ABSTRACT
Psychoanalysis aims to restore the artist in the patient, the part of the person that makes interest despite, or whatever, the early environment. At its most extreme, for the artist her own life, it is not so much a question of what she has been given (no one chooses their parents, but everyone invents them, makes what they can of them). The psychoanalytic model here is the dream, or the child's infantile sexual theory, in which so-called reality functions more like a hint than an instruction, setting the dreamer and child off on the work of transformation (Phillips, 1998, pp. 4-4).
Subject(s)
Child Development , Freudian Theory , Psychoanalytic Therapy/methods , Child , Fantasy , Female , Humans , Psychoanalytic InterpretationABSTRACT
To explore the concept of the "good hour" in child analysis I discuss an hour in the analysis of a six-and-a-half-year-old girl. Elements of this hour include a palpable therapeutic alliance, affective immediacy, surprise, and discovery, oscillating therapeutic action of action, play, and verbalization, creative accessibility to the unconscious, the transference, the countertransference, and a capacity to work with conflict, defense, and fantasy. These qualities are similar to those described by Kris for adult analysis over forty years ago. The present hour, however, illustrates greater emphasis on affect rather than drive, the therapeutic action of play in the analytic setting, and the transformative importance of the relationship. In addition, the hour highlights a greater focus on communication by action and enactment, the highly informative uses of the countertransference, and the co-creation of the analytic process.
Subject(s)
Child Behavior Disorders/psychology , Child Behavior Disorders/therapy , Object Attachment , Psychoanalytic Therapy/methods , Psychotherapeutic Processes , Child , Defecation , Female , Humans , MasturbationABSTRACT
OBJECTIVE: This report examines the clinical features and correlates of juvenile panic disorder in referred children and adolescents to test specific hypotheses about its relationship with adult panic disorder. METHOD: The sample consisted of consecutively referred children and adolescents (N = 472) comprehensively evaluated with structured diagnostic interviews, cognitive tests, and psychosocial assessments. RESULTS: Panic disorder was identified in 6% and agoraphobia in 15% of psychiatrically referred children and adolescents. Children meeting criteria for panic disorder also frequently met criteria for agoraphobia. The latter disorder was more prevalent and had an earlier age at onset than panic disorder. Children with panic disorder and those with agoraphobia had similar correlates with frequent comorbidity with other anxiety and mood disorders. A high level of comorbidity with disruptive disorders was also identified. CONCLUSIONS: These results support the hypothesis of continuity between the juvenile and the adult form of panic disorder. However, the high level of comorbidity with disruptive behavior disorders also suggests developmentally specific discontinuities between juveniles and adults with panic disorder.
Subject(s)
Agoraphobia/epidemiology , Panic Disorder/epidemiology , Panic Disorder/physiopathology , Adolescent , Adult , Analysis of Variance , Case-Control Studies , Chi-Square Distribution , Child , Child Behavior Disorders/epidemiology , Comorbidity , Confidence Intervals , Female , Humans , Logistic Models , Male , Neurotic Disorders/epidemiology , Prospective StudiesSubject(s)
Child Psychiatry , Play Therapy , Child , Humans , Physician-Patient Relations , Play and Playthings/psychologyABSTRACT
BACKGROUND: This study investigated whether family-environment risk factors are associated with attention-deficit hyperactivity disorder (ADHD). Compelling work by Rutter and coworkers revealed that it was the aggregate of adversity factors (severe marital discord, low social class, large family size, paternal criminality, maternal mental disorder, and foster care placement) rather than the presence of any single factor that led to impaired development. Based on the work of Rutter, we hypothesized a positive association between indicators of adversity and the diagnosis of ADHD and ADHD-associated impairments. METHODS: We studied 140 ADHD and 120 normal control probands. Subjects were non-Hispanic white boys between the ages of 6 and 17 years. Rutter's indicators of adversity were used to predict ADHD-related psychopathology as well as impaired cognitive and psychosocial functioning. RESULTS: The odds ratio for the diagnosis of ADHD increased as the number of Rutter's adversity index predicted ADHD-related psychopathology (depression, anxiety, and conduct disorder), learning disabilities, cognitive impairment, and psychosocial dysfunction. CONCLUSIONS: A positive association appears to exist between adversity indicators and the risk for ADHD as well as for its associated psychiatric, cognitive, and psychosocial impairments. These findings support the work of Rutter and stress the importance of adverse family-environment variables as risk factors for children with ADHD.
