Jacqueline Adler
1998
BREASTFEEDING, AMBIVALENCE AND THE PSYCHE-SOMA OF THE INFANT :
“A CASE STUDY BASED ON AN INFANT OBSERVATION”
ABSTRACT
Psychoanalytic infant observation is put forward as a method of research into the
processes of early personality development. Findings of an infant observation are
presented in which the infant developed a number of symptoms and mannerisms.
These are examined and discussed in the context of the mother-infant relationship with
particular focus on maternal ambivalence about breastfeeding and the mother’s
capacity for containment. Some conclusions are drawn about the origin and
development of psychosomatic symptoms and asymbolic behaviour in infancy.
1
Lynne Allison
2004
CHILD PSYCHOTHERAPISTS’ VIEWS ON OUTCOME EVALUATION
RESEARCH OF PSYCHOANALYTIC CHILD PSYCHOTHERAPY
ABSTRACT
This study began with the desire to establish the first steps in the design of an outcome
evaluation research project in the field of psychoanalytic psychotherapy. The context
of outcome evaluation research, its relation to the field of child psychotherapy was
explored from which key concepts and findings were identified. It was then possible to
examine the field of psychoanalytic child psychotherapy and outcome evaluation
research. It was found that there are few research studies of psychoanalytic child
psychotherapy and a stated gap between clinical practice and research. There had
further been little exploration of the views’ of psychoanalytic child psychotherapists of
outcome evaluation research.
Consequently, a survey of eight members of the Victorian Psychotherapy Association
was undertaken to explore the views’ of psychoanalytic child psychotherapists
regarding outcome evaluation research, utilising a semi-structured, in depth interview
methodology.
The results indicated a high level of interest and desire to participate within the area of
outcome evaluation research, a finding not previously identified within the professional
literature. Additionally, ambivalence was expressed regarding a perceived lack of
objectivity and bias with regard to the organisational structures that support outcome
evaluation research and there was a further questioning of the appropriate
methodology for research such that it represents psychoanalytic child psychotherapy
as it is done in the field.
The study was planned as exploratory, and the results of the findings led to
recommendations for the beginning steps in the development of an outcome evaluation
research project of psychoanalytic child psychotherapy.
2
Andreas Alt
2009
“MY DAD HIT ME AND THAT IS WHY I DO IT TOO” :
VICISSITUDES OF IDENTIFICATION WITH THE AGGRESSOR : A CASE STUDY OF
A SIX-YEAR-OLD BOY IN INDIVIDUAL PSYCHOANALYTIC CHILD
PSYCHOTHERAPY
ABSTRACT
Aggressive children often create a challenge for their environment; for their families,
their kindergartens and schools. They are often presented to child mental health
services. The history of these children frequently reveals disrupted attachments with
an abusive and traumatized background which often manifests in aggressive
oppositional and remorseless behaviours. This thesis explores the origins of these
externalising behaviours through the analysis of a single case study and draws upon
Ferenczi’s concept of identification with the aggressor. Anna Freud subsequently
elaborated and extended this theory which was found to offer a plausible explanation
for what transpired in the thesis material.
The psychotherapy of a male child patient, offered an opportunity to investigate what
lay behind his habitual aggression and remorseless behaviour, expressed in the
therapeutic space. Although the patient had major disruptions in his attachment
relationships and suffered from attachment disorder, the retreat to identification with the
aggressor in the context of identification in ego development offered an alternative
explanation. A single case study enabled an in depth investigation of this case. The
experience of the psychotherapy was understood through identifying and reviewing
relevant literature. Significant findings were: the influence of identification with the
aggressor on child development; the importance of a supportive carer, and the impact
on the resolution of the Oedipus complex.
A further key factor which arose in the study concerned the importance of neuro
developmental understanding to inform the psychoanalytic child psychotherapy. The
therapist makes a strong recommendation that neuroscience be given greater
prominence in psycho analytic child psychotherapy and that further research be
conducted to substantiate the claim.
3
Carolyn Aston
2000
BETWIXT AND BETWEEN
ABSTRACT
This thesis is a description of my work with a Catholic Secondary School whereby I
hypothesise that the key characteristics of the school organization and my relationship
with the school is reminiscent of a psychodynamic therapist working with an anorectic
patient.
I locate this discussion within a broader societal context of a spiritual vacuum (my
italics) drawing on Lawrence and Ellingsen to briefly consider the impact of
industrialization and secularization to think about the school’s inability to make the
transition from an essentially religious and child-focused identity to a secularized
adolescent one.
It is on this background that I draw on Bion (1970) and a range of key contributors to
the field of treatment of eating –disordered patients to gain a deeper understanding of
the school’s aforementioned dilemma, its struggles with ‘taking in’ (or feeding),
dynamics within the organisation, and between it and myself, particularly in relation to
‘container/contained’ and response to grieving.
In addition I argue that the school’s key characteristics such as its emphasis on
appearance, perfectionistic traits, resistance to change, false self, difficulties with
separation/individuation, punitiveness, fear of aggression and issues of sexuality, and
use of primitive defences such as idealisation, splitting, projection denial and projective
identification strongly contribute to its similarities to that of an anorexic individual.
4
Sylvia Azzopardi
Accepted: 17 November 2006
“SHOW ME YOUR BOOBS” :
HOW DO CHILD PSYCHOTHERAPISTS UNDERSTAND THE SEXUAL BEHAVIOURS
OF TRAUMATISED LATENCY AGED BOYS IN THE THERAPY SESSIONS?
ABSTRACT
Sexuality is an integral part of human development from infancy. Psychoanalytic
research about childhood sexuality has shown that sexual development involves
complex inter-psychic processes which can be traumatic to the developing child. Recent
empirical research has confirmed that curiosity about sex and engaging in sexual play is
a common feature of early childhood. The impact of external trauma on childhood
sexual development has been recognised by psychoanalytic writers since Sigmund
Freud first drew attention to childhood seduction. Recent writers have examined the
impact of trauma arising from abandonment, neglect and abuse in the child’s sexual and
psychic development. Their research has demonstrated that particular difficulties arise in
the psychotherapy of traumatised children and that the impact on the child
psychotherapist of treating traumatised children can be very powerful. The growing
discourse on the issue of counter-transference has included discussion regarding child
psychotherapy and erotic or sexual forms of counter-transference. However, relatively
little has been written about the responses of child psychotherapists to the sexual or
erotic behaviours of child patients. There is even less written about the erotic or sexual
counter-transference of the child psychotherapist.
This paper examines how a child psychotherapist understands the sexual behaviours of
latency aged, traumatised boys in therapy sessions. The thesis is that boys who
experienced trauma in the form of maternal abandonment, abuse or neglect face
particular challenges on working through Oedipal and pre-Oedipal difficulties and hence
struggle to achieve or maintain latency. The body and mind of the psychotherapist
becomes a target for the projections arising from the developmental anxieties and
confusions of such boys in therapy. The conscious and unconscious material of the
psychotherapist impacts on her responses to the child patient. Therefore, the capacity of
the psychotherapist to understand the patient’s sexual behaviours is influenced by the
extent to which she understands her own mental productions.
Vignettes from the assessment and therapy sessions of three latency aged, traumatised
boys have been examined, with attention to the behaviours of the boys and the
reflections of the therapist. The examination of the vignettes revealed that while the
three boys displayed some similar behaviours, they each responded to the therapeutic
setting with unique expression of erotic or sexual impulses.
The psychotherapist’s response to each boy differed according not only to what they
evoked in her, but also according to what she brought of her own making to the
encounters.
5
The research highlighted the importance of both analysis and supervision in assisting
the psychotherapist to understand and manage her responses in order to move towards
understanding the behaviours of her child patients.
6
Dimitra Bekos
2005
AN EXPLORATION OF MOTHERS’ EXPERIENCE OF INFANT OBSERVATION IN
CHILD PSYCHOTHERAPY TRAINING
ABSTRACT
Infant observation initially introduced by Bick in 1948 as a component of child
psychotherapy training, has received considerable attention in the literature to date.
Copious illustrations of infant observations highlighting its significance in understanding
infant development and functioning, and the usefulness of observations as a training
and research tool, has been well documented. However, despite this being a
technique which is frequently used, very little had been written about the experience of
mothers taking part in the twelvemonth infant observation. It seemed that no empirical
research concerning this had been reported.
This aim of this study was to explore mothers’ experience of infant observation with
particular emphasis on the emerging relationship between mother and observer, and
the impact of the observation on the mother-infant dyad. Mothers who were involved in
an infant observation between the year 2000 and 2003 as part of Monash University’s
Master of Psychoanalytic Psychotherapy, were invited to participate in the study. From
this, three mothers responded, and an in-depth freely structured interview was
conducted to collect data. A thematic content analysis of this data was applied in order
to identify common and individual themes amongst participants and then placed in a
chronological order of the different phases of the observation. That is, themes
emerging prior to the observation, at its commencement, during the observation and
the ending of the observation.
From this process several important findings emerged and were discussed. It became
clear that the infant observation was perceived by mothers to be an important
experience. The relationship with the observer became increasingly significant and
containing for them over the course of the observation resulting in greater receptivity
from mothers towards their infants and an enhanced awareness of their infant’s
emotional needs. However, although mothers reported the infant observation to be a
positive experience overall, there were areas which proved to be difficult. Mothers
experienced considerable anxiety, resembling early primitive anxieties, at the beginning
of the observation, and were left with unresolved feelings of loss, anger, hurt, confusion
and abandonment at the conclusion of the observation and thereafter. As a result,
these findings gave rise to an examination of theoretical implications and practice
implication of infant observation and recommendations were made for future research.
7
Anne Brown
1997
THE INFANT, THE MOTHER AND THE TRICKSTER
ABSTRACT
This thesis is concerned with the effect of teasing on infant psychological development.
