Anna Freud, Melanie Klein and the Psychoanalysis With Children and Adolescents (Book Review)

Author:  Holder, Alex
Publisher:  Karnac
Reviewed By:  Carol Lachman, PhD, Vol. XXVII, 1 (Winter 2007), pp. 62-64

The colorful picture on the cover of Alex Holder’s scholarly and practical perspective on the roots, controversies, and relevance of child psychoanalysis to the field of psychoanalysis as a whole, conveys the heart of this book. It was drawn by an eight and a half year old girl named Monica at the end of her five sessions a week analysis with the author. Monica titled the drawing “posh lady.” This child’s fantasy of what an elegant, grown up woman looks like is the embodiment, so to speak, of the tremendous growth and change that took place in her during her treatment. Monica began her analysis as an obsessional, difficult to manage, school phobic child. With pertinent clinical descriptions, the author shows how Monica’s initial constricted behavior in the play room, (partially out of fear of disapproval) gradually unfolded to an expression, in play and in the transference, of her anxieties and fears, along with accompanying aggression. Alex Holder describes this gradual (but sometimes sudden) deepening of the analysis, in showing how he tried to understand Monica’s play and verbalizations in the context of her psychosexual development and the dynamics of her anxieties. At the end of her analysis, as her drawing suggests, Monica emerged as a decidedly more confident girl, much more at ease with her feelings. This is a very interesting case to read, and the reader feels joy at the transformation that takes place with this child.

Preceding this clinical case, the author sets the stage for exploring the origins of child psychoanalysis, delving into what constitutes an analysis including technique. In carrying out this goal, Holder tries to understand and contrast the contributions of the two major pioneers in the field, Anna Freud and Melanie Klein. The author is a Child and Adult Analyst, and Training Analyst presently working in Germany, with forty years of clinical experience in both Great Britain and Germany. He is very conversant with the early writings on child treatment during the first two to three decades of the twentieth century. In considering the early work with children, Holder is careful to distinguish between what is actual child psychoanalysis, and other forms of helping a child that are more pedagogical in nature. Holder is firm in his conviction that it is the high frequency of sessions per week, over an extended period of time, which constitutes a child analysis. Only this lengthy process allows the child to safely loosen defenses to reveal less conscious conflicts and fantasies, while the analyst in his awareness of his countertransference reactions can keep in mind and try to piece together the often nonverbal expressions of the child’s concerns. The author states that even in the more short-term successful treatment of Little Hans, the child’s overcoming of the symptom was only possible because the authority of the father and the physician were united in a single person. It was the father, in his daily care and love of the child as well as his scientific interest in the child’s anxieties, who made the cure possible. However, it should be mentioned that at some point in the book, Holder indicates that there are a few other countries, such as France, where child analysis is carried out on a less frequent basis, as three times per week. The practical obstacles to finding cases where the parent is agreeable and the child can be brought five times a week are very difficult everywhere.

The author believes that both Anna Freud and Melanie Klein, who were influenced by the theories and work of Sigmund Freud, set the structure and theoretical underpinnings of child psychoanalysis. The two of them believed that training in adult psychoanalysis should come before the technically more difficult arena of child psychoanalysis, so that the analyst in training would have had his own analysis, and would be familiar with the psychoanalytic theories regarding psychosexual development, the working of the mind, and repression. Holder notes that it took about forty years from the time Anna Freud first recommended it before the International Psychoanalytic Association granted official recognition to training as a child analyst (2000). There were many in the psychoanalytic community, and perhaps still are, who believed that child psychoanalysis was not truly analysis. The need for, efficacy of, and relevance of child psychoanalysis to the field of psychoanalysis as a whole appears to be the underlying aim of this compact book.

As suggested above, frequency of sessions and aims of child psychoanalysis, (that is, to help the child work through the anxieties, fixations, and inhibitions that hindered development) were points of accord between Anna Freud and Melanie Klein. Holder also shows how Anna Freud was most likely influenced by Melanie Klein (for example, by eliminating the introductory phase of the analysis for a child, and realizing the value of play as a means for understanding the child). However they appear to diverge significantly in crucial ways. Melanie Klein, for example, thought that child psychoanalysis could be helpful for all children as an aid in the modulation of their anxieties, while Anna Freud felt that analysis is only appropriate when a child had developed an infantile neurosis. Interestingly, earlier in her work, Anna Freud felt that psychoanalytic principles could be incorporated prophylactically into child rearing, but later concluded this was overly optimistic.

