Psychoanalytic and psychoanalytically oriented treatment for children and adolescents is based on the same principles as adult treatment but is modified for the developmental level of the child. With young children, it is an intensive version of play therapy that seeks to address conflicts and developmental impediments to forward progression. With adolescents, the treatment approximates adult psychoanalysis, but the teen is not required to lie on the couch if he or she finds that awkward or uncomfortable.
While there is no couch requirement, child analysis is like adult analysis in that it seeks to address not just problematic behaviors but their underpinnings. The frequency of sessions (4-5 times per week with regular parent meetings in many cases) promotes a deepening of the therapeutic relationship and the child’s willingness to expose vulnerabilities, worries, and unwanted feelings. The depth and access in turn allows to treatment to work on the sources of the child’s suffering and to facilitate the achievement of optimal adaptation.
Psychoanalysis in these formative years is indicated for particular kinds of difficulties; not all childhood mental illness are helped by this method. It is sometimes used in conjunction with medication or behavioral interventions. Strong indications for psychoanalysis are not necessarily linked to diagnosis, but children in the autistic spectrum or who are psychotic are not generally suitable. Similarly, addictions require direct treatment of the addiction before considering a psychoanalysis. In general, psychoanalysis is best suited for children who are manifesting problems of sufficient duration and causing sufficient unhappiness that there is concern about deleterious impact on their lives. Because it is an arduous treatment that involves sustained effort by the family, there must be a shared conviction that the child’s forward development is at risk. Examples of these kinds of presentations are:
· Persistant irritability and/or sadness with diminished interest or pleasure in daily life
· Marked inhibitions that interfere with socialization and/or learning
· Recurrent “melt-downs” in children who otherwise are high functioning
· Excessive anxieties such as separation anxiety, some phobias, and chronic worrying
· Unhappiness with gender and gender role
· Highly conflictual relationships with parents and/or siblings despite adequate functioning elsewhere
· Fears of growing older and resistance to taking on the demands of the next developmental phase, including clinging to earlier patterns of behavior in a regressive manner
· Poor socialization with the peer group
· Unwillingness to accept criticism and/or excessive oversensitivity to injuries to self-esteem with reactions such as defeatism or resistance to learning
· Extreme perfectionism and/or rituals that interfere with social or school adaptation
· Persistent unresolved reactions to childhood trauma such as loss of a parent, divorce, or abuse.
These complaints that can be part of a range of “diagnoses” such as obsessive-compulsive disorder, attention-deficit disorder, anxiety disorder, gender identity disorder, and childhood depression. And while some children with these diagnoses can benefit from a behavioral therapy and/or medication, psychoanalysis is indicated when the child (and the family) is still struggling with the consequences of the illness on personality development and adaptation, when the child him- or herself wants the opportunity to explore the meaning of his or her symptoms, and when residual disturbance and on-going impact on development is observed by parents.
In order for the analyst to become a meaningful person in the child’s life, he or she has to become part of it and must have time to understand how the family works in depth. Children do not reveal their innermost thoughts and feelings readily and words are often not sufficient or not meaningfully used to express inner experience. The capacity to use words alone to explore the mind is a developmental achievement that usually is possible only in adolescence and young adulthood. The relationship to the analyst is a key factor in the treatment process gradually permitting the child to express innermost feelings and conflicts.
Yes, there is child psychodynamic psychotherapy and parent-infant psychotherapy. In these psychotherapies, the treatment is informed by the same principles but the frequency is reduced to 2-3 times per week. For some children and adolescents, psychotherapy, while not as deep a treatment, can be effective especially if the problem seems situational and/or not deeply entrenched.
Parent-infant psychotherapy is an intervention informed by psychoanalysis that addresses problematic mother-infant or father-mother-infant dynamics that are creating risk for the child’s development. Treatment is conducted with the dyad or triad to help parents understand their infants and facilitate their emotional attunement and sensitivity to the particular development needs expressed.