Donald Rosenblitt, in a 1999 TAP article, asked the question, “Who Speaks for Child Analysis?” He pointed out that child analysis is facing “very serious challenges,” with fewer families seeking child analysis for their children. A result of this trend is that fewer candidates are seeking child analytic training in many of our institutes.
What are we already doing to reverse this ominous trend, and what more can be done? The Committee on Child and Adolescent Psychoanalysis (COCAA), under the able leadership of Ruth Karush, continues its outstanding work in enabling the development of new child analytic programs in institutes that do not yet have child training available, and re-enabling those programs that have run into difficulty.
The child psychoanalytic training that is available in our institutes is of excellent quality. Add to that the outstanding contributions made to psychoanalytic theory and developmental theory by child analysts, as well as the very high degree of professional satisfaction reported by child analysts. Then why are so few children and candidates choosing child analysis as a treatment or as a profession?
We believe that many child analysts see their primary identity as psychoanalysts, not as child psychoanalysts. The trend toward integration of child and adult analysis is one we fully support. But does this model create people who move on to become training analysts, directors of institutes, and officers in our Association, and who then give up their primary identity as child psychoanalysts?
Around the country, many groups that are flourishing have one or two people who see themselves first as child and adolescent psychoanalysts. Often these people have a gift for “creating” child analytic cases and are able to make referrals to other graduate child psychoanalysts and child candidates.
How can we help foster this primary identification as child and adolescent analysts? COCAA vice chair Leon Hoffman has some thoughts about making the public more aware of what child analysts do and what they have to offer. Martin Silverman's Task Force on Child Analysis also made suggestions, some of which have already been implemented. In many institutes, candidates can treat a child or adolescent patient as their first case. In an integrated curriculum, all candidates are exposed to development courses taught by child analysts and to child analytic case material.
People who are interested in pursuing primarily a child analytic career now can be certified only in child and adolescent psychoanalysis by the Certification Committee. After a successful six-year experiment at the NYU Institute, all of our institutes are now able to train IPA graduates in child and adolescent analysis only.
Are these very significant changes enough to save child psychoanalysis? More might be necessary. Through its workshops, COCAA is now studying and discussing the possibility of either child- and adolescent-only training or a specialization in child/adolescent psychoanalysis without full adult immersion.
Some feel that this runs counter to the integrated approach. It seems quite possible to offer an integrated curriculum for adult candidates while training people in both adult and child analysis. Could we consider, on an experimental basis, some form of child/adolescent-only training?
This was discussed more fully at the COCAA workshop in New Orleans. If approved, one or more institutes could devise a program, implement it, and report back to COCAA and BOPS at our biannual meetings. If problems arise, the programs could be modified to include more adult work. While many child analysts do not feel it is necessary to have adult analytic training to work with parents, others feel that it is absolutely essential. Could this question be studied empirically?
Hoffman, in a recent letter to JAPA, asks us to consider why child psychoanalysis has been excluded from mainstream psychoanalytic discourse. He mentions Berta Bornstein's seminal paper on defense analysis, which convinced Anna Freud that a “preparatory phase” was no longer necessary. This resolved one of the conflicts between Anna Freud and Melanie Klein; it also shifted the technique of child analysis closer to that of adult analysis. Hoffman also raises the question of whether or not Bornstein's 1945 paper was an unacknowledged forerunner of Paul Gray's conceptualization of adult analysis.
We all want and need child analysis to survive and flourish. If this requires some form of child/adolescent-only training, we could try it on a limited basis and see how effective it is. Further collaboration with our child analytic colleagues in the Association for Child Psychoanalysis (ACP) would also prove beneficial.
At the time this article was written, Leon Hoffman, M.D., was acting secretary of BOPS and Calvern E. Narcisi, M.D., was acting chair of BOPS.