the international journal of psychoanalysis volume 90 issue 6 2009 [doi...

7/27/2019 The International Journal of Psychoanalysis Volume 90 Issue 6 2009 [Doi 10.1111%2Fj.1745-8315.2009.00212.x] Alan Sugarman -- Child Versus Adult Psyc

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Child versus adult psychoanalysis: Two processes orone?

Alan Sugarman

4180 La Jolla Village Drive, Suite 550B, La Jolla, CA 92037, USA

[email protected]

(Final version accepted 14 May 2009)

Child analysis continues to be seen as a different technique from adult analysisbecause children are still involved in a developmental process and because the pri-mary objects continue to play active roles in their lives. This paper argues that thisis a false dichotomy. An extended vignette of the analysis of a latency-aged girl isused to demonstrate that the psychoanalytic process that develops in child analysisis structurally the same as that in adult analysis. Both revolve around the analysisof resistance and transference and use both to promote knowledge of the patient smind at work. And both techniques formulate interventions based on the analyst sappraisal of the patients mental organization. It is hoped that stressing the essen-tial commonality of both techniques will promote the development of an over-arching theory of psychoanalytic technique.

Keywords: child analysis, defense, development, enactment, interpretation, resistance,transference

Child analysts no longer find ourselves having to defend our technique asgenuine analysis. Indeed, we are often pleased to find that our applicationof psychoanalytic principles to the treatment of children and adolescents isregarded as valuable both in the development of a psychoanalytic identity,and for providing important information that expands the theory of adultpsychoanalytic technique (e.g. Dowling, 1990). Nonetheless, a general ten-dency to consider child analysis as valuable but different from adult analysiscontinues to pervade our training programs, our professional standards andour literature. Only Ferro and Basile (2006) have noted the basic similarity

in the two techniques so long as the theory of mutative action prioritizes thehere-and-now interaction between patient and analyst. Thus psychoanalytictraining programs continue to separate child analytic training from adulttraining. Different committees oversee the separate programs, different cur-ricula are used, and debates continue to occur about the degree to whichchild control cases should count toward adult training. When institutes tryto implement the recommendations of the American Psychoanalytic Associ-ations Committee on Child and Adolescent Analysis to integrate the childcurriculum into the adult one, it is not uncommon to hear some candidatescomplain that motherinfant observation courses or child continuing case

conferences are irrelevant to adult analysis and training. Likewise, theAmerican Psychoanalytic Association has only recently allowed analysts tobe certified in child analysis before being certified in adult analysis; the twocertifications continue to be separated so that child cases cannot be counted

Int J Psychoanal (2009) 90:1255 1276 doi: 10.1111/j.1745-8315.2009.00212.x

2009 Institute of PsychoanalysisPublished by Blackwell Publishing, 9600 Garsington Road, Oxford, OX4 2DQ, UK and350 Main Street, Malden, MA 02148, USA on behalf of the Institute of Psychoanalysis

e International Journal of


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toward adult or vice versa. Finally, the child analytic literature is replete withemphases on child analysis being a more complicated treatment because thechild is engaged in a developmental process at the same time (e.g. Abrams,1988; Abrams and Solnit, 1998; Ritvo, 1978; Sandler, Kennedy and Tyson,

1980, etc.).This latter point is certainly true. It is my impression, however, that this

unassailable truth that children undergoing analysis are also in the midstof a developmental process has interfered with the recognition that thechild and adolescent psychoanalytic process has far more similarities thandifferences with the adult psychoanalytic process. To be sure, there are cer-tain differences in technique between child and adult analysis (the role ofthe parents, use of the couch, emphasis on free association, etc.). But over-emphasis on these differences between the two techniques may have short-changed the field of child analysis, at times. For example, some argue that

transference is less intense, less organized, or less pervasive with childrenthan adults because the child is still so involved with the primary objects(Tyson, 1978).

Analysts have repeatedly emphasized that the child has less of a tendency or a needto make transferences to the analyst because he still has his primary love objects inhis daily life for instinctual drive gratification or for symptom formation, which less-ens the involvement of the analyst in the transference or the transference neurosis.

(Ritvo, 1978, p. 299)

Yet Chused (1988) has questioned this perspective and suggested that such

limitations in transference development are usually caused by the child ana-lyst being too gratifying. She has found that a more interpretive and lessgratifying approach with children leads to deep, intense, and pervasive trans-ference manifestations, particularly negative ones. Furthermore, those whoquestion the degree of transference possible in children rely implicitly on anarrow definition of transference as the displacement or projection of pastobject ties. To the degree that transference of defense (Gray, 1994) or ofother aspects of mental structure (Sugarman, 2006) occurs, the primaryobjects become less central to the occurrence of transference. Many analyststoday see transference as ubiquitous and involving more than displaced or

projected object ties (Joseph, 1985; Schlesinger, 2003).Young children have been said to be incapable of insight (Kennedy, 1979),another truism that can be questioned if one redefines insight as a functioncalled insightfulness that needs to be promoted by the analyst (Sugarman,2003a). From this perspective, the young child does not gain access somuch to repudiated content as to a key psychological process that has beenderailed by internal conflict (p. 331). That is, we help child (but also adult)analysands to reflect on their inner worlds and to realize the importance ofself-reflection for self-regulation. Busch (2007) has emphasized how thefacilitation of this process with adult patients promotes a profound change

in the analysand

s relationship to his own thoughts and feelings

(p. 426).Shifting ones focus from promoting insight into repudiated mental contentto facilitating the emergence of this function reduces the degree to which theattainment of insight differentiates child from adult analysis.

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Still other child analysts emphasize that the common need to be a devel-opmental object when analyzing less organized children makes for a verydifferent technique called psychodynamic developmental therapy (Fonagyand Target, 1996). This assumption, too, has been studied and thought to

be possibly overstated if one considers more carefully what we mean by theconcept of developmental object (Sugarman, 2003b). The process of insight-fulness seems to occur on a developmental continuum ranging from actionmodes of experiencing and communicating to verbal, abstract, symbolicones (Sugarman, 2006, 2009, in press). Actions of the analyst usually sub-sumed under the rubric of developmental help can be recast as action inter-pretations, occurring at the same level at which the child is communicating(Sugarman, 2003b, 2009, in press). Ferro (1999) emphasizes the importanceof meeting the patient at the level being used to communicate to the analyst;such action interventions occur in many analyses, child and adult (Chused,

1996; Ferro, 1999; Pine, 2007), not just in other treatment modalities. Hence,one can question the extent to which the activities we traditionally call beinga developmental object actually differentiate the child from the adultpsychoanalytic process.