It uses concepts from Jungian psychology and psychoanalysis as a framework for
analysis. Two intensive, longitudinal infant observations provide the data for this study
of teasing, and its unconscious manifestation as inconsistency.
The parallel process of the unfolding of the Self and the development of defences of
the Self is examined in both the context of archetypal psychology and psychoanalytic
thought. Particular reference is made to the archetype of the Trickster as central to the
notion of teasing on a symbolic and collective level.
The thesis addresses questions relating to the way in which an infant might experience
teasing and also considers possible developmental outcomes. It examines how the
archetype of the Trickster may be activated in the baby by the infant’s experience of
being teased and tricked and fooled.
This study suggests that there is a strong link between the experience of separation
and teasing which is characterised by aggression rather than playfulness. The context
in which separation and subsequent teasing occurs and the psychic space from which
it originates appears to be of major significance in relation to potentially damaging
effects on the baby.
8
Jennifer Carver
1998
THE USE OF EROTICISED TRANSFERENCE AND COUNTERTRANSFERENCE
IN THE PSYCHODYNAMIC TREATMENT OF A SEVEN AND A HALF YEAR OLD
BOY
ABSTRACT
The concept of eroticised transference and eroticised countertransference in child
psychoanalytic psychotherapy have received little attention in the child psychoanalytic
psychotherapy literature. An interest in exploring the meaning of these concepts grew
from the author’s experience of working long term within the psychoanalytic framework
with a seven and a half year old boy. By utilising the single case study method,
extrapolating from the adult psychoanalytic literature and analysing the key themes in
three years of therapy with this child, it was possible to link eroticised transference with
pre-Oedipal sexual abuse and the development of perversion. Working with a child
without involving the child’s family in therapy is controversial within the field of child
psychiatry. Reasons for this are discussed. Liaison with the child’ school therefore
became the main and essential systemic link. Therapy enabled this child to relate to
others as a whole person rather than as a part object and allowed him to get back on
the tract of more normal psycho sexual development. Therapy may have prevented
the development of further psychopathology such as paraphilias. Therapists engaged
in this type of work should be aware that powerful sexual feelings can be evoked in
them when working with a child with a perversion. This points to the need for both
therapy and supervision for the therapist.
9
Carolyn Coburn
1997
AN EPISODE OF WITHDRAWAL IN THE PSYCHOANALYTICALLY ORIENTED
PSYCHOTHERAPY OF A LATENCY AGED CHILD
ABSTRACT
This observational study began with a wish to explore an episode in child
psychotherapy not previously encountered in the therapist’s clinical experience. The
study traced and reflected upon the emergence and resolution of a four month episode
of withdrawal from therapeutic contact in the long term psychoanalytically oriented
psychotherapy of a latency aged child.
The thesis outlined the theoretical perspectives the therapist explored to understand
the episode of withdrawal. It was found that the theories of mourning and narcissism
offered a valuable descriptive framework in which to conceptualise the patient’s
previous need to play out scenes of separation, loss and reunion, and the self
absorption evident in the episode of withdrawal. The thesis examined the need to reestablish a therapeutic alliance, and reflected upon the way in which the therapist came
to focus attention on the vital importance the transference/countertransference
relationship played in the eventual resolution of the episode.
The thesis documented the literature on the theory of negative therapeutic reactions
and the found the area of withdrawal from contact in psychotherapy with non-autistic
children has not been extensively reviewed. The study speculated that the paucity of
clinical documentation on this subject may be due to the inherent difficulties of an in
depth examination of the therapist’s countertransference.
The thesis concluded, from reflection a single case study, that Freud’s (1914g) theory
of the patient’s compulsion to repeat painful life events is a valuable method of
theoretical inquiry in psychotherapy with children. The practical application of this
theory in conjunction with the interpretation of the transference/countertransference
relationship was found to afford the opportunity to work through the patient’s pre-verbal
memories that were considered to have been acted out in the episode of withdrawal.
10
Nichola Coombs
2003
DOWN WILL COME BABY:
PSYCHOANALYTIC PSYCHOTHERAPY WITH A CHILD TRAUMATISED BY
NEONATAL DRUG WITHDRAWAL AND A HEROIN-AFFECTED MOTHER
ABSTRACT
Babies born addicted to heroin are subjected to traumatic, impinging bodily
experiences and medical interventions. For some of these babies the trauma
continues with the possibility of an uncontaining mother, distracted by the drug she is
addicted to. This thesis explores the available research on children of heroin addicts
and draws on psychoanalytic theory to develop a more in-depth understanding of an
infant’s experience of opiate withdrawal immediately after birth and the ongoing trauma
of having a substance-affected parent.
A summative narrative of a psychoanalytic psychotherapy of a three year-old girl is
discussed. The child was traumatised both acutely by the pain of withdrawing from
heroin immediately after birth, as well as exposure to traumatic scenes without the
availability of an attachment figure to attend to her basic needs and help process her
emotional experience. The child was compromised in the domains of attachment,
affect regulation, symbolic play and communication. This thesis aims to provide an
explanation of how psychoanalytic psychotherapy positively affected those symptoms.
It provides an overview of the core intervention techniques used, with special reference
to modifications that were necessary to intervene in this instance, including additional
play room materials and ‘privileging’ interpretation. These modifications may be
relevant for the psychotherapy of other children within an exceptionally psychosocially
disadvantaged and traumatised population.
The case material is important in illustrating an example of an infant’s experience of
acute and chronic trauma in a drug-using environment, which is not uncommon in
western culture today. It also illustrates that in some cases the damaging effects of
early deprivation and relational trauma may be alleviated by appropriate therapy and
socio-environmental conditions.
11
Allison Cox
2002
THE INVISIBLE THERAPIST EXPLORATION OF SUPERVISED PSYCHOANALYTIC
PSYCHOTHERAPY
ABSTRACT
This paper explores aspects of the process of supervision and its impact on the
therapist and therapy. It will look at the assumptions and practices behind the idea of
supervision in psychotherapy training and explore the subjective experience of a
trainee under supervision in the work with a particular child.
The hypothesis being investigated is that the provision of supervision to the trainee
therapist will lead to improved outcomes in the child patient. The outcomes will be
distinguished by changes in the therapist, patient, their therapeutic relationship as well
as their inter-relationship.
The author explores the contention that the provision of supervision to the therapist
enabled her to intervene more effectively with the client by the process of the therapist
introjecting an object capable of containing anxiety. In a parallel process the
supervisee was then in a position to act as such a containing therapist for the patient
which contributed to a positive outcome for the client.
Supervision, the author will discuss, also acted as a reflective space in which difficult
material could both be heard and thought about in a way that enabled the therapist to
process such material in a meaningful way. This paper aims to clarify this experience
via a critical analysis of the data fro the supervision and the therapy and revision of the
literature relevant to psychoanalytic psychotherapy and supervision.
A single case study analysis will be conducted using qualitative methodology with the
material to be analysed pertaining to the patient, therapist, therapeutic interactions and
supervisory sessions.
The analysis of the data supports the original hypothesis that supervision, by providing
a containing, thinking space, contributed significantly to the ability of the therapist to
provide a similar environment that enabled the patient to move from a ‘part object’
relations to ‘whole object’ relations.
12
Gillian Cross
1997
THE SOUND OF SILENCE :
A CASE STUDY OF A SELECTIVELY MUTE 11 YEAR OLD BOY
ABSTRACT
This thesis is based on a case study of an 11 year old selectively mute boy. Clinical
material arising from the initial ten month period of psychoanalytic psychotherapy
raised issues relating to the aetiology of the disorder, the internal world of the child and
the use of the countertransference, especially humour in the therapeutic process.
A systematic case study was undertaken to examine some of these issues. The
underlying rationale being, that given the rarity of the disorder and the many and varied
views of aetiology, this process provided a viable method of examining threefold.
Firstly, to gain a psychoanalytic understanding of the inner world of the child.
Secondly, to investigate the origins of the mutism in the child and thirdly, examine the
use of the countertransference, especially the use of humour and gesture, and its
contribution to the therapeutic process.
Literature, theory and therapy were integrated in order to investigate the aims of this
thesis. Data was obtained from an assessment of the case, school reports, additional
information from concurrent parent therapy and clinical material which was collated
from 35 sessions of individual psychotherapy. The clinical material was analysed in
terms of the recurring theses, the countertransference material and change points.
Clinical vignettes were used to illustrate the themes occurring in the therapy.
The clinical findings are that in this case the origins of mutism lay in the early motherinfant relationship. A proposal was made of inherent vulnerability within the infant and
a depressed mother in the context of poor family communication. The underlying
disturbance in the mother-infant relationship contributed to a fragile sense of self in the
child. Selective mutism was seen as a defence of the fragile ego and also as a psychic
retreat which allowed the child to be in the world but not connecting with it. The
importance of countertransference issues, including the use of humour, in this therapy
are also discussed.
Psychoanalytic psychotherapy is regarded as providing the child with a means of
developing an integrated sense of self. Recommendations are made regarding future
areas of research.
13
Catherine Darbyshire
2008
HOLDING THE AGONY :
THE EXPERIENCE OF THE THERAPIST WORKING WITH CHILDREN AND YOUNG
PEOPLE WHOSE MOTHERS HAVE DIED TRAUMATICALLY
ABSTRACT
The death of a parent in childhood is a profound experience. The emotional
development of even a well-attached and well-resourced child may be compromised
when a parent dies. In this thesis, therapy with three children and young people whose
mothers died traumatically is used to explore some of the implications for therapists
undertaking this work. The dead mothers in this instance were mothers who had
previously abused and neglected the child or young person. The children and young
people had each experienced sexual abuse.
It is proposed that this history of a
damaged and damaging relationship with the child’s now deceased primary attachment
figure adds a different dimension to therapy that might ordinarily focus mostly on
mourning, loss and grief. Work with this cohort of children necessitates that close
attention be paid to the therapists’ experience. Unconscious processes occurring
between the therapist and the child also require careful attention.
