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The Transference Neurosis in Child Analysis
JUDITH FINGERT CHUSED, M.D.
Dr. Chused is a training and supervising analyst at the Washington
Psychoanalytic Institute, Washington, D.C. and an associate clinical professor of
psychiatry at George Washington University School of Medicine. She is in full-time
private practice.
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The developm ent of a transference neurosis, manifeste d by symptoms or the
intensification of characteristic, pathological modes of perception and interaction in
relation to the analyst, is, I believe, the sine qua non of psychoa nalysis. Although
every attemp t at analysis does not result in a transference neurosis (or an
analysis), when a full analytic process occurs, analysis of the transference neurosis
is a central element. Many analysts believe it to be the pivotal mutative experience
in adult analysis; this, however, is not the general opinion for child analysis. Until
recently, most child analysts in the United States (other than the followers of
Melanie Klein) saw the child as having a limited capacity to form and sustain a
transference neurosis. Though this perception of analysis with children is changing,
and a growing number of analysts today practice "adult- type" child analysis, there
remain many who believe children do not develop transfere nce manifestations and
transference neuroses as adults do, in either frequency, endurance, or depth. The
determinants of this belief lie both in the preconceptions and political struggles that
mark the history of child analysis and in certain characteristics of child analysis
itself.
I have not found intense transference manifestations developing around the
person of the analyst unusual in children; quite the contrary, without it I find there
is no analysis (though there may be very good psychother apy). However, if the
term "transference neurosis" is limited to the developme nt within the analytic
situation of a new neurosis, complete with a new set of symptom s, then I have to
agree that this is not a regular occurrence in the analysis of children (or adults).
This is the definition recomme nde d by Marjorie Harley (1971). But if "transference
neurosis" is broaden ed to include the intensification of pathological character traits
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and modes of relating within the analytic setting, with the gradual emergenc e of
regressive, incestuous fantasies, conflicts, and impulses experienced in relation to
and centered on the analyst, and with the intensity of affect and sense of reality
described by Bird (1972), then an analyzable transference neurosis can develop
almost as frequently with children as with adults. This definition of transference
neurosis is similar to that advanced by Sandler et al. (1975): "By transference
neurosis we mean the concentration of the child's conflicts, repressed infantile
wishes, fantasies, etc., on the person of the thera pist, with the relative diminution
of their manifestations elsewhere" (p. 427).
If the developm ent and utilization of a transferenc e neurosis can be an
integral part of child analysis, then when children fail to develop an analyzable
transference neurosis, we need to question why this is. After a child has developed
sufficient capacity to retain a memory of human interactions and to form an
internal mental represe nt ation of an object, he has the capacity for transference , to
"misperceive" an interaction with one person so that it "feels" the same as with
another. And when he has sufficient structural development to sustain
intersystemic conflicts (Panel, 1966), and the ego capacity to tolerate (even
minimally and only transiently) conflictual feelings, impulses, and fantasies, he can
develop a transferen ce neurosis. But whether the child develops a transference
neurosis, and if he does, how it is utilized for the work of analysis, will depend not
only on his level of development and his individual psychopathology, but also on
the theoretical position of the analyst. The analyst's theory and his expecta tions,
regardless of his neutrality, always influence his perceptions and his technique.
One consequen ce of the skepticism about transference neurosis in children is
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that it has led to a discrediting of conflict resolution as the major mutative element
in work with children. Although theoretical discussions support conflict resolution
as the core therapeutic agent in child analysis, clinical present ations often
emphasize other elements, such as the relationship with the analyst as a "real
object," as important for the therapeutic efficacy of the work. On occasion this has
obfuscated the distinction between child analysis and child psychotherapy, leading
analysts of adults to declare that "child analysis isn't really analysis."