This paper stresses the ways in which the structure of the child and ado-lescent analytic process is the same as that seen in adult analyses, despitecertain technical differences. Examining the commonalities in these processeshas the potential to clarify an overarching theory of the psychoanalytic pro-cess and to eliminate the artificial division of child and adult psychoanalystsinto separate communities. There may be just one treatment that we call

analysis, so long as our work with patients always takes into account theorganization of their minds, as regards their diagnostic status, or as regardstheir developmental capacities and limitations. The concept of psycho-analytic process can be particularly helpful in clarifying the essential same-ness of the two so-called separate treatments. This paper will not addressthe myriad of complexities we run into when trying to define the concept ofpsychoanalytic process. Others have already done so (Abend, 1990; Abrams,1990; Arlow and Brenner, 1990; Boesky, 1990; Compton, 1990; Dewald,1990; Erle, 1990; Weinshel, 1990a, 1990b) and concluded that it is a helpfulthough complex concept. Instead, the analysis of a latency-aged child will

be presented that seems to demonstrate virtually the same analytic processas one sees with adult patients if one views the analytic process through thelens of modern-day conflict theory.

To be sure, the patients developmental limitations affected how she pre-sented material and how I phrased my interventions. And her parentsremained an active force in her life and the analysis. Nonetheless, the struc-ture of the psychoanalytic process we developed was essentially no differentthan the one that occurs with most of my adult patients despite theabsence of free association and use of the couch and despite my regularlymeeting with her parents. This view complements Ritvo (1978) who finds

that,

the process in children not only must be adapted to the develop-ment of the child, but is in many instances limited by his developmental sta-tus as well (p. 300, my italics). To be sure, the patient was a particularlyverbal, insightful child who could participate in this sort of analytic

Child versus adult psychoanalysis: Two processes or one? 1257

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process. But I find that even younger andor less organized children can behelped to engage in a similar process so long as one takes into account thenature of their mental organization (Sugarman, 2008a). This process andmodifications necessary with younger children will be conceptualized in the

discussion section of this paper.

Danielle

Danielle was 9 years old when her parents (the Ws) consulted me abouther rigid conscience and pervasive inhibitions. Danielle was perfectionisticand compulsive about rules. Homework caused her inordinate tension; butshe only cried and balked when her parents suggested she take school lessseriously. Danielle was so rule-bound that she would criticize her mother forparking in a time-restricted parking space. She was self-conscious and wor-ried excessively about hurting others feelings. Danielles unusually intensesibling rivalry with her younger brother and sister suggested these concernswere rooted in conflicts over competition. She also criticized her mothersexpensive shopping, seemingly an identification with her fathers rants abouther mothers spendthrift ways. Peer relations were also inhibited. Danielleavoided close friendships despite being well liked. She preferred one bestfriend at a time, becoming jealous and possessive if that friend had otherfriends. Her parents and teachers described her as a follower, not a leader.Both parents dated Danielles emotional inhibition to the past two years.Hypochondriacal worries occurred over the slightest scrape or cold. Daniellewas also excessively cautious in activities requiring gross motor skills.

History

Danielles history contradicted her mothers guilty belief that her threeyear-long depression had damaged Danielle. There was clear evidence thatDanielles problems antedated her mothers depression and accompanyingmarital strife. Danielle was unplanned; the pregnancy led Mr. W reluctantlyto marry her mother. Mrs. W was over-protective and refused to leave thebaby for more than a few hours until Danielle was 4 years old. Daniellelacked age-appropriate aggression during her anal-rapprochement years, sug-

gesting early inhibition of anger and autonomy andor passive submission toan intrusive and overwhelming mother. She was also more timid on slidesand play-structures in the park than other children between ages 2 and 5.Noises and animated characters at theme parks and restaurants frightenedher at age 3; her fears soon expanded to include snakes, spiders, and deadanimals from which Danielle feared she might catch disease during her oedi-pal years. At age 4 she insisted on falling asleep in her parents bed and beingcarried asleep into her own bed for about one year. All these pre-existingdifficulties would have made her mothers depressive withdrawal difficult, butnot causative of her problems. Psychoanalysis was recommended and I saw

Danielle four times a week for three and a half years and met weekly withher parents. It is important to emphasize that the following summary ofDanielles analytic process makes it seem more coherent than it felt at thetime. Writing up cases such as this one retrospectively gives the analyst the

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benefit of emotional and temporal distance, clarifying patterns that seem lessevident and more confusing in the actual clinical moment. None of us are aswise during a clinical analysis as we may seem in retrospect.

Opening phase

Danielle began the analysis by mentioning that her mother had fired ahousekeeper for supposedly calling her a bitch when the housekeeper hadonly said her mother was full of bullshit. I pondered the possible meaningsof this statement and said that Danielle might worry in her mind that she,too, could make her mother angry. Her nodded agreement allowed me tosay that she might also wonder what was okay to say or do with me. AgainDanielle nodded. I then explained that she could say whatever she wantedor do anything except intentionally hurt either of us; I also explained confi-

dentiality. She responded by telling me of a family vacation that her motherhad boycotted after a fight with Mrs. Ws brother. I commented that shemust worry about her mothers anger a lot while thinking to myself how shemight fear being rejected by me should she get angry. Her sensitivity to hermother, who was experienced as overwhelmingly powerful, aggressive, andintrusive, foreshadowed a central issue of her analysis and my own counter-transference struggle not to over-identify with this view of Mrs. W.

Our relationship quickly became the field in which Danielle expressed herconflicts over aggression. Early on, for example, she hesitantly hinted thatI buy a game for the office. But she denied my observation that she seemed

uncomfortable asking me. Thus, I reminded her that she had told me abouther parents frequent arguments over spending money and wondered if shefeared I, too, would become angry or say No to spending money. Daniellesmiled and mentioned the game she would like me to buy. I did so only to bemet by a barrage of requests for new games or toys that she rationalized whilerefusing to explore. While I tried to analyze these requests to get out of thebind into which I had inadvertently put myself, she called her father cheap.I asked if she was seeing if I was cheap like her father or easily angered likeher mother. In this way I emphasized our here-and-now interaction. Danielledenied being angry with me while belittling her fathers cheapness. I wondered

if she was telling me that she tried to make her own angry feelings go away bythinking the person toward whom she felt angry was bad; perhaps that helpedher feel she was not bad. Using my preferred conflict model, I was trying toaddress her defenses and superego injunctions against anger before trying todirectly discuss her anger. But Danielle simply denied having any angry feel-ings, making me aware of the danger of premature interpretation.

