Sofa Art: How Freud Selected Patients for Psychoanalysis. Developmental Psychology - Shapovalenko I.V.
Attempts to organize analytical work with children from the standpoint of traditional psychoanalysis have encountered real difficulties: children have no expressed
interest in studying one's past, there is no initiative to contact a psychoanalyst, and the level of verbal development is insufficient for
putting your experiences into words. At first, psychoanalysts mainly used observations and
messages from parents.
Later, psychoanalytic methods were developed aimed specifically at children. Freud's followers in the field of child psychoanalysis A. Freud and M.
Klein created their own, differing versions of child psychotherapy.
A. Freud (1895-1982) adhered to the traditional position for psychoanalysis about the child’s conflict with the social world full of contradictions. Her works
“Introduction to Child Psychoanalysis” (1927), “Norm and Pathology in Childhood” (1966), etc. laid the foundations of child psychoanalysis. She emphasized that for
To understand the causes of difficulties in behavior, a psychologist must strive to penetrate not only into the unconscious layers of the child’s psyche, but also to obtain
the most detailed knowledge about all three components of the personality (I, It, Super-Ego), about their relationships with the outside world, about the mechanisms of psychological
protection and their role in personality development.
A. Freud believed that in the psychoanalysis of children, firstly, it is possible and necessary to use analytical methods common to adults on speech material:
hypnosis, free associations, interpretation of dreams, symbols, parapraxia (slips of the tongue, forgetting), resistance analysis and transference. Secondly, she
She also pointed out the uniqueness of the technique for analyzing children. Difficulties in using the free association method, especially with young children, may be partly due to
overcome through the analysis of dreams, daydreams, daydreams, and drawings, which will reveal the tendencies of the unconscious in an open and accessible way
form. A. Freud proposed new technical methods to help in the study of the Self. One of them is the analysis of transformations undergone by affects
child. In her opinion, the discrepancy between what was expected (based on past experience) and what was demonstrated (instead of grief - a cheerful mood, instead of jealousy -
excessive tenderness) of the child's emotional reaction indicates that defense mechanisms are working, and thus the possibility arises
penetrate into the child's self. Rich material on the formation of defense mechanisms at specific phases of child development is provided by the analysis of phobias
animals, characteristics of school and family behavior of children. Thus, A. Freud attached great importance to children's play, believing that, being carried away
game, the child will become interested in the interpretations offered to him by the analyst regarding defense mechanisms and unconscious emotions,
hiding behind them.
A psychoanalyst, according to A. Freud, to be successful in child therapy must have authority with the child, since the child’s Super-Ego
relatively weak and unable to cope with the urges released as a result of psychotherapy without outside help. Of particular importance is
the nature of a child’s communication with an adult: “Whatever we start doing with a child, whether we teach him arithmetic or geography, whether we educate him
or subject to analysis, we must first of all establish a certain emotional relationship between ourselves and the child. The harder the work,
that lies ahead of us, the stronger this connection should be,” emphasized A. Freud. When organizing research and correctional work with
difficult children (aggressive, anxious), the main efforts should be aimed at the formation of attachment, the development of libido, and not on direct
overcoming negative reactions. The influence of adults, which gives the child, on the one hand, hope for love, and on the other hand, makes him fear
punishment allows him, over the course of several years, to develop his own ability to control his inner instinctual life. Moreover, part
achievements belong to the forces of the child’s self, and the rest belongs to the pressure of external forces; the relationship between influences cannot be determined.
When psychoanalyzing a child, A. Freud emphasizes, the external world has a much stronger influence on the mechanism of neurosis than in an adult. Children's
the psychoanalyst must necessarily work to transform the environment. The outside world and its educational influences are a powerful ally
the weak self of a child in the struggle against instinctive tendencies.
The English psychoanalyst M. Klein (1882-1960) developed her approach to organizing psychoanalysis at an early age. The main focus was
spontaneous play activity of the child. M. Klein, unlike A. Freud, insisted on the possibility of direct access to the contents of children's
unconscious. She believed that action is more characteristic of a child than speech, and free play is the equivalent of the flow of associations of an adult;
stages of the game are analogues of the associative production of an adult.
Psychoanalysis with children, according to Klein, was based primarily on spontaneous children's play, which was helped to manifest itself by specially created conditions.
The therapist provides the child with a lot of small toys, “a whole world in miniature,” and gives him the opportunity to act freely for an hour.
Most suitable for psychoanalytic gaming equipment are simple non-mechanical toys: wooden male and female figurines of different
sizes, animals, houses, fences, trees, various vehicles, cubes, balls and sets of balls, plasticine, paper, scissors, not sharp
knife, pencils, crayons, paints, glue and rope. The variety, quantity, and miniature sizes of toys allow the child to widely express his or her
imagination and use existing experience conflict situations. The simplicity of toys and human figurines makes them easy to incorporate into stories.
moves, fictitious or suggested by the child’s real experience.
The game room should also be equipped very simply, but provide maximum freedom of action. In it for play therapy necessary
a table, a few chairs, a small sofa, a few pillows, a washable floor, running water and a chest of drawers with drawers. Everyone's gaming materials
The child is kept separately, locked in a specific box. This condition is intended to convince the child that his toys and play with them will be known.
only to himself and the psychoanalyst.
Observing the child's various reactions, the "flow of child's play" (and especially manifestations of aggressiveness or compassion) becomes
the main method for studying the structure of a child’s experiences. The undisturbed flow of the game corresponds to the free flow of associations; interrupts and
inhibitions in games are equivalent to interruptions in free association. A break in the game is considered as a protective action on the part of the ego,
comparable to resistance in free associations. Various emotional states may appear in the game: feelings of frustration and
rejection, jealousy of family members and accompanying aggressiveness, feelings of love or hatred for the newborn, pleasure in playing with a friend,
opposition to parents, feelings of anxiety, guilt and the desire to correct the situation.
Prior knowledge of the child's developmental history and presenting symptoms and impairments assists the therapist in interpreting the meaning of children's play.
As a rule, the psychoanalyst tries to explain to the child the unconscious roots of his play, for which he has to show great ingenuity,
to help the child recognize which real family members the figures used in the game represent. At the same time, the psychoanalyst does not insist on
that the interpretation accurately reflects the experienced psychic reality, it is rather a metaphorical explanation or an interpretative proposal,
pulled out for testing.
The child begins to understand that there is something unknown ("unconscious") in his own head and that the analyst is also participating in his game. M. Klein
provides a detailed description of the details of psychoanalytic gaming techniques using specific examples.
