Ana Freud: Is child psychoanalysis possible?

Psychoanalytic intervention in childhood requires essentially pedagogical techniques.

Criticism of psychoanalytic intervention has not only been directed at adults, but also, and especially, at its application to children. This latter criticism has even arisen among psychoanalysts specializing in child psychopathology.

Here I briefly present the answers and alternatives proposed by Anna Freud when we wish to carry out psychodynamic therapy with children.

Anna Freud's proposals

She makes several considerations in the child psychoanalytic process: Decision-making process; foundations of psychoanalysis in childhood; preparation phase; technical readjustments; the problems of transference; pedagogical intervention and the role of the superego¹.

1. Decision Analysis

The decision to undergo psychotherapy is not made by the child, but rather by the parents. Typically, the child is unaware of any difficulty requiring psychotherapeutic treatment, even in objective situations where they are anxious, moody, or restless. There is no apparent need to be cured because they do not perceive themselves as ill.

It is usually the parents who make the request, either due to concern about their child's symptoms or because of pressure from their environment, especially the school. It is very important to assess the parents' level of tolerance for the "symptoms" that prompt the request.

2. Fundamental principles of psychoanalysis in childhood

Most professionals who use psychoanalytic techniques with children agree on the need to eliminate suggestion processes, as well as abreaction.¹ as a therapeutic process. Manipulative intentions should be minimized, we must analyze the unconscious material that arises during the process and consider the resistances and manifestations that occur as a result of transference.

The goal of psychotherapy is to achieve greater adaptation, which would translate into the acquisition of skills to cope with giving up unpleasant situations that produce the renunciation of immediate gratification, as required by the dynamics of it.

However, this adaptation will not be successful if we do not take into account the child's innate need to continue their own development. Indeed, this relative tolerance over time raises the question of whether the observed improvements might be the result of spontaneous developmental evolution rather than psychotherapeutic treatment.

3. Preparation phase

In childhood, creating a favorable environment for psychological intervention is absolutely essential. Therefore, we must establish a relationship of trust with the patient.

When speaking to the patient, we must appear as someone who can help them, who is interested in their situation, and even as someone who possesses a certain power to assist them. Establishing a good rapport from the outset is fundamental to bringing about change.

Assess how many resistances and defense mechanisms may arise. We should not make psychoanalytic interpretations, since neither the setting nor the techniques are strictly psychoanalytic.

4. Technical adjustments

Most of the clinical information gathered is provided by the parents, which inevitably leads to emotional bias and reduces objectivity. Therefore, Anna Freud recommends techniques such as drawing interpretation, which also facilitates verbal communication with the patient.

Regarding free association, it is not a particularly useful technique in childhood since it occurs very rarely. Dream interpretation is much more helpful.

The game can provide us with symbolic information that can be used therapeutically, despite its subjectivity, even its somewhat arbitrary nature.

According to Anna Freud, when sexual fantasies arise, they can trigger aggressive behaviors that must be carefully regulated so as not to lose information that may be relevant to explaining the clinical situation.

5. The problems of the transfer

He insists on the need to establish a genuine positive relationship with the child during the pre-analytic phase based on affection, love, and attachment, knowing how to channel rebellion and oppositional behaviors.

However, this positive relationship is not a transference in the strict sense, since this is not possible due to the active relationship the child has with their parents, on whom they depend for all gratifications and frustrations, whether real or imagined. The child experiences conflictual relationships as something external without having yet been able to internalize them.

Anna Freud uses psychoanalysis despite the absence of genuine transference. The child sees the therapist as a mere object, which he uses as such. The relationships established during therapy are neither libidinally nor aggressively invested. Freud uses this situation to externalize a psychic instance that allows for freedom of verbal expression. He acts as an auxiliary ego in which the child finds protection.

Therefore, transference is neither possible nor desirable. It is more advisable to work on clarifying the defense mechanisms the child uses to protect themselves from anxiety.

6. Pedagogical viewpoint and the role of the superego

Another objection raised by Anna Freud regarding psychoanalysis in childhood concerns the construction of the superego. It is known that the superego develops throughout the child's emotional development through the introjection of the demands of love objects, who represent the parents. Precisely because the superego is a developing process marked by weakness and instability, it is not surprising that children exhibit regressive behaviors in response to early separations.

It recommends that during the child's emotional development, direct and excessively important rewards should be avoided, as this can lead to fixations at some of the previous stages in the face of adaptive difficulties in later stages.

The psychotherapist must assume an educational role with respect to the child, making him see which drives are compatible with a satisfactory social life and which ones must be sublimated.

The therapist must position themselves as the ideal self, enabling the child to develop the ability to successfully cope with anxiety. In other words, the therapist must allow the child to freely express their fantasies and desires and facilitate awareness of what must be repressed due to environmental pressures, working on both external situations and the child's internal structures. This allows the child to relax the demands of the superego and resolve the symptoms that control anxiety, while simultaneously fostering the development of a less tyrannical superego, one more in harmony with social reality.

In summary, the psychodynamic approach to problems arising in childhood can be successfully implemented provided we make the necessary technical adjustments.

1. Victor Smirnoff. La psychanalyse de l'enfant. POOF. Paideia. Paris, 1984 [↩]

1. Emotional release through which the subject frees himself from the affect linked to the memory of a traumatic experience.