Denial gave way gradually to more open demonstrations of Daniellesconflicts over anger, particularly around our relationship. Mildly sadisticteasing about not wanting to attend sessions seemed safer than directexpression of anger at me. For example, she mentioned that attending a pre-

vious session had prevented her from riding in a truck. I said she might beangry and resentful at me for saying she needed to come. Danielle empha-sized that her parents, not me, made her come. But I seemed to controlthem. They asked me if she could miss a session and I said: Its not a




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good idea! Danielle then asked me how long her analysis would last; hermother said that she would probably only need two years. I commented thatshe seemed to hope it would be over as quickly as possible. She agreed butcould not explain why she disliked coming. I said: Talking about feelings

you try not to think about probably hurts just like the feelings, themselves.Danielle shook her head no, nodded yes, and explained that she was notsure. She was glad she was not her mom because Mrs. W had to attendanalysis five sessions weekly. I said she was probably glad not to be like hermother in other ways, reminding her of complaints about her mothersanger. Danielle agreed emphatically that she was glad to be different thanher mother in that respect.

Thinking about her loyalty conflicts, I added that she might also want tobe like her mother but worried that I would disapprove. Danielle replied thatshe wished she was more talkative like her mother. I inquired into this wish.

She explained that she thought it had to do with being shy. Danielle felt puz-zled because she did not feel shy, but she acted as though she did. She thenrealized that she had not always been so quiet; she had been talkative untilshe was 3. My question of what had happened at age 3 led Danielle to saythat her sister had been born. Her sister had been a pest, imitating everythingDanielle said and did. I then wondered whether she might have stopped talk-ing so much to prevent her sister from repeating her words. Danielleexclaimed: I just had that same thought! I added that her quietness seemedto be a way to control and express her anger at the same time , while I won-dered to myself if she was just complying with my interpretation to please

me. But to date, I had not noticed tendencies to comply in the analysis.She became more comfortable with her aggression, playing tricks on me,bringing in peppered candy, packs of gum that would snap my fingers, fakepiles of feces or vomit, etc. She laughed gleefully when I fell for them.I struggled to find ways to use such behavior to promote self-reflectiveness.Thus, I suggested she was trying to show me about the tricks she felt wereplayed on her, like the trick of expecting to be picked up by her mother onlyto be disappointed. Danielle angrily enumerated the times her mother hadforgotten to pick up her car-pool, take her to school, etc. Her need to bal-ance anger at one parent with anger at the other led her then to complain

that her father was also always late except for work. She said she fearedcomplaining to her mother because of her mothers anger. I labeled herinhibited affect a freezing of her feelings because she was also afraid ofhow big and destructive her own anger was. Over the first year of analysisI showed Danielle how she moved her feelings from her parents to otherpeople as well, and that her freezing of her feelings also contributed to hershyness. In this way I tried to help her to observe and learn about how hermind functioned more than interpreting repressed mental content.

Midphase

Danielles transition to midphase was characterized by much greater accessi-bility to affect, both at home, and in the analysis, as we worked through heremotional freezing. Our work on her defenses against anger led initially to

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tantrums at home over having to dress up to accompany her parents to cul-tural events, and other control issues, most notably about the analysis. Sheprotested directly to Mrs. W and me that attending analysis was ruining herlife by messing up other activities. Danielle challenged me repeatedly with

questions about the duration of analysis and why her siblings were not in it.I was encouraged by the affective immediacy with which her anger wasentering our relationship. Other more modulated expressions of angeraccompanied her increasing awareness of and comfort with this emotion.Giggling, competitive banter and teasing also occurred as her frozendemeanor gave way to an affective range more typical of a child her age.Physical games with Nerf equipment replaced board-games and drawing,and Danielle became interested in baseball, insisting on playing it in our ses-sions, regularly cheating in order to beat me. I chose not to prematurelyinterpret her identification with my own interest in baseball while I watched

her motoric inhibitions gradually disappear during our sessions.Danielles complaints about seeing me were increasingly belied by herobvious pleasure at playing and discussing baseball during our sessions.Danielle told me that I knew more about baseball than any other grown-up in response to my questions about her preoccupation with the subjectmotivated by my concern that it was being used primarily as a resistance.Her response made me think that her protests about attending defended agrowing idealization that might seem dangerous to a child already strug-gling with loyalty conflicts toward two battling parents. Hence, I focusedon her defensive need to minimize her positive feelings toward me. During

one session she chatted about some activity which our session had inter-rupted while we tossed a Nerf ball back and forth. I told Danielle thatI thought another reason she disliked sessions might have to do with herreluctance to talk and feel close to me for fear I would learn about herbig feelings. She probably questioned whether I would help her to feel safewith them. Danielle responded with a seeming non sequitur, complainingthat her mother picked at everything her father did. She then rantedabout her mothers spendthrift habits, reciting her fathers litany of feelings.Then she lamented her father saying they would have less money to spendon their Caribbean vacation because Mrs. W spent so much. Puzzling over

her response I realized that Danielle was confirming my transference inter-pretation by expanding on her anger toward her mother. Danielle went onto associate to her phobic fear of stingrays in Jamaica which I then under-stood as involving guilt and displaced anxiety over her loyalty conflicts andcompetitive strivings toward her mother. Interpreting such unconsciouscontent risked seeming unempathic and adding to Danielles fear thatI could not help her to feel safe with her feelings, particularly her powerfulanger.

Instead, I watched and listened to Danielles somatic complaints andanger at her mother as the trip grew closer. Worries over scabs, concerns

that a cold would cause her ears to hurt while snorkeling, etc., occurred.I considered whether Danielles anxiety about time away from me might alsobe contributing, but she only discussed her parents bickering over the detailsand cost of the vacation. Thus I tried to address her fear of her own affects,




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saying that it seemed difficult to talk about her fears of how big her ownanger toward her mother felt; it seemed easier for her if her parents werethe ones who were angry. Danielle acknowledged that her emotions felt inbetween being scared of her anger and excited about the trip.

Only upon Danielles return did her separation anxiety become clear. Inher first session back she expressed surprise her luggage had made it back,detailing the familys almost missing their return flight. Mrs. Ws phonemessage about Danielle worrying excessively about missing the return flightled me to think she might have feared being separated from me permanently.Atypical concerns about missing or rescheduling sessions around anotherimminent long weekend away suggested how important I was to her andhow frightening separation from me was. So did her requests that I notleave the office for the day until her mother arrived or that I leave the doorbetween the waiting room and my office open so that she might see me. The

transference was reaching the intensity and extent usually associated with atransference neurosis. We spent the next six months working on her separa-tion concerns and their connection to her anger that she feared was so pow-erful it could destroy those whom she loved.

These separation anxieties, often expressed in the transference, becameintermixed with oedipal ones as Danielle talked about feeling mistreated byher mother who scolded: You learned that from your father! Danielleadmitted that sometimes she thought her mothers complaints of You loveyour father more might be correct. I interpreted: That probably makesyou feel guilty since you also love your mom. Danielle agreed but com-

plained:

I cant win with her. She doesn

t like to play with me. My dadplays and she stands around talking to her friends. I said she might fear

her mother did not like or play with her because she loved her father.Danielles eyes teared up as she listed all she felt she had in common withher father, and how little she shared with her mother. I considered the trans-ferential implications but her emotion was more outside the transference atthe moment.