Four key questions are addressed. Firstly, the question of what happens to a child or
young person with an abuse and neglect history whose mother dies is considered.
Many counselling approaches focus on the pain and grief associated with the physical
loss of the ‘real’ mother and the child’s understanding of that loss. Less attention has
been paid to the internal world of the child whose mother dies traumatically, particularly
when the death was preceded by earlier trauma. Secondly, the thesis explores the ways
in which therapists can work with this particular group of children and young people.
There is an examination of the therapist’s own experience, particularly the countertransference. Events in the external world that have implications for the child, the
therapist and the therapy, are briefly discussed.
The third question being posed is whether there is benefit in working with children and
young people whose lives have been punctuated by violence, substance abuse and
poverty and whose dead and damaged mothers could not keep them safe. This thesis
proposed that there is benefit in a therapy that allows the child or young person to
experience a safe and present adult with whom an attachment, or the beginning of an
attachment, might be possible. Finally, based on this small sample, it is tentatively
concluded that it is possible to work in a psychodynamic way with children and young
people who are emotionally damaged and whose mothers have died traumatically.
Psychoanalytic psychotherapy pays attention, and gives meaning to, important aspects
of the relationship between child and therapist in a way that other counselling
approaches may not. The child’s agony is held by the therapist at critical times in the
therapy. Limitations to the effectiveness and efficacy of psychodynamic therapy for this
group of children is acknowledged. Further work in this area may result in refinement of
technique and the development of a body of knowledge. It is concluded that therapy
with such children and young people offers the possibility of adaptation and survival
14
S.E.Doherty
2000
A PICTER OF MY MOUTH :
A CASE STUDY OF A FIVE YEAR OLD GIRL WITH SELECTIVE MUTISM
ABSTRACT
A five year old girl diagnosed with selective mutism is the subject of the case study
which covers a three year period of psychodynamic psychotherapy. The aims of the
case study were to contribute to an understanding of the aetiology of selective mutism,
to explore the development of speech as an aspect of emotional development and to
expand understanding of working with nonverbal systems of communication in a child
with selective mutism.
Literature, psychoanalytic theory relating to emotional development and the case
material were integrated in a discussion of the aims of the case study. Data was
obtained from the assessment of the child, school reports and clinical material. This
was selected to reflect the recurring themes of child’s inner world, changing levels of
emotional functioning and development of connectedness with the therapist.
The clinical findings indicated that the origins of mutism in this child lay in the earliest
stages of her emotional development which was adversely affected by both
constitutional vulnerability and environmental factors. The difficulty the child had in
acknowledging a sense of separateness from her object resulted in overwhelming
anxiety and a dependence on the use of projective identification to communicate her
inner feeling states. The changes that occurred in her use of symbolism eventually
included speech, as she moved in therapy towards an acceptance of separateness,
and a greater ability to integrate her inner world with reality. The connection between
emotional development and a sense of separateness with the development of speech
remains an area in need of further research.
15
Sue Fraser
1995
THE SEED, THE EGG-SHELL AND THE DARK VOID :
IN SEARCH OF A SPACE FOR PSYCHOLOGICAL BIRTH
ABSTRACT
Material from three severely disturbed children seen in psychoanalytic psychotherapy
is presented with a view to both illustrating various interruptions of the process of
“psychological birth” and exploring how these particular children reached a point where
they could form a relationship. Current theory, particularly that of Francis Tustin and
Allessandra Piontelli, is explored and developed. All the children studies brought
something with them to therapy; a latent potential, upon which a personality started to
develop. This potential is seen as having originated from a combination of something
innate within the child and from experiences of love and safety during pregnancy and
very early postnatal life. Development of this potential had, however, been interrupted.
It is suggested that this potential, stored like a “seed” inside an “egg” within the child, is
sown at conception. In normal circumstances, this gradually develops during
pregnancy and is “germinated”, post-birth, through maternal “reverie”. When progress
has been interrupted, we need to recognise this “seed” in order to reach the child.
Once located, “germination” can occur and the child can regress sufficiently to begin
working towards “psychological birth”. Gradually, the need for the protective barrier,
which the child had built around himself lessens and capacity to relate can then
develop.
16
Maria Ganci
2006
HOW BIOLOGICAL CHILDREN IN A FAMILY EXPERIENCE & PERCEIVE THE
INTRODUCTION OF A FOSTERED CHILD : “AN EXPLORATORY STUDY”
ABSTRACT
Over the past 50 years, foster care has become the preferred out-of-home care for
children, and whilst the majority of research in the area of foster care has focused on the
needs of the foster children, minimal research has focused on the impact of fostering on
the family’s biological children.
The research conducted over the past 30 years on the impact of fostering on biological
children has mostly focused on identifying the difficulties faced by biological children and
has also highlighted that the introduction of a foster child has the potential to place the
family’s own children at psychological risk.
Whilst this study has explored the effects of fostering on a family’s biological child of
latency age, and has confirmed the findings in the current literature in relation to the
difficulties experiences by biological children, this thesis has focused on understanding
the underlying sources that contribute to these difficulties by understanding the child’s
emotional and cognitive development through the theories of Winnicott, Bowlby and
Piaget.
Three foster families were involved in this study. At the time of the study, all three
families were in the process of fostering therefore it was an invivo study. Parents and
biological children were interviewed individually in order to gain an understanding of the
parent/child attunement, and their respective perception of the fostering experience.
The findings of this study suggest that, whilst the fostering experience is a difficult
experience for latency aged children to negotiate, it is not the fostering experience per
se that contributed to many of the difficulties, rather it was the parental management of
the environment and fostering experience that ultimately contributed to the child’s
capacity to negotiate the experience.
17
KayeGeohegan
2003
ATTACHMENT, SEPARATION AND LOSS :
MEANINGS FOR CHILDREN IN COMPLEX FOSTER CARE
ABSTRACT
For psychotherapists working with children in foster care, a main concern is to help the
child deal with having to be separated from his or her primary attachment figure, in most
cases the mother. The mother-child relationship is the supportive context wherein the
emotional needs of the infant are met, allowing a sense of safety and security to flourish.
Separation of the child from the primary caregiver is proposed by attachment theory to
be catastrophic, with major implications for psychological development. In some cases,
the resilience of foster children in their capacity to form new attachments, is striking. The
present exploratory, qualitative study investigated issues of attachment, separation and
loss in three children with a complex history in foster care, and who were referred for
psychotherapy. Each child had endured the trauma of separation from significant people
– mother, father, and siblings, and later from a series of foster parents and their families.
This was an archival study of the clinical assessment material relating to each child. It
examined the history of the children, through the transition stages of severed
attachment, separation and loss, and attachment to their foster parents. The study went
on to explore the factors that assisted these children through their torturous journey, and
identified some key factors that appeared to have helped them retain a sense of secure
attachment. One such factor was found to be that in all the cases the protective services
worker remained stable throughout the child’s transitions, providing a level of
consistency and containment. A second major factor was the commitment of the foster
parents to the child. Perhaps the most important factor was the early development of a
secure base relating to internal models of attachment. Implications for attachment
theory, foster care practice and further research are drawn out.
18
Karyn Graham
2000
PSYCHOANALYTIC PSYCHOTHERAPY FOR CHILDREN AND ADOLESCENTS IN
FOSTER CARE : PERCEIVED USEFULNESS
ABSTRACT
Clinical experience and review of the literature has drawn attention to the usefulness of
psychoanalytic psychotherapy in addressing the psychological needs of children and
adolescents in long-term foster care. However, this has been little studied in general,
with no systematic research on the Australian experience published so far.
Commentaries have suggested that close liaison with foster parents and welfare workers
in the wider foster care system is essential in the effective delivery of psychotherapy to
this group of needy children and adolescents, indicating issues that present difficulties in
successfully working with them. Despite their central role, there is no reported empirical
research into the perceptions of foster care workers and foster parents as to the
usefulness of psychoanalytic psychotherapy for children and adolescents in long-term
foster care. The present study is hence an exploratory study in to the perceived
usefulness of psychoanalytic psychotherapy for Australian children in long-term foster
care, seeking to confirm if a similar pattern of benefits and difficulties was experienced
as reported in the literature from overseas. It was planned to explore existing gaps in
understanding and knowledge in the literature through tapping foster parent’s and foster
care social workers’ experience and perceptions, particularly of the value, role,
difficulties, initial obstacles and possible disadvantages of providing psychotherapy for
children and adolescents in long-term foster care. Four foster care social workers, four
foster parents and four psychotherapists, all of whom volunteered to participate in the
study and with experience in this area were interviewed and asked to complete an
attitude rating scale as to the impact of psychotherapy on specific areas considered
important in the literature. Qualitative data from the in-depth inter interviews was
analysed according to content analysis procedures using matrices, and quantitative data
from the rating scales was examined in visual form. This permitted comparison of the
perceptions by the three groups of participants. The findings supported the proposition
that psychoanalytic psychotherapy is indeed perceived as beneficial to children and
adolescents in long-term foster care. The finding are discussed in terms of the role of
psychotherapy here, issues around provision of psychotherapy and service delivery for
this population, the differential roles of the three groups, and the need for greater
education within the foster care system and public mental health arena.