Thus, at the request of her parents, M. Klein conducted psychotherapeutic treatment of a seven-year-old girl with normal intelligence, but with negative
attitude towards school and academic failure, with some neurotic disorders and poor contact with the mother. The girl didn't want to draw and
actively communicate in the therapist's office. However, when she was given a set of toys, she began to act out the relationship that had excited her with
classmate. It was they who became the subject of interpretation by the psychoanalyst. Having heard the therapist's interpretation of her game, the girl began to
trust him more. Gradually, during further treatment, her relationship with her mother and her school situation improved.
Sometimes the child refuses to accept the therapist's interpretation and may even stop playing and throw away toys after hearing that his aggression
directed at father or brother. Such reactions, in turn, also become the subject of interpretation by the psychoanalyst.
Changes in the nature of the child’s play can directly confirm the correctness of the proposed interpretation of the game. For example, a child finds in a box with
a dirty figurine with toys, which symbolized him in the previous game younger brother, and washes it in a basin from traces of its previous aggressive
intentions.
So, penetration into the depths of the unconscious, according to M. Klein, is possible using gaming techniques, through the analysis of anxiety and protective
mechanisms of the child. Regularly expressing interpretations of his behavior to the child patient helps him cope with emerging difficulties and
conflicts.
Some psychologists believe that the game itself is healing. So, A.V. Winnicott emphasizes the creative power of free play in comparison
with playing according to the rules (game).
Child psychoanalysts were the first to understand and describe the internal movements of the child’s soul, the features of the dyadic relationship between mother and child, and the formation of his self-esteem as a bearer of various roles, including gender.
They recognized not only and not so much as the driving forces of development of the psyche and the body biological factors how many object relations the child has with significant adults. Study of periodization mental development allows psychiatrists and psychotherapists to translate the language of symptoms of a neuropsychic disorder into the language of human experiences, that is, to understand what frustrations a person has endured throughout his life. We can say that the personality traits and character of an adult reflect the experiences of frustration that he suffered in the early stages of his life. Roughly speaking, we can say that many psychosomatic disorders are a consequence of psychological frustrations in the period from 0 to 3 years, and neurotic disorders are a consequence of frustrations from 3 years and older.
A. Freud (1895–1982) adhered to the traditional position for psychoanalysis about the child’s conflict with the social world full of contradictions. Her works “Introduction to Child Psychoanalysis” (1927), “Norm and Pathology in Childhood” (1966) and others laid the foundations of child psychoanalysis. She emphasized that in order to understand the causes of difficulties in behavior, a psychologist must strive to penetrate not only into the unconscious layers of the child’s psyche, but also to obtain the most detailed knowledge about all three components of the personality (I. It, Super-I). about their relationships with the outside world, about the mechanisms of psychological defense and their role in personality development.
A. Freud believed that in the psychoanalysis of children, firstly, it is possible and necessary to use analytical methods common to adults on speech material: hypnosis, free associations, interpretation of dreams, symbols, parapraxia (slip of the tongue, forgetting), analysis of resistance and transference. Secondly, she also pointed out the uniqueness of the technique for analyzing children. The difficulties of using the method of free association, especially in young children, can be partially overcome by analyzing dreams, daydreams, daydreams, games and drawings, which will reveal the tendencies of the unconscious in an open and accessible form. A. Freud proposed new technical methods to help in the study of the self. One of them is the analysis of the transformations undergone by the child’s affects. In her opinion, the discrepancy between the expected (based on past experience) and demonstrated (instead of grief - a cheerful mood, instead of jealousy - excessive tenderness) emotional reaction of the child indicates that defense mechanisms are working, and thus it becomes possible to penetrate into the child’s self. Rich material on the formation of defense mechanisms at specific phases of child development is presented by the analysis of animal phobias, characteristics of school and family behavior of children. Thus, A. Freud attached great importance to children's play, believing that, being carried away by the game, the child will become interested in the interpretations offered to him by the analyst regarding defense mechanisms and the unconscious emotions hiding behind them.
A psychoanalyst, according to A. Freud, to be successful in child therapy must have authority with the child, since the child’s Super-Ego is relatively weak and unable to cope with the impulses released as a result of psychotherapy without outside help. Of particular importance is the nature of the child’s communication with an adult: “Whatever we begin to do with a child, whether we teach him arithmetic or geography, whether we educate him or subject him to analysis, we must, first of all, establish a certain emotional relationship between ourselves and the child. The more difficult the work that lies ahead of us, the stronger this connection should be,” emphasized A. Freud. When organizing research and correctional work with difficult children (aggressive, anxious), the main efforts should be aimed at forming attachment and developing libido, and not at directly overcoming negative reactions. The influence of adults, which gives the child, on the one hand, hope for love, and on the other hand, makes him fear punishment, allows him to develop over the course of several years his own ability to control his inner instinctual life. At the same time, part of the achievements belongs to the forces of the child’s self, and the rest to the pressure of external forces: the ratio of influences cannot be determined. When psychoanalyzing a child, A. Freud emphasizes, the external world has a much stronger influence on the mechanism of neurosis than in an adult. The child psychoanalyst must necessarily work to transform the environment. The outside world and its educational influences are a powerful ally of the child’s weak self in the fight against instinctive tendencies.
The English psychoanalyst M. Klein (1882–1960) developed her approach to organizing psychoanalysis at an early age. The main attention was paid to the child's spontaneous play activity. M. Klein, unlike A. Freud, insisted on the possibility of direct access to the content of the child’s unconscious. She believed that action is more characteristic of a child than speech, and free play is the equivalent of the flow of associations of an adult; stages of the game are analogues of the associative production of an adult.
Psychoanalysis with children, according to Klein, was based primarily on spontaneous children's play, which was helped to manifest itself by specially created conditions. The therapist provides the child with a lot of small toys, “a whole world in miniature,” and gives him the opportunity to act freely for an hour.
The most suitable for psychoanalytic play techniques are simple non-mechanical toys: wooden male and female figures of different sizes, animals, houses, fences, trees, various vehicles, cubes, balls and sets of balls, plasticine, paper, scissors, a soft knife, pencils, crayons , paints, glue and rope. The variety, quantity, and miniature size of toys allow the child to widely express his fantasies and use his existing experience of conflict situations. The simplicity of toys and human figures ensures their easy inclusion in plots, fictional or prompted by the child’s real experience.
