Limitations of the psychoanalytic approach

A series of limitations render child psychoanalysis vulnerable to being seen as impractical, non-scientific, and uneconomical:

1. lack of operationalization in most descriptions of technical interventions, with the effectiveness of interventions supported almost entirely by evocative case illustrations;

2. inadequate specificity regarding technical interventions appropriate for children with a particular diagnosis or clinical presentation;

3. limited evidence of efficacy, particularly evidence derived from randomized controlled trials;

4. a rather loose relationship between theories of psychopathology (in turn poorly supported by empirical data), theories of technique, and technique as actually carried out in clinical practice;

5. lengthy treatment, with rather global goals, raising concerns about cost-effectiveness;

6. shortage of reliable procedures for evaluating ongoing clinical progress.

Child analysts thus face formidable challenges to their clinical and theoretical convictions, to their professional status, and, as evidence-based medicine and managed care relentlessly expands its control over reimbursement and denies payment for child therapy, to their livelihood. If child psychoanalysis is to have a future, its unique effectiveness for specific childhood disorders must be demonstrated in randomized controlled trials. We believe that children with severe disorders of personality and multiple psychiatric diagnoses are indeed well suited and dramatically benefit from a psychoanalytic approach. However, such faith now requires support from empirical investigations.

Chapter References

1. Bowlby, J. (1980). Attachment and loss. Vol. 3: Loss, sadness and depression. Hogarth Press and Institute of Psycho-Analysis, London.

2. Winnicott, D.W. (1965). The maturational process and the facilitating environment. Hogarth Press, London.

3. Freud, A. (1936). The ego and the mechanisms of defence. Reprinted by International Universities Press, New York, 1946.

4. Vaillant, G.E. (1992). Ego mechanisms of defense: a guide for clinicians and researchers. American Psychiatric Association Press, Washington, DC.

5. Wollheim, R. (1995). The mind and its depths. Harvard University Press, Cambridge, MA.

6. Tyson, R.L. and Tyson, P. (1986). The concept of transference in child psychoanalysis. Journal of the American Academy of Child Psychiatry, 25, 30-9.

7. Kennedy, H. and Moran, G. (1991). Reflections on the aims of child psychoanalysis. Psychoanalytic Study of the Child, 46, 181-98.

8. Freud, S. (1900). The interpretation of dreams. In Standard edition of the complete psychological works of Sigmund Freud (ed. J. Strachey), Vols 4 and 5, pp. 1-715. Hogarth Press, London.

9. Freud, S. (1920). Beyond the pleasure principle. In Standard edition of the complete psychological works of Sigmund Freud (ed. J. Strachey), Vol. 18, pp. 1-64. Hogarth Press, London.

10. Freud, S. (1909). Analysis of a phobia in a five-year-old boy. In Standard edition of the complete psychological works of Sigmund Freud (ed. J. Strachey), Vol. 10, pp. 1-147. Hogarth Press, London.

11. Hug-Helmuth, H. (1921). On the technique of child analysis. International Journal of Psycho-Analysis, 2, 287-303.

12. Freud, A. (1946). The psychoanalytic treatment of children. Imago, London.

13. Klein, M. (1932). The psycho-analysis of children. Hogarth Press, London.

14. Klein, M. (1946). Notes on some schizoid mechanisms. In Developments in psychoanalysis (ed. M. Klein, P. Heimann, S. Isaacs, and J. Riviere), pp. 292-320. Hogarth Press, London.

15. Bion, W.R. (1959). Attacks on linking. International Journal of Psycho-Analysis, 40, 308-15.

16. O'Shaughnessy, E. (1988). W. R. Bion's theory of thinking and new techniques in child analysis. In Melanie Klein today: developments in theory and practice. Vol. 2: Mainly practice (ed. E.B. Spillius), pp. 177-90. Routledge, London.

17. Winnicott, D.W. (1971). Playing and reality. Tavistock, London.

18. Altman, N. (1994). The recognition of relational theory and technique in child treatment. Psychoanalytic Psychology, 11, 383-95.

19. Freud, A. (1981). A psychoanalytic view of developmental psychopathology. International Universities Press, New York.