Historically, child analysis began with Freud's analysis of Little Hans (1909)
conducted through the child's father. The report of this case opened up a world of
possibilities to analysts, who hoped that because children were in close tempor al
proximity to the origin of their neurotic conflicts, the conflicts would be available for
rapid resolution through the analytic method. However, analysts trained in working
with adults quickly found the work with children extre mely frustrating; Ferenczi
(1913) decided that "direct psycho- analytic investigation was therefore impossible,"
(p. 244) when his attempts with a 5-year- old boy failed because the child was bored
and wanted to get back to his toys. Analytic work with children soon became the
province of educators and pediatricians. From the start, therapists such as the
teacher Hug- Hellmuth (1921, 1924), Anna Freud (1927), and Dorothy Burlingham
(1932), whose work Hug- Hellmuth influenced, were sensitive to the unique
characteristics of the child and felt that the techniques and tools of child analysis
would have to be modified; specifically, that the relative abstinence and neutrality
utilized in adult analyses should be set aside as intolerable to children who would
neither participate in nor benefit from analysis under nongratifying conditions.
They also believed that since the child was still very attached to and quite
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depend ent on his original objects, his parents, there would be no transference or
transference neurosis formed around the person of the analyst. At this time the
differenc e between the psychic represe nt ation of the child's earlier relationship with
his parents and the external reality of his present relationship with them was not
yet elucidated; the relationship of the past and present were seen as the same, and
being currently active, as nontransferable. In addition, the awaren es s of the
developmental need for a positive attachm ent between mother and child led to a
belief among these early child analysts that if analytic work was to enable the child
to resum e progressive development, a similar type of positive attachme nt to the
analyst was essential.
The work of Melanie Klein and her colleagues, presente d in a panel in 1926
and reported in the International Journal of Psychoanalysis in 1927 reveals a very
different perception of child analysis. But until recently, their work has had little
influence on the majority of child analysts in the United States.
It was Anna Freud who had the dominant influence on child analysis in the
United States. Her beliefs, including that it was important for the child to want to
come to analysis, led child analysts to present themselves as benevolent providers,
with gifts, skills, or powers (even omnipotence) the child would value (A. Freud,
1927; Bornstein, 1949). It gradually becam e apparent that exuberan t benevolence
was not needed to ensure the child's participation in the analysis. But though the
seductions and gratifications that occurred in the early years of child analysis are
now no longer sanctioned, many analysts still believe it is important for them to be
perceived as a "benevolent object." This has lead to a self-perpetua ting prophecy
in child analysis: an analyst who believes the child cannot tolerate significant
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deprivation in analysis can justify the very gratification that interferes with the full
development of transference and a transference neurosis. Thus it is not surprising
that in a recent Panel (1983) on the reanalysis of child patients, those contributors
who held this belief found "A transference neurosis, which requires the ability to
contain an internal conflict, does not develop before the end of latency" (p. 684),
and that "the transference had not been analyzed" (p. 686).
By the 1950s and 1960s most analysts (Harley, 1986, p. 133) recognized that
children had transference reactions to the analyst and that these could be utilized
for interpret ations and clarifications much as in work with adults. Yet there was still
a general feeling that because of the immaturity of the child's psychic structure and
the continuing dependence on the parents, transference neurosis as such did not
occur with children; that since transfere nce manifestations were so fluid and of
such relatively short duration, they did not occupy the same central role in the
child's analysis as in the adult's. Only when case reports of fully developed
transference neuroses in children began to appear in the analytic literature (Kut,
1953; Fraiberg, 1966; Harley, 1967) did the concept gain more acceptance.
Anna Freud (1965) later modified her position, and her observation that a
transference neurosis can develop in children but does not equal the adult variety
in every respect (p. 36) is currently quoted or referred to in almost every article on
transference neurosis in children. The accuracy of her observations of children's
behavior in analysis (their inability to free associate, the preponderance of
aggressive transference reactions, the use of the analyst as a real object, and their
tendency to externalization of psychic structures onto the analyst) lends credence
to her conclusion that the transference neurosis is less significant in child analysis
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than adult analysis.