In this context, transference wishes that I protect Danielle and her motherfrom each others anger occurred, via displacement, as she criticized thesnack her nanny had brought her which she threw out in my waste-basket.

She asked me to tell the nanny that she had eaten it all if I was asked.I interpreted her wish that I protect her from her nannys disapproval andDanielle agreed. Her association that her nanny had driven because Mrs. Wwas ill suggested a displacement of her wish to be protected from hermothers anger. But she seemed not ready to know this about herself.I waited until Danielles complaints about her mother mounted to point outher provocations of her mothers anger, focusing on the defensive functionof her provocations. For example, she complained about her mother alwaysthreatening to call Dr. Sugarman about parental arguments. I first saidthat this must make her feel I was on her mom s side against her dad.

Danielle responded:

And you

re not on anybody

s side but mine,

repeating an earlier clarification to her. I agreed, adding that it must still bedifficult for her dad because he probably believed I was on her moms side.Danielle agreed and said that her mother probably felt I was on her dads

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side. I lamented feeling caught in the middle like her, worrying that eachparent thought she was on the others side. Danielle insisted that her dadwas the one in the right 99% of the time. I underlined her idealization ofher father, her angry devaluation of her mother, and her feeling united with

him against Mrs. W. I then interpreted that that she provoked her mother toblame her or feel the helpless victim of two warring enemies to avoid feelingguilty.

Oedipal struggles with her mother peaked in the middle of her secondyear of analysis; complaints about her mother and vociferous argumentsbetween them occurred frequently in the waiting room whenever Mrs. Wrefused to bring Danielle her preferred sort of food. In this way Daniellebrought her internal conflicts directly into our relationship. Danielleremained reluctant to acknowledge how her provocative demands and rigid-ity about acceptable food contributed to these arguments. Wishes to leave

sessions early began to emerge along with an idealizing paternal transfer-ence, even accidentally calling me Dad one session. Unconscious guilt overher longings for her father in the transference seemed the most likely con-tributor to these wishes to leave early that left me initially confused. Eventu-ally I realized that her paradoxical tendency to then stall when I said it wastime to stop revealed the degree of conflict Danielle felt about her longingsfor me.

Interpreting these conflicts over several months eliminated her fear ofsleeping in her own bed (a symptom that had reoccurred during the openingphase); now she feared riding the elevator in my building. Her oedipal guilt

seemed solidly in the transference at this point, replacing the separationconcerns we had analyzed and worked through. Danielle linked her fearwith a dream she remembered from a year earlier in which she and her dadwere riding an elevator during an earthquake. It turned upside down, leav-ing her and her dad standing on their heads. At that point her mom cameto the rescue, pulling the elevator doors apart with superhuman strengthfrom outside. Danielle associated that an elevator could not flip over unlessthe entire building did something there was only one chance in a quadril-lion of happening. I wondered about things she thought more likely. Shereported fearing that my elevator would fall when it shook while she and

her brother rode it without a grown-up. Then she complained about hermother not getting her ice-cream before our session prompting me to thinkthat her anxiety involved her longings for me as father and competitiveanger at her mother which she defended by having her mother buy her food.Interpreting this conflict over a series of sessions, I explained that Daniellehoped her mother agreed to her requests to avoid feeling angry. Daniellereiterated her need to eat during sessions; I said this need might also helpavoid uncomfortable feelings about me. She associated to hating her musicteacher, suggesting anger at me that I interpreted. The dynamic meaning ofher anger remained unclear although I suspected it defended positive, oedi-

pal longings for me.Indeed, Danielle became more curious about my personal life while moreopenly acknowledging anger with me. Mrs. W reported that Danielle toldher she listened to me in a phone conversation through the closed door of




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the consulting room. Primal scene fantasies seemed implicit in her reportthat she had heard my wifes name, and planned to find out more aboutme. Danielle told me she had seen a Porsche with a personalized licenseplate saying TALK2ME in the parking lot and concluded it was mine. She

became hypersensitive to change in the analytic situation, complaining onesession that a chair in my office had been moved. I said she dislikedchanges; perhaps she wanted to be sure I did not change. Danielle rational-ized away such feelings as normal while openly idealizing my ability toanticipate her moves at board-games, which I took as both a defense againstcompetition with me as mother and an expression of an oedipal paternaltransference. Exploring these issues led first to the paternal transferencewith complaints about her mothers chronic lateness. Danielle then askedme to help her with her math homework, explaining that her father, not hermother, helped her with that subject. I noted that she assumed only her dad

and I could help her. She explained this was because her dad and I hadattended college. My reminder that her mother had also graduated from col-lege led Danielle to say that her mom had forgotten all her math. Workingthrough her devaluation of her mother over some months finally allowedme to link it to her self-reported dislike of menstruation and her self-proclaimed wishes to be a tomboy, telling her I thought she disliked being agirl, and did not want to be a woman, because she wanted to be like herfather and myself. Later, I added that being like us helped her avoid compe-tition with her mother for us and guilt. This conflict was worked throughfor some months and Danielle began to enjoy stereotypically feminine

activities.Danielle gradually admitted her tendency to defend her father to hermother because he and she had more in common, such as playing sports.But soon she regressed back to blaming her mothers temper, leading meto remind her that she pushed your mothers buttons so that her mom,not she, lost control of her anger. We tied her fear of losing control toher old fears as well as the inhibitions that had precipitated analysis.Weeks later, Danielle reported going to a ball game with only her father,fearing her mothers temper would embarrass her. She caught herself rue-fully: There I go again, putting my mom down! Danielle added that

she now preferred doing homework with her mother over her father

slong-winded explanations. Working through her loyalty conflicts led toincreasing affection and admiration for Mrs. W. As her competitive striv-ings resolved Danielle wistfully wished she enjoyed being with her mothermore. In this context, she mentioned termination for the first time, sayingthat she wanted to feel more loving toward her mother and to fearthrowing up less before ending. Shortly thereafter, she noticed continuingconflicts over having much in common with her mother, saying in aschool assignment that she liked Jeeps more than Mercedes. Daniellelaughingly told me this saying: Boy, I keep doing it even when I dont

want to!

I wondered if this

insight

might reflect anxiety about termi-nating and a wish to hold onto me through maintaining her conflicts.But I did not feel sufficiently confident of this formulation to make aninterpretation.