The game room should also be equipped very simply, but provide maximum freedom of action. Play therapy requires a table, a few chairs, a small sofa, a few pillows, a washable floor, running water, and a chest of drawers. Each child's play materials are kept separately, locked in a specific drawer. This condition is intended to convince the child that his toys and playing with them will be known only to himself and the psychoanalyst.
Observation of the child’s various reactions, the “flow of children’s play” (and especially manifestations of aggressiveness or compassion) becomes the main method of studying the structure of the child’s experiences.
The undisturbed flow of the game corresponds to the free flow of associations; interruptions and inhibitions in games are equivalent to interruptions in free association. A break in play is seen as a defensive action on the part of the ego, comparable to resistance in free association. The game can manifest a variety of emotional states: feelings of frustration and rejection, jealousy of family members and accompanying aggressiveness, feelings of love or hatred for a newborn, the pleasure of playing with a friend, confrontation with parents, feelings of anxiety, guilt and the desire to improve the situation.
Prior knowledge of the child's developmental history and presenting symptoms and impairments assists the therapist in interpreting the meaning of children's play. As a rule, the psychoanalyst tries to explain to the child the unconscious roots of his play, for which he has to use great ingenuity to help the child realize which of the real members of his family are represented by the figures used in the game. At the same time, the psychoanalyst does not insist that the interpretation accurately reflects the experienced psychic reality; it is rather a metaphorical explanation or an interpretative proposal put forward for testing.
The child begins to understand that there is something unknown ("unconscious") in his own head and that the analyst is also participating in his game. M. Klein provides a detailed description of the details of psychoanalytic gaming techniques using specific examples.
Thus, at the request of her parents, M. Klein conducted psychotherapeutic treatment of a seven-year-old girl with normal intelligence, but with a negative attitude towards school and academic failure, with some neurotic disorders and poor contact with her mother. The girl did not want to draw or actively communicate in the therapist’s office. However, when she was given a set of toys, she began to act out the relationship that had excited her with her classmate. It was they who became the subject of interpretation by the psychoanalyst. Having heard the therapist's interpretation of her game, the girl began to trust him more. Gradually, during further treatment, her relationship with her mother and her school situation improved.
Sometimes the child refuses to accept the therapist's interpretation and may even stop playing and throw away toys when told that his aggression is directed at his father or brother. Such reactions, in turn, also become the subject of interpretation by the psychoanalyst.
Changes in the nature of the child’s play can directly confirm the correctness of the proposed interpretation of the game. For example, a child finds a dirty figurine in a toy box, which symbolized his younger brother in a previous game, and washes it of traces of his previous aggressive intentions.
So, penetration into the depths of the unconscious, according to M. Klein, is possible using gaming techniques, through the analysis of the child’s anxiety and defense mechanisms. Regularly expressing interpretations of his behavior to the child patient helps him cope with emerging difficulties and conflicts.
Correction for children differs from correction for adults in that adults, as a rule, seek help themselves, while children are usually brought by teachers or parents. Therefore, children often lack any motivation to communicate with a psychologist and not all of them can immediately establish close contact. A psychologist requires great resourcefulness and ingenuity to “talk” a child.
In these cases, play is especially useful for attracting the child to cooperate. To do this, the psychologist should always have on hand bright, attractive toys, various puzzles, colored pencils and paper, and other entertaining things that can interest children and provoke them to communicate.
An important condition for establishing and maintaining contact is the form of contact with the child. Only calling by name is acceptable. It must be remembered that not all turns of adult speech can be understood by a child, therefore, during the consultation, you need to take into account the age, gender, and living conditions of the children. In addition, in order to understand the child himself, the psychologist must be familiar with the children's dictionary, must know and, if necessary, be able to use widespread teenage and youth slang in communication with schoolchildren.
The data obtained in the conversation, the degree of its completeness and reliability depend on the extent to which the person being interviewed is capable of self-observation. It is known that children's capabilities in this regard are limited. The ability to consciously observe one's own emotional reactions and verbalize them appears in most children only in adolescence. In principle, children are able to describe their thoughts and feelings, but have limited ability to do so.
That is why in a conversation with children the role of correctly asked questions is especially important. A correctly formulated and posed question not only allows the psychologist to obtain the necessary information, but also performs a unique developmental function: it helps the child to understand his own experiences and expands the possibility of verbalizing subjective states.
When conducting a conversation with children, it is very important for a psychologist to take the right position. The optimal position may be one that corresponds to the principles of non-derivative psychotherapy:
1) the psychologist must create a warm, humane, understanding attitude towards the child, allowing contact to be established as early as possible;
2) he must accept the child as he is;
3) with his attitude, he must make the child feel an atmosphere of condescension, so that the child can freely express his feelings;
4) the psychologist must tactfully and carefully treat the child’s positions: he does not condemn anything and does not justify anything, but at the same time he understands everything.
The implementation of such an attitude, based on creating an atmosphere of unconditional acceptance, sincerity and openness, helps the child to show his capabilities, open up and therefore has a significant psychotherapeutic effect.
The stories of children and adolescents can be deeply personal and intimate. Therefore, in a conversation with them, just like in any other psychological research, confidentiality conditions must be observed. If there is an urgent need to report something the child has told his parents or his teacher, it is imperative to obtain the child’s consent.
A. Freud supplemented psychoanalytic teaching the concept of the integrity of the mental system (“I” as its center). In the doctrine of the mental structures of personality, she traces the formation of the child’s “It,” “I,” and “Super-Ego,” and studies the relationship between their influence on the psyche. The main merit of A. Freud in this area is the identification of the so-called genetic lines of development.
· Developing and filling with specific psychological content the main provisions of classical psychoanalysis, A. Freud described in detail the patterns of changing phases of normal child development.
· She also reviewed a wide range mental disorders- from “ordinary” difficulties of upbringing (fears, whims, sleep and appetite disorders) to severe autistic disorders - and proposed practical methods for their treatment.
· She highlighted several lines individual development : from infantile dependence in childhood to love in adulthood, from selfishness to friendship, from breastfeeding to a balanced diet, etc. In her opinion, identifying the achieved level of development along each line, as well as taking into account the harmony between them, makes it possible to make a diagnosis and give recommendations for solving practical issues: what age is most favorable for entering kindergarten and school, what is the optimal time for the birth of a second child in the family, etc.