19
Anita Hallam
2008
CLINICIAN EXPERIENCE OF OUTREACH AS A PSYCHOTHERAPEUTIC
INTERVENTION WITH OLDER CHILDREN IN OUT-OF- HOME CARE
ABSTRACT
Outreach is a psychotherapeutic intervention which has been mainly employed in recent
years to engage clients with a history of abuse and trauma. To date, little empirical
research has been reported which evaluates or even describes such work. The present
study constituted a preliminary, qualitative exploration of this area, investigating the
experience of clinicians using outreach as a therapeutic intervention with children. Five
senior clinicians were recruited from the Take Two program of Berry Street Victoria
which provides therapeutic services to minors in out-of-home care. The work of the
clinicians with the 10-14 year old age group, a large group within the Take Two clientele,
was targeted by the study. In depth interviews with the clinicians elicited data relating to
five domains of enquiry. These domains comprised factors in deciding to use outreach
as an intervention, models favoured in therapeutic outreach work, clinicians’ experience
of the process of therapy in outreach, successful use of research and factors limiting
successful use. The findings of the thematic content analysis concluded in each domain
of enquiry provided a detailed picture of the clinicians’ range of experiences in this
practice. They are discussed with particular reference to demonstrating the potential of
outreach as a means to first engage this client group in a psychotherapeutic process,
critical clinician qualities required to do this work, and facilitating therapeutic change for
the child and his or her broader interpersonal systems. It is concluded that the
participating clinicians found that outreach promotes the development of a facilitating
space between a child and clinician, leading on to a therapeutic space in turn facilitating
possibilities for creative change within the child. Limitations and strength of the study
are discussed, as are implications for theory, practice and future research.
20
Katrina Louise Hillier
2008
OEDIPAL ISSUES IN A CASE OF PSYCHODYNAMIC PARENT PSYCHOTHERAPY
ABSTRACT
This study focuses on the Oedipal issues which arose in my work as a parent therapist in
a parent psychotherapy case supervised within the Master of Child Psychoanalytic
Psychotherapy degree. A qualitative single case study method was utilised to analyse
these themes.
The case illustrates the significance of Oedipal issues for mother, father and child in
explaining the dynamics and difficulties within the family. It highlights the importance of
unresolved Oedipal issues which the parents brought to their parenting and how these
impacted upon the child and related to her behaviour. Through the parent therapy, the
parents made some gains towards understanding their child’s behaviour within the
context of their family dynamics.
The case showed that it is important that child psychotherapists are mindful of the
significance of Oedipal issues within their work and that these issues can particularly
come to the fore in the practice of psychodynamic parent therapy.
21
Julie Hooy
2003
ENQUIRY INTO THE EXPERIENCE AND THINKING OF CHILD
PSYCHOTHERAPISTS WORKING AS SECONDARY CONSULTANTS TO THOSE
WHO WORK WITH CHILDREN LIVING IN FOSTER CARE
ABSTRACT
This study linked the difficulties evident for children who have been removed from their
parents with the difficulties workers and secondary consultants can have in keeping a
‘potential space’ available to reflect upon these children and their emotional needs.
The ideas of Klein, Bion and Winnicott in regard to the creation of reflective thinking
were used in this qualitative research enquiry to discuss findings from interviews with
four child psychotherapists working as secondary consultants to workers involved with
children in foster care. People who work with children in foster care and secondary
consultants who consult to these workers all require ‘containing’ spaces to consider
their work. They require a relationship that is respectful and valuing of their efforts and
of the pressures they are under and it is this which contributes to the creation of a
‘contained’ or ‘potential’ space.
22
Jennifer Howard
2005
SHAME IN THE COUNTERTRANSFERENCE :
REFLECTIONS ON “OUT OF ROOM” BEHAVIOUR IN ORDER TO ILLUMINATE
ASPECTS OF PSYCHOTHERAPY WITH A FOSTER CHILD IN A TRANSITIONAL
PLACEMENT
ABSTRACT
This thesis is a study of an aspect of the behaviour of a child in foster care who was in
a transitional placement. The child was resistant to coming into the therapy room in
about a third of her therapy sessions. This raised the issue of whether exploring this
aspect of the treatment would bring a clearer understanding of the underlying conflicts
for the individual child, as well as create some areas for further exploration in relation to
the treatment of these children.
A single case study methodology is employed using a segmentation paradigm to
analyse this aspect of her behaviour. A multiplicity of issues became apparent as the
therapy progressed. These included:
 The impact of the abuse and of the family disorganization she had experienced;
 The impact of the iatrogenic components of the care system;
 The developmental deficits that had occurred during her childhood.
The literature review focuses on the areas of child abuse and the resulting impact on
the child’s neurobiological functioning, attachment behaviour and development of
mentalizing. Iatrogenic components of the care system are examined, along with the
clinical literature concerned with the psychodynamic therapy of foster children. The
data for this study came from the process notes written at the time of the therapy.
The discussion and conclusion highlight the need to take into account the
developmental deficits that occur in these children, as well as the iatrogenic
components of the care system. The findings support the existing clinical reports of the
difficulties and challenges in treatment of these children.
The use of
countertransference feelings especially of shame is highlighted as being an essential
component of the therapy.
23
Jennifer Jackson
2005
NO SONGS FROM THE CRADLE : CLINICIAN EXPERIENCE OF ASSESSING
ABANDONED INFANTS
ABSTRACT
Children entering the out-of-home care system under the state authority’s legal custody
have experienced trauma associated with abuse, neglect and separation from their
parents. They are considered at high risk of developing emotional and behavioural
difficulties and, therefore, early therapeutic intervention is recommended. Often these
children come into foster care with very little information having been transferred from
one carer to another about their history, care routine and health, sometimes with no
information at all. Infants are particularly vulnerable in this instance as they have limited
verbal language to communicate their experience and needs. The transitory nature of
out-of-home care for these infants, where multiple short-term placements are common
place, is yet another factor which contributes to the difficulties there infants have in
accessing health services in Australia.
This paper explores individual clinician’s experiences of assessing infants separated
from their families. This is presented in the context of the Australian, and other Western
societal experience of the separation of children from families through history. The
research was conducted as a pilot study. The thesis, undertaken for the Monash
University, Masters of Child Psychoanalytic Psychotherapy, is that there are many
challenges (to be described) facing mental health clinicians who attempt to assess the
traumatised infant’s emotional world in the absence of the primary carer. Coping with
such work requires a web of supportive structures on an individual and organisational
level. Despite the costs, the value of such early intervention is found in the potential
reduction of pathological emotional and behavioural symptoms resulting from trauma
experienced by babies through abuse, neglect and separation from primary attachment
figures.
Interviews with two senior clinicians, who had received psychoanalytically informed
training, were examined, incorporating reflection on case material. The research was
approached from a grounded theory qualitative research design. Through the data
analysis it was discovered that an application of complexity theory may provide another
layer of insight into the dynamics confronting clinicians engaged in this particularly
difficult work.
The results the complex and emotionally challenging nature of the clinical experience,
evidenced both in the examples of the work provided, and in the process of recall and
relating to the interviewer. The skills developed in the training of infant observation and
the importance of working in a reflective clinical team were considered by the
participants to be critical in this demanding work, in developing the capacity to bring
thought to bear on these infants experiences and the clinician’s own. The research
interview process itself was analysed as providing another layer of facilitative, reflective,
and containing space for the clinician’s processing of primitive anxieties aroused in this
work and in their development of a more integrated, coherent sense of their practice.
24
Linae Jolly
2008
SOMEONE VERY IMPORTANT IS COMING TO DINNER :
RELATIONAL TURNING POINTS IN PSYCHOTHERAPY WITH CHILDREN IN
OUT-OF-HOME CARE
ABSTRACT
This thesis discusses three case vignettes which reflect relational ‘turning points’ in
individual child psychoanalytic psychotherapy. The children discussed in these vignettes
were living in out-of-home care throughout the extensive period of psychotherapy. Each
of the children studied had difficulties developing and maintaining relationships prior to
treatment. Their eventual acknowledgement of the emotional connection to their
therapist was considered a significant relational turning point in their psychotherapy.
These turning point moments were explored from a child psychoanalytic perspective to
identify whether any key factors may have contributed to the children allowing
themselves to acknowledge their emotional connection with their psychotherapist. Case
material and case vignettes were explored for common themes and the therapist’s
reflections were also examined for similarities with a focus on the transferences and the
therapist’s countertransferences. From this, further underlying themes of love and
acceptance of the reality of separation were derived. These were then discussed as
potential factors contributing to the turning points and to facilitating the children’s
development.
Through the therapeutic relationship the children were considered to have developed the
capacity to engage in a meaningful relationship, to develop a more positive sense of
themselves and to experience themselves as lovable. These developments were
considered to support them in accepting the reality of separation in their lives.
25
Jody Kernutt
2007
THE EYE, OR THE I, AND THE OTHER :
THE INFANT, OR THE MOTHER AND THE OBSERVER : A WINNICOTT
PERSPECTIVE ON POSSIBLE PRECURSERS TO THE DEVELOPMENT OF THE
‘FALSE SELF’ TAKEN FROM A VIGNETTE IN A MOTHER INFANT OBSERVATION
ABSTRACT
“If the mother’s face is unresponsive, then a mirror is a thing to be looked at not to be
looked into” (Winnicott, 1971)
This study focuses on the turbulence observed between a mother and infant in a feeding
relationship in a longitudinal psychoanalytic mother infant observation. Winnicott
described the ‘False Self” presentation as a picture of general irritability and
disturbances, along with possible feeding difficulties, becoming less evident only to
represent in later life. A vignette of the last observed breast feed taken from the mother
infant observation was the data to analyse the infant (the I), the mother (the Eye) and the
observer (the Other) against the “False Self” development of the infant. Within this
feeding relation the infant was tracked from the first observation until aged six months
and three weeks when she became compliant in the feeding relationship to an ego ideal
disconnected from her ‘True Self’. In the infant’s experience the ‘not me’ (outside),
impacts on the ‘me’ (inside), with the ‘False Self’ coming into existence as a way to hide
her ‘True Self’. For the infant to survive she had to feed on the mother’s terms, and take
on a ‘False Self’ to represent to the outside world as a mask to hide the ‘True Self’
existence. The infant’s only residue of the “True Self” was the protest of ‘not to eat’ as a
way to survive.