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Termination phase

Instead her ability to reflect on herself and to understand her mental func-tioning continued to improve as did her comfort with emotion, her present-

ing inhibitions, and her relationship with her mother. I realized thatDanielle seemed ready to begin a termination phase and was open to explor-ing it when Danielle broached it more seriously toward the end of her thirdyear of analysis. She reviewed her analytic gains, acknowledging desires tofeel even more comfortable with her mother, and to fully eliminate her occa-sional somatic anxiety. Danielle believed she could work on these issues dur-ing a termination phase. After teasing she would terminate the next day,Danielle suggested terminating in six months, about three and a half yearsafter beginning analysis. Exploring this plan for several sessions reassuredme that she seemed sufficiently established on a positive developmental path

to make it realistic. Danielle responded to setting a date by briefly regressingback to a mode wherein she would not express feelings. I worried that I hadbeen premature in agreeing with her wishes to terminate. But I thought thatwe had carefully explored her various feelings about it. Therefore, I justpointed out her emotional reticence, suggesting she might not want to talkabout her feelings about terminating. She reported feeling glad about termi-nating but wished it was sooner. I wondered to myself if she had set the ori-ginal date to please me. But her immediate association that she had justthought of another fear rattlesnakes led me to think that her wish toterminate earlier was more likely a reaction formation against fears about it.

With less than three months left, Danielle calculated the remaining num-ber of sessions on my calendar. She expressed surprise, thinking more ses-sions remained, and then wished fewer sessions remained. I asked aboutthis. Danielle suggested we meet for two solid days instead. I wondered outloud if this fantasy was a wish to be with me around the clock which shewanted to deny. Soon she began holding in angry feelings toward me again.It seemed that old issues were resurfacing to be worked through one moretime similar to the termination phase in adult analyses (Sugarman, 1991).Danielle admitted her anger when I interpreted but refused to discuss itdirectly. Thus I focused on her resistance to direct expressions of anger and

interpreted, once again, her fear of losing control. This work led her to ven-tilate anger about still attending sessions, comparing the 45 minute sessionsto school classes. But analysis is worse because I can still talk to my friendswhen Im bored in school! I suggested that holding in her feelings as shewas doing, and had done earlier in the analysis, might make her bored.Danielle responded with a joke that made the listener become angry bybeing repetitious. She said she never told it for 45 minutes, fearing angertoward her. I asked if she thought she was testing whether I would tolerateher angry feelings or become angry at her; then I added that she mightworry who would tolerate it when we stopped seeing each other. Danielle

denied worrying about terminating.But her complaints about sportswriters forgetting the local baseball team,the Padres, during the off season allowed me to ask if she thought I wouldremember her once she terminated. She asked if I would while refusing to




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share her fantasy. Danielle was surprised when I said I would remember herand asked why I would. I said she seemed to feel we had no real relationship

just like the sportswriters and baseball players. She said only a few playersand writers were genuine friends. I asked what she thought the players felt

about being forgotten. Danielle thought that they probably did not care.Some players did not like sportswriters. Tony Gwynn, the local star, said hewould never bat .400 because of them. I said this was because he felt sopressured by them, and added that Danielle seemed to feel pressured by mewhen I tried to talk about feelings, just as she used to feel pressured by hermother. She agreed, saying that she had not realized how much pressureaffected Tony Gwynn or herself.

Soon she lamented the trade of her favorite catcher, suggesting that thePadres sign another catcher who had a phobia of throwing the ball to thepitcher. He could see a psychoanalyst. I commented that maybe she thought

he could see me; I added that he might fear his feelings and had moved hisfear over to throwing the baseball just as Danielle used to move her fear ofher feelings over to elevators, germs, and vomit. She agreed and mentionedthere were only three and a half weeks of analysis left. Over the last few ses-sions, we discussed her fears about terminating and Danielle reviewed theprogress she had made. Our last weeks together were spent talking abouther feelings without her previous veiled hostility.

Follow-up

Mrs. W maintained contact for the next decade, providing news of Daniellesprogress. During high school, she participated in various sports and dramaticactivities that put her in the limelight without anxiety. Peer relations wereexcellent; she was popular, shared friends, was a class leader, dated, and evenhad a boyfriend. Her mother remained highly anxious about her, however,calling frequently with concerns about the inevitable fluctuations inDanielles behavior. The occasional B in a class, peer difficulty, etc., threwMrs. W into a tizzy. Generally, brief reassurance calmed her down. Danielleexcelled at college and, at present, is attending graduate school. She wentthrough a period of seemingly masochistic relationships with weak, passivemen, inciting her mothers criticism. Mrs. Ws reaction to this seeming imper-

fection in her daughter needed my reassurance that new developmental taskswould always lead to ebbs and flows in Danielles functioning just as withanyone else. Most of my follow-up information was provided by Mrs. W whowas both thankful and reluctant to lose me as a source of advice when shewas worried about Danielle. But Danielle, herself, sent me a note at the timeof her high-school graduation expressing gratitude for our work together.I did wonder if she sent the letter to please her mother or me but the wordingfelt heartfelt. The fact that it was the only time she ever contacted me afterterminating also made it seem more likely to be genuine.

DiscussionI believe that the structure of Danielles analytic process is virtually thesame as the sort of analytic process that one finds in adult analyses. As

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mentioned above, notwithstanding the complexities of defining a psycho-analytic process, such a process does emerge in most clinical analyses that isrecognizable to most psychoanalysts, regardless of theoretical persuasion.This position is analogous to the oft-heard political wisdom about defining

pornography: I may not be able to define it but I know it when I see it.Many of us in national or international study groups have noticed that col-leagues operating from theoretical models very different from our own,nonetheless, present material that undeniably demonstrates a psychoanalyticprocess that we recognize. The psychoanalytic process apparently has astructure or organization that is relatively consistent regardless of the mentalcontent emphasized by a particular school of psychoanalysis. Whether onefocuses on narcissistic vulnerability, drivedefense configurations, primitiveobject relational paradigms, etc., most analyses, child or adult, demonstratecertain phenomena characteristic of a psychoanalytic process. These phe-

nomena comprise its structure.Toward this end, one can agree with Boesky (1990) who says: My ownopinion is that transference and resistance remain the core of any definitionof the analytic process (p. 572). These are two structural elements of thepsychoanalytic process that tend to occur regardless of the analysts schoolof thought. The analysis of resistance as a key element in an analytic pro-cess has been emphasized by analysts who operate from some variant of thestructural model (e.g. Abrams, 1987, 1990; Davison, Pray and Bristol, 1990;Feigelson, 1977; Ritvo, 1978; Weinshel, 1984, 1990a, 1990b), the Kleinianmodel (Joseph, 1985; Steiner, 1993), the British object relations model

(Casement, 1982; Guntrip, 1969; Stewart, 1992) and the self-psychologicalone (Malin, 1993). Weinshel (1984, 1990a, 1990b) clearly articulated thecentrality of negotiating and analyzing resistance in the analytic process,anchoring his view in structural theory and the ubiquitousness of conflictand compromise formation. But Smith (2003, 2005) notes that even analystswho do not anchor their thinking in terms of intrapsychic conflict do, inreality, analyze clinical phenomena that can be understood in terms of suchconflict; hence Weinshels perspective should apply to other persuasions.