· Anna Freud believed that a psychoanalyst working with children should set himself three additional tasks simultaneously:
1. Convince a neurotic child that he is sick.
2. Win his trust again and again.
3. Convince the child to undergo treatment.
· An adult comes to a psychoanalyst because he is driven by suffering. He pays for treatment, and this payment forces him to delve deeper into his problems. Finally, an adult goes to the psychoanalyst he trusts. The child is not yet able to compare himself with others, does not realize the severity of his mental state, and it is unusual for him to reveal himself to others. stranger. Therefore, Anna Freud did not consider it a waste of time to play with a child, embroider, knit, in order to become “necessary” in his eyes.
· Originally Anna Freud used play as a way to establish contact with a child. But while working with children who survived the bombing of London during World War II, she made a surprising discovery. A child who had the opportunity to express his experiences in play was freed from fears and did not develop neurosis. Anna Freud described in detail the differences in reactions to the bombing of London between adults and children in her book Children and War (1944). The adults tried to tell the psychotherapist about their feelings again and again, but the children remained silent. Their reaction to the fear they experienced was expressed through play: the child built houses from blocks, dropped imaginary bombs-cubes on houses, the house burned, sirens howled, ambulances arrived and took the dead and wounded to the hospital. Such games could last for several weeks...
· Already at the stage of gaining trust, you can learn a lot about the child by analyzing his fantasies, drawings and dreams, which the little patient talks about at his own request. The only difficulty that not every psychoanalyst can cope with is the child's inability to freely associate, because all psychoanalysis is built on the method of associations. When trust has been gained, Anna Freud recommends discussing with the little patient those actions that cause him constant anxiety. The purpose of such conversations is for the child to realize that many of his bad actions do not bring him any benefit, but only harm. The child must know that everything he tells the psychoanalyst will remain a secret. The child’s adult environment must come to terms with the fact that the psychoanalyst will occupy a significant place in the child’s inner world for some time. The child and the psychoanalyst enter into a kind of alliance against problems.
· When an adult comes to a psychoanalyst, treatment begins with an analysis of the past. But the child either has no past, or it is small! There is no point in accessing the baby's memory. What to do? Firstly, Maintain constant contact with the baby's family. Secondly, record all the childhood memories of the little patient. Third, devote Special attention dream analysis. Surprisingly, children understand the rules of dream interpretation no worse than adults. As Anna Freud herself writes, the child “is amused by this exploration of individual elements of a dream, similar to playing with blocks, and is very proud when he succeeds in something...” Many children can not only fantasize, but also tell stories with continuations. “From such stories with continuation, the doctor understands better internal state child,” says Anna. Drawing is the richest field for interpretation by a psychoanalyst. The drawing symbolically reflects the baby’s anxieties, feelings towards others, desires, dreams and ideals.
General view of the problem
The process of transition from all kinds of deviations that are within normal limits to real pathology occurs smoothly and depends, rather, on changes in quantitative ratios than on qualitative differences. In accordance with our psychoanalytic concepts, a person’s mental balance is based, on the one hand, on the relationships of his internal authorities, and on the other, on the relationship of his personality as a whole to the outside world, i.e., on connections subject to constant fluctuations. Instinctive energy spontaneously increases or decreases depending on what phase of development the individual goes through. So, for example, during the latent period it weakens, during puberty it increases, and during menopause it also increases. If pressure is exerted on the “I” and “Super-Ego” agencies, the strength of the “Ego” and the influence of the “Super-Ego” are reduced, just as it happens in a state of fatigue, in physical illness and in old age. If, due to the loss of an object or other deprivations, the possibilities of satisfying desires are reduced, their distribution increases. In this regard, 3. Freud argued that “we are not able to draw a sharp boundary between “neurotics” and “normal” children and adults; “illness” is a purely practical summary concept, and it is necessary that predisposition and experience converge and achieve such summation, which will be sufficient to overcome a certain threshold. Thus, all the time, many individuals move from the class of healthy to the class of neurotic patients, although a much smaller number of them make this path in the opposite direction ... "(1909).
Since these provisions are valid for a person of any age, “for children as well as for adults,” then the boundary between healthy and sick, normal and abnormal in the first case is no easier and no more difficult to draw than in the second. The picture of the essence of childish nature described above shows that the relationship of forces between the “It” and the “I” is in constant flux, that adaptation and protection, beneficial and painful influences penetrate each other, that each advancement from one stage of development to another brings with it the danger of stops, delays, fixations and regressions, that instinct and the “I” develop at different rates and therefore can introduce disorder into movement along individual lines of development, that temporary regressions can turn into long-term states, and finally, that it is hardly possible to estimate the number of negatively influencing factors, that undermine or disrupt mental balance.
Currently available classification systems can do little to help the diagnostician, who is obliged to understand these phenomena, and therefore he is in a very difficult position.
Currently, child analysis is moving in a variety of directions. Having created, despite numerous difficulties and obstacles, its own instructions, the technique of child analysis has largely freed itself from the basic rules of adult analysis. Theoretical discoveries have been made that represent new contributions to analytical knowledge because they go beyond simple confirmation of materials reconstructed in adults. Only when it comes to classifying phenomena does the child analyst continue to use diagnoses that are accepted in adult analysis, psychiatry and criminology, thus taking a conservative position and adopting long-established forms for his work, which are clearly not enough to make a correct diagnosis, prognosis and choice of treatment method, since they are poorly suited to the conditions of modern childhood psychopathology.
Differences between descriptive and metapsychological ways of thinking
The descriptive way of thinking when classifying both childhood and adult disorders contradicts the metapsychological way of thinking, since the first is based on the similarities and differences of the manifested symptoms, and the second on the comparison of the hidden causes behind them. Only at first glance does the classification of disease states in the description seem satisfactory. In fact, in this case we are not talking at all about deepening ideas and not about finding significant differences between individual states, which are so necessary for us. Therefore, an analyst who is content with this type of diagnostic thinking will inevitably introduce confusion into his own therapeutic and clinical views, built on other principles, and will find himself in error.
Let's prove this with examples: fits of rage, passion for travel, fear of separation, etc. are diagnostic terms that unite under one name a variety of disease states (clinical pictures), which, in terms of their behavior and symptoms, are similar or even identical, but require completely different therapeutic effects, since they belong to completely different analytical categories in their metapsychological structure.