However, the factors which she described as limiting the developmen t of a
transference neurosis in child analysis are also found in adult analyses, and some
analysts (Bird, 1972) believe these are the very factors that constitute the
transference neurosis. I sense, instead, that the specific limiting factor to the
development of a transference neurosis in child analysis arises from the analyst and
the child patient automatically responding to each other as adult and child, falling
into customary roles of adult who educate s and/or directs, child who learns,
complies or rebels. This is similar to the problem Bird (1972) alludes to in adult
analyses when he said, "One of the most serious problems of analysis is the very
substan tial help which the patient receives directly from the analyst and the
analytic situation" (p. 285).
For example, with an intensification of transferenc e, not infrequently a child
will create bigger and bigger messes in the office, regressively trying to engage the
analyst in a reenactme nt of anal- phas e struggles (P. Tyson, 1978, p. 227). It is
extraordinarily difficult for the analyst to time his interventions so that the child
experiences the impulse but does not become so overwhelme d by the associated
affects that he loses the capacity to hear verbal interventions. Children move very
fast- -objects are broken, guilt escalates, and behavior gets out of control as the
attempt to elicit punishm ent intensifies. A conflict is repeated rather than
rememb er ed and verbalized. At this point there is a temptation for the analyst to
control the child's behavior and instruct (which often contains superego
injunctions). However, if the analyst can provide (and the child receive) the
structure necess ary to halt regression and support self- observing ego capacities, if
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he analyzes rather than educates, a new solution based on experience can be
forged. Enactm ent of a conflict, a common occurrence in child analysis, does not
always require the interruption of an analytic attitude in the analyst. Abstinence is
important not only in its effect on the patient; its effect on the analyst is to permit
him to becom e more an "analyzing" and less a "modifying" force.
Unintentionally Anna Freud's words (1965) have contributed to a prematur e
closure of the issue of transference neurosis in child analysis. Analysts have yet to
explore adequately: (1) What inhibits the full developmen t of transference and a
transference neurosis in child patients? (2) In which ways does this inhibition alter
the treatme nt? (3) How, if the development of a transference neurosis with child
patients is useful, might it be facilitated? Excellent papers have been written
(Sandler et al., 1975; Harley, 1986; R. L. & P. Tyson, 1986) in which transference
and the transfere nce neurosis in children are discuss ed. Unfortunat ely, they offer
little new underst an ding as to its infrequent appeara nc e, with Harley's doing just
the opposite: looking for something out of the ordinary in the child who does
develop a transferen ce neurosis.
In my experience, transference and transference neuroses are not
uncommon in the analysis of children, although they do differ in some respects
from their adult counterparts. In children, as in adults, oedipal conflicts are a
significant feature of the transference neurosis, with these conflicts reflecting not
only pathogenic experiences during the oedipal period but also organizing
pathology derived from earlier preoedipal phases. When the developm ental level of
the child's ego functions, including cognitive development, affect tolerance,
narcissistic vulnera bility, and maturity of defenses are taken into account, as well
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as the nature of the child's attachme nt to his current objects (R. L. & P. Tyson,
1986), a thoughtful analytic procedure, with strict attention to the analysis of
resistance and to countertran sference interferences, can lead to a full-blown
transference neurosis in the child patient.
I reache d this conclusion several years ago when I was analyzing,
concurrently, two girls, Sarah (11 years old) and Molly (10 years old), both of whom
had an intensely negative transference to me. During the many months when
exploration of the deter min ants of their negative feelings did little to alter their
behavior, I had ample time to examine our interactions. Three observations stand
out: (1) The negative transference from these children was much more unpleasant
than negative transference from adults- -they were hypersensitive to and openly
critical of my failings, and I, in turn, was sensitive to their comme nt s. (2) Even
though there was no evidence of any positive feeling from either child and both
spoke of wanting to quit the analysis, material continued to emerge that could be
beneficially utilized. (3) My initial respon se to their negative feelings was less
abstinent than with adults. Specifically, my atte mpts to educate them about
transference as a phenome no n were clearly defensive, as were some of my
interpretations, which in retrospect were intended to dissipate the transference
rather than understa nd it. In both cases, the patients picked up on my
defensiveness: one became frightened she had hurt me and went through a brief
period of "goodness" with some hypochondriacal obsessing during the sessions; the
other became more sullen and withdrawn, as if she experienced my defensiven ess
as coercive, which, I fear, it was unconsciously intended to be.