To the degree that most, if not all, mental phenomena involve intrapsychicconflict and compromise formation, it is simply inevitable that resistance

analysis will occupy a significant part of an analytic process. After all, theinternal world is constantly being externalized into the analytic frame andthe relationship with the analyst (White, 1996). Hence, all key facets of thepatients key conflicts and compromise formations will appear for analysisas they appear in the analytic interaction. Resistance is simply the interper-sonalization of the defensive facets of the compromise formations that shapethe patients mind and the symptoms and character traits it creates. Itrequires analysis so that self-reflection and self-knowledge can deepen.Resistance analysis involves understanding the motives or fantasies thatcause the need to defend, not just removing the defense to get to that which

is defended (Busch, 1995, 1999; Gray, 1994). After all, defenses exist becausethey feel necessary to the patient, not just to complicate the analysts job.This clinical principle should hold just as true for the analysis of resistance.That is, the self-knowledge gained from the analytic process will ideally




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include knowing why one prevents oneself from knowing all aspects of onesmind and the ways one does so. Children, in particular, avoid certain inter-nal phenomena; affects, for example, are so frightening that they try toavoid facing them (Bornstein, 1945, 1949; Hoffman, 2007). But, as Ritvo

(1978) makes clear, the child analyst will hopefully analyze resistance anddefense to initiate, guide, and intensify the analytic process. Doing so pro-motes the childs self-reflection.

To this end, Danielles analytic process demonstrates my attempt to consis-tently understand her resistances and the reasons for them. For example,early on I pursued her reluctance to ask me directly to buy her a new gamefor the office, interpreting the anxiety I thought caused her to inhibit thedirect knowledge and expression of her wish. Analyzing this resistance fur-thered the analytic process, leading Danielle to express her wishes moredirectly. Those wishes were then analyzed, both their defensive function and

the impulses expressed. Just as with the analytic process with adult patients,the analytic process with children is facilitated by interpreting in the neigh-borhood (Busch, 1993, p. 151). In this way, analyzing resistance and defenseexpands child analysands knowledge of the workings of their minds. Indeed,Danielles ability to reflect on and understand the workings of her mind impulses, defenses, and moral injunctions and ideals as well as the ways inwhich she tried to balance these elements of conflict deepened andexpanded. Labeling her resistance to knowing and expressing emotions asfreezing her feelings increased Danielles awareness and expression of anger,other emotions, and associated fantasies. It also interested her in her minds

workings, motivating her to understand even more. To be sure, my interest inunderstanding her resistance also promoted her interest in self-reflectiveness.After all, the relationship with the analyst is thought to be another way bywhich the analyst promotes insightfulness (Sugarman, 2003a). But this holdstrue for the adult psychoanalytic process as well (Sugarman, 2006).

One could say that her analytic process was characterized by the emergenceand analysis of one resistance after another as her ability to examine, know,and integrate her minds intricacies expanded. Resistance to aggressive deriv-atives was replaced by resistance to positive feelings toward me which gaveway to resistance to dependent longings and separation anxiety that were fol-

lowed by resistance to oedipal competition and so on. Analyzing and work-ing through each resistance both expanded her awareness of a particularconflict and allowed another to emerge. Weinshel and Renik (1992) believethat analyzing resistance inevitably modifies symptoms and character traits:

Whatever an analysts particular theoretical orientation or emphasis, he is likely tounderstand analytic work as some sort of ongoing process in which an analysandscapacity for self-observation is enlarged and refined. Therefore, in clinical psycho-analysis as it is generally understood (the diversity of individual approaches not-withstanding) when analytic work proceeds, insight and symptom relief merge into asingle goal. The analysands resistances clarify themselves as the most immediatelyrelevant symptoms to be studied, and no distinction can or need be made betweeninvestigation of the analysands self-observational difficulties and investigation ofhis psychopathology.

(p. 97, original italics)

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Danielle demonstrated this clinical truism repeatedly for example, herresistance to knowing and expressing emotion in the sessions and her present-ing symptom of affective inhibition. It is important to note, however, that suchself-reflectiveness or insightfulness occurs through a number of interventions,

not just verbal interpretations. Younger andor more anxious childrenmay need such self-reflectiveness to be promoted in the displacement of theplay, for example, before they can use it more directly (Sugarman, 2003b,2008a). But it is often necessary to work in the displacement with adultpatients too, particularly by using their function of fantasizing (Sugarman,2008b). Likewise, analysands (child and adult) may also learn to self-reflect inorder to identify with the analysts interest in their minds.

Danielles analytic process also supports Fraibergs (1967) contention thata transference neurosis emerges when analyzing children if one conductstheir analysis similarly to adult analyses, conceding only the use of play,

free movement, and the substitution of another therapeutic contract for theanalytic rule (p. 101). Implicit in this statement seems to be agreement withthe thesis of this paper; the structure of the child analytic process is quitesimilar to that of the adult, notwithstanding certain technical differences.Fraiberg (1967) appears prescient in saying that:

increased appreciation of transference by child analysts may lead to changes intechnique toward minimizing supportive measures and encouraging autonomy. Thevery change in technique may create an atmosphere which facilitates the develop-ment of transference manifestations. The result will be a decrease in the tendency tomanipulate the transference and an opportunity to encourage the full development

of the transference. (p. 102)

This approach assumes that transference is a basic aspect of interpersonalrelating. Most modern-day analysts (child or adult) believe it unnecessary tomake special efforts to promote the formation or emergence of transference.It occurs naturally so long as nothing interferes. Anna Freuds early effortsto ensure a positive transference were unnecessary and probably preventedfull expression of child patients transferences from this perspective.

The work with Danielle seems to support Chuseds (1988) contention that

the most effective conflict resolution and symptom relief can be foundthrough the analysis of the childs transference; the same can be said for theanalyses of adults. But children, in particular, because of their often lessmature cognitive abilities, are more concrete. Hence it is easier and evenmore important to draw their attention to their internal workings as theymanifest in the relationship with the analyst. This point brings up the defini-tion of transference neurosis. More traditional definitions of it as thedevelopment within the analytic situation of a new neurosis, complete witha new set of symptoms (Chused, 1988, p. 51) reduce the likelihood of find-ing it in a childs analytic process, although Danielle did develop a new

symptom (elevator phobia) with a range of oedipal fantasies in the transfer-ence. Nonetheless, this is an outdated definition based on other theoreticallyvague concepts such as the infantile neurosis (Tyson, 1996). Chuseds (1988)more modern definition of a transference neurosis as the intensification of




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pathological character traits and modes of relating within the analytic set-ting, with the gradual emergence of regressive, incestuous fantasies, conflicts,and impulses experienced in relation to and centered on the analyst (p. 52)more accurately describes the transference neurosis that characterizes both

child and adult analytic processes and is the one shown by Danielle. Asmentioned earlier, too often we forget that transference includes more thanthe displacement and projection of past object ties onto the analyst. Trans-ference of defense (A. Freud, 1936; Gill, 1982; Gray, 1994) can be expandedto the transference of intrapsychic structure more generally (Sugarman,2003a, 2003b, 2006) so that transference can be more comprehensivelyunderstood as the interpersonalization of psychic structure (Silk, 2004).Joseph (1985) seems to have a similar idea in mind with her emphasis onthe total situation of transference as does Schlesinger (2003) with his viewof transference as a process. Thus, a transference neurosis has occurred

when the childs (or adult

s) internal structure including impulses, defenses,prohibitions, ideals, etc. become centered on the person of the analyst

andor in the analytic interaction much of the time and with significantemotional intensity.

