In consolidating a psychoanalytic identity, there is a pleasure in being an analyst; in seeing psychoanalytic patients, whether adult, adolescent, or child; in gaining theoretical knowledge and clinical confidence. I have found that training in child and adolescent analysis, in addition to adult training, has made my professional experience considerably richer and more challenging. Candidates in adult analytic training may wish to do the same. It keeps you young.
There are different ways to become an analyst now. I first trained as a child psychoanalyst in Cleveland. I have completed my adult training at the Cleveland Psychoanalytic Institute, fulfilling the requirements for an institute graduation in child/adolescent psychoanalysis as well. Thus I can be certified in child/adolescent analysis and adult analysis. This will allow me to be a part of the training of the next generation of analysts through the institute, should I wish to do so, while being an active APsaA member and a member of the International Psychoanalytical Association. Ill approach such participation with a depth of experience that comes from a vantage point of having trained broadly and with many years of a clinical analytic practice.
Seeing patients of all ages in analysis makes for an interesting work day. I pick up on the transference feeling of a five-year-old boy when a block structure he has been building topples to the floor.
“Why you make me do it?” It is a simple, direct question, which he asks repeatedly when his structure topples. “Why you make me do it?”
It feels like I'm being accused, and because of my countertransference feelings, I wonder if he is enacting his paranoid father's point of view. I begin to formulate how I will interpret his identification with this man who no longer sees him.
A six-year-old girl is referred to me for anxiety. In the course of a careful evaluation, I first see the parents together, then the mother alone for several sessions, before I see the daughter. In taking the history, I hear about the mother's twenty years of phobic and obsessive difficulties and her current attempt to manage these with medication. She doesn't want her daughter treated with drugs.
As I begin working with this child, the question in my mind is, “Whose anxiety are we dealing with, the child's or her mother's?” I think of how my adult patients communicate anxiety to their children and how children communicate anxiety to their parents.
In one of this child's sessions, just before the end of the hour, she takes magic markers and colors her fingers instead of the paper. I wonder with her what has happened. She says to me, “My hands are out of control. I can't stop them!”
“So there we have it,” I thought to myself, “a masturbation conflict before my very eyes, in the transference connected with a 'leaving feeling.”
Doing intake for our institute's analytic clinic, the Katan Center, I get a call from the mother of a thirty-seven-year-old man. He has asked his mother to call for him, telling her, “I'm not feeling so well.” I ask her to have the son call me, and he does. When I see him, I learn that since high school he has been living in the basement of his parents' home, sleeping days and working nights in his own computer business. He is on the verge of becoming financially independent, which would mean that he could move out on his own. This frightens him. He both wishes to and wishes not to do this. He is feeling suicidal, as he has been for many years.
We begin a dialogue. He has been unable to go places since age twelve, when a younger sibling died of melanoma. He graduated from college with honors, without ever speaking in any class. I think of a selectively mute seven-year-old I currently have in analysis and realize what I have in this instance is a selectively mute adult! He has what feels (to both patient and analyst) like a rigidly held fixed idea that the death of his brother is his fault because his gerbil bit the brother before he got sick.
From the beginning of my analytic career, the scene was set for doing analysis at both ends of the generational spectrum, though my initial interest was primarily in children. When I was a child analytic candidate at the Cleveland Center for Research (the American version of Anna Freud's Hampstead Clinic), in 1967–72, psychiatrist Anny Katan, its founder, would invite all Cleveland child analysts to her home for Monday evening clinical case conferences.
Medical and non-medical, child and adult analysts, we would hear a child analytic case for fifty minutes. We'd break for chocolates and coffee in demitasse cups, then discuss the case together for another forty minutes. To gain admittance to this conference, you had to have a child or adolescent in analysis.
If a question was raised how a child with a particular difficulty might look as an adult, an analyst of adults might bring a clinical example from his practice. There was an exchange of ideas, mutual respect, and enthusiasm for analysis as we assembled in “Dr. Anny's” living room (it held thirty people!), year after year, from September to June. This makes for a rich background.
Since graduating from the institute in adult analysis, I have received many more referrals of child and adolescent cases from my colleagues. I wonder with these colleagues: Why these referrals now? I am told a fully trained analyst who can evaluate and treat children, teens, and adults is hard to find.
Having child training helps me treat the child in the adult. I am approached by out-of-town analysts to see if I might be interested in relocating because of my child analytic training. Being an analyst connected with a therapeutic nursery school for many years helps as well; so does teaching infant observation, with a pediatrician colleague, to adult and child analytic candidates. Referrals come from those I have had contact with, pediatricians, child analysts, adult analysts, the therapeutic nursery school, etc.
Joanne Naegele, M.A., L.P.C.C., is program chair of the Cleveland Psychoanalytic Society. She is on the faculty of the Cleveland Psychoanalytic Institute and the Cleveland Center for Research in Child Development.