Psychoanalytic Study of the Child

This paper introduces the topic and unique format of the section that follows, on psychoanalytic work with transgender children. We first review the apparent impasse that characterizes our field regarding clinical work with gender diverse kids, as well as the reasons we pursued a live dialog to push thinking forward. Then, we outline the structure of the entire section, in which four contributors offer short essays, followed by a transcribed and edited version of the dialog we facilitated, which uses these essays as a starting point...

In March 2021, Hannah Wallerstein and Jordan Osserman facilitated a live dialogue over Zoom on the subject of transgender young people, with four psychoanalytic clinicians and thinkers. The conversation draws on short essays submitted in this section of The Psychoanalytic Study of the Child as a springboard for discussion. It has been transcribed and edited for length and clarity, and is reproduced here. Questions explored include the differences surrounding gender identity in childhood versus adulthood, the use of medical interventions for children experiencing gender dysphoria, the tension between psychoanalytic neutrality and affirmation, and the ethical stakes of working in this field...

For children with moderate to severe emotional or behavioral problems, the current approach in child psychiatry is to make an assessment for the use of both psychotherapy and medication. This paper describes integration of antidepressants and stimulants with psychoanalytically oriented techniques.

In the world of education the emotional life of the child has come in and out of focus. Psychoanalytic ideas and principles, including an emphasis on the individual, unconscious motivations, attachments, transferences, disavowed intentions, and feelings defended against, are in full operation within school settings. More recent developments in social-emotional skill promotion in schools and the emphasis on instilling skills such as perseverance and self-control have aims similar to psychoanalytic ideas of healthy ego functioning but use a more direct, didactic approach...

The self begins as a social self and is dependent on the other and the self-other relationship. Furthermore, shortly after birth, the intersubjective self is nurtured and sustained by the reciprocal interactions with the significant other. Recent research suggests that the significant other's reciprocity depends on his or her capacity for mentalization, and this reflective functioning capacity influences not only the child's developing sense of I, other, and we, but also his or her developing attachment pattern...

This paper represents and attempts to describe psychoanalytically informed work applied in a school setting with children with special needs. While many therapists at the Parkside School are trained in analytic techniques and principles, these ideas have not traditionally been applied to children with language-based learning difficulties. Over the years, we have found that analytic ideas such as transference, countertransference, projective identification, containment, and attachment are especially salient to our understanding of these very complex children...

In this paper we describe an intake evaluation process of elementary schoolchildren who have exhibited difficulties in a more traditional school environment. We show how a dynamic understanding of the child's emotional life and the child's emotions affects his or her behavior, cognitive development, and academic performance. We illustrate how to utilize this understanding in planning an approach in the classroom.

In this collection of papers, psychoanalytic principles come to life in a variety of settings: in a therapeutic nursery, in two schools serving children with special needs, in mainstream schools, and in a psychiatric practice. From dyadic work with a two-year-old's tantrums, to play therapy using deep-sea symbolism with a five-year-old; from the interchange with parents and school administrators in a middle school regarding "sexting, " to the in-depth assessment of children upon entry to a special school, these papers illustrate enriching exchanges between psychoanalysts, educators, children, and their communities...

This paper addresses factors other than symbolic capacity that can influence the use of language by children on the autism spectrum. Chief among the issues considered are the influence of bodily experience on the articulation of words and the influence of fantasies concerning bodily relationships on the construction of words and sentences. It is suggested that such considerations may shed light on the behavior of those children on the autism spectrum whose symbolic capacity is greater than might be assumed from their use of language, and also on that of some children with selective mutism...

Observations of videotaped sessions of the analytic treatment of a four-year-old autistic boy offer insights into the meanings and the mechanisms of transference. These observations illustrate the well-known fact that the relationship of transference to symbolization is ambiguous. They also demonstrate that multiple simultaneous meanings exist in a transference field, and many of these meanings emerge from partially or nonsymbolized domains of experience, including and perhaps most important, bodily experience...

The current paper provides an overview of an evidence-based treatment, Pivotal Response Treatment (PRT), for autism spectrum disorder (ASD). The paper describes PRT principles and then illustrates the approach using two case reports. The children are preschool-aged children with high-functioning ASD. They were participating in a four-month clinical trial of PRT. At the start of treatment, they presented with significant social communication impairments, including a minimal understanding of reciprocity, limited play skills, and repetitive behaviors and speech...

