychoanalysis for their children. Many potential candidates choose to not pursue training because they are concerned that they will have little opportunity to practice child analysis.
Lest the lamentations become excessive, we should remember that the halcyon days of child psychoanalysis were not that golden. Nationwide and worldwide, there has never been a great number of children in analysis. We should also remember there are many bright spots even in the current dark days for child analysis. Some child analytic programs are flourishing, others are reviving, and still others are being developed. Our Committee on Child and Adolescent Analysis, under the leadership of Sam Rubin (who has passed the leadership of the committee to Ruth Karush), has creatively and diligently facilitated the development and continued excellence of our programs. The committee's work has been deeply enriched by the questions and suggestions developed by the Ad Hoc Task Force on Child Analysis, chaired by Marty Silverman.
Nevertheless, in this time of general concern about the future of psychoanalysis, there is cause for special concern about the future of child psychoanalysis. How can we explain the current state of affairs? Are there potential remedies in addition to those in place?
Child psychoanalysis has always been a difficult sell. Child psychoanalysts have long been aware of the complex resistances that parents bring to the psychoanalytic setting. Perhaps the most specialized skill of the child psychoanalyst is her or his ability to work with parents' resistances to beginning and continuing their child's analysis. Familiar cultural shifts have objectified children, dismissing the role of development and internal experience. Parents tend to reduce children's behavior to issues of genetics, temperament or, at best, trauma. With symptoms so conceptualized, medications and behavioral strategies are the logical therapeutic responses. Also, parents have less time and energy to support the logistics of psychoanalysis; psychoanalyses are particularly difficult for families when both parents work outside the home. Insurance support for child psychoanalysis is perhaps even less available than for adult psychoanalysis. These cultural perspectives and realistic impediments have reinforced the ubiquitous resistance of parents, leading to a potentially lethal combination.
Parents have not been the only ones to whom it has been difficult to sell child psychoanalysis. Psychoanalysts themselves are threatened by the raw emotional life of children. This resistance has often manifested as a tendency to view child psychoanalysis as “derivative” or “applied” psychoanalysis. Another manifestation of this resistance is the rarity in many communities with which adult psychoanalytic colleagues make referrals to child psychoanalysts.
If only the resistance among analysts were confined to adult analysts! Child analysts have also earned their place on the list. How many child analysts would respond to the question “What do you do?” with the answer, “I am a child analyst”? Most child analysts do not primarily organize their professional identity around analytic work with children. Many child psychoanalysts never achieve large practices in child analysis, and often they gradually shift to an essentially full-time practice with adults. Life for child analysts is complicated by the decreasing remuneration for child analytic work. There are more reasons that many child psychoanalysts cease treating children as the analysts grow older than just arthritic knees, as the time-worn joke has it.
Within the institutes of the American, the child psychoanalyst in training has for many years been expected to acquire experience in the analysis of adults before beginning child psychoanalytic training. Graduation in child psychoanalysis has required, and continues to require, prior or concomitant graduation in adult psychoanalysis. In recent years, there has been a shift toward integrated training, which has incorporated much of the child didactic curriculum into the general curriculum for all candidates. Many institutes have incorporated material on child psychoanalysis into clinical case seminars for all candidates. There is a trend toward allowing candidates in adult and child analysis to begin child analytic work earlier in their sequence of cases.
Do our historical reasons for asking that child analysts also be fully trained as adult analysts continue to make sense? What are the implications of such a training model? I believe that it is time to consider whether child analysis should be treated as a discipline for which one can be trained independently from or in coordination with the discipline of adult psychoanalysis.
There have been many rationales for dual training. One rationale for this approach is that the technique of child psychoanalysis derives from adult technique; therefore, one must first have mastery of the core adult technique. Related to this line of thinking has been the requirement to have experience with adults before beginning with children. Supervisors were concerned that candidates could not learn the more basic or model technique if they first learned a “modified” technique.
