Handbook of Infant Mental Health

Remembering, Repeating, and Working Through

Ritual and Spontaneity in the Psychoanalytic Process: A Dialectical-Constructivist View

Under Anna Freud's guidance, the Anna Freud Centre developed a rigorous approach to the collection of child psychoanalytic data. Material contained in detailed diagnostic assessments and weekly written reports of 763 cases treated in intensive and nonintensive therapy has now been subjected to systematic study. This is the first, retrospective stage of a major investigation of child psychoanalytic outcome, carried out in collaboration with Yale University Child Study Center, New Haven, CT. The main findings of the work are reviewed. The study showed child analysis to be particularly effective for seriously disturbed children under 12 years suffering from a variety of psychiatric disorders, particularly those which involve anxiety.

Predictors of outcome in child psychoanalysis: a retrospective study of 763 cases at the Anna Freud Centre

The Earliest Relationship

The concept of parenthood as defined in classical theory and later theorizations is discussed. Parenthood is defined as a transformative process, activated by the idea of having a child and by interaction with the child, through which a constellation of affective and psychic capacities is developed, promoting growth and psychic change and evolving over time. Parental functions, rather than being learnable skills, are considered as mind functions linked to character traits that cannot be split from the personality as a whole and are, as such, susceptible to improvement through psychotherapeutic work. The author illustrates this with a model of psychotherapies and parallel analyses of parents and children tested and elaborated in public and private practice, showing its therapeutic and cognitive advantages. The central thesis of the paper is that whatever the approach and working method with the parents, the therapeutic space offered encourages certain processes that are vital for the structuring of the sel...

Parenthood and parental functions as a result of the experience of parallel psychotherapy with children and parents

Two definitions of the concept of analytic boundaries—the analyst's boundaries in the analytic relationship and the boundary between analyst and patient—focus, respectively, on the analytic function and the analytic relationship. A long analysis of a 20-year-old girl is characterized by the analytic work being slowed down by her chronic tendency to arrive late. A miscarriage very early in her pregnancy, occurring almost at the end of the analysis, produces associations and fantasies on ‘crushed’ fetuses and children. It also encourages reflection on the importance of the analytic space, equated by the analyst with the womb, in fostering the development of fetal aspects of the self that do not develop. In the clinical material from two sessions 4 months before termination, two analytic events—the introduction in the analytic field of the character of the autistic child and the episode of self-disclosure—mark a turning point in the analytic process. In the discussion, the author demonstrates the cr...

The function of the analyst's boundaries in the psychoanalytic relationship

The title is challenging and the reader is immediately presented with the difficulties encountered by child analysts who, in the forties, began to involve parents in the analytical treatment of children. The author dates the beginning of parent-infant psychotherapy to the period when Anna Freud and Dorothy Burlingham opened the Hampstead War Nurseries (1944–1995) in which also the children’s mothers and relatives were welcomed. In 1954 Dorothy Burlingham founded a Kindergarten for blind children with an auxiliary advisory service for their parents. The author also cites Bowlby’s research on the mental health of homeless children, published in his monograph “Maternal Care and Mental Health” (1) and the research project carried out from 1972 to 1979 at the Michigan University in Ann Arbor by Selma Fraiberg, considered a pioneer of the parent-infant therapy. I think it is important to mention here Alicia Lieberman’s contribution to parent-infant therapy (2). She emphasized beneficial links between the attachment theory and the work of psychoanalytic parent-infant psychotherapy. More recently, in 1994, Jack and Kerry Novick founded the Allen Greek Preschool in Ann Arbor which provides experts for young children and their parents to promote intellectual, social and emotional growth in young children, by blending the objective of early childhood education with a psychoanalytic perspective. The author comments that neither Bowlby’s attachment theory nor Anna Freud’s work with children carried out at her Child Psychoanalysis Educational Institute received the recognition it deserved from the official psychoanalysis of that period. I would like to add that working with parents did not fare any better. The application of work methods used with adults and Klein’s emphasis on the role of internal objects and the unconscious phantasy in fact minimised the importance of the relationship with the parents and interfered with the elaboration of a theory on work with parents. The Novicks group together the reasons for the history of relative neglect of work with parents under social/historical, theoretical and political headings. Since her early work in 1957 (3), Erna Furnam has presented a rich and complex theory of parentinfant relationship. In her work (4, 5) she maintains that the aims of child analysis can be reformulated not only as the restoration of the child’s progressive development, but also as a restoration of the parent-child relationship to its potential as a lifelong positive resource for both. Furnam claims that the progressive, mutual narcissistic investment between parent and child is important not only at the start, but also throughout therapy. I want to also draw attention to the research carried out in the sixties at the Hampstead Child Therapy Clinic by I. Hellmann (6), K. Levy et al. (7) on simultaneous mother-child therapies aimed at exploring the pathogenic role of the parent’s p rsonality in the genesis of the child’s disorder; the relations between the mother’s unconscious fantasies and the child’s attitude and disorders; the points of interaction between the abnormalities of mother and child. I presented a research and treatment model involving supervision by one supervisor carried out separately with the psychotherapist of the child nd the psychotherapist of the parent/parents (8). This technique facilitates the exploration of the reciprocal influence of mother and child, with particular reference to the traumatic impact of the mother’s mental and emotional life on the child and vice versa. I noted that the mental functioning, defensive structure, fantasy-making and changes of the mother can have a traumatic effect on the child and, vice versa, the child’s primitive or archaic mental functioning may reveal or activate depressive nuclei and psychotic scars in the

Comment on “Parent‐Infant Psychotherapy and Psychoanalytic Treatment: Contradiction or Mutual Inspiration?” by Christiane Ludwig‐Körner

This article presents the evolution of a face-to-face analysis of a severely disturbed 16-year-old girl. In the first part of the analysis, communication was mainly at a nonverbal level, via gestures, body movements, gaze, long silences and the coded language of dreams without associations. The importance of listening is stressed, including a “hearing with eyes,” in order to attune to presymbolic levels of the patient's psychic organization and to gather preverbal elements of her subjective expression. The analytic device is considered as a transformation system through which unconscious somatopsychic processes – sensorial, emotional and protomental states – acquire the quality of representability. In the final phase of the analysis, thanks to her acquired capacity to narrate, relive and work through what had been enacted in the relationship and what had been discarded, repeated and transformed in dreams, the patient succeeded in revealing and signifying her internal experience in the context of ...

Barbara Piovano

Papers

Parenthood and parental functions as a result of the experience of parallel psychotherapy with children and parents

The function of the analyst's boundaries in the psychoanalytic relationship

Comment on “Parent‐Infant Psychotherapy and Psychoanalytic Treatment: Contradiction or Mutual Inspiration?” by Christiane Ludwig‐Körner

Acting, dreaming, thinking in adolescence: An analysis from the beginning to the end