Academic journal article The Psychoanalytical Study of the Child

What Child Analysis Can Teach Us about Psychoanalytic Technique

Academic journal article The Psychoanalytical Study of the Child

What Child Analysis Can Teach Us about Psychoanalytic Technique

Article excerpt

my child analytic patients have insisted i listen to their ideas about how they need to communicate the pain that brings them to treatment. They do this by letting me know how we are going to interact, how our play and talk needs to evolve. If I fail to recognize what they have in mind, they are surprisingly forgiving and return to their unconscious plan. They have said things like "Stop talking and play; watch and you will learn." One child asked "How many children do you have?" When I asked what he thought, he said, "Dr. A., don't you know how many children you have?" Perhaps their youth, their developmental energy, and their being less bound by conventions of social interaction and expectations of therapeutic process make them freer. They point out when conventional approaches are not useful. Children seem to have an innate developmentally driven sense of analytic process (Klein, 1932, 1961). A five-year-old boy at the beginning of analysis cut out a drawing of a good boy and bad boy. He wanted to throw out the bad boy, but I wondered if we could keep it in his folder. Three years later when finishing up, he found the bad boy and the good boy and stapled them together. But I think our adults may know as much about the process as he did. Perhaps if I were more skillful with my adult patients, I would not need my child patients to clarify technical issues.

I am going to tell you about the treatment of a boy who first came to see me at age nine and how he made me think about technique. Of course, there is no technique separate from the uniqueness of each therapeutic experience.

Sam was referred because he was deeply unhappy and had severe temper tantrums. He picked up large pieces of furniture and hurled them around. He was frightened to be alone, was indecisive, and perfectionistic. If the family went for ice cream, when asked what flavor he would like he would stand for hours trying to decide. He always wore sweatpants and a sweatshirt with the hood pulled up over his head so you could hardly see him. In school he would erase his work over and over until there were holes in the paper. He had frequent nightmares that kept him and the family up at night. He was quite bright and did well in school but was anxious and without confidence. At school kids picked on him and sometimes locked him screaming in his locker. He was particularly interested in science, and his favorite activity was to go to the science museum. Sam has one sibling, a brother four years older who had demanding educational needs that took a great deal of time and energy in the family. His brother was unhappy and angry and would boss Sam around and hit him. The parents' impression was that Sam resented all the attention his older brother required, but Sam didn't say so directly.

Sam's parents were both in their early forties. His father was a mathematics professor who specialized in complex problems of probability. He acknowledged that he was on the obsessional side and was good at weighing all the possibilities. He was nurturing and attentive with Sam and his brother. Sam's mother was an art historian who took the boys hiking, camping, and fishing. She struggled with periods of anxiety, de- pression, and angry outbursts. During Sam's treatment it became clear that these outbursts were overwhelming for him.

The summer before Sam came to see me he had a bicycle accident, fell, and broke his jaw. He had to have his jaw wired in the operating room. Sam's development had been normal, and he had no other hospitalizations or major injuries. Because of his brother's learning problems, Sam had extensive testing and no difficulties were found. He and his parents were eager to undertake a more intensive treatment involving four-times-a-week sessions. They described how his problems were extremely disruptive for the family. They weren't sleeping. They couldn't go anywhere because he would have tantrums or become paralyzed with indecision. They talked about how hard they tried to help Sam, tried to be caring and sympathetic, but were infuriated with him most of the time. …

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