Chapter 6: Anna Freud – Ego Psychology

Part 3: Psychoanalysis with Children

As mentioned above, Anna Freud began her career as a school teacher.  Her interest in children never diminished, and as she began to devote her career to psychoanalysis and psychoanalytic research, her focus remained on the psychological lives of children.  In 1946, Anna published The Psycho-Analytical Treatment of Children (A. Freud, 1946).  The book begins with an interesting preface, an apology that the book had not been available in English at an earlier date, particularly in the country of England.  The reason for this, according to Anna Freud (and many historians agree), is that in England the theories of Melanie Klein dominated the psychoanalytic community (see also Mitchell & Black, 1995).  Klein and her colleagues believed that psychoanalysis could be conducted successfully with young children, and that the process of transference occurred in the same manner as it did with adult patients.  Initially, Anna Freud believed that psychoanalysis could not be performed with young children. Later, she acknowledged that the efforts of her colleagues had helped to make that a possibility, but she steadfastly denied that she had ever seen the normal process of transference in anyone younger than adulthood (A. Freud, 1946).

The importance of the analysis of children in terms of research is threefold, according to Anna Freud.  First, it helps to confirm the theories developed by Sigmund Freud and others based on the analysis of adults.  Second, it leads to fresh conclusions and new conceptions (and she commends Melanie Klein on this point). Lastly, it serves as a point of transition to a field of applied analysis that she felt might become the most important of all: working with children as they develop (A. Freud, 1927/1973).  What Anna Freud tried to do the most in her writings was to point out the circumstances that make psychoanalysis with children different than psychoanalysis with adults. Fundamentally, there is no difference in the process. However, the results of the process must be viewed differently in order to understand what happens with children.  Since Melanie Klein was actively pursuing the same goals, Anna Freud often wrote specifically about Klein, acknowledging her accomplishments, but also pointing out their differences.

The basic argument was aimed at the intellectual and psychological abilities of young children, and the extent to which the psychical apparatus (the id, ego, and superego) have developed.  Since all three personality structures have developed in an adult, there is no need for the analyst to worry about that. All the analyst needs to do is to bring into consciousness the neurotic processes that have led to the patient’s symptoms (granted, that may be easier said than done).  In children, however, the ego, and especially the superego, are still developing. Therefore, the analyst must consider the role he/she may play in the development of the child. The analyst must consider the extent to which the superego has already developed, and the analyst may be able to take advantage of its continuing development and help to direct and/or instruct superego development.  According to Anna Freud (1927/1973):

…In the analysis of the adult we are at a point where the superego has already established its independence – an independence which is unshakable by any influence from the outside world…But child analysis must include all those cases in which the superego has as yet not reached any true independence.  Only too clearly it strives to please its taskmasters, the child’s parents and others responsible for his training…we have to use our influence from without in an educational manner by changing the child’s relation to those who are bringing him up… (pgs. 138-139)

As these processes are actually observed, Anna Freud believed that the child’s symptoms could transform in the presence of the psychoanalyst, in a way that simply did not happen with adults.  Thus, it was essential to observe children from a different point of view than one observes adults. She acknowledged that Melanie Klein had contributed to our understanding of how children might be observed, but she felt that Klein had attributed too much to what Klein and her colleagues observed.  Klein allowed children the opportunity to play with toys in her office, a situation in which the child’s imagination can run wild. Klein believed this was the same for a child as free association was for an adult. However, Anna Freud countered that an adult is aware of their goals in psychoanalysis, whereas a child at play is not aware of being in therapy.  As a result, Anna Freud viewed the play of children as fundamentally different than an adult’s free association.

Is a child at play engaging in the same mental activity as an adult engaged in free association?  Melanie Klein believed yes, but Anna Freud disagreed. Do you think that children are capable of the same participatory role in psychoanalysis as adults, and is play the best way to observe children?

