Psychoanalysis with Children: a Brief Journey

This blog explores different approaches to child psychoanalysis after Freud.

Drawing of a giraffe made by Little Hans's father who reports that Hans has asked to draw it with a widdler.

Drawing of a giraffe made by Little Hans’s father who reports that Hans has asked to draw it with a widdler.

Little Hans :

The famous case of Little Hans was the first clinical report of an analysis of a child. The treatment occurred through an exchange of letters between Freud and Hans’s father. Freud met with the child only once, and the father conducted the analysis under Freud’s supervision. Freud published the case in 1909, marking the beginning of child psychoanalysis.

Hans’s parents sought Freud’s help because Hans, at four years and nine months old, developed a phobia and subsequent anxiety after his sister’s birth, preventing him from leaving the house for fear of being bitten by a horse. Hans’s parents had been followers of Freud for several years. The mother had been Freud’s patient when she was single , and the father had attended Freud’s lectures. The child had genuine affection for his father , who developed a positive transference towards Freud, referring him as “the professor” and believing Freud could help cure him.

Freud had never treated children, but he had always emphasised the importance of early years, especially regarding sexuality and its role in adult neuroses. Hans’s case provided Freud with the first opportunity to confirm his recent conclusions about child development, the Oedipus complex, castration anxiety and the importance of erogenous zones.

Hans’s father observed and reported his sons’s behaviours and comments, while Freud interpreted their meanings for Hans. Freud adhered to the analytical technique of the time, interpreting  Hans’s Oedipal desires and castration anxiety through his play, dreams and fantasies.  Hans was diagnosed with anxiety hysteria, and the therapeutic results were excellent, likely  aided by the child’s charming and intelligent personality.

In his 1908 article “Creative Writers and  Daydreaming”, Freud stated that children’s play corresponds  to adult fantasies,  suggesting that play is a way to access the child’s unconscious. Freud later described play as a way to work through anxiety and traumatic experiences. He observed his grandson Ernest’s play with a cotton reel  (Fort/Da game) to cope with his mother’s absence, demonstrating that children don’t just play for pleasure but repeat certain games to process painful events.

Freud was pleased with the immediate results of Hans’s analysis, which alleviated his phobia, and hoped it would benefit him in the future. Fourteen years later, the patient visited Freud, identifying himself as Little Hans. He had grown into a healthy young man, free from inhibitions, with no memory of the analysis.

Herbert Graaf ( LIttle Hans)

Herbert Graaf ( LIttle Hans)

Freud’s initial scepticism about analysing children was changed by his experience with Hans, representing a significant advancement in psychoanalysis, and broadening its practice.

Development of Child Analysis and different approaches:

It took time for child analysis to fully develop. It wasn’t until the 1920’s that the practice expanded, with some psychoanalysts embracing this new modality.  This practice introduced several specific practices for working with children, including different aspects of transference, the duration of treatment, the role of the caregivers and the use of speech and play.

Some different approaches from psychoanalysts who contributed to this field:

Anna Freud                  

Anna Freud, Sigmund Freud’s daughter with a background with pedagogy, emphasised an educational approach in psychoanalytic treatment with children. She meticulously observed children’s behaviour, believing that observation could provide valuable insights into underlying psychological processes.

Unlike many contemporaries who focused primarily on the unconscious, she gave significant importance to conscious aspects of children’s behaviour, considering that observable behaviours could reflect internal conflicts and identify defence mechanisms.

Anna Freud highlighted the developmental stages and their influence on behaviour and psychological problems. She saw symptoms as expressions of psychic disturbances often related to internal conflicts or traumatic experiences. Recognising  the presence of transference in child psychoanalysis, she questioned its similarity to adult transference neurosis, highlighting the importance of positive transference and the crucial role of parents in children’s psychic lives. She actively involved parents in the therapeutic process, believing their changes were vital for the child’s progress. Anna Freud used dream interpretation, drawing and play as mechanisms for observation. Her methods were pedagogical in nature, focusing primarily on studying the ego and its function.

Melanie Klein :

Klein, object relations and child psychologyMy work with both children and adults, and my contributions to psycho- analytic theory as a whole, derive ultimately from the play technique evolved  with young children“. (Melanie Klein, 1955)

Melanie Klein is known for her pioneering work with children, differentiating herself from classical Freudian theories through her clinical practice and observations. She focused on analysing the child’s unconscious through play, using it to interpret the child’s psychic process. Klein introduced concepts like the paranoid schizoid and depressive positions, describing specific early stages in emotional development.  The paranoid schizoid position involves primitive defence mechanisms, such as splitting between good and bad objects, while the depressive position is characterised by the integration of these objects, leading to feelings of guilt and a desire for reparation.