Autism is a prevalent and strongly genetic brain-based disorder. Early focus in the field on the relevance of psychogenic factors led to the blaming of parents for the occurrence of the disorder, and as a result mainstream research on psychotherapeutic approaches has until recently been limited. Although psychoanalytic approaches continue to be considered of limited relevance for these individuals, dynamic theory is both informative and informed by conceptual approaches to the understanding of autism. Theory of mind in particular is a prominent model for understanding the core deficits of autism and bears strong resemblance to the concept of mentalization...

Contemporary child and adolescent psychoanalytic technique has evolved and changed a great deal in the last thirty years. This paper will describe the analysis of an adolescent girl from early in the author's career to demonstrate the ways in which technique has changed. The clinical material presented highlights six areas in which contemporary child and adolescent analysts practice and/or understand material and the clinical process differently than they did thirty years ago: (1) the contemporary perspective on mutative action, (2) the contemporary emphasis on mental organization, (3) the developmental lag in integrating the structural model, (4) the child analyst's multiple functions, (5) the child analyst's use of countertransference, and (6) the child analyst's work with parents...

The authors apply a two-systems approach to demonstrate improved treatment possibilities and outcomes in this group of children and suggest that psychoanalysis can be defined as a multimodal strengths-based learning experience. Using clinical material from the analysis of an aggressive, "out-of-control" child, they discuss how these behaviors and symptoms are better understood as an actively constructed effort at self-regulation than as a deficiency in capacity or primitive, lagging development. They illustrate how a two-systems framework can allow for an expanded repertoire of techniques and reclaim psychoanalytic concepts that have fallen into disuse...

Some older members of the Boston Psychoanalytic Society remarked that in the 1950s and 1960s there was a group of prominent women analytic leaders at BPSI. They were training analysts, writers, and teachers active in the society and in the community. They were succeeded primarily by men. The question arose Was that an expression of "the war on women"? This paper explores and discusses this question. Although there were some expressions of resentment at being "dominated" by women, the answer appears to be more complex...

From the very first efforts to analyze children and adolescents to the present day, child and adolescent analysis has been denigrated in the analytic community. It has been viewed as "women's work" and regarded as clinically inferior to the analysis of adults. It has been seen as less important for understanding the psyche and in the training of psychoanalysts. This attitude is rationalized by observations that children and adolescents engage psychological material differently than adults do, so that, it is claimed, child and adolescent analysis is severely limited compared to adult analysis with regard to the material available for analysis...

Psychoanalysis has both waged "hot" war on women overtly and "cold" war covertly over the years by colluding with cultural stereotypes offered as "theory," starting with Freud and his Viennese circle. True freedom of thinking, however, broke through in Freud's originality even then, and from time to time subsequently in the history of the movement only to keep retreating. Fritz Wittels's thesis on the "Child Woman" will exemplify Horneys (1924, 1926, 1933) and Jones's (1927) grounds for engaging in the "hot war" in the 1920s and challenging the unselfconscious inbuilt denigration of women...

"The war against women" is a systemic process of discrimination that seeks to subjugate women. In this essay, I will critically examine a contemporary paper, published in a well-known psychoanalytic journal, that views the patient through the lens of Bion's "reverie-ing mother" concept. I argue that leaning upon any particular theory to explain an individual's complex psychological disturbance adheres to a reductionistic line of reasoning that falls prey to the genetic fallacy; interpreting psychological phenomena in this way becomes a myopically focused perch that narrows the clinician's range of vision in scanning the field for other features that influenced the patient's symptomatology and suffering...

It has long been recognized that many of the original psychoanalytic views of women were derived from misguided theories. Regrettably, residues of the foundational postulates that informed those theories still persist, assuring a pervasive gender bias even in contemporary psychoanalytic investigations. This contribution describes where those postulates reside, while proposing alternates that could prove far more useful for the theory and practice of our profession.

The phrase "the war against women" refers to the overt an a stealth global prejudice against women that aims to subjugate them. Freud was not immune to this prejudice, as can be seen in those late-nineteenth-century Victorian views about sexuality that helped to shape his conceptualizations of gender. Despite the fact that many of these antediluvian views have been overturned, some continue to live on in the contemporary psychoanalytic scene. This introduction provides an overview of the contributions in this section, which explore how the war quietly or openly insinuates its way into our psychoanalytic culture...