Anna Freud’s steadfast belief that children do not have the intellectual or psychological capacity for free association, in part because they simply can’t relax and lie still for an hour on the psychoanalyst’s couch, also raises questions for the use of the second most common psychoanalytic technique; dream analysis.  Dream analysis depends on the patient’s ability to freely associate about the manifest content of the dream. With children, it is necessary for the psychoanalyst to connect the manifest content with the latent content, and this process will always be somewhat suspect (A. Freud, 1946). These problems lead into another controversy; the age at which psychoanalysis can occur.  Whereas Klein and her colleagues believed that psychoanalysis could occur at any age, since babies are involved in play as part of their earliest activities, Anna Freud believed that some amount of speech was necessary to form an adequate therapeutic relationship with a child (so the earliest reasonable age for psychoanalysis would be around two to three years of age; A. Freud, 1946).

In her conclusion to The Psycho-Analytical Treatment of Children, Anna Freud re-emphasizes the role that developmental processes play as a child (and their id, ego, and superego) grows.  As such, a child analyst needs to be “as intimately familiar with the normal sequence of child development as he is familiar with the neurotic or psychotic disturbances of it” (A. Freud, 1946).  She specifically mentions academic psychology and the tests being created by psychologists for the measurement of personality as useful in this regard. She also mentions the Rorschach test as being especially useful in examining libido development and its disturbances.  Still, she acknowledges that our understanding of the developmental processes of the libido and the ego is “very incomplete.” Yet she cautions psychoanalytic investigators “not to confine examinations to short-cuts of any kind…” (A. Freud, 1946). Clearly her concern for children, and for a professional approach to psychoanalytic research and practice, were foremost in her mind.

So what does current research tell us about the effectiveness of psychoanalysis on children?  As is often the case, the results are not clear. Although a number of studies have shown that children benefit from psychoanalysis, the degree of that benefit has been disappointing (see Jarvis, 2004).  When children of different age groups were studied, the results showed that psychoanalysis was more effective for younger children than it was for adolescents, which is something that Anna Freud would probably not have predicted.  An important problem in many of the studies providing positive results, however, is that the results are based on reports by the therapists. Such reports are highly subjective and open to bias (Jarvis, 2004). Also, as we might expect, the effectiveness of psychoanalysis is dependent on the experience and skill of the analyst.  Typically, analysts who have experience teaching and supervising psychoanalysis, as well as those who are prepared to try a variety of psychoanalytic techniques, achieve significantly better outcomes with their patients (Kernberg, 2004). So we must consider the question of the effectiveness of child psychoanalysis as one that remains unanswered.

Late in her life and career, Anna Freud extended her work beyond the psychoanalytic treatment of children to larger issues of child advocacy.  In collaboration with Joseph Goldstein, a professor of law at Yale University, and Albert Solnit, a professor of pediatrics and psychiatry at Yale’s medical school and Director of the Child Study Center at Yale, she co-authored two books:  Beyond the Best Interests of the Child (Goldstein, A. Freud, & Solnit, 1973) and Before the Best Interests of the Child (Goldstein, A. Freud, & Solnit, 1979).  These books focus on the importance of placing the interests of children first when the government intervenes in cases involving the custody and placement of children.  These situations arise is many circumstances, such as in the case of orphans or following a difficult divorce, but also in more extreme cases of abuse or when certain parents do not believe in allowing medical care for very sick children.  Since these situations can pit one parent against another, or the parents against the interests of society, the authors addressed very clear reasons why the interests of the child should be placed first.

Supplemental Materials

Anna Freud and ‘The Conscience of Society’ by Elizabeth Ann Danto and Alexandra Steiner-Strauss

This video [15:26] describes the intersection of psychoanalysis and education through the perspective of Anna Freud.

Source:  https://youtu.be/46g6VM9FSFQ

References

Text:  Kelland, M. (2017). Personality Theory. OER Commons. Retrieved October 28, 2019, from https://www.oercommons.org/authoring/22859-personality-theory.  Licensed under CC-BY-4.0.

Botstiber BIAAS.  (2019, July 9). Anna Freud and ‘the conscience of society’ by Elizabeth Ann Danto and Alexandra Steiner-Strauss.  [Video File]. Retrieved from https://youtu.be/46g6VM9FSFQ. Standard YouTube License.