With adults one expects negative transfere nce reactions; their absence raises
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concern about defensive compliance, the possibility of a "good" patient who "loves"
analysis but derives no lasting benefit from it. Yet during training, most child
analysts are taught to maintain a positive therapeu tic alliance with the child
patient. They learn that though they should not gratify with the aim of suppressing
the child's hostile feelings, they must prevent deprivations which would arouse so
much negative affect that active participation in the analytic work ceases (Sandler
et al., 1980).
I was powerless to alter, through any chang e in my deme anor, Molly's and
Sarah's dislike and distrust of me, their perception of me as potentially hurtful,
instead of helpful. And, with an abstinence dictated as much by the patient as by
theory, what began as negative transference went on to become a transference
neurosis, similar in that both girls concentra te d their rage and feelings of
deprivation and injury on me (with an increasingly positive interaction with the
outside world), but different in the specific content and course of developmen t.
However, in both children the transferenc e neurosis was relatively uncontaminated
by any attempt on my part to maintain a therap eu tic alliance or be a benevolent
"good object."
The analytic process with these two children was interesting. Molly, who had
re- created with me the horror of her fourth through sixth year, when she had spent
many hours alone in a hospital waiting room while her already depresse d and
unavailable mother attended to her baby brother who had leukemia, continued to
feel negative about me until termination. However, during the last year she
continued in the analysis voluntarily (that is, she no longer begged her parents to
let her quit), because she thought it was doing her some good. During the earlier
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"months of hate," the ideational content of her negative attitude changed several
times. Her perception of me as nonempa thic and "not too smart" (which developed
in the sixth month in response to what had been intended as neutral questions
about her drawings and description of a future world) shifted gradually to a quite
comp etitive and aggressively taunting battle over when and what she would talk
about, followed by a long period in which I was seen as intrusive and controlling.
The associations in this period were to her father, and were both provocative of and
defensive against the gratification she had experienced when he (in part in
response to his wife's preoccupa tion with their ill son) had begun to spend large
amounts of time with Molly, instructing her about intellectual matters in a
domineering, impatient manner.
After the termination date was set, Molly's attitude toward me chang ed
dram atically. As we examined the change during our final months together, she
was able to talk about her longing to be nurtured and loved by me, her
disappoint ment in me, and her awaren ess that she could not see me as anything
but disappointing- -anything more would have been too scary (and too stimulating)
and would have made thoughts of the past too painful.
Sarah, on the other hand, had a more abbreviated period of negative feeling
about me, though hers was the more intense, with a definite paranoid flavor. In
addition to imagining that I was taping the sessions with the aim of blackmailing
her, she also feared, for a one week period, that there was poison gas in the office
room and during several other isolated sessions was frightene d that I was trying to
hypnotize her. What emerged during the course of her analysis was an erotic
attachme nt to her mother, which played itself out in the transference neurosis,
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complete with perverse sexual fantasies and intense rivalry with the male patient
whose hour followed hers.
The analysis of these two girls added to my appreciation of the therapeutic
value of analytic abstinence with children. Let me make it clear, however, that by
abstinenc e I do not mean withdraw al or withholding. For along with being
abstinent, the child analyst needs to be available, speaking and behaving in a
manner that is understandable to the child, and that, as nearly as possible, conveys
what the analyst intends to convey. Thus I will tie the shoe (when asked) of a child
who has not yet learned to perform this task. On the other hand, I will not offer to
tie a child's shoe unsolicited, no matter how often the child trips- -and will both
interpret the value of "tripping" when that seems appropriate (which may include
pointing out the wish to have me offer to help) and try to avoid making
interpretations that are really covert suggestions. Similarly, depending on the age
of the child, I often answer direct questions- -my first name, my age, my dog's name
etc.- -becaus e with the very young child not to do so seems strange, and I can think
of no explanation that would make sense at the beginning of an analysis to a child
under 5 or 6. As time goes on, and the child has a sense of me, I say that I prefer
to hear what the child imagines the answer to be, and though this often seem s
"silly," my refusal to answer becom es another aspect of the analytic situation, like
the way I talk, the color of my hair, my clothing, the decor of the office, the toys
and the limits. All these things- -physical and behavioral- -may beco me recipients of
transference, to be perceived as the child's internal conflicts, wishes, fantasies, past
and present experiences dictate.
