Revisiting Child Psychoanalysis

Why are young children in therapy without their parents?

Posted Feb 16, 2018

Beth was troubled by her fraught relationship with her 4-year-old son Alex. "I don't feel connected to him," she declared. Having herself been in analysis for many years, she could clearly articulate, almost as if it were a case study, the patterns in her own family relationships that led to her current situation.

At our next visit, when the three of us sat on the floor, Alex immediately engaged in elaborate imaginary play, instructing his mother on the roles she should take. While he was a flurry of activity, Beth sat and watched. I sensed tremendous effort on her part to be present. At one point, a yawn escaped.

When we later discussed this moment, she said, "I just don't like to play." While her intellectualized understanding of the intergenerational dynamics had some significance, it was this insight that led to dramatic shifts in their relationship. We acknowledged Alex's imagination as a great strength but respected her difficulty in meeting him there. We talked about other things they could do together, where she would not feel "deadened." Feeling freed from a kind of paralyzing guilt, Beth used her skill in managing the household, a role she had much greater comfort with, to organize activities that she and Alex would enjoy together. Their relationship flourished.

When I teach students in the relatively new discipline of infant mental health, which brings together researchers at the interface of developmental psychology, neuroscience, and genetics, I tell them that almost everything they need to know to support young children and their families can be found in the essay "The Ordinary Devoted Mother" by pediatrician turned psychoanalyst D.W. Winnicott. 

Thus, I was troubled when I read his famous case "The Piggle," and learned that Winnicott treated Gabrielle from age 2 and 1/2 to 5 by seeing her alone without her mother, who stayed at home with Gabrielle's infant sister. My suspicion was that he was in a sense a victim of historical context. 

When I had the privilege of attending a presentation at the National Meeting of the American Psychoanalytic Association about the speaker's meeting with Gabrielle as an adult, my suspicions were confirmed.

The field of child analysis was born out of adult psychoanalysis. There was, and in some ways continues to be, a need to be considered "true analysis." Given the centrality of the transference relationship between analyst and patient, bringing the child's parent into the room for therapy presents a significant conceptual challenge. 

But contemporary developmental science offers abundant evidence of the value of treating parent and child together. Arietta Slade's compelling work illuminates the role of facilitating parental reflective functioning as I describe in my book, Keeping Your Child in Mind. Ed Tronick's mutual regulation model, which he developed out of decades of observational research with infants and parents, shows us that healing and growth occur by repairing the countless moment-to-moment mismatches in the relationship between child and caregiver.

When at the presentation I raised my question about the separation of Gabrielle from her mother, I experienced at first a rather defensive reaction. The mother was very involved with Winnicott. But as the conversation progressed, I felt a shift. One participant noted how mother and daughter did not have the opportunity for mutual regulation. Another observed the mother's involvement as intellectualized, as if her own daughter were a case study (similar to my initial conversations with Alex's mother). 

Gabrielle spoke about her work with Winnicott a number of years following the death of her mother, as described in a magnificent paper "The name of the piggle: Reconsidering Winnicott's classic case in light of some conversations with the adult 'Gabrielle.'" I wonder if something might have been lost by not having the opportunity to treat mother and daughter together. 

Both psychoanalysis and contemporary developmental science are founded in the fundamental human need to make meaning in our lives. I hope each discipline can continue to inform the other in meaningful ways.