The Psychoanalytic Study of Lives Over Time (Book Review)
Author: Cohen, Jonathan and Bertram Cohler
Publisher: Hillsdale, NJ: Academic Press, 2000
Reviewed By: Judith Ruzumna, Fall 2002, 31-32
It is such a pleasure to review a book that is excellent throughout and lives up to its promises. Jonathan Cohen and Bertram Cohler’s, The Psychoanalytic Study of Lives Over Time, provided that very opportunity. This wonderful contribution to our psychoanalytic literature combines fascinating clinical material, enlightening didactic discussion and well-designed empirical studies in one book.
The authors’ quest was to test the usefulness of the child analytic perspective by expanding the usual mode of study of developmental hypotheses, i.e., reconstructions from adult analyses and/or clinical case studies of children. Three clinical cases of child analytic work at different periods provide the focal point of the text. Comments and evaluations by the therapists themselves and others from different perspectives are then used to assess the validity of basic clinical and theoretical questions.
The first case presentation by Calarusso includes sessions of the analysis of the same boy at age nine years, nine months to age twelve and then again at intervals after age twenty-five. In selected clinical material Calarusso explains how his theoretical orientation, greatly influenced by Anna Freud, Mahler, Erikson and Offer, justifies his interventions and technique. He emphasizes the continuing thrust of development throughout adulthood and strives to show how this particular patient dealt with these issues. Although Calarusso agrees with Anna Freud about the limitations of child analytic work and the fact that it does not preclude the necessity for therapy later in life, he concludes, as do most of the contributors in this book, that early therapeutic work with children reduces psychic suffering and prepares the individual to better cope with later developmental tasks.
The ramifications of treating the same patient as a child and then again in adulthood is not specifically addressed. Anna Freud, Gitelson, Sklansky and others have discussed the differences in the transference relationship between adult and child or adolescent treatment. Especially in therapy with young adolescents the analyst can serve as a new idealized object for displacements and an auxiliary ego as well as the transference object embodying the neurotic conflicts. Seeing the same therapist allowed Calarusso’s patient to feel he could return and be welcomed back to pursue the therapeutic relationship. It might have been different in an adult analysis.
The second case study compares two therapists’ treatments of a seriously disturbed child living in a chaotic environment. Karen Marschke-Tobier was the first analyst in an oft-interrupted therapy of an eight-year-old girl. At age nineteen the patient was seen by Marianne Parsons until she was twenty-five. Parsons notes the importance of the external or environmental differences at the time of each therapy and skillfully provides a dynamic description of this narcissistically vulnerable youngster’s conflicts and dynamics. In addressing the importance of early treatment, she felt the experience allowed this girl to form a positive attachment to the analytic process and provided enough hope so she could use therapy as a means to seek relief from her suffering.
The final and most complete case presentation was by Arthur L. Rosenbaum of a boy at ages twelve to seventeen. He saw him again for a shorter time when the patient was in college then after four years, then five years, and then at intervals “keeping in touch” later. This certainly reinforces the adage that therapy never ends; only the interval between appointments does.
Using these three cases as stepping stone the rest of the book focuses on the nature of change in the analytic situation. Contributors such as Herzog, Pine and Silverman critique the case descriptions and consider how they might have handled certain clinical material and/or where their focus might have been.
As a reader I find criticism of treatment technique not particularly interesting. More useful was some presentation of their own case material and excellent restatements of developmental theory emphasizing different aspects of it. All basically agree that child therapy seems to help to remove obstacles and allow the child to restabilize and move again in a more or less normal developmental line. This is addressed more objectively later in the empirical studies in the book.
The pervasive influence of Anna Freud’s work is obvious in most of the articles though some authors use other terms and labels to describe their observations. One of the most interesting, even delightful, chapters is by Samuel Abrams labeled “The Jennifer Correspondence: A Rhetorical Dialogue.” Abrams describes an exchange of letters with a graduate student who questions the role, process, and efficacy of our work. He reviews the problems we all face relating to the contradictions inherent in differing interpretations, techniques and the entire lexicon of psychoanalysis. Acknowledging that different modes of therapeutic action raise more questions than answers, he invites “Jennifer” to enter the field stating, “… your revolutionary leanings, your gift for metaphor, your organizational competence, your capacity to engage confusion, your sensitivity to illusion offering of certainty, and the ease with which your feelings are mobilized to engage—all of the above are favorable traits for preaching this profession.” Abrams certainly provides an interesting and provocative list of attributes to consider in an individual’s suitability for our field.
Studies measuring changes after child therapy are presented by Target and Fonagy based on records at the Anna Freud Centre. The most striking results were the improvement in children with severe emotional disorders who had intensive treatment as compared to those who did not. Quoting Main (1995) the authors emphasize that psychotherapy helps a child develop an ability to relate in a consistent way regardless of the environmental climate. Shifting from Anna Freud’s view that childhood treatment does not mitigate against the reactions to later stress they believe that “…therapy might have a vital function in enhancing resilience in the face of later events…facilitating the capacity for mentalization, or reflection on mental states, and enhancing the security and autonomy of internal working models of attachment relationship.” Finally they emphasize the need for continuing systematic empirical research to provide reliable validation of the merit of psychoanalytic theory and technique.
Expanding on the question of usefulness of early therapy, Robert M.Galatzer-Levy attacks the exaggeration and misuse of statistical methods as a kind of Holy Grail in measuring therapeutic outcome. He feels the oversimplification of variables to be measured, e.g., number of therapy sessions, superficial behavior of symptom change, etc., are poor indicators of real intrapsychic change and do injustice to validating psychoanalytic theory. It simplifies but distorts results and he states, “[T]reatment must be regarded as appropriate for the problem and... outcome measures should accord with intended treatment goals.” Too often practical considerations facing researchers related to time and money have led to studies using descriptive outcomes indicators of success or failure. Galatzer-Levy provides a model of an exemplary study and reasserts the strong interaction between development and psychopathology. Most child or adolescent research does not address or test whether real intrapsychic change occurs nor does it test the dictum of a normal developmental thrust.
The remainder of the book contains valuable assessments of aspects of the three cases described earlier. Tuber presents an interesting evaluation of one of the cases using the Rorschach and TAT to assess predictability of outcome. Cramer uses the same case to look at changes in defense postures. Ritvo provides his own clinical material and comments on the three treatments.
In conclusion, the editors, Drs. Cohn & Cohler, provide a coherent reevaluation of the outcome of the three cases presented. They plead for a database of cases to be available for all to benefit and for a sharing of clinical material despite the issues of confidentiality, practicality and self-interest. All the contributors seem to agree we need tolerance in our judgments regarding the usefulness of early treatment. Normal development requires a recapitulation and reworking of early conflicts and its not surprising that these same issues reemerge later in life. Hopefully with early intervention, when necessary, these problems can be dealt with in a more adaptive manner.
Freud, A. (1958) Adolescence. Psychoanalytic Study of the Child,13:255-78
Gitelson, M. (1948) Character synthesis: The psychotherapeutic problem - adolescence. American Journal of Orthopsychiatry,18: 422-31
Slansky, M. (1971) Panel report: Indications and contra-indications in the analysis of adolescents. Journal of the American Psychoanalytic Association, 21:134-44.
Judith Ruzumna practices in Farmington Hills, MI and is on the clinical faculty of Wayne State University Medical School and the adjunct faculty at University of Detroit-Mercy University.
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