With an older child who I feel can better understa nd, I usually make some
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statem ent, in respon se to questions at the beginning of the analysis, about my not
answering; that my interest is, instead, to figure out what led to the question. This
not infrequently leads to a "drying up" of the questions, a retaliative refusal to
respond to my questions, provocative questions, or battles over why I don't
answer- -but all this is subject for analysis.
My office provides considerable structure, which helps me and the patient
understand the meaning behind the process of our interactions. Each child has a
drawer to which no one else is permitted access. Drawings, favorite toys, Lego
constructions, whatever, can be kept private in the drawer, but I request that
nothing be taken home during the course of treatm ent. If the child is insistent
about taking home his drawings, we analyze it. I do not struggle with him about it,
nor say "It's okay." Instead, if he takes some thing home, his "breaking a rule,"
feeling of guilt, concern about my anger (and, not infreque ntly, his wish to
stimulate it), are analyzed. If the child is worried that another patient or one of my
children will go into his drawer and take his stuff, we analyze it. And if the child
thinks I am mean, we analyze it. One 4-year- old child, Robert, was so frightened of
his rage (which he projected onto me), that he refused to come into my office for
three weeks. We had his sessions outside on the street with Robert inside his car
and me talking to him through the window. Later, when he returned to my office
(after spending the hours outside repetitively telling me that the car was his and I
could not get into it), we spent many months sitting with our legs drawn up, in
chairs across from one another, pretending that the floor was an ocean filled with
sharks, the chairs our boats, and the back of the chairs control panels for our
defense against the sharks. The sharks had one end in mind- -eating us, eating our
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penise s, getting into us--and in this displaced way we explored Robert's fantasies,
both feared and wished for. The earlier experience and resolution of Robert's
tremen dous fear of me had increased his capacity to distinguish reality from
fantasy and gave him a sense of control over his fantasies. This, in turn, made
possible the full flowering of the shark fantasies and their connection with his own
wishes.
Robert's difficulties (insomnia, stool retention, marked separation anxiety,
temper tantrums and rage reactions directed at his younger sister) had begun after
the birth of this sister, his only sibling. Robert was the product of his father's
second marriage, and was much adored by this loud, large, and forceful man, who
had lost contact with the children of his first marriag e. Robert was terrified that he
would lose his father after his sister was born, and he was jealous of his mother
having the father's baby. He also wanted to have his adored mommy for himself
and to get rid of the baby that his daddy had made. In essenc e, his fear of the
consequence s of both his negative and positive oedipal rivalry, of his wish to be
pregn ant and what that would do to him, had disrupted the course of his
development. Some of his wishes and fears about his family members were
conscious at the onset of the analysis and others became conscious later- -but it
was his fear of me, his later identification with me in the shark play, and the
connection of the two in the interpretation of the transference that led to Robert's
recovery.
During Robert's analysis I often wondered about the therapeu tic importance
of the reconstructions we made, for example, of his feeling jealous when his mother
became pregn ant. In general, I am uncertain about the value of reconstruction in
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child analysis, particularly since a child analyst's investm ent in the reconstruction of
past events can interfere with the developm ent of a transference neurosis in his
patients. If an analyst wants verbalized content, ideas, information- -and wants it
from the child, not the parents- -then he needs a patient who is willing not just to
talk but also to "tell" things, and not just things he feels an urgency to tell but
things he feels the analyst wants to hear. Such a patient needs both to understand
what is expected of him and to be willing to provide that. This means that the
analyst has conveyed his desire for information and created a relationship with the
patient (albeit covertly or even unconsciously) in which the latter performs as is
expected. In so doing the analyst deviates from neutrality and abstinence (Hoffer,
1985) with respect to the direction of the analysis and the use of his power to direct
it.