So the phenomenon called a fit of rage in children has three completely different meanings. For example, for the smallest children they usually mean nothing more than an age-appropriate motor-affective process of removing instinctive excitations for which there is no other way out yet. This symptom disappears on its own without treatment as soon as the child’s “I” matures so much that other possibilities for substitution open up for instinctive processes (especially in speech). But the same symptoms may also mean that manifestations of hatred and aggression against the objective world cannot manifest themselves in their entirety and therefore are directed back to the child’s own body and objects available to him (self-harm, hitting his head against the wall, breaking furniture, etc.) . P.). In this case, the transferred affect must become conscious, connections with its causal purpose must again be formed. A third way to interpret such symptoms is that the supposed rage is actually an attack of fear. If something prevents phobic children from carrying out their protective actions or avoidance (suppression of agoraphobia when a phobia appears from going to school), they react to this with violent outbursts of fear, which an unqualified observer may not distinguish from ordinary attacks of rage and rage, perceiving them as a manifestation of aggression . However, unlike the latter, such conditions can be eliminated only by two types of measures - by restoring phobic defense, i.e. avoiding fear-causing circumstances, or by analytically identifying the causes of fear, their interpretation and resolution.
About the same can be said about the so-called wandering of children (vagrancy, running away from home, school “truancy,” etc.). We find the same symptom under different circumstances and under different interpretations. Some children run away from home if they are abused in the family or if their libidinal attachment to the family is unusually weak; some skip school (wander the streets instead) if they are afraid of teachers or classmates, do not study well, or want to avoid reprimand and punishment. In both of these cases, the cause of the symptom is external and can be eliminated by changing the external conditions of life. In other children the cause of the same symptom is found in the inner life. They are influenced by unconscious urges and usually try to find a love object in the past. From a descriptive point of view, it is true that they “run away,” but metapsychologically their wandering is purposeful, even if the goal set for them by “It” is nothing more than the embodiment of desires. In such cases, therapy requires internal change through analytical interpretation and translation of an unconscious desire into a conscious one, and any external intervention will not be successful.
Although similar objections can be made to the very common diagnosis of separation anxiety, there is little to argue against its current use in many children's clinics, where a variety of conditions are also labeled without qualification. Although from a metapsychological point of view, there is no similarity between the fear of separation in young children and the latent school fear of children or the nostalgia of children separated from their families and children living in a boarding school. In the first case, we are talking about a violation of a biologically justified need (unity with the mother), to which the child responds with fear and despair; in this case, nothing can help better than a reunion with the mother or, at a minimum, the introduction of a person replacing her. In the second case, the cause of fear lies in the child’s emotional ambivalence. In the presence of parents, love and hatred balance each other; in their absence, the fear increases that the hostile forces of the death wish for the parents can actually harm them, and the child seeks to save them from himself, clings to the parents. In this case, the symptom can only recede before an analytical understanding of the emotional conflict, and reunification with parents or unhindered stay with them will only be a superficial calm.
For analytical thinking and therapeutic action, a description of the manifested symptomatology in this and similar cases is clearly not enough.
Differences in diagnostic terminology in cases with children and adults
On the one hand, the diagnostic designations we use, relating to various mental disorders in adult life, have nothing to do with the numerous types and varieties of developmental disorders, and on the other hand, with the difference between genetically determined symptoms and those caused by conflict. However, in the field of child psychopathology, such direct differences play a primary role. Thus, regardless of the stage of development at which they appear, it is impossible to consider such phenomena as lying or cheating, aggression or the desire for destruction, perverted activities, etc. as completely normal or abnormal.
Lie
The question may be how to determine the moment after which it can be said with confidence that the child is “lying,” that is, the falsification of the truth takes on the character of a symptom and contradicts what others expect from the child. Of course, the need for truth, as we understand it, appears only after he has passed through a number of preliminary stages of development and is not present in a child from his very birth. There is nothing unnatural about Small child gives preference to what causes pleasant sensations, neglecting everything unpleasant and refusing to perceive stimuli imposed on him that cause a feeling of discomfort and fear. This means that in this case he behaves exactly the same as older children or adults when deceiving. But the child analyst (or diagnostician) needs to understand the difference between the primitive attitude towards truth at an early age, due to the dominance of the pleasure principle and the primary process over the child, and later symptoms of lying. The analyst has the right to use the term “lie” only when the reality principle and rational thinking reach a certain maturity, and the child, despite this, continues to falsify the truth.
In some children, the process of maturation of these functions of the “I” is slowed down, and therefore, even at an older age, they continue to lie. For others, the “I” develops according to their age, but due to some failures and disappointments they retreat to the previous primitive stages of development. This refers to dreaming liars who try to protect themselves from real troubles using infantile methods of wish fulfillment. At the opposite end of the series are children whose “I” functions are normal in themselves, but there are reasons for evading the truth that are different from those determined genetically. In this case, the motives may be fear of adults, of reproach and punishment, as well as greed, delusions of grandeur, etc. It is quite obvious that it is these last examples of “dissocial” lies that it makes sense to limit the use of the term “lie.”
In children's analytical practice, this phenomenon most often occurs not in its pure form, but in a mixed form, consisting of renunciations, fantasy lies and dissocial lies. Thus, the diagnostician has the opportunity to distinguish between individual constituent elements and identify the contributions to symptom formation that correspond to both maturational and developmental processes and experiences.
Theft
As with lying, certain genetic stages of development must be passed through before the term can acquire diagnostic meaning.
The desire of children to appropriate for themselves everything to which their desire is directed is usually attributed to the “oral greed” of this period. But upon closer examination, this behavior can be explained in two ways: it also corresponds to the pleasure principle, as a result of which the child, without thinking, appropriates for himself everything that gives pleasure, and also automatically exposes to the outside world everything that causes trouble. It also corresponds to the age-specific inability to distinguish between self and object. As we know, an infant or small child treats his mother’s body as if it were his own, plays with her fingers and hair in no other way than in autoeroticism, or provides her with parts of his own body to play with. The fact that young children can alternate between bringing a spoon to their own mouth and to their mother's mouth is often misinterpreted as spontaneous early generosity, when in fact it is a consequence of the lack of self-boundaries and nothing else. It is this confusion between the “I” and the objective world, which leads to a readiness to give, that turns every baby into a thunderstorm for someone else’s property, despite all his innocence.
At first, the child’s understanding lacks the concept of “mine” and “yours,” which in later life is the basis of honesty. It develops very slowly and gradually, with a gradual increase in the independence of the “I”. First of all, the child begins to belong to his own body (“I” - the body), then to the parents, then to the transitional objects, still filled with a mixture of narcissistic and object libido. Along with the sense of ownership, a tendency arises in the child to protect his property with all his might from any outside influence. Children understand what it means to “lose” their own much earlier than they acquire the ability to reckon with someone else’s property. For him to realize this, it is necessary to understand that the people around him take care of their property no less than he takes care of his. And such an understanding can arise only under the condition of further expansion and deepening of relations with the outside world.