In addition to Sigmund Freud, Melanie Klein was also very much influenced by the theories and work of Karl Abraham on the oral phase. As a result, Klein was interested in child and adult development from its earliest beginnings, that is, from infancy. She had direct infant observation with her three children, and shared perspectives and ideas with other analysts and, I believe, pediatricians who were conducting observations and theorizing on infant development. It is an informative experience to read Klein directly, as in her 1952 paper, “On the Behavior of Young Infants,” and “On the Psychoanalytic Play Technique: Its History and Significance” (1955). These papers are very trenchant, particularly the first mentioned, as one can see the development and value of her observations describing how aggression and libido co-mingle in the sucking phase and how infants vary in their sucking capacity. Klein also addressed what mothers do to assist the child in the development and elaboration of this earliest object relation. As a result of her interest and observations of the oral phase, Klein posited an early defense of the infant to split its good and bad experience of the mother. She also theorized that, as a consequence of the sadistic cannibalistic phase that occurs in the second half of the first year, rudiments of the superego were already established at this time of life. This view contrasts with the one held by Anna Freud that the superego comes into being in the third to fifth year of life with the resolution of the Oedipal complex.

One might consider that these two very different points of view with regard to the superego, are perhaps describing two different parts, or aspects of this concept, and within the superego there could be an earlier, nonverbal part. Holder does say that Klein sheds light on the “earliest object relations, and the origins of anxiety, guilt and conflict.” Holder also suggests that Klein may have seen more manifestations of an early superego in the children whom she treated, as they may have been “more psychically ill children “ where “an archaic super-ego” dominated.

The theoretical underpinnings for technique were also dissimilar between these two. Melanie Klein thought that children’s play was like free associations. Therefore, if a child opened a pocketbook in play, Klein might make an interpretation related to the child’s curiosity about the mother’s womb. Of course, one does not know what else Klein might have known about the child that prompted her to say this. Anna Freud did not believe that a child’s play could be considered the same as an adult’s free association. She felt that the analyst was required to build up an understanding of what the child is expressing over many play sessions, considering the child’s verbalizations as well, before making an interpretation.

They also differed significantly in how they regarded transference, and the role and need for working with parents. As Holder suggests, perhaps one does not have to be divisive about these two major perspectives, but instead consider ideas selectively, as to what applies most in understanding a child, and how to work with him or her.

The next two chapters in the book, though the smallest, pack in a good deal of important thought and information. In the chapter on adolescence, Holder strongly advocates adolescence as a distinct phase with its own developmental hurdles and risks. The author, as well as others, feels that the field of child psychoanalysis has neglected adolescence, so much so that in the 1990s the European Association for Adolescent Psychoanalysis was established to further understand some of the problems of adolescence and the technical issues that come up. It was interesting, for example, to read that in adolescence there is a waning of the grandiose self-representations, superseded by actual gratification in professional and sexual experiences. For an adolescent, psychoanalytic treatment may exert a regressive pull, so that the analyst needs to be more flexible with regard to frequency and length of treatment.

The last chapter in this book, “The Significance of Child Analysis for Adult Analysis,” is unique as the ideas do not seem to have been so clearly illustrated elsewhere. Holder (along with Kernberg and Peter Blos, Jr.), recommends that adult analysts have experiences analyzing a few children of various ages and pathologies. This could sensitize and deepen the adult analyst’s understanding of the dynamic unconscious, and preverbal world of their patients, with the accompanying pressures and conflicts. Holder provides a clinical example, cited by Peter Blos, Jr., that the latter was able to stay with an adult patient’s “strong but not yet understood need to move about the consulting room, an action often inhibited on the grounds of fantasized disapproval by the analyst.” Blos indicates that because he understood from his child analytic work with children walking around the room, he could help the adult patient get to unconscious fantasies regarding the meaning of “action, inhibition, and prohibition.”

Holder also recommends that adult analysts consider engaging in infant observation for at least a year, as he feels it could assist in empathizing with a preverbal world, not only with the baby, but also with the mother. It is interesting that this idea of Holder dovetails with the establishment of Infant and Child Observation programs at a few institutes in New York City. Though not mandatory for analytic training, they provide an opportunity for those interested to add to their knowledge of this important developmental phase. Holder ends by making the point that despite some of the strenuousness and technically difficult aspects of child psychoanalysis, the gratification lies in the awareness that “one is dealing with a human being who has almost all his life ahead of him, and who still is in the early stages of developing his potentialities.” For this, and other aforementioned reasons, this book is a rich resource, particularly for those involved in child clinical work, and for those thinking of doing so.

Blos, P., Jr. (2001). Child analysis, COCAP and the IPA. International Psychoanalysis, 10, 18-19.
Freud, A. (1954). The ego and the mechanisms of defense. London: Hogarth Press. (Original work published 1936)
Klein, M. (1957). Envy and gratitude and other works 1946-1963. London: Tavistock (reprinted New York: Basic Books, 1975, pp. 176-235).

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