20. Freud, A. (1963). The concept of developmental lines. The Psychoanalytic Study of the Child, 18, 245-65.

21. Cicchetti, D. and Cohen, D.J. (1995). Perspectives on developmental psychopathology. In Developmental psychopathology. Vol. 1: Theory and methods (ed. D. Cicchetti and D.J. Cohen), pp. 3-23. Wiley, New York.

22. Housman, A. (1997). The history of child psychoanalysis. Routledge, London.

23. Abrams, S. (1988). The psychoanalytic process in adults and children. Psychoanalytic Study of the Child, 43, 245-61.

24. Kernberg, P.F. (1995). Child psychiatry: individual psychotherapy. In Comprehensive textbook of psychiatry (6th edn) (ed. H.I. Kaplan and B.J. Sadock), pp. 2399-412. Williams and Wilkins, Baltimore, MD.

25. Fonagy, P. and Target, M. (1997). Perspectives on the recovered memories debate. In Recovered memories of abuse: true or false? (ed. J. Sandler and P. Fonagy), pp. 183-216. Karnac Books, London.

26. Sandler, J., Kennedy, H., and Tyson, R. (1980). The technique of child psychoanalysis: discussions with Anna Freud. Harvard University Press, Cambridge, MA.

27. Bleiberg, E., Fonagy, P., and Target, M. (1997). Child psychoanalysis: critical overview and a proposed reconsideration. Psychiatric Clinics of North America, 6, 1-38.

28. Dowling, A.S. and Naegele, J. (1995). Child and adolescent psychoanalysis. In Psychoanalysis: the major concepts (ed. B.E. Moore and B.D. Fine), pp. 26-44. Yale University Press, New Haven, CT.

29. Fonagy, P. and Target, M. (1996). A contemporary psychoanalytical perspective: psychodynamic developmental therapy. In Psychosocial treatments for child and adolescent disorders: empirically based approaches (ed. E. Hibbs and P. Jensen), pp. 619-38. American Psychiatric Association and National Institutes of Health, Washington, DC.

30. Mandler, G. (1985). Cognitive psychology: an essay in cognitive science. Erlbaum, Hillsdale, NJ.

31. Sandler, J. and Rosenblatt, B. (1962). The concept of the representational world. Psychoanalytic Study of the Child, 17, 128-45.

32. Fonagy, P., Moran, G.S., Edgcumbe, R., Kennedy, H., and Target, M. (1993). The roles of mental representations and mental processes in therapeutic action. Psychoanalytic Study of the Child, 48, 9-48.

33. Greenson, R.R. (1967). The technique and practice of psychoanalysis. International Universities Press, New York.

34. Hoffman, L. (1993). An introduction to child psychoanalysis. Journal of Clinical Psychoanalysis, 2, 5-26.

35. Chethik, M. (1989). Techniques of child therapy: psychodynamic strategies. Guilford Press, New York.

36. Feigelson, C.I. (1977). Essential characteristics of child analysis. Psychoanalytic Study of the Child, 32, 353-61.

37. Kernberg, P.F. (1991). Termination in child psychoanalysis: criteria from within the sessions. In Saying goodbye: a casebook of termination in child and adolescent analysis and therapy (ed. A.G. Schmulker), pp. 321-37. Analytic Press, Hillsdale, NJ.

38. Fonagy, P. and Target, M. (1996). Predictors of outcome in child psychoanalysis: a retrospective study of 763 cases at the Anna Freud Centre. Journal of the American Psychoanalytic Association, 44, 27-77.

39. Heinicke, C.M. (1965). Frequency of psychotherapeutic session as a factor affecting the child's developmental status. Psychoanalytic Study of the Child, 20, 42-98.

40. Heinicke, C.M. and Ramsey-Klee, D.M. (1986). Outcome of child psychotherapy as a function of frequency of sessions. Journal of the American Academy of Child Psychiatry, 25, 247-53.

41. Moran, G.S. and Fonagy, P. (1987). Psychoanalysis and diabetic control: a single case study. British Journal of Medical Psychology, 60, 357-72.

42. Moran, G., Fonagy, P., Kurtz, A., Bolton, A., and Brook, C. (1991). A controlled study of the psychoanalytic treatment of brittle diabetes. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 926-35.

43. Fonagy, P. and Moran, G.S. (1990). Studies on the efficacy of child psychoanalysis. Journal of Consulting and Clinical Psychology, 58, 684-95.

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