Introduction

Child psychoanalysis is a unique intensive psychotherapy for children based on a range of assumptions concerning mental functioning which have gradually evolved from the work of Freud over the past 100 years. As these assumptions have been widely reviewed, only a very brief introduction to the defining features of this treatment will be provided here.

Child analysts make the following assumptions.

1. Mental disorder may be usefully examined at the level of psychological causation; the representation of past experience, whether conscious or unconscious, determines the child's adaptation to the external world.

2. Unconscious processes determine the content of conscious ideation as well as behaviour.

3. Self-other experiences are represented in the mind as structures of interpersonal interaction. These structures may be substantially distorted by unconscious fantasy, but nevertheless determine the child's emotional relations with these figures. (l)

4. Psychic conflict is both ubiquitous and a cause of unpleasure. Adverse environments increase the intensity of conflict or fail to equip the child with the capacity to resolve such incompatibilities through mental work.(2)

5. The child's mental mechanisms for dealing with intrapsychic conflict include defence mechanisms which distort mental representations in order to reduce conflict and unpleasure.(3) Defence mechanisms become more complex with maturation. At the bottom of the developmental hierarchy are defences (splitting, denial, projective identification) which are most prominent in severe disturbances of personality, and at the top of the hierarchy are more complex, adaptive mechanisms such as displacement, sublimation of impulses, and humour.(4)

6. The child's communication in a therapeutic setting has meaning beyond that which is manifest, or of which the child is aware. Analysts assume that the child's behaviour may be seen as rational if the child's unconscious desires and unconsciously held beliefs are taken into consideration. (5)

7. The child's relationship with the analyst quickly becomes the vehicle for disowned aspects of the child's thoughts and feelings. This process, which is termed transference, enables the psychoanalytic clinician to understand the child's representation of relationships and his or her feelings about them. (6) Modern child analysis recognizes that, in addition to bringing consciousness to bear on what the child experiences as insoluble conflicts, child analysis has an important holding function in the child's life, creating the possibility of reintegration and further development of the child's internal world. (D

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