When unpacked in conjunction with Winnicott’s theory of the ‘False Self’ this thesis was
a means of providing insight into the internal world of the infant who may later present as
an adolescent of (sic) adult with an eating disorder.
26
Nada Lane
2008
AN EXPLORATION OF THE RELATIONSHIP BETWEEN AN OBSERVER AND
OBSERVED MOTHER IN PSYCHOANALYTIC INFANT OBERVATION
ABSTRACT
Despite the internationally recognised significance of infant observation as a
psychoanalytic training method, now practised for over six decades, and despite the
fact that it has involved uncounted numbers of observers and volunteer mothers with
their infants, no empirical research has been reported on the relationship that develops
between the observer and the observed mother. Written commentaries to date have
been made principally in the context of psychoanalytic exploration of other aspects of
infant observation. The aim of this exploratory study was to shed some light on some
of the dynamics that can emerge in the relationship between observer and observed
mother. Semi-structured, in-depth interviews were conducted individually with three
observers and three observed mothers, eliciting retrospectively their lived experience of
the relationship as it developed. The narrative material generated by these six
interviews was so abundant that it was beyond the scope of this minor study to do full
justice to the data. Therefore, the narrative material of one observer and observed
mother pair that, while clearly unique, represented typical themes that emerged across
all the interviews, was c hosen to be the focus of the data analysis. Analysis and
interpretation of the narrative material indicated that, in the initial stage of the
observation, for both observer and observed mother, primitive anxieties surfaced in
response to the emotionally arousing context of the observation, namely the presence
of the infant and infantile feelings. Furthermore, the intrusive nature of the observation
situation for both parties, in their respective positions of observer and observed,
amplified these anxieties. Over time, the regularity and reliability of the observation
situation evoked an intimacy between the observer and the mother with her infant.
This provided a continuing focus for the re-arousal of primitive feelings in observer and
mother. The mobilisation of these intense feeling resembled transference and
countertransference feelings of an infantile and maternal kind which appeared to
mingle at various levels between observer and mother. The relationship could also be
understood in terms of a container-contained interaction, with the mother making
unconscious use of the observer as maternal container. Over time, the relationship for
the observer and the observed mother, for each in different ways, became profoundly
important and psychically developmental. The thesis concludes by drawing out the
implications of the research for theory, training practice and future exploration.
27
Toni Long
2001
THE DEVELOPMENT OF SEPARATENESS :
A LONGITUDINAL INFANT OBSERVATION STUDY – FROM BIRTH TO FIVE YEARS
ABSTRACT
This is a study of the impact on emotional development of the tension between drives
for union and separateness in human relations. It is based on a longitudinal
psychoanalytic infant observation that extended from birth into the child’s 6th year.
Against the background of an ordinary development, the deep emotional engagement
between mother and baby and ensuing separation struggles stood out in high relief. In
light of this, it was hypothesized that unresolved separation and loss issues emanating
from the mother’s primary relationships in infancy may lead to the child becoming a
‘replacement object’ for his mother and thus interfere with his developing separateness.
These dynamics were particularly apparent in the area of sleep. However, over the
course of time it became evident that the mother was ‘reworking’ her separation issues
through the process of faciliting her child’s growth and development. The child’s
capacity to sustain separations and develop separateness appeared to proceed in
tandem with his mother’s shifts. Developments in the transitional space and the child’s
use of transitional phenomena were especially illuminating. The impact of other factors
are examined. These include the contributions made by the child, the father’s role and
‘emotional containment’ as conceptualized by Bion.
28
Marita Lowry
2008
AN EXPERIENCE OF PERSECUTORY ANXIETY IN A LATENCY AGED GIRL IN
PSYCHOANALYTIC PSYCHOTHERAPY
ABSTRACT
Persecutory anxiety is an important theoretical and clinical construct in the field of
psychoanalysis. This qualitative study aimed to explore the experience of persecutory
anxiety as it manifested in a latency age girl in psychoanalytic psychotherapy. A review
of theoretical literature relating to persecutory anxiety in the Kleinian object relations field
revealed that persecutory anxiety is a multifaceted concept, positioned within and
influencing/ influenced by other relevant concepts such as envy, greed, projective
identification, containment, phantasies of aggression and oedipal coupling. These
dimensions of persecutory anxiety were investigated in the case study analysed. The
child presented for treatment at a child mental health centre, with high levels of
emotional and psychological disturbance. Examination of the child’s material was
approached from a Kleinian object relations perspective. The psychoanalytic case study
method was utilized in combination with thematic content analysis to identify emerging
themes in the child’s therapy pertaining to persecutory anxiety. These themes were
extracted from five sources of data, consisting of an analysis of the sessions overall,
aspects of the case history, and close examination of one identified session, chosen for
its evocative illustration of persecutory anxiety. The interplay between oral aggression
and persecutory anxiety appeared as central, drawn from interpretation of the child’s
expression of oral aggression and identification with fierce, orally devouring animals,
notably the werewolf. The study moves to contextualize the experience of persecutory
anxiety using an integration of Kleinian theory, case history material and themes from
session material. The origins of the child’s experience of persecutory anxiety, revived
from infancy and enacted with force in the transference-situation in the therapy, are
connected with multiple experiences of trauma and distress suffered by the child in the
earliest days of infancy. The conclusion drawn in concurrence with the outcome of the
review of literature is that any consideration of aspects of the theory of persecutory
anxiety cannot be undertaken is isolation from these and other constructs. Implications
of the research for theory, practice and future research are discussed.
29
Marell Lynch
1995
PSYCHOTHERAPY OF A CHILD WITH AUTISTIC FEATURES :
ISSUES OF DIAGNOSIS, PRESENTATION, CASE MANAGEMENT, TREATMENT
AND STRUCTURE
ABSTRACT
The psychotherapy of children with autistic features is controversial within child
psychiatry. The controversies are not just about the usefulness of therapy, but also
about the conduct of the therapy and the phenomenology and structure of the disorder.
In the case of this five year old boy, the diagnosis was controversial as well as the
decision to refer for psychotherapy assessment. Therapy did produce changes which
had the effect of clarifying the diagnosis and thereby ended the therapy. The case
material has been analysed from several case and conceptual perspectives. It is
postulated that autism is a syndrome that complicates the position of the observer as
either diagnostician or therapist, as described by Alvarez (1992). Implications for
service provision to children thought to be autistic are discussed with respect to
diagnosis, therapy and family support.
30
Janet F. Manders
2001
A SEVERELY TRAUMATISED FOUR YEAR OLD BOY :
A TESTIMONY OF RECONSTRUCTION AND WORKING THROUGH
ABSTRACT
This thesis, which comprises the single case study of a traumatized boy, contributes to
the field of child psychoanalytic psychotherapy in the area of child psychological
trauma. The author works in a child and adolescent mental health service and has a
special interest in childhood psychological trauma. In her experience, in many cases
the real circumstance of the trauma is not clear and the subjective experience of the
child is represented in a complex set of symptoms. It was the severe and disturbing
symptoms of this child that brought him to the mental health service for assessment
and management.
The aim of this thesis is to explore the concepts of trauma, and the development of
object relations, drives and the Oedipal structure to indicate the complexity of the
different levels at play in psychological trauma. The process of the reconstruction and
the working through of the subjective experience of this boy is examined. These levels
are:
.
being orphaned in his war torn country of origin, including the possibility of
witnessing the death of one or both parents.
.
living in a beggar gang and being taken by the police to an orphanage at a very
early age
.
becoming a victim of sexual abuse whilst in foster care
.
adjusting to adoption by a white Caucasian family
.
moving to a new country and adjusting to a different culture
.
adjusting to living in a family with his adoptive parents and brothers
As the therapy progressed the circumstances of his traumatic experiences became
apparent as he reconstructed them. The recovery of repressed memories has become
controversial. It is important that the repressed memories belong to the child and not to
the prefabricated memories from the therapist theories. Neutrality and floating
attention whilst hypothesizing what the child may bring to the conscious level, is of
paramount importance to avoid the trap of suggestion on the part of the therapist. The
study of repressed memory is not within the scope of this thesis.
31
The literature reviewed focuses on the fields of child psychological trauma and
psychoanalysis. Data for this study was the clinical material contained as the process
notes in summary form. The multiplicity of the levels of the trauma is apparent in the
24 sessions covered. The therapy was not completed because the family relocated.
The discussion and conclusion were not to focus on the symptomatic improvements
that did occur, but to explore the underlying psychopathology, in particular the drives,
internalized objects and the Oedipal structure through the reconstruction and working
through that occurred in his psychotherapy.
This traumatized four year old boy has to process through his new adoptive family his
earlier tragic experiences that happened in his war torn country of origin. This single
case study is unique, but the method of psychoanalytic psychotherapy has general
application with traumatized children.
32
Carolyn Mier
1999
ADOLESCENTS EXPERIENCE OF PSYCHOANALYTICALLY ORIENTED
PSYCHOTHERAPY
ABSTRACT
The paucity of research into the adolescent experience of psychotherapy, and
specifically the absence of studies on adolescents’ own views of the therapeutic
process and particularly the therapeutic relationship, led to the present study.
This exploratory study of adolescents’ views and experiences of psychoanalytically
oriented psychotherapy has focused on their experience of the therapeutic relationship.
In particular, it has focused on the aspects of the relationship or therapist style which
were found to be helpful or unhelpful. Additionally, adolescents’ opinions on issues
related to the context of therapy, including the therapeutic boundaries, were
canvassed. Process variables such as attitudes to and expectations of therapy,
perception of choice about attending therapy or the choice of therapist and level of
understanding the therapeutic process were also analysed. The adolescents’ account
of their presenting problems and past experience provided a background for this
discussion.
Ten adolescents who were currently involved in ongoing, regular psychoanalytically
oriented psychotherapy were interviewed using a semi-structured approach to
ascertain their experienced of individual therapy.