I also have some reservation about the value for conflict resolution of
"knowing" the reconstructed distant past. The ego that reconstructs has changed
markedly since the events reconstructed (Kennedy, 1971); past experience has
been overlaid with other experiences which alter the impact and meaning of earlier
events (as with the Wolf-Man's primal scene experience, Freud, 1918). In child
analysis (but also in work with adults), genetic reconstructions often seem to be for
the analyst's benefit, to achieve closure (for example, understanding all the
determinants of a particular compromis e formation) when closure is impossible, or
to reaffirm, for the analyst, the truth of his theories.
The process of reconstruction does increase the child's appreciation of the
influence of past events on current thinking, feeling, and functioning, which adds to
his understanding of the pheno menon of transference (E. Furman, 1971).
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Reconstructions can also lead to reorganization of memories with a beneficial
change in both object and self represe nt ation. In addition, when a reconstruction
leads to the recovery of the associated affect, in particular, affect associat ed with a
recent experience (such as five minutes earlier during the analytic hour), it can
significantly enhanc e a child's ability to self-observe. Useful are the
reconstructions/constructions/r em em bering of immediate past events as, for
example, when a child has a specific thought or feeling (like Robert's fear of me)
during the course of analysis and the determinant s, in term s of unconscious
fantasies or affects (like Robert's wish to cut open my stomach), are constructe d
from the conscious associations (the shark's wish to eat my insides). In the work
with Robert, we eventu ally articulated his early wish to cut the baby out of his
mother and eat it--thus destroying it, turning it into stool, and having this gift from
the father for himself. However, I believe it was his experiencing how his wishes in
the transfere nce and the associate d aggression turned to fear of me, not the
knowledge of past fantasies, that was most therap eutic for Robert.
The perception of the analyst as a benevolent object may lead, through
identification and/or a wish to please him, to development in many areas, including
a cognitive precocity that can enhance intellectual understanding. It may even help
the child tolerate his internal conflicts and modify his behavioral and affective
response to these conflicts. However, the wish to please neither resolves conflicts
nor increas es ego autonomy. Nonetheless, the "basic transference" continues to be
cited as a useful if not essential ingredient of child analysis (Ritvo, 1978, p. 300f.),
with the child turning to the analyst for help as toward a benevolent parental figure.
Certainly a perception of the analyst as exclusively aggressive, destructive, or
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overstimulating will interfere with any analysis, particularly that of a child with
immatur e observing ego functions. But the opposite is also true; a perception of
the analyst as exclusively benevolent can contamin ate the transference template
and dilute the mutative force of anxiety- producing impulses.
Those analysts who believe in the importance of experiencing during the
analytic process tend to emphasize the development of as full an analytic
transference as possible; shared cognitive understanding seems to be the goal of
those who stress the need for a therape utic alliance strongly rooted in a positive
relationship. I sense that without the first (experiential) phas e of Strachey's (1934)
mutative interpretation, the therapeutic value of the second (interpretive) phase
lies largely in strengthening defens es for more adaptive functioning- -which, of
course, can enhance developm ent. In contrast, the experience of the transferen ce,
with an elucidation of defensive behavior and the inadequ at e and inappropriat e
compromise formations that wish and fear engender, can lead to therap eutic
change even without complete genetic understanding.