For Klein, symptoms directly expressed the child’s unconscious conflicts related to fantasies, anxieties and primitive defences. Interpreting these symptoms through play and the child’s speech was essential for understanding and treating psychic problems. Unlike Anna Freud, Klein viewed the analysis as non educational and saw transference as a spontaneous phenomenon to be interpreted in both positive and negative forms. She avoided contact with parents during treatment, considering them secondary in the child’s psychic life once the psychic apparatus was constituted.


Donald Winnicott:

It’s in playing and only in playing that the individual child or adult is able to be creative and use the whole personality, and it is only in being creative that the individual discovers the self “. (Winnicott, 1971)

Donald Winnicott, known for his extensive clinical work with babies and children, was a paediatrician before becoming a psychoanalyst around 1935. Despite being influenced by Melanie Klein, Winnicott developed his own  theories.

He emphasised the environment and mother infant relationship as fundamental factors in development, introducing concepts like “holding” and “transition space”. “Holding” refers to the physical and emotional care a mother provides, crucial for developing a cohesive self. “Transitional Space” is the intermediate space where the child can explore and develop creativity, based on the trust and security provided by a good enough environment.  Winnicott viewed symptoms as manifestations of emotional sufferings due to failures in the care environment, believing that a supportive therapeutic environment could help the child develop healthily.  He valued parental involvement but focused more on the care environment and quality of the mother infant relationship.

Therapy could include guiding parents to improve “holding” and emotional support, emphasising the importance of the care environment and emotional relationships in the child’s physical health. For Winnicott the analyst’s role  was to create a safe, welcoming environment that fosters the patient’s creative capacity, especially through play, allowing the deep communication necessary for psychoanalytic analysis.

Jacques Lacan

Jacques Lacan introduced a new approach to child psychoanalysis, emphasising the importance of  language, the symbolic and the father’s role in the subject’s formation. Criticising earlier approaches for neglecting the symbolic dimension, he stressed that the unconscious is structured like a language. For Lacan, the paternal function is essential for the child’s identity and position regarding sexuality, introducing the law and phallic norm crucial for the subject’s constitution as a desiring being.

Although Lacan did not work directly with children, his theories profoundly influenced child psychoanalysis. His concepts were applied in clinical practice by various psychoanalysts like Francoise Dolto, Maud Mannoni, Jenny Aubry, Rosine Lefort and Robert Lefort.

These followers adopted Lacan’s view, criticising  the reduction of child psychoanalysis to mere games and drawings, arguing that the child should be seen as a subject, with no significant difference between the analysis of an adult and a child. Lacan saw the child’s symptom as either a product of the family symptom, or corresponding to the mother’s phantasy, as she aims to occupy the object of her phantasy.

Listening to parental discourse was essential in treatment, not for anamnesis but to unveil the child’s position in the parental fantasy, while the analyst managed the transference in its dual aspects: that of the parents and the child.

Françoise Dolto :

In France from 1939, Francoise Dolto introduced innovations in child psychoanalysis . Strongly influenced by early Lacanian teachings, she became known for her contributions and approaches centred on listening to the unconscious, attending to very young children and even babies. Dolto saw the child as part of the family’s desiring structure, formed by the desires of the father, mother and the subject itself, viewing the child’s symptom as a reflection of the family structure.

Dolto emphasised the other’s relationship for the baby’s humanisation, and highlighted maternal speech as organising the child’s world. She advocated telling the truth about the child’s history, even when it’s difficult.

Dolto also explored the link between parents and children’s neuroses, stressing the family’s role in preliminary interviews to understand family dynamics.

In clinical practice, she used techniques like speech, drawing and modelling, prioritising associative work. She introduced symbolic payment for children to mark the treatment’s register.

Dolto was active publicly, engaging in radio and television programmes and was involved in prevention and childcare activities, such as founding la Maison Verte, where she provided care for young children.

Her approach valued the child’s word in the analytical discourse and significantly promoted child psychoanalysis.

When Treatment is Sought early in Childhood

Exploring the different approaches of the child, the diversity of these analytical practices becomes evident. Each approach provides unique ways and perspectives with which to address a wide range of childhood issues, including developmental difficulties, traumas, relationship issues, school problems and common symptoms like hyperactivity, anxiety, phobias and compulsion. Children are often brought to analysis by parents or caregivers who identify the need for treatment. At the other times, children themselves express the desire to be supported.

Seeking early treatment can help symptoms from escalating into more serious emotional problems in the future.  Early analysis provides a safe space to explore internal conflicts, increasing the child’s ability to communicate their emotions effectively, deal in a different way with their feelings, better understand the other’s need and build more positive and fulfilling relationships.  Additionally, child psychological support also provides support to parents and caregivers. Often, they do not know how to act or help properly, and it can be important to offer them a space for feel heard and understood.

Child Psychoanalysis remains an essential field for supporting and promoting children’s mental health.

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