... Psychoanalysis in Childhood and Adolescence

Psychoanalysis in Childhood and Adolescence..

Psychoanalysis in Childhood and Adolescence Editors Kai von Klitzing, Basel Phyllis Tyson, La Jolla, Calif. Dieter Bürgin, Basel 3 figures, 2000

Kai von Klitzing, MD Department of Child and Adolescent Psychiatry University of Basel Basel (Switzerland) Phyllis Tyson, PhD La Jolla, Calif. (USA) Dieter Bürgin, MD Department of Child and Adolescent Psychiatry University of Basel Basel (Switzerland) Library of Congress Cataloging-in-Publication Data Psychoanalysis in childhood and adolescence / editors, Kai von Klitzing, Phyllis Tyson, Dieter Bürgin. p.; cm. Includes indexes. ISBN 3 8055 6993 9 (hard cover) 1. Child analysis. 2. Adolescent analysis. I. Klitzing, Kai von. II. Tyson, Phyllis, 1941 III. Bürgin, Dieter. [DNLM: 1. Psychoanalytic Therapy Adolescence. 2. Psychoanalytic Therapy Child. WS 350.5 P9735 2000] RJ504.2.P795 2000 618.92 8917 dc21 00 023280 Bibliographic Indices. This publication is listed in bibliographic services. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Ó Copyright 2000 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) www.karger.com Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISBN 3 8055 6993 9 IV

Contents VII Preface 1 Psychoanalysis and Development von Klitzing, K. (Basel) 12 Can Therapists Learn from Psychotherapy Research? Cramer, B. (Geneva) 23 Comments on the Chapter Can Therapists Learn from Psychotherapy Research? Simoni, H. (Basel) 25 The Forms of Play Kernberg, P.F. (White Plain, N.Y.) 42 Comments on the Chapter The Forms of Play Riedesser, P. (Hamburg) 45 Love and Hate, and Growing Up Female Tyson, P. (La Jolla, Calif.) 55 Comments on the Chapter Love and Hate, and Growing Up Female Pestalozzi, J. (Basel) 59 Psychic and Somatic Expressions of Preverbal Loss: Analysis of a Child Adopted at Thirteen Months of Age Blos, P. Jr. (Ann Arbor, Mich.) 71 Comments on the Chapter Psychic and Somatic Expressions of Preverbal Loss: Analysis of a Child Adopted at Thirteen Months of Age Steck, B. (Basel)

75 The Impact of Illness and Medical Intervention on a Child s Inner World: A Psychoanalytic Viewpoint Miller, J.M. (Denver, Colo.) 87 Inpatient Psychoanalytically Oriented Treatment of Traumatized Children and Adolescents Streeck-Fischer, A. (Rosdorf-Tiefenbrunn) 100 Comments on the Chapter Inpatient Psychoanalytically Oriented Treatment of Traumatized Children and Adolescents Meng, H. (Basel) 104 Wandering between the Worlds From the Analysis of a Late Adolescent Leuzinger-Bohleber, M. (Kassel) 126 Comments on the Chapter Wandering between the Worlds From the Analysis of a Late Adolescent Rost, B. (Basel) 129 Mentalisation and the Changing Aims of Child Psychoanalysis Fonagy, P.; Target, M. (London) 140 Comments on the Chapter Mentalisation and the Changing Aims of Child Psychoanalysis Walter, U. (Basel) 144 The Principles of Compensation and Pain as Organizing Factors of the Psychic Apparatus Bürgin, D. (Basel) 154 Subject Index Contents VI

Preface Ever since Anna Freud and Melanie Klein, psychoanalysis in childhood and adolescence has been a major field of clinical theory and practice. It has also undergone significant changes. On the one hand, the technique of child analysis has been expanded and adapted to a broader array of indications; on the other, it has had an important impact on other approaches including psychodynamic therapy, family therapy and group therapy. Furthermore, the growing body of experience and knowledge arising from psychoanalytical work with children and adolescents has had widespread influence on several clinical and scientific fields. In child and adolescent psychiatry, psychoanalytic methods offer a unique way of looking at the subjective world of the child, with profound consequences for the diagnostic and therapeutic process. In psychiatry, psychoanalytical experience with children and adolescents has drawn our attention to the framework of development as a background for all functional and dysfunctional psychological processes. In psychoanalysis, analytical work with children and adolescents has led to a broader view of the psychoanalytical process including nonverbal expressions like play and behavior. Children are usually well connected to the relational world in which they live. Furthermore, child and adolescent psychoanalysts are connected to many related scientific and clinical fields dealing with human development. It is a fascinating enterprise to connect the insight obtained through many long and intensive psychoanalytical encounters with our young patients, with the results of systematic developmental research and thus to broaden our knowledge of child and adolescent development from both clinical and theoretical perspectives. In January 1999, leading child analysts from the United Kingdom, USA, Germany and Switzerland met in Basel, Switzerland on the occasion of the 60th birthday of Dieter Bürgin. The participants represented a broad spectrum of psychoanalytical approaches, including clinicians in private practice, heads VII

of university departments of child and adolescent psychiatry, and academic researchers. This volume is an attempt to reflect this exchange of experience and ideas developed against the varied backgrounds of psychoanalytical work with children and adolescents in different countries. We are glad that Jill Miller agreed to include her paper that she had given to the Department of Child and Adolescent Psychiatry of the University of Basel on an earlier occasion. All the authors have elaborated their conference papers into the chapters presented here. We have also included the commentaries that were given to some of the papers, because they contain important additions to the material presented and open up additional perspectives. The core of the volume consists of chapters that deal mainly with clinical questions and theories by presenting extensive and detailed case studies. Paulina Kernberg designs a sophisticated outline of the forms of children s play and demonstrates its usefulness with a detailed example. Phyllis Tyson considers the issue of female development. Jill Miller shows us how important the psychoanalytical approach can be in work with children with chronic somatic illness. Three other chapters deal with the consequences of psychological trauma and with psychoanalytical work with traumatized children and adolescents: Peter Blos Jr. presents a detailed case report of the analysis of a girl who had experienced loss and separation in her preverbal development. Chapters by Marianne Leuzinger-Bohleber and Annette Streeck-Fischer deal with the analytical treatment of traumatized adolescents, the former in a classic outpatient setting, the latter in a child psychiatric inpatient unit. Chapters connecting the experience of child analytical therapies with the results of systematic scientific research and theory frame the clinically oriented chapters: Kai von Klitzing presents results from research into early development and describes the impact of these data on psychoanalytical practice. Bertrand Cramer s chapter deals with the results of psychotherapy research and what clinicians can learn from it. Dieter Bürgin gives us a theoretical concept of compensation and pain as principles that organize the psychological apparatus. Peter Fonagy and Mary Target describe their new thinking on the development of the reflective function and mentalisation, using these theories and research results to define new goals of psychoanalytical work with children and adolescents. The editors are grateful to Hoffmann-La Roche AG, Basel, Novartis AG, Basel, and to the Freiwillige Akademische Gesellschaft, Basel whose support made the conference and this book possible. Kai von Klitzing Phyllis Tyson Dieter Bürgin Preface VIII