It is by now abundantly clear that the fields of adult and child analysis deal with concepts that have their own particular modes of manifestation in the two arenas. Each field deals with its own particularities and complexities. Although the continuity is evident, to see either child or adult analytic technique as primary is a kind of narrow privileging that, in my view, has no merit from a scientific or pedagogic standpoint. If I may be whimsical, why do we not argue that the technique of adult psychoanalysis requires grounding in child psychoanalytic technique? It has been my experience that child psychoanalysts are much more likely to discuss how their child psychoanalytic experience has enriched their adult work than vice versa!
In the past, there has been concern that some individuals who are only trained in child psychoanalysis would then conduct the analyses of adults. I do not know if this remains a concern. Our long experience has shown that those who have been trained in good-quality, free-standing child psychoanalytic programs, such as the Anna Freud Center or the Cleveland Center for Research and Child Development, have been responsible in this regard. If I may continue my whimsy, why have we not been so worried about adult psychoanalysts extending their range to adolescents (and even young children) as they sometimes do?
Another rationale for dual training has been that the child psychoanalyst must have a sufficient understanding of adult diagnoses and depth psychology to be able to navigate the shoals of parental resistance. This is true without question. However, what is the role of
adult psychoanalytic training in achieving these skills? What are the core experiences and education that will help a child analyst achieve this necessary capacity to work effectively with parents?
Although supervised experience with adult psychoanalytic cases will significantly deepen the capacity of a child psychoanalyst to work with parents, in my view it is not a necessary element in achieving this skill. The proficiency with which many of our non-psychoanalyst colleagues work with parents demonstrate this. The capacity to work effectively with parents requires an appropriately broad and deep, psychodynamically informed mental health background with adults. Particular focus upon the special issues of parenthood is an invaluable component to such training. Is it not time to clarify the range of prerequisite experiences that qualify a mental health professional for child psychoanalytic training, in much the same way that we have clarified these for psychoanalytic training in general (i.e., for adult training)?
There are many reasons to train child psychoanalysts independently, other than the basic fact that one can achieve excellence as a child analyst without the addition of arduous adult psychoanalytic training. This is an entirely different issue from one that I feel is incontrovertible: Dual training profoundly enriches and broadens the clinical work and scientific contributions of any psychoanalyst.
What might independent training in child psychoanalysis look like? It could occur within our institutes or even within free-standing child psychoanalytic training centers. There are the aforementioned models outside the administrative scope of the American or IPA from which to learn. Certainly, independent child psychoanalytic training should be as steeped in the tripartite model as is our training in adult psychoanalysis.
I would envision that the child analyst in training would need to master most if not all of the current curriculum in adult psychoanalysis. This degree of understanding of adult psychology would broaden the child analyst's understanding of a child's developmental trajectory and support the analyst's skills in working with parents. The current model of three child psychoanalytic cases might or might not provide sufficient experience when the cases were not supplemented with adult psychoanalytic experience. Optimally, a focus upon independent child training would help highlight the special issues for child training—including the need for our institutes to focus upon the development of skills for working with parents.
Independent child psychoanalytic training can be more focused upon the specific needs of the child psychoanalyst. After the rigors of adult training, we have perhaps been reluctant to require too much from our child candidates. We may have given them much more than they need of some things (on the adult side), and less of what they need of others (on the child side). Our current system may also discourage some potential future child psychoanalysts from becoming candidates.
If we develop a cadre of psychoanalysts whose primary identification is as child psychoanalysts, we will have developed analysts who, as a group, may be more likely to practice and develop the field than are those who are dual-trained. Are not analysts whose primary identity is as child psychoanalysts — whether trained in child analysis only or dual-trained — more likely to carry the messages about child psychoanalysis into the community through various outreach activities, to think and write about child analysis, and to want to teach it? Might not those individuals be the ones who, at least collectively, will ultimately speak most clearly and strongly for child psychoanalysis?
(Erna Furman's lucid discussion of the issue of the acceptance of child psychoanalysis, when she received an Honorary Membership at the May Meeting of Members, stimulated me to write this column, for which I thank her.)