When Geleerd (1967, p. 10) speaks of the developm ent, after a period of
time in analysis, of verbal ability and self-observation that is far beyond the child's
maturation, I feel concern lest the precocious ego developm ent reflects a tendency
to intellectualization based on a partial identification with the analyst. Such
intellectualization either diminishes the force of the internal conflicts so they can be
more successfully repressed or shifts the economic balance by providing more
successful defenses (augmente d by the auxiliary ego strength of the analyst)
without really resolving the conflict. As Abrams (1980) observed, "cognitive growth
is stimulated in the analysis of children.... Generally, this serves the treatmen t
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process, but it may backfire and prove disruptive if a proper balance is not
maintained between the freeing of the unconscious, on the one hand, and the
stimulation of cognition, on the other ... there may be a fixing of earlier
organizational modes if the therapist fosters submission to an omnipotent id-
wisdom; or there may be a further encapsulation of the entrapp ed unconscious if
analysis builds a wall composed of a precocious cognitive system" (p. 306).
A relationship with a benevolent object can have enormou s therap eu tic
power. Analysis is not the only form of child psychother apy; criteria of analyzability
and whether one can or should analyze children with major ego deviations remain
important issues for child analysts. I am reminded of Susan, a 5-year- old girl I saw
in psychothera py four times a week for two years. Her mother had been severely
depress ed after Susan's birth, and, aside from times of feeding and diaper change s,
she had left Susan alone in her crib for the first six months. (The mother was
already on lithium when I began treating Susan; and although no longer clinically
depress ed , she was always anxious and emotionally distant.) Susan's two older
siblings occasionally played with her, but basically she had no consistent human
contact during early infancy. When I first saw Susan, she had no language . The
most striking thing about her, aside from her markedly retarded cognitive
development, was the juxtaposition of a warm, see mingly responsive smile and
complete unavailability.
Work with Susan was exhausting, frustrating, and ultimately exhilarating. I
began treatm ent by imitating Susan's move ments and speech as closely as
possible, rolling on the floor, drawing, or bouncing a ball when she did; essentially, I
tried to enter her world. With excruciating slowness she began to take notice of me
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and to express anger when she felt I was "doing it wrong." Perhaps the most
dram atic achievem ent over those two years was her becoming aware of the
differenc e between "you" and "me." Susan went on to many years of treatment
with other therapists, including a long stay in a residential treatme nt center. She is
now a young adult and functioning quite well with a job, an apartm ent of her own,
and a boyfriend- -able to communicate not only in English but also in German.
The most succes sful treat ment I have participated in was Susan's, but it was
not analysis. I was a very specific person for Susan- -an intrusive, benevolent force,
whose job was to convince her she got more from being with me (even though it
made her very mad at times) than from not being with me (even though that meant
she was sometimes very sad when I wasn't there). Her therapy clearly contributed
to her develop me nt- -I could see that in the two years we were together- -but it was
not analysis. Analysis is a quite specific treatment for individuals whose
development and function are handicapp ed primarily by unconscious internal
conflicts, not by environme nt al interferenc es or by structural deficits, except when
the latter are the results of fixations second ary to retreat from conflict. Neurotic
individuals also can be helped by learning new ways to deal with conflicts.
However, if therapy is aimed at the resolution of conflict (with an underlying
assumption that with conflict resolution, develop me nt will resume of its own
accord), then, to that end, there is nothing so effective as the developm ent of a
transference neurosis within the analytic setting. And if an analyst believes that
intense transference (or a transference neurosis) is essential for a successful
analysis, he needs to learn what interferes with its emerge nc e and what promotes
its development.
Chused - 19
Many of the techniques of child analysis are based on the same principles as
those used in the analysis of adults. Nonetheless, there are some significant
differenc es in how they are employed, differences dictated by (1) the maturity of
the child's ego apparatus (including his cognitive skills, his reality testing, his
capacity for self-observation, and his system of defenses); (2) the appearance and
pressure of drive derivatives; (3) the phase of superego development; and (4) the
intensity of current develop me ntal demand s. Although the "use of the analyst as a
new object" in a current phase of developme nt can require technical adaptations in
child analysis, it should not be cited as a justification for deviations from an
abstinent analytic position. The child (and adult) will use the analyst concurrently
as a transference object, a "new type" of object to rework preceding phases of
development, and an object to fulfill current developmental needs (Chused, 1982).