Danielles analysis shows the interpersonalization of the structure of hermind to a degree and intensity that fits this definition. From the beginningof her analysis, her key conflicts were expressed and analyzed in the trans-ference. As noted by Chused (1988) to characterize childrens transferenceneuroses, these often involved vicissitudes of aggression as I adopted theneutral position that many (Feigelson, 1977; Fraiberg (1967; Weiss, 1976)

suggest allows the child the greatest freedom to externalize her inner worldinto the analytic interaction. Not excessively gratifying Danielles wishesallowed her to feel, express, and understood her aggression toward me. Thiswork began with her inhibition about asking me to buy a game, moving intocomplaints about attending analysis, playing tricks on me, worries aboutbeing separated from me, and, ultimately, oedipal longings for me leading tofears of riding in the elevator in my building. In these ways she enactedevery important conflict contributing to her presenting symptoms in thetransference; and we used these enactments to expand her knowledge of herminds working.

The guiding principle in this work was conflict resolution. Learning toconsciously represent and articulate aspects of her inner world that werepreviously unconscious and, hence, latent allowed Danielle to know herselfin new ways. Structural change followed as this new knowledge was inte-grated into her self and object representations, and reorganized her mentalworkings (Abrams, 1990). Affect tolerance improved, peer relationsexpanded and deepened, and her superego became less punitive. Using herever-deepening transference as one would with an adult promoted conflictresolution. Never did I see myself as functioning primarily as a developmen-tal object to compensate for her parents obvious deficiencies, even in the

face of Danielle

s complaints about them. To be sure, Danielle often castme in the role of one parent or the other, often with the aim of idealizingme (as someone who would protect her from her mother, who knew moreabout baseball than anyone else, and who would accept her feelings without

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retaliating, etc.). But these perceptions were analyzed and used to furtherher self-knowledge our relationship was not seen as curative in its ownright, despite its importance in moving the analytic process along, deepeningit, and encouraging self-reflection through a secure attachment. One could

argue that my equanimity in the face of her anger, my regularity and punc-tuality in our meetings, etc. offered a new experience that contrasted withher parents. This is certainly true just as it is in adult analyses. But I believethat the ability to reflect on and express her feelings about me was the mainfactor in the stability of her change.

Furthermore, our analytic work followed the suggestion of several promi-nent child analysts (Chused, 1988; Ferro and Basile, 2006; Yanof, 2005) tominimize reconstructions. I rarely found it necessary or helpful to tie theunderstanding of any particular conflict unearthed in our work to its pre-sumed past origin. I would regularly link the conflicts manifested to their

current-day expressions in Danielles life, particularly her current-day rela-tionship with her parents. But this sort of understanding usually seemed suf-

ficient. This way of working should not be taken as a sign of a differentkind of analytic process from that which develops with adult analysands.Many (Ferro and Basile, 2006; Fonagy, 2001) argue that reconstructions ofthe past are rarely necessary in adult analysis either. Memory is never veridi-cal and present-day conflicts serve dynamic functions in the current equilib-rium of mental functioning. Knowledge of these present-day meanings ofconflict is often more mutative than understanding their historical origins.This approach facilitates greater emergence and ability to work in the

transference because it reduces the likelihood of defensive displacement tothe past in order to avoid affects in the room.Finally, I believe that Danielles analytic process demonstrates the series

of changes that usually define an adult analytic process (Boesky, 1990;Weinshel, 1990a, 1990b). These include:

Gradual and progressive revealing of current and historical materialrelevant to presenting symptoms

Unfolding in the analytic relationship of all aspects of key conflictsexplaining presenting symptoms

Cooperative interest in understanding the meaning of everything emerg-

ing in sessions Improvement in symptoms and functioning in and out of analysis Emergence of dynamically new material and thematic shifts in content Alternation between progressive and regressive phenomena, e.g. regular

defensive regressions as new conflicts emerge and are analyzed Fluctuations in representations of self, key others, and the analyst Improved affect tolerance and modulation Reduced need for self-punishment

These characteristics of an analytic process were as evident in the work

with Danielle as with any of my adult patients; they were brought about bya similar kind of interaction. As with adult patients, I tried to create a framein which she externalized the workings of her mind, reflected on thoseworkings, understood them, and used that self-knowledge to modify her




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symptoms, behaviors, or character traits. This is consistent with Feigelsons(1977) sine qua non of both child and adult analysis:

That is, the existence of a discernible process that leads from defense and characteranalysis to repressed wishes, impulses, memories, and fantasies with the goal ofbringing about a higher level of psychic organization by increasing self-awarenessand problem-solving.

(p. 357)

From this perspective, insight remains as important to the childs analyticprocess as it is to the adults. Most children, even very young ones, are capa-ble of insight if we redefine it as a process (insightfulness) whereby theylearn to mentalize and develop an ability to reflect on their own minds andunderstand that the workings of their minds affects their behaviors, fears,fantasies, etc. Developing this process of insightfulness or insighting (Abrams,1996; Boesky, 1990) often has a greater mutative impact than gaining insightinto repressed mental content. This holds true for adult analysands just asmuch as for child patients (Sugarman, 2006, 2008b): what is central isthe minds ability to elaborate experience in a more or less symbolic key, nomatter how old the subject (Ferro and Basile, 2006, p. 497). To be sure,child analysts must take into account the childs mental structure, particu-larly their affect tolerance and ability to differentiate reality from fantasy.But this holds true for adult analyses, too, as many adult analysands presentwith minds that are less than neurotically organized (Sugarman, 2007):hence, the recommendation to promote insightfulness by working in thedisplacement in the play. Helping a young or less integrated child tolearn about the intricacies of his mind by articulating characters thoughtsand feelings in the play allows him eventually to discuss these mentalphenomena directly.