It was found that the unique developmental period of adolescence required special
factors to be considered in the setting up and maintenance of the therapeutic
relationship. Issues of trust, flexibility, consistency, stability and therapist awareness of
changing adolescent needs in the context of their shifting developmental pressures
(familial, peer related, educational and social) were found to be of particular importance
in creating optimal conditions for adolescent psychotherapy.
33
Eve Newman
1994
MUMMY DON’T CRY :
A CASE STUDY OF A 6 YEAR OLD PARENTIFIED GIRL
ABSTRACT
This thesis is based on a case study of a 6 year old parentified girl. The study dealt
with parentification, or compulsive care-giving, and was prompted by the author’s
clinical experience of children seen in psychotherapy who frequently presented with
over protectiveness and over-concern for their parents. Observations were that they
could be precocious, omnipotent, self sufficient, controlling, pseudomature with
obsessional and compulsive symptoms, which included compulsive care-giving.
The aim of this study was to gain a psychoanalytical understanding of parentification
and its development and of the inner world of a parentified child. Also examined was
whether parentification was an appropriate defense, both as a way to cope and a way
to achieve closeness with her parents.
The Literature review focused on parentification as a construct, as this was a theme
central to the therapy. The review also examined the functions of parentification, its
aetiology and development, with a special focus on the early mother-infant attachment
and object relations theory. Recognition was also given to the contribution made by
family therapy theory.
The thesis integrated literature, theory and the therapy case. Data included an
assessment of the case, collateral information from the school and parents’ therapy
and clinical material. One year of individual psychoanalytic psychotherapy was
examined, and recurring therapy themes explored, but the focus was on compulsive
care-giving. Vignettes were used to illustrate compulsive care-giving and other themes
from therapy sessions.
Clinical findings were that compulsive care-giving had offered this girl an identity,
although this was a “false self”. Obsessional defences had helped to ward off
unwanted thoughts, anxieties and drives, with excessive and repeated use of other
defences including compulsion, reaction formation, projection and undoing.
A
consequence of her defence system was that she had a harsh and rigid super-ego with
resultant anxieties, conflicts and guilt. The ongoing projections and introjections
included omnipotent phantasies, with hostility, anger and fear of her own alienation and
abandonment. This was overlaid by ongoing family chaos which included her mother’s
depression, escalating marital problems, birth of a sibling and her consequent
placement in foster care. This family instability was seen as a dynamic that sustained
her compulsive care-giving.
34
The study concluded that, despite this girl’s unpredictable external world, her
obsessional compulsive symptoms seemed to bring her the best solution and thus she
had found a way to cope, although under increased stress her obsessional defenses
proved to be inadequate. The ongoing family chaos with the crisis of the children’s
placement, interrupted the therapy, but as the therapeutic relationship was not
destroyed, the therapy was able to continue at a meaningful level. Through this
corrective experience her phantasies and projections had not proved to be omnipotent,
and the experience of a relationship that had not collapsed meant that her
compulsiveness could therefore lessen, and she could thus start to relinquish her
compulsive care-giving and obsessional defenses.
Due to limitations place upon this study it was not possible to expand the parameters,
but analysis of the case suggests that this child had achieved a later stage of
development, so it would have been valuable to explore the oedipal stage of
development, as well as superego anxieties in greater depth.
35
Andrea O’Byrne
1997
PSYCHOANALYTIC PSYCHOTHERAPY AND THE SENSE OF SELF :
A CASE STUDY OF A CHILD
ABSTRACT
The idea of a case study emanated from an interesting and successful psychoanalytic
psychotherapy treatment of a latency aged boy diagnosed with Pervasive
Developmental Disorder Not Otherwise Specified.
The central issue of the
psychoanalytic psychotherapy appeared to be that of individuation and the
development of a sense of self during a thirty-two session phase of psychotherapy.
The focus of the research was the role of the psychoanalytic psychotherapy that may
have facilitated the positive change in this boy in terms of the development of an
integrated sense of self.
Three sources indicated that change had occurred in the child’s symptomology, namely
the child’s behaviour in the psychotherapy itself, reports by the parents from the parent
psychotherapist, and an Achenbach Child Behaviour Checklist completed by the
referring school before and after the phase of treatment studies.
The aim of the case study was to explore what interaction in the psychoanalytic
psychotherapy may have facilitated the growth in the integration of the sense of self.
Sequential, evenly spaced psychotherapy sessions were selected provide the raw
data. Data from the process notes from these psychotherapy sessions, therapist’s
supervisory notes and the child’s drawings were collated. A three state process of data
distillation and organisation was the method of data analysis chosen. The raw data
were summarised as categories of verbal and nonverbal behaviour for both the child
and therapist and dimensions of meaning assigned to them. The variables in each of
these categories were then identified, given a coded abbreviation and defined with the
help of the psychotherapeutic literature where possible.
The child’s inferred level of integration was also coded for each of his behaviours
recorded within a session. This coded data was then put into tabular form for each
session to enable analysis of the data within sessions and across the phase of
treatment. Patterns were noted by inspection.
The results of the data analysis indicated that nonverbal interventions from the
therapists (‘Active Listening’ and ‘Attuned Body Position’) were particularly potent
techniques as these techniques were usually followed by an improvement in an
integrated presentation of sense of self in the child. Verbal interventions, in particular
‘Reflections of Feeling’ and ‘Interoperation of Feeling’, appeared to be most helpful
towards the end of each session and during the later part of the thirty-two session
36
phase of treatment. Often verbal interventions (‘Questions’, ‘Interpretations of
Behaviour’ and ‘Prompts’) were not found to be helpful, in that it appeared that the
presentation of sense of self either did not improve or became more unintegrated
following this type of intervention. The study was planned as exploratory and the
implications of the findings led to recommendations for further research.
37
Georgina Parker
1994
THE QUESTION OF INFANT OBSERVATION AS RESEARCH :
A PHENOMENOLOGICAL PERSPECTIVE
ABSTRACT
The thesis aims to examine the research possibilities of Esther Bick’s model of infant
observation from an empirical phenomenological perspective within the framework of
the Human Sciences.
This is done, initially, by describing the infant observation method and considering
Brafman’s (1988) and Rustin’s (1989) comments on its research dimensions. The
guardedness of their optimism about its research potential is influenced by their setting
of standards for infant observation as research that have origins in a natural scientific
conceptualisation of science.
A phenomenological critique of the extension of the natural sciences to the study of
complex human psychic phenomena is offered to question the necessity of this
guardedness.
The inherent research worth of infant observation is then considered via an
examination of the valuable research dimensions it shares with psychoanalytic
methodology, upon which its foundations rest. This is considered from Kvale’s (1986)
perspective.
It is proposed that the method of data analysis, as developed by empirical
phenomenological research (Giorgi,1971,1975,1983,1985,1989,1992) can offer a
certain rigour to the analysis of the infant observation material when it is used for
research purposes. Such analysis, while limited, is an attempt to scientifically and
rigorously treat descriptions within an area of psychoanalytic interest. A practical
example of data analysis in this manner is illustrated via an excerpt from infant
observation research.
38
Jill Pullen
2000
USING PSYCHOANALYTIC THEORIES TO ENHANCE OUR UNDERSTANDING OF
THE EFFECTS OF SEXUAL ABUSE ON CHILDREN UNDER FIVE
ABSTRACT
The legal and health systems have been slow to recognise the needs of sexually
abused children under five. Often these children are unable to put into words the
nature of their experiences and it has been assumed that they do not require treatment.
Whilst much has been written about childhood sexual abuse from adult retrospective
studies, it is only recently that children have been studied. Children under five years of
age, because they are less verbal about their experiences, have been difficult to study
directly. This work attempts to explore the usefulness of psychoanalytic theories of
emotional development in explaining the effects of sexual abuse found in clinical
studies and empirical research on children under five. Case illustrations from sexually
abused children in psychoanalytic psychotherapy have been used. The method used
has been to divide this work into three sections. The first section outlines several
psychoanalytic theories. The second section reviews empirical and clinical findings on
four broad effects found most frequently in sexually abused preschool children. The
third section attempts to understand the processes underlying the development of such
effects using psychoanalytic theory and case illustrations. It is concluded that
psychoanalytic theory can enrich our understanding of the effects of sexual abuse in
very young children, and the implications of the abuse for their subsequent emotional
development.
39
Eve Raper
1995
ALL DARK IN THE CONTROL ROOM
ABSTRACT
This thesis employs a research method informed by naturalistic enquiry drawing on a
single case study in order to investigate whether a child with a diagnosis of Pervasive
Developmental Disorder.
Not Otherwise Specified, could benefit from
psychoanalytically oriented psychotherapy. The child was seen twice weekly for twelve
months and the themes that arose in the therapy are examined in order to establish
whether or not his emotional state and ability to socialise and learn improved. The
clinical developments demonstrate clearly that this child did benefit from the therapy.
The results of the research are discussed in the light of the prevailing view that children
with Pervasive Developmental Disorder are rarely considered to be able to benefit from
this type of work because their presenting problems are currently seen to be of an
exclusively organic nature. In addition, the broad nature of this diagnostic category is
discussed in relation to the tendency to consider that all children who fall within this
category have some form of autism and therefore will not benefit from
psychoanalytically oriented psychotherapy.
40
Jennifer Re
1999
THERE’S A CROCODILE IN THE HOUSE :
SYMBOL FORMATION AND ITS RELATION TO SYMPTOMS IN A 4 YEAR OLD GIRL
ABSTRACT
The word symbol is from the Greek word Symbolon meaning a sign of recognition. The
Greeks used the two halves of a broken disk for identification. The equal and opposite
matching pieces carry the connotation of a link providing meaning in the context of
absence.
The author explores the nature of symbol formation in a young child who was brought
for psychoanalytic psychotherapy.