Subject(s)
Attention Deficit Disorder with Hyperactivity/epidemiology , Family , Adolescent , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/etiology , Child , Child Behavior Disorders/diagnosis , Child Behavior Disorders/epidemiology , Comorbidity , Family Characteristics , Humans , Interpersonal Relations , Learning Disabilities/diagnosis , Learning Disabilities/epidemiology , Male , Marriage , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Odds Ratio , Probability , Psychiatric Status Rating Scales , Risk Factors , Social ClassABSTRACT
OBJECTIVE: To evaluate the discriminative ability of the Child Behavior Checklist (CBCL) to identify children with structured interview-derived diagnosis of bipolar disorder. METHOD: We evaluated the convergence of CBCL scales with the diagnosis of mania in 31 children with mania, 120 children with attention-deficit hyperactivity disorder, and 77 prepubertal normal control children aged 12 years or younger. We evaluated the strength of association between each CBCL scale and structured interview-derived diagnoses with total predictive value and the odds ratio. RESULTS: Excellent convergence was found between the CBCL scales of Delinquent Behavior, Aggressive Behavior, Somatic Complaints, Anxious/Depressed, and Thought Problems and the diagnosis of mania. CONCLUSIONS: These findings indicate that the CBCL could serve as a rapid and useful screening instrument to identify manic children in clinical settings.
Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Bipolar Disorder/diagnosis , Personality Assessment/statistics & numerical data , Attention Deficit Disorder with Hyperactivity/classification , Attention Deficit Disorder with Hyperactivity/psychology , Bipolar Disorder/classification , Bipolar Disorder/psychology , Child , Female , Humans , Interview, Psychological , Male , Psychometrics , Reference Values , Reproducibility of ResultsABSTRACT
This paper explores the idea that dreams in analysis during pregnancy offer an especially valuable perspective for understanding and facilitating mastery of the developmental challenges of pregnancy as well as related central unresolved conflicts and earlier developmental problems. In this way, dreams during pregnancy facilitate the long-range work of the analysis. The regressive and self-oriented focus of pregnancy, and the heightened awareness of what is happening within, lend extra meaning, impact and richness to dreams in the analytic process, with its inward-seeking and regressive elements. In addition, during pregnancy, patients often feel highly motivated to resolve problems prior to the birth of the baby. A shift in our understanding of the narcissistic and early developmental aspects of transference has helped analysts understand how analysis during pregnancy can be useful. During pregnancy there is often an increased access to experiences from early childhood, involving a feeling of being taken care of and of feeling abandoned. In addition, during pregnancy, identifications with the analysand's mother and separation from her mother are perhaps especially deeply felt. These ideas are explored in discussing the dreams and associations of a 36-year-old analysand during different phases of the pregnancy.
Subject(s)
Dreams , Pregnancy/psychology , Psychoanalytic Interpretation , Psychoanalytic Therapy , Adult , Anxiety/psychology , Depression/psychology , Female , Gender Identity , Humans , Labor, Obstetric/psychology , Self ConceptABSTRACT
How the analyst and the patient shape the analysis is a complex matter varying with the stage of the analysis and the individual characteristics of each patient and analyst. Examining analytic hours from the beginning, middle, and end of a five-through-seven-year-old girl's treatment suggests an intricate pattern evolving from observing and learning toward elaborating a free-ranging, creative, multilevel interplay of internal dialogues and affects.
Subject(s)
Masturbation/therapy , Child , Child, Preschool , Female , Humans , Psychoanalytic TherapyABSTRACT
This paper explores the vicissitudes of self-esteem in the analysis of an 11-year-old boy. The paper highlights the complex interplay from different developmental periods that underlies the growth and sustaining of self-esteem. This interplay, catalyzed in the crucible of the transference, includes issues of evolution of affect states, self-structure, object relations, psychosexual development, conflict, and defenses.
Subject(s)
Child Behavior Disorders/psychology , Personality Development , Psychoanalytic Therapy , Self Concept , Child , Child Behavior Disorders/therapy , Humans , Male , Maternal DeprivationABSTRACT
Re-examining Sigmund Freud's 'Analysis terminable and interminable' (1937) from the perspective of child analysis highlights the importance of developmental assessment and developmental forces in psychoanalysis. This paper explores the questions of the goals of child analysis and the criteria for successful treatment. Also discussed is how unrealistic expectations on the part of the analyst and the parents, as well as the parents' and analyst's conflicts may result in an analysis being interminable. An additional problem at termination is the mourning involved for both the child and the analyst. These issues are explored in the context of the final year of analysis of a 5-year-old boy who stuttered. Reflecting on this boy's analysis, questions about the relationship of termination to developmental forces, the resolution of the transference neurosis, reconstruction, counter-transference and identification with the analysing function of the analyst are explored. The importance and meaning of the child's, the analyst's, and the parents' simultaneously intuitive sense of the time for termination are discussed.
Subject(s)
Child Development , Psychoanalytic Therapy , Aggression/psychology , Child, Preschool , Humans , Male , Oedipus Complex , Stuttering/therapy , Transference, PsychologySubject(s)
Aggression/psychology , Psychosexual Development , Twins/psychology , Adult , Humans , Individuation , Male , Oedipus Complex , Sibling RelationsSubject(s)
Dreams , Psychoanalytic Interpretation , Child , Child, Preschool , Humans , Psychoanalytic TherapyABSTRACT
In group psychotherapy and follow-up studies, the interpersonal relationships and psychodynamics of the married manic depressive patient and spouse were studied. Prominent among these subjects were massive denial of grief, rage, and dependency in the context of symbiotic relationships; and the absence of a father during early development. Clinical expressions of these factors are presented, and therapeutic implications are discussed.