But, on the other hand, the development of the concepts “mine” and “yours” is not enough to have a decisive influence on the child’s behavior; This is countered by powerful desires for the appropriation of property. He is inclined to steal by: oral greed, analgenic tendencies to have, hold, collect and accumulate, the need for phallic symbols. The foundations of honesty are laid with the help of educational influences and the subsequent demands of the “Super-I”, which are in constant and difficult opposition to the “I”.
Whether or not it is possible to label a child with the word “thief” diagnostically and from a social point of view, indicating that he is “cheating”, ultimately depends on many conditions. Such an individual action can be provoked by a delay in the child’s “I” on the path to achieving its independence, insufficiently formed object relations between the external world and the “I,” or an overly infantile “Super-Ego.” Because of such reasons, undeveloped and mentally retarded children cheat. If development proceeds normally, then such actions may be due to temporary regressions. In such cases, the scam is a temporary phenomenon and disappears with further development. Long-term regressions in each of these relationships lead to cheating as a compromise formation in the form of a neurotic symptom. If a child cheats because his “I” is not able to dominate the normal, age-appropriate desires of appropriation, then such actions indicate insufficient adaptation to the moral demands of the outside world and are a “dissocial” symptom.
In practice, as in the case of lies, etiological mixed formations are more common than the pure forms described above; Usually we are dealing with the combined consequences of developmental delays, regressions and defects of the “I” and “Super-Ego” combined. In the end, all cheating returns to the causal unity of “mine” and “yours,” self and object, as evidenced by the fact that all dissocial children steal from their mother first.
Criteria for assessing disease severity
There is no doubt about whether mental disorders occurring in childhood should be taken lightly or seriously. In adult life, in such cases, we proceed primarily from three criteria: 1) the picture of the symptom; 2) the forces of subjective suffering; 3) the degree of impairment of vital functions. Neither of these points of view can be acceptable in a child's life for obvious reasons.
1. As we already know, symptoms in the developmental years do not mean the same thing as later, when we “guide ourselves when making a diagnosis” (3. Freud, 1916-1917). Not always (as happens later) childhood delays, symptoms and fears are the result of pathological influences. Often these are simply accompanying phenomena of normal developmental processes. Regardless of the number of excessive demands that a certain phase of development places on the child, symptom-like phenomena can still occur, which, in a reasonable environment, disappear as soon as adaptation to the new stage occurs or its peak is passed. No matter how much we study these phenomena, even such momentary disturbances are not easy to understand: they correspond to warnings about the vulnerability of the child. Often they disappear only externally, that is, they can appear again in the form of new disorders at the next stage of development, leaving behind scars that can serve as starting points for later symptomatic formation. But it still remains true that in childhood, sometimes even apparently serious symptoms can disappear. Often, as soon as parents come to the clinic, phobic avoidance, obsessive neurotic caution, sleep and eating disorders are rejected by the child simply because the diagnostic tests cause more fear in them than the underlying fantasies. This is why symptomatology changes or disappears soon after the start or during treatment. But ultimately, symptomatic improvement means even less to a child than to an adult.
2. The situation is approximately the same with subjective suffering. Adults make decisions about treatment if mental suffering from an illness becomes unbearable. This cannot be said about children, since the factor of suffering in them in itself says little about the severity of a mental disorder or the presence of it. Children suffer less from their symptoms than adults, with the exception of states of fear, which are difficult for the child to bear. So, for example, phobic and obsessive neurotic measures that serve to evade fear and displeasure are quite desirable for a child, and the corresponding restrictions on normal life interfere more with the adult environment than with the patient himself. Malnutrition and refusal to eat, sleep disturbances, fits of rabies, etc. are justified from the child’s point of view and only in the eyes of the mother are undesirable phenomena. The child suffers from them only as long as the world around him prevents him from expressing them in their entirety, and therefore sees the source of suffering in the intervention of adults, and not in the symptom itself. Even such shameful symptoms as bedwetting are sometimes considered unimportant by the child himself. Neurotic delays often lead to the withdrawal of all libido from fear-producing activities and thereby to a limitation of the interests of the “I”, which hides the loss of activity and the desire for gain. Children with obvious disabilities - autistic, psychotic or mentally retarded - cause great suffering to their parents, since they practically do not feel their impaired state.
Other grounds also do not make it possible to determine the severity of a mental disorder. Children suffer much less from their psychopathology than from genetically determined circumstances, such as refusals, demands and difficulties of adaptation, which are caused by dependence on the objective world and the immaturity of their mental apparatus. The sources of fear and trouble in early childhood are the inability to satisfy one’s own bodily needs and instinctive desires, reluctance to be separated, inevitable disappointments in unrealistic expectations; in the next (oedipal) phase it is jealousy, rivalry and fear of castration. Even the most normal children cannot be “happy” for a long time, and therefore they often have tears, anger and rage. The better a child develops, the more affectively he responds to manifestations Everyday life. We also cannot expect that children, like adults, will naturally master their emotions, succumb to their influence, become aware of them and come to terms with their circumstances. On the contrary, when we observe such compliance, we begin to suspect that something is wrong with the child, and assume either organic damage, or a delay in the development of the “I,” or excessive passivity in instinctive life. Young children who part with their parents without protest, most likely due to internal or external reasons, are not sufficiently connected to them libidinally. Children for whom the loss of love is not a hindrance may be in a state of autistic development. If there is no feeling of shame, then the “Super-I” does not develop: the forced price that each individual must pay for the highest development of his own personality is painful internal conflicts.
We must admit that the feeling of subjective suffering, no matter how paradoxical it may sound, is present in every normal child, and in itself is not the basis for pathological development.
3. The third factor that is decisive for adults in the violation of achievements in children's practice is also deceptive. It was already noted above that achievements in childhood are not constant, but change due to temporary regressions from stage to stage, from genetic direction to genetic direction, day by day, from hour to hour. There are no firm criteria for assessing when fluctuations between progress and regression can be considered phenomena of normal life. Even when the deterioration in function lasts for a very long time and the external environment begins to worry, characterizing the child on this basis as “delayed” or “lagging behind” is diagnostically risky.