The author is a child psychotherapist who practices within a child and adolescent
mental health service, and became interested in the problems of early childhood when
some of those children who were brought for treatment, showed a mixed picture of
development. These young children often had some features of age-appropriate
functioning together with delays in some areas. Sometimes a symptom might also be
present, indicating an emotional factor.
This thesis has been undertaken within the model of a single case study and as such
submits a detailed account of the therapy of one child. This child came to therapy with
a particular pattern and level of symbolic functioning associated with a background of
family, constitutional and possible genetic factors. Vignettes of clinical material, some
artwork, and one entire session are presented in the account of her therapy. It was an
unfinished therapy.
Following the detailed case study presentation, the psychoanalytic literature is
surveyed with relevance to symbolism as it is elucidated in the Kleinian tradition and
traces its precursors in the classical theorists’ ideas, details Kleinian theory and postKleinian formulations. An appraisal is made of the contributions of these theorists to
this field.
A discussion of the clinical material follows, examining the evidence for different levels
of symbolic functioning from several different perspectives, incorporating the clinical
and theoretical significance of these. The perspectives include: processing early
anxieties through play, the transference relationship where the child can be helped to
understand her experiences in a specialised setting, the child’s artwork as evidence for
some of the ways internal processes can be reflected through this medium,
communication, with reference to the child’s ability to communicate with herself and to
others successfully, and the importance of this capacity, and finally, the meaning of the
symptoms and their fate.
41
In conclusion, the problems of interpreting the exact nature and origins of this child’s
difficulties are noted. Some limitations of the theoretical constructs are noted in view of
future areas to be further elucidated.
42
Lynne M. Regan
2007
THE OBSERVER’S REVERIE IN AN INFANT OBSERVATION
ABSTRACT
This paper attempts to bring the shared experience of a twelve-month, once a week,
observation of an infant to life for the reader. It is based on the tradition of infant
observation begun by Esther Bick. It is a translation into words of an encounter with
infantile states. Bion’s notion of reverie provides the lens through which the infant is
viewed. Three intertwined memory bundles based on the observers’ attempt to record in
detail the infant’s actions and environment and the juxtaposition of the observer’s
thoughts and feelings about the infant’s experience are presented. The shifts in the
observer’s stance and the internal and external space that is available for the
observation is outlined. This paper explores the state of mind of the observer as a
means of knowing the infant state of mind.
43
Juliet Rouse
1996
A ROSE BY ANY OTHER NAME :
THE STUDY OF AN UN-NAMED BABY
ABSTRACT
In this thesis, a case study approach is used to examine material from a year long
infant observation, conducted in the psychoanalytic tradition pioneered at the Tavistock
Clinic in London in 1948. The baby observed remained un-named by her parents
throughout the year of the observation. The thesis uses a psychoanalytic perspective
to examine both the significance of the delayed naming in terms of the mother’s
experience of the baby, as well as the impact of the delayed naming on the baby’s
development. The case material is also discussed in the light of information about
names and naming practices in different cultures and spiritual traditions, as well as
research which indicates that there is a link between a person’s name and her identity
or sense of self. Bion’s theory of the container and the contained is used to develop
the hypothesis that a person’s name functions as a container for her sense of self, and
that the naming of a baby by her parents can be seen as one aspect of the containing
function usually provided by an infant’s caregivers. This hypothesis is then examined
in relation to three themes in the mother-baby interaction that arose during the course
of the infant observation. It was concluded that the mother’s difficulty in naming her
baby, in this case, was a symptom of a more general difficulty in containing her baby’s
experiences. In the light of anthropological information concerning naming, it is
suggested that a name functions not only as a container, but also as a defence against
primitive existential anxieties.
44
Jennie Rowntree
1994
TOWARDS AN UNDERSTANDING OF PSYCHODYNAMIC PARENT
PSYCHOTHERAPY
ABSTRACT
The study began with a desire to explore the somewhat elusive and confusing concept
of ‘parent therapy’ as used in the Victorian Master of Child Psychoanalytic
Psychotherapy Course. The literature about therapeutic work with parents in general,
and using psychodynamic principles in particular, is sparse. This study aimed to
investigate issues in both these areas, by means of a survey of child psychotherapists.
A recursive method was used; this involved the design of questionnaire, three in-depth
interviews, the redesign of the questionnaire, and finally a survey using the
questionnaire. The interviews demonstrated that the term ‘parent therapy’ was itself a
source of confusion, often used as a generic term to cover all work with parents. The
term ‘psychodynamic parent psychotherapy’ (Ferholt, 1991) was introduced into the
study to denote more precisely the area under investigation. The questionnaire was
sent to all 32 members of the Victorian Child Psychotherapists Association, resulting in
a response rate of 84%. Descriptive statistics were used to summarize the resulting
qualitative and quantitative findings.
Respondents described psychodynamic parent psychotherapy as a distinct way of
working with parents but there was no agreement about the way its distinctiveness was
defined. A majority considered there to be inconsistency between the theory and
practice of psychodynamic parent psychotherapy. There was variation in the way
respondents reported handling some of the challengers in practice, such as individual
adult and marital issues, case management and collaborative therapy. The work
setting appeared to influence practice. Although a majority of respondents considered
working with parents to be very important, a minority reported seeing more parents
than children and most preferred to work with the child. Only a small percentage of
parent cases were reported to be psychodynamic parent psychotherapy.
The study was planned as exploratory, and the implications of the findings led to
recommendations for further research.
45
Jan Rudd
1998
LIMITS IN CHILD PSYCHOANALYTIC PSYCHOTHERAPY AND THEIR USE AS A
TECHNIQUE FOR DEALING WITH RESISTANCE
ABSTRACT
Limits in child psychoanalytic psychotherapy are inadequately defined and
conceptualized in work with neurosis. Inconsistencies concerning their place in
psychoanalytic theory and practice is shown, especially in handling resistance. A
conceptual framework is proposed that views limits on different relational levels within
the therapy.
An examination of the place of limits in dealing with intense resistance that impedes
therapy was undertaken through an examination of the literature, and data of a single
case study involving psychoanalytic psychotherapy with an eight year old boy
diagnosed as having an anxiety disorder with obsessional features, and who displayed
enduring resistances in the form of repetitive behaviours. Firm, explicit limits placed on
these resistances produced a freeing up of material previously blocked. Limits were
found throughout all relational levels of the proposed framework.
Two conclusions were drawn, requiring further research. Firstly, limits may be useful in
dealing with repetition compulsion resistance in an obsessional child. Secondly, the
concept of limits requires further illumination to extend understanding of the
psychoanalytic process, particularly countertransference aspects of limits, those implicit
in holding and containment, and the subjective experience of the child of their use in
practice.
46
Frances Salo
1997
THE CONTRIBUTION OF INFANT OBSERVATION TO CLINICAL WORK
ABSTRACT
Since Infant Observation was introduced by Esther Bick into the Tavistock training of
child psychotherapists in 1949 its uses and applications have been widely extended.
Virtually no formal research, however, has been conducted into how helpful it is for the
observer particularly in his/her clinical work. The aim of the pilot study described was
to examine this.
A semi-structured interview was conducted with five child
psychotherapists within 2-4 years of qualifying. All had found infant observation a
valuable exercise. Analysis of the themes in the data suggests that infantile anxieties
of a very specific, and mainly negative, kind are powerfully aroused in the observer,
usually not fully consciously. These can be reworked to some extent in a kind of
transitional space created by the observation experience. This does not seem to have
been fully explored before in the literature. The main conclusion is therefore the
development of the hypothesis that it is upon the success of reintegrating the infantile
anxieties that sensitivity in clinical work is deepened. More support for observers
particularly at the conclusion of their observation also seems indicated.
47
Elizabeth Skeels
2000
THE MOURNING PROCESS IN CHILDHOOD AND ADOLESCENCE :
IMPEDIMENTS AND OPPORTUNITIES – A CASE STUDY OF A 14 YEAR OLD GIRL
ABSTRACT
The ‘mourning process’ in childhood and adolescence, is an area which has historically
been neglected. Psychoanalytic writings on childhood mourning have tended to focus
on the mourning of children when there is the loss of a parent. There is little research
focusing on the mourning process of children who have lost siblings.
This thesis is a case study, which looks at the effect of a traumatic car accident in
which Lucy, a three-and-a-half year old girl was injured, and her brother killed. At age
fourteen, Lucy had sixteen months of weekly individual psychotherapy, which aided her
in the process of ‘mourning’. I hypothesize that mourning is a life-long process which
needs reworking at different developmental stages throughout the life cycle.
48
Jeannette Stevenson
2001
IT’S QUITE A PROCESS TO SAY GOODBYE :
A PILOT STUDY OF THERAPISTS EXPERIENCES OF TERMINATION IN CHILD
PSYCHOANALYTIC PSYCHOTHERAPY
ABSTRACT
Terminations in child psychoanalytic psychotherapy are rarely written about or included
in training programs and yet every therapy comes to an end at some point. This study
was motivated by a curiosity to understand how therapists conceptualise and
experience the endings of therapy with children twelve years old or younger, and why
the topic appears to be avoided. As a minor thesis it was regarded as a pilot-study,
opening up the topic for further research and investigation.
Five experienced child psychoanalytic psychotherapists were interviewed and the
contents of the interviews underwent two levels of qualitative investigation and
analysis-for the descriptive contents and for unconscious material. Research questions
included: the importance of a termination phase; the extent of parental influence with
young children; the nature of therapist emotional reactions at termination; particular
difficulties of terminating child psychoanalytic psychotherapy; and the extent that
termination is viewed as a healthy process by therapists. Areas under examination
included the importance of a termination phase; the criteria for determining a
termination; the procedures, influences, negotiations and uncertainties of the
therapists; and their emotional reactions at termination. Literature included some
background information about the theory relating to terminations in adult analysis as
well as child psychotherapy, as well as an extensive review of the areas under
examination. The findings from the interviews were compared with points made in the
literature.