Older and more integrated children, such as Danielle, may not need thisfirst step. Her affect tolerance and ability to distinguish her inner worldfrom the external allowed an immediate focus on her mind. And her mate-rial progressively deepened with corresponding shifts in her symptoms andproblematic ways of relating as she gained insightfulness. In my model,evolutionary changes correspond to differing abilities to elaborate and trans-form experience (Ferro and Basile, 2006, p. 497). As with any successful

analysis, her appreciation for the importance of understanding her mindsintricacies increased as it affected her own behavior and emotions. Thus,even with regard to the important dimension of insight, it appears unneces-sary to distinguish between an adult and a child analytic process.

To be sure, parents do occupy a role in child analysis different from thatin adult analysis, most notably with regard to deciding to start or continuethe treatment, and by communicating with the analyst. But my experience isthat they rarely affect the childs analytic process. Danielles work exempli-fies how these aspects become just more grist for the mill so long as theanalyst makes promoting self-reflection a key focus of the process. One can

analyze the meaning to the child of the parents contact with the analyst ortheir insistence that the child be in analysis. This is similar to the ways weanalyze adult analysands interpersonal interactions. They are handled as

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just one more type of mental content that is entering the analysis at anyparticular moment for a number of reasons that can be reflected upon andunderstood. One of the most common reasons parents come into childrensassociations is as a displacement from the transference, something that can

be analyzed as it was with Danielle.

Conclusion

In summary, I believe that Danielles analytic process supports the conten-tion that there is no structurally meaningful difference between the analyticprocess that defines adult psychoanalysis from that which defines child andadolescent analysis so long as one emphasizes the structural phenomenathat define that process. To be sure, ones interventions with children mustalways take their level of mental organization into account. But this isequally true of adult analysis. There, too, we consider issues such as affecttolerance, fantasyreality boundary, regressive potential, etc. when wedecide where and how to intervene. But the same principles of resistancebefore impulse, process before content, and interpreting from the surfacedownward operate in all analyses. And the analytic process with children, aswith adults, is based on the centrality of analyzing resistance and transfer-ence toward the goal of promoting insightfulness into the workings of thepatients mind so that structural change occurs. Even the role of the parentswith the child can be incorporated into the analytic work that defines theanalytic process. Recognizing that these traditionally separated treatmentprocesses (child versus adult analysis) are, pretty much, one and the sameshould help us to better clarify and define what is unique to the treatmentprocedure we call psychoanalysis. For most analysts, the significant differ-ence between psychoanalysis and other treatment modalities, includingpsychoanalytic psychotherapy, is the emergence and centrality of the psycho-analytic process.

Translations of summary

Kinder- und Erwachsenenanalyse: zwei verschiedene Prozesse oder der gleiche? Die Technikder Kinderanalyse wird noch immer als von der Technik der Erwachsenenanalyse verschieden betrachtet,da Kinder sich noch in der Entwicklung befinden und die Primrobjekte weiterhin eine aktive Rolle in

ihrem Leben spielen. In dieser Abhandlung wird dahingehend argumentiert, dass es sich hier um einenfalschen Gegensatz handelt. Eine ausfhrliche Vignette der Analyse eines Mdchens in der Latenzzeitzeigt auf, dass der psychoanalytische Prozess, der sich in der Kinderanalyse entwickelt, strukturell demder Erwachsenenanalyse gleicht. Beide drehen sich um die Analyse von Widerstand und bertragungund beide nutzen diese, um die Kenntnis ber die Funktionsweise der Psyche des Patienten zu erweitern.Und beide Techniken entwerfen Interventionen, die auf der Einschtzung des Analytikers der mentalenOrganisation des Patienten beruhen. Es wre wnschenswert, dass die Betonung der wesentlichen Gem-einsamkeiten der beiden Techniken die Entwicklung einer bergreifenden Theorie der psychoanalytischenTechnik frdert.

Psicoanalisis de ninos versus psicoanalisis de adultos: dos procesos o uno? El anlisis denios sigue considerndose una tcnica diferente que el anlisis de adultos, porque los nios affln se en-cuentran involucrados en un proceso de desarrollo y los objetos primarios continfflan desempeando unpapel activo en sus vidas. Este artculo sostiene que esa es una falsa dicotoma. Mediante una vietaextensa del anlisis de una nia en periodo de latencia se demuestra que el proceso psicoanaltico des-plegado en el anlisis de nios es estructuralmente el mismo que el del anlisis de adultos. Ambos giranen torno al anlisis de la resistencia y la transferencia, y son empleados para promover el conocimientodel funcionamiento mental del paciente. Asimismo, ambas tcnicas formulan intervenciones basadas en




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la evaluacin de la organizacin mental del paciente por parte del analista. Se espera que el nfasis enla comunidad esencial de ambas tcnicas promueva el desarrollo de una teora general de la tcnicapsicoanaltica.

Psychanalyse de lenfant vs de ladulte: deux methodes ou une? La psychanalyse de lenfant

continue tre perue comme une technique diffrente de celle de l

adulte car les enfants sont encore prisdans un processus de dveloppement et car les objets primaires continuent jouer des rles actifs dansleurs vies. Cet article soutient quil sagit l dune fausse dichotomie. Une vignette dtaille de lanalysedune fillette dans sa phase de latence servira montrer que le processus psychanalytique qui se dvel-oppe dans lanalyse denfant est structurellement le mme que dans lanalyse dadulte. Toutes deux gravi-tent autour de lanalyse de la rsistance et du transfert, deux lments quelles utilisent pour favoriser laconnaissance du psychisme du patient en travail. Et les deux techniques formulent des interventionsbases sur lvaluation par lanalyste de lorganisation mentale du patient. Il est espr que mettrelaccent sur la communaut dessences des deux techniques favorisera le dveloppement dune thorieglobale de la technique psychanalytique.

La psicanalisi del bambino rispetto a quella dell adulto: due processi o uno? Lanalisi del bam-bino continua a essere considerata una tecnica diversa rispetto a quella dell adulto perch i bambini sonoancora coinvolti in un processo evolutivo e perch gli oggetti primari continuano a rivestire un ruolo

attivo nelle loro vite. Questo saggio sostiene che si tratta di una falsa dicotomia. Viene [qui] unutilizzataunampia vignetta relativa allanalisi di una bambina in fase di latenza per dimostrare che il processopsicanalitico che si sviluppa nellanalisi del bambino strutturalmente uguale a quello dellanalisidelladulto. Entrambi si concentrano sullanalisi della resistenza e del transfert, che vengono usati permigliorare la conoscenza della mente del paziente al lavoro. Entrambe le tecniche formulano interventibasati sulla valutazione, da parte dellanalista, dellorganizzazione mentale del paziente. Si auspica chesottolineando lessenziale comunanza di intenti di entrambe le tecniche si favorisca lo sviluppo di unateoria globale della tecnica psicanalitica.

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