We also do not know which of the children's achievements has the right to be called “vitally important.” Despite the fact that games, study, free fantasy activity, the warmth of objective relationships, and the ability to adapt are very important for a child, they cannot even be compared in importance with such fundamental concepts as “the ability to love” and “work capacity.” Returning to my earlier hypothesis (1945), I will repeat the statement that only the ability to develop normally, to go through planned stages, to form all aspects of the personality and to fulfill accordingly the demands of the external world deserves the definition of “vital” for a child’s life. As long as these processes proceed relatively undisturbed, we need not worry about the symptoms that arise. The need for treatment arises in a child only when this development begins to slow down.
Developmental processes as diagnostic criteria
At the present stage, to understand childhood disorders, diagnostic categories based on points of view other than genetic and psychological ones are clearly not enough. Only when the diagnostician is freed from them will he be able to abstract himself from symptomatology and begin to study what genetic stages his patient has reached in relation to the “Id”, “I” and “Super-Ego”, how far the structuring of his personality has advanced, i.e. the process separation of these internal authorities from each other; whether mental phenomena are still under the dominant influence of the primary process or are already in the stage of the secondary process and the principle of reality; whether the child’s development generally corresponds to his age, “matures earlier” or “lags behind”, and if so, in what respect; how much the pathology has affected or threatens to affect developmental processes; whether regression is present in the development process, and if so, when, to what extent and to what points of fixation.
Only such an examination makes it possible to assess the influence of important factors on childhood psychopathology, to link together normal developmental processes, deviations from them and mental health disorders.
Discrepancies in the development of “It” and “I”
We have a right to expect that pathological consequences are felt when different parts of the personality develop with at different speeds. The most famous clinical example of this kind is the etiology of obsessive neurosis, where the “I” and “Super-Ego” in their formation are ahead of progress in instinctive life. For this reason, high moral and aesthetic qualities coincide with relatively primitive instinctual impulses and fantasies. This causes conflicts that prompt the “I” to obsessive and also conflictual actions. According to 3. Freud: “I don’t know how risky it will look if... I suggest that a temporary advance in the development of the “I” in relation to the development of libido should cause a predisposition to obsessive neurosis” (1913). A later regression can also lead to this result, as will be shown below.
No less often, and perhaps even more often, the opposite process occurs today - a slowdown in the development of the “I” instance with normal or premature instinctive development. Object relations, as well as the functions of the “super-ego,” are too underdeveloped in such “autistic” and borderline children to be able to keep primary and aggressive impulses under control. As a result, at the anal-sadistic stage there is no ability to neutralize libido and aggression, to create reaction formations and sublimations that are important for character; at the phallic stage there are no contributions from the “I” to the organization of oedipal object relations; in puberty, the “I” comes to sexual maturity without the ability to form emotional formations preceding it at the genital stage.
Based on this, we can conclude (Michaels, 1955) that premature development of the “I” leads to internal conflicts and, as a consequence, to neuroses; premature instinctive development leads to defective and instinctive character formation.
Discrepancies between genetic lines
As shown above, discrepancies between genetic lines are within normal limits and become the starting point for violations only when the results exceed expectations.
If this happens, then both parents and teachers feel equally helpless. Such children turn into unbearable members of the family, they interfere with others in the school class, they are constantly looking for quarrels in children's games, they are unwelcome in any society, they cause indignation everywhere, and at the same time, as a rule, they are unhappy and dissatisfied with themselves.
They also do not fit into any of the usual diagnostic categories of clinical examination, and only when viewed from the point of view of genetic lineages can their abnormality be understood.
It also became clear to us that the achieved stages on various lines of development are in no way interconnected with each other. High mental development can be combined not only with poor results in the intellectual field, but also with the lowest steps on the path to emotional maturity, bodily independence and social relationships with older comrades. Such discrepancies lead to artificially rationalized instinctive behavior, excessive fantasies, failures in the cultivation of neatness, in other words, to a mixed symptomatology, difficult to distinguish in its etiology. Usually such cases are classified in descriptive diagnoses as “prepsychotic” or “borderline”.
A discrepancy also occurs between the line from play to work, on which the child’s development is delayed, and the line to emotional maturity, social adaptation and bodily independence, on which progress is quite consistent with age. Such children enter clinical research because of failures in their studies, which cannot be explained either by their mental development or by their school behavior, which remains quite adequate up to a certain time. In such cases, the researcher’s attention should concentrate precisely on the area where there are no expected correspondences between “It” and “I” on a specific line of development - on the transition from the principle of pleasure to the principle of reality, on the insufficient mastery and modification of pregenital aspirations, on the delayed displacement of pleasure from the successful solution of problems on whether there is regression in all or only certain directions, etc.
Such cases in a descriptive diagnosis are referred to either as “intellectual impairment,” which is fundamentally incorrect, or, answering only the external side of the phenomenon, as “insufficient concentration.”
Pathogenic (permanent) regressions and their consequences
As noted above, regressions are harmless and even desirable as long as they are transitory (the level of development achieved before them can be re-achieved spontaneously). They become pathogenic if the damage they cause itself causes a new formation within the personality, which means that their consequences are long enough for this to happen in time.
In any part of the mental apparatus, regressions of both types are possible.
The state of instinctive derivatives indirectly worsens if regression begins in the “I” or “Super-Ego,” lowering the achievements of both structures to a lower level. Such damage to the “I” and “Super-Ego” has negative consequences for the mastery of instincts, disrupts the protective ability and causes breakthroughs from the “It” into the organization of the “I”, which lead to instinctiveness, emotional outbursts and irrational behavior, changing beyond recognition picture of the child's character. Usually, research reveals that the reasons for such a decline in personality are experiences that the “I” could not overcome (fear of separation, painful refusals on the part of the object of love, disappointment in the object, leading to the collapse of identifications (Jacobson, 1946), etc. .), and therefore they found embodiment in fantasy.
The second possibility is that the regression begins from the “Id” side, and the “I” instances are confronted with immediate primitive instinctual derivatives, which they are forced to confront anew in some way.
Such a clash may consist in the fact that instinctive regression itself causes regressions of the “I” and “Super-Ego,” i.e., the “I” begins to lower its demands in order to maintain agreement with instinct. In this case, internal balance is preserved, and the consequences of instinctive regression in relation to the “I” are justified. But such a new formation has to be paid for by a decline towards infantilism, dissociality and instinctiveness of the personality as a whole. The depth of the pathological disturbance depends on how strong the recurrent movements are in instinct and in the “I”, to what point of fixation the latter reach, which of the achievements of the “I” are preserved at the same time, and at what genetic level such an internal revolution comes into balance again.