The pilot-study found that child psychoanalytic psychotherapists experience
terminations as quite painful and frequently premature or forced by parents whose
goals differ from theirs. Therapy with children is never seen as complete and the ideal
of agreement between all parties is rarely achieved.
Termination is often a
compromise decision that, over the years, has led to many modifications of clinical
practice for the therapists interviewed. Differences were noted in the management of
parents and the style of finishing. Several underlying anxieties and individual issues
were suspected to be influencing the therapists’ decision making and emotional
experiences at termination. Despite a real commitment to this style of work, some
have found it quite a challenge to survive in the field and have found their work
interests moving away from individual child therapy. Based on the literature and
interviews, speculations were made about possible reasons for the avoidance of this
topic. The pilot-study has highlighted many areas for further research and includes
some recommendations for training courses.
49
Karen Story
1996
A COMPARATIVE STUDY OF MOTHER-INFANT INTERACTION IN AUSTRALIA AND
BALI
ABSTRACT
This thesis, a pilot study, examined cross cultural differences in physical holding
behaviour of mothers with their infants as one aspect of ‘holding’ as conceived by D.W.
Winnicott. Several questions related to the frequency and duration of periods of
physical holding and the degree to which infants were settled were explored. ‘Holding”
as conceived by D.W. Winnicott included physical holding of the infant and the ‘holding
environment’ around the infant, i.e. the family and the wider culture.
Winnicott believed physical holding and the ‘holding environment’ was necessary for
the health development of the infant. One ‘holding’ therapy (Foster Cline) directly links
conduct disorders with the need for therapeutic physical containment. The greater
incidence of conduct disorders presenting in Western society and the apparent
absence of conduct disorders in Bali raised interest in the link between the infant’s
early holding experiences and later patterns of disorders.
Observation of six Australian and Balinese mother/infant dyads, aged 14 to 18 weeks
was conducted in the infant’s home over six weeks for two hours. A mixture of
quantitative and qualitative methods was used.
Three hypotheses were tested, namely that Balinese infants would be physically held
for longer periods of time, would have more time in interaction with their carers and
would be more settled than their Australian counterparts. These hypotheses were
supported by the data although the difference between the two samples was not as
great as expected. This was related to the finding that although Australian infants were
picked up and put down more often (but held for less time), when infants were not held,
the Australian sample spent more time on average interacting with their infants.
Differences in the ‘holding environment’, that is culture and religion, were found to play
a major part in determining the nature of physical holding as one aspect of infant care.
Conclusions were drawn that the role and purpose of physical holding in the culture
carried implications for the infant’s later development and for the profile of disorders in
adult life. Winnicott’s concept of ‘holding’ in its broadest sense was found to be useful
in exploring these ideas. The study raised speculation about possible links between
social and cultural values placed on physical holding and the manifestation of conduct
disorders in the society.
50
Heather Kennedy Whitefield
2002
PREMATURE BABY, PREMATURE MOTHER, THE EXPERIENCE OF THE MOTHER
ABSTRACT
Research exploring the mother’s perceptions of her experience of giving birth to a
premature baby is yet at its beginning, especially in the area relating perceived
experience to her internal world and the stage of pregnancy in which she gave birth.
The opportunity for the present study arose from narrative data that had been collected
during a group therapy intervention for mothers and premature babies with relationship
difficulties. The narratives of three mothers were investigated using a qualitative data
analysis methodology and a psychoanalytic theoretical framework regarding pregnancy
as a normal developmental crisis which, if fully negotiated, allows the mother to be born
as a mother to the child to whom she has given birth. The study considered the
mothers’ experience of pregnancy, birth, the premature nursery and then adjusting at
home, when her pregnancy had been interrupted before she entered the second stage
of pregnancy. The data around experiences of the premature nursery were of
particular interest. Themes systematically emerging from the mothers’ narrative
indicated a level of primitively in thinking consistent with psychoanalytic theory and
previous research concerning regression experienced during the first stage of
pregnancy. In line with previous research, the study found that, whilst their babies
were cared for in the neonatal intensive care nursery, the mothers felt alienated as
mothers, persecuted by staff, and fearful that their baby would be stolen and they were
going crazy. Three aspects of the mothers’ experience were illuminated to a greater
extent than in previous literature. The first concerned the fear that the baby would be
stolen – not so much that the baby had been stolen from the womb or by the intensive
care nursery, but rather that the baby would be stolen by others in the immediate
future. The second finding, reported in literature but related to the baby’s immature
physical state, was the mother’s need to have the baby actively acknowledge her; it is
hypothesized that this need to be recognized as mother by the baby is the germ of the
intrusive interaction so often observed between mothers and their premature babies.
The third area of special interest was the experience of splitting of objects. The good
verses bad mother, the bad mother projected out to other mothers and the absence of
the good mother – only integrated in the mothers self after the baby came home and
possibly with therapeutic input.
Implications of the findings for psychoanalytic theory, for hospital and after care
practice and for further research are drawn out.
51
Karen Wilkinson
2004
THE IMPACT OF MEDICAL INTERVENTION ON BODY EGO IN CHILDREN :
A CASE STUDY OF A 6 YEAR OLD BOY
ABSTRACT
The concept of the body ego has been recognised in the literature as an important
theoretical construct since Freud (1923) initiated the term in The Ego and the Id. The
emphasis in psychoanalytic psychotherapy and psychoanalysis, however, has been on
psychological aspects rather than the physical experience of the body and there is little
clinical material available especially in relation to children. In this thesis, the concept of
the body ego was examined for its value in psychoanalytic psychotherapy with children
who undergo medical interventions. Using a case study design, data analysis was
conducted through interpretation of pre-existing case notes of the assessment and
psychoanalytic psychotherapy of a 6-year-old boy with a history of chronic constipation
who underwent two medical interventions. This research revealed five themes
pertaining to the body ego: loss of bodily function, fear of damage, body boundary
disturbance, regression, and the therapeutic relationship. The use of the body ego
concept illuminated an alternative view of the therapy process and provided clarity and
insight into the child’s internal world.
52
Carol Woolcock
1998
A CROSS-CULTURAL COMPARISON OF MOTHER & INFANT INTERACTION IN
BALI AND AUSTRALIA:
FEEDING AND SLEEPING PRACTICES
ABSTRACT
A low incidence of certain internalizing and externalizing psychiatric disorders of
childhood and adolescence, i.e. conduct disorders and eating disorders, has been
reported in Bali by some Balinese clinicians. A pilot study was undertaken to explore
cultural differences in infant feeding and sleeping practices in six Balinese and six
Australian families. A multimethod approach, using observations, interviews and
videotapes was used to identified similarities and differences. The results indicate
observable differences in infant feeding and sleeping practices in the two cultures and
notable differences in the development of the infant cohort. Psychoanalytic theoretical
explanations are explored to account for these differences. The findings support
follow-up in a larger longitudinal study in each culture to assess the significance of
these observed differences and identify the role that feeding and sleeping practices
may play in child development over time.
53
Ruth Wraith
1994
INTRA-PSYCHIC REGRESION IN A TRAUMATISED CHILD
ABSTRACT
Professional involvement of the author as a State Health Department mental health
consultant and service co-ordinator and child psychotherapist clinician, in a
kindergarten siege of seven hours duration led to consideration, from a psychoanalytic
perspective, of the phenomenon of regression observed in all the participant children
following their experience.
This thesis reviews the initiation, progression and resolution of the intrapsychic
regressive process in one four-year-old child in response to his sudden, extraordinary,
single incident of traumatisation, while simultaneously recognizing that regression is
one of a cluster of reactions and form sonly a facet of the totality of the experience for
this child. The impact is observable, in part, through the child’s drawings and paintings.
The drawings are viewed as unconscious engagement with the incident-generated
trauma.
The study traces the shift in symbolic representation of the intrapsychic experience
through drawings which span the ages of two years eleven months to five years, with
particular focus on the series of drawings in the nine months following the siege when
the child was four years old. The availability of pre-siege data provides the prospective
component of the study.
The drawings are illuminated by vignettes of play and verbal communication which
provide the opportunity to explore some related parameters within the unconscious and
also to trace the unfolding of the regressive/progressive process within the context of
psychotherapy treatment. The collection was assembled in response to the unfolding
clarity of the regressive process, expressed through these drawings. The study,
therefore, was not established as a research project.
As the thesis is presented as a psychoanalytic study of the process of trauma induced
regression in a specific context, the material is analysed and commented on only in
relation to regressive and post-regression processes initiated by that event. A full
enquiry of the available material, including consideration of the interface of oedipal,
transference and counter transference issues, is outside the scope of the thesis as the
issues introduced would stretch beyond the parameters of the study. The thesis is not
a study of trauma or a case study of a traumatized child.
Also it is beyond the scope of the study to review the extensive literature on the
traumatic impact and resultant sequelae, including regression, arising from civil unrest,
54
sociological events such as the Holocaust, Cambodian genocide and South African
apartheid, and incest, sexual, physical and verbal abuse.
It was not a primary aim of the study to compare this child’s artwork in relation to
developmental norms, although these are briefly considered to provide an opportunity
to introduce developmental considerations.
The study provided an opportunity to initiate, through artwork, a review of the
expression of regression frequently noted as a reaction to trauma in pre-school children
and to consider it in relation to psychoanalytic theory.
Analysis of the drawings from a psychoanalytic perspective shows that the loss of
recently attained skills evident in behaviour reported by parents to kindergarten
teachers had an intrapsychic parameter with engagement of primary process
functioning and diminishment of secondary process functions through engagement of
drives, libidinal stages and compromisation of the ego. The progressive movement
was similarly reflected in manifest behaviour and drawings.
It is recommended that application of the psychoanalytic dimension of understanding
within the mainstream health, welfare and education services would enrich the
management of children following externally generated traumatic experiences.
C:\My Documents\MCPP\MCPPTheses abstracts.doc
55