But in all instances the patient's use of the analyst must be dictated by the
patient's needs and perceptions- -not by the analyst's preconceptions of the
patient's needs. The use of the analyst should be determined by the patient's
psychic reality, not by the analyst's "real" behavior.
I shall use the analysis of 11- year- old Sarah as illustration. During the course
of her treatment , she made many references to the deprivation she suffered at her
mother's hands. She was highly critical of her mother- -not only for being self-
indulgent and infantile, but also for being ugly, silly, flirtatious, poorly dressed, and
overly made up. It was clear there was nothing the mother could do that was
accepta ble to Sarah. Yet it was only after her complaints turned on me, in the
transference, that we were able to explore her hunger for her mother's attention,
her rage at feeling rejected after her brother was born, as well as the tremendous
Chused - 20
comp etitivenes s with her mother. During the course of her analysis, Sarah entered
adolesc ence. This, as a phenome no n, was fascinating to watch and hear about- -in
particular the progression from disgust over boys first, to a fear, embarra ss ment,
and displacement of her impulses (lots of criticism of "boy- crazy" classma te s); then,
to a relentless pursuit of boys, a combination of counterp hobic behavior and active
defense against passive vulnerability; subsequently, to a feeling of terror when one
young man began to pursue her; and finally, at the time of termination, to real
pleasur e in early sexual exploration. Throughout this struggle to establish a
feminine identity, her scrutiny of me was intense. She carefully noted my dress,
my makeup, my laugh- -in a way that is typical of adolescent girls' scrutiny of their
mothers. But interposed with this ceaseless yet relatively objective nonmalevolent
scrutiny were repeated hostile attacks, with negative, fantasy- filled observations.
All was in the subtleties: her comme nt, "That's an interesting color [pointing to a
mauve skirt]; I never thought of wearing it with purple; I wonder, did you try to
match your lipstick to your blouse?" had a different feel (and different
determinants) than "Yuk, one of my teachers still wears bell-bottom s; that's
probably from the '60s; that's when you were young, isn't it? I don't mean to say
that you look funny- -but quite honestly, it's hard to trust you when you look so, I
don't know, weird; I wonder if you're still married or divorced; I heard that women
really begin to live in the past when they can't get a man; I don't mean to make you
mad, but..." The first seem ed an attempt to use me as a new object for
identification; the second a transference perception of me as a devalued oedipal
rival. At other periods of the analysis, when Sarah beca me able to mourn the loss
of the nurturing moth er, she fantasized having me be her mother. This was a hard
Chused - 21
phase of the analysis; it was difficult to distinguish what was an expression of loss
from what was a regressive defense against oedipal feelings. One of the clues I
used was how the transference affected her participation in the analytic process:
when her words became whining and endlessly repetitive, when she misheard my
comment s as critical and behaved as if she were too injured to analyze, her
complaints of deprivation were understood as a defensive transference resistance
against the emergence of oedipal rivalry.
It was clear that many of Sarah's observations about her mother's self-
preoccupation and unavailability were correct. However, Sarah needed me as an
analyst, not a substitute moth er; it was the resolution of conflict which enabled her
to use me as a current object for identification (without my ever altering my
analytic stance); and it was the resolution of conflict that allowed her to mourn not
having a "warm mommy for the little Sarah" and to find two teachers at school for
whom she could excel and who treated her as a favorite. That it was two teachers
instead of one defended against any impulse to act out her strong erotic
attachme nt to women. This had entered the transference at age 12 when she
talked about wanting to touch and kiss me and her fear of being homosexual. Her
anxiety was intense during the analysis of these wishes; but before the
determinants had been fully explored, her homoerotic concerns disappeare d. As
she was comfortable with her relationship with these two teachers, I decided not to
"push" an exploration of the unconflicted compromise (two objects) she had made
in the outside world. Similar decisions are made in the analysis of adults, but
usually after a longer period of working through. With children in whom
development is still in flux, the analyst may wonder whether to "push" harder to
Chused - 22
create conflict over what appears to be a potentially pathological solution that
might affect future development. Child analysts