The confrontation between the “I” and the degraded instinct can also take reverse forms, which are better known to us from analysis. If the “I” and “Super-Ego” achieve high development in children ahead of time, then the so-called secondary autonomy of achievements of the “I” is formed (Hartmann, 1950) - such a degree of independence from instinctive life that gives them the opportunity to tear away from themselves instinctive regressions as hostile selves. Such children, instead of following the newly emerged pregenital and aggressive impulses and allowing the corresponding fantasies into consciousness, develop fear, strengthen instinctive defenses and, if this fails, find refuge in a compromise between instinct and “I”. In such cases, we observe internal conflicts leading to the formation of symptoms, on the basis of which hysterical fear, phobias, nightmares, obsessive symptoms, ceremonies, delays and other characteristic infantile neuroses arise.
In clinical work with boys who, due to fear of castration, have degraded from the phallic (oedipal) to the anal-sadistic stage, we find clear examples of the difference between the justified and hostile consequences of instinctive regression towards the “I”.
Boys with deviations of the first kind, in whom the “I” and “Super-Ego” are drawn into reverse movement, become less neat and more aggressive than before, or return to greater dependence on their mothers (lose independence), turn passive and lose masculinity . In other words, they again develop tendencies and properties that are characteristic of the pregenital sexuality and aggressiveness of the fixation point in question without internal contradiction.
In children with deviations of the second kind, when the formed “I” is quite sufficient to protect with the help of fear and guilt from the consequences of instinctive regression, the specific pathological consequence depends on which instinctual element the protest of their “I” is most strongly manifested against. In those cases where the manifestations of anality, sadism and passivity are equally energetically reflected by the instances of the “I”, the symptomatology is most widespread. When the condemnation of the “I” is directed only against sloppiness, excessive neatness, an obsessive desire to wash, etc. arise. When manifestations of aggression and sadism are primarily reflected, as a consequence, one’s own achievements are suppressed and an inability to compete appears. When passive feminist aspirations are most feared, there is heightened fear of castration or uncompensated aggressive masculinity. In all cases the consequences - symptoms or characters - are neurotic.
It is worth noting that from analytical experience working with adults it is known that with neuroses, ultimately, the “I” is also subject to various regressions. The “I” function is reduced to a particularly low level by renunciation, magical thinking, passivity and other obsessive-neurotic defensive forms. However, this kind of regression of the Self is a consequence of the collapse, not its cause; in this case, the decline relates only to the achievements of the “I”, and the requirements of the “Super-ego” remain without violation. Rather, on the contrary, the neurotic “I” does everything possible to fulfill the demands of the “Super-ego”.
Conflicts and anxiety during diagnosis
On the way from the causal unity of the personality to its composition from the instances of “It”, “I”, “Super-Ego” and the structure of the personality, each individual in the course of normal development goes through a number of phases. First of all, the previously undifferentiated psychic mass is divided into “It” and “I”, that is, into two areas of action that have different goals, intentions and methods of functioning. The first division is followed by the second stage in the “I”, i.e., the division of this authority into the “I” itself and into the “Super-I” and the ideal “I” standing above it, which perform critical and guiding functions in relation to the “I” ".
In the study, with the help of doubly manifested phenomena, namely, by a special type of conflict and the fears associated with them, it is possible to establish how far ahead the child has gone or, conversely, fallen behind along this path.
In childhood, we distinguish three types of conflicts: external, deeply conscious and internal.
External conflicts that occur between the child’s integral personality and the objective world arise every time the surrounding world intrudes and interferes with the child’s impulses, delaying, limiting or prohibiting their implementation. Until the child masters his instinctive impulses, that is, until his “I” coincides with the “It” and barriers have not yet been established between them, he is not able to overcome such influences from the surrounding world. External conflicts are a hallmark of childhood, a period of immaturity; we have the right to characterize an individual as “infantile” if they remain or are regressively reborn at a later time. Exist different kinds fears associated with this form of conflict and proving its existence, which differ depending on the age and level of development of the child; What they have in common is that their sources are located in the outside world. Their staged sequence in time looks approximately as follows: fear of death with loss of maternal care (fear of separation, fear of loss of an object during the period of biological unity of mother and child), fear of loss of love (after establishing a constant loving relationship with the object), fear of criticism and punishment (during the anal-sadistic phase, in which the child projects his own aggression onto his parents, which increases fear of them), fear of castration (during the phallic-oedipal phase).
The second type of conflict is deeply conscious. They appear after the child, through identification with the parents, turns their demands into his own, and his “Super-Ego” already perceives parental authority to a greater extent. Conflicts that arise in matters of fulfillment of desires or refusals differ little from conflicts of the previous type. However, collisions and discrepancies in this case no longer occur externally between the child and the object, but in his inner life between mental authorities, where it falls to the “I” to resolve the dispute between instinctive desire and the demand of the “Super-Ego” in the form of a feeling of guilt. As long as the feeling of guilt does not disappear, the research analyst has no doubt that the child has reached the “Super-I”, creating steps in the “I”.
The third type of conflict is internal conflict. Basically, they differ in that the outside world does not play any role for them - neither direct, as in external conflicts, nor indirect, as in conscious ones. Internal conflicts arise due to genetically determined relationships between “It” and “I” and differences in their organization. Instinctive derivatives and affects of the opposite kind, such as love and hate, activity and passivity, masculinity and femininity, coexist without hostility with each other as long as the “It” and the primary process control the mental apparatus. They become unbearable for each other and come to conflict as soon as the “I” matures and tries to incorporate resistant contents into its organization with the help of a synthetic function. Even where the content of the “It” is not resisted qualitatively, but is only strengthened quantitatively, this is perceived by the “I” as a threat and leads to internal conflict. This leads to the emergence of fears of a special kind, threatening the mental balance of the individual in a special way. But, unlike fear of the outside world or feelings of guilt, they are born in the depths and usually make their presence known not during a diagnostic examination, but only during analytical treatment.
The above division of conflicts and fears into external, conscious and internal significantly helps the diagnostician in classifying and assessing the strength of conflicts caused by childhood disorders. This also explains why, in some cases, changes in behavior are sufficient for recovery. external conditions life (cases of the first kind, when conflicts are pathogenically influenced by the outside world), why cases of the second kind, requiring analytical help, with the cause of the disease consisting of conscious internal conflicts, can be changed without much difficulty, and why in cases of the third kind, when we are dealing with internal instinctual conflicts require particularly complex actions and very lengthy analytical efforts (according to Z. Freud, 1937 - “endless” analyses).
General characteristics and their significance for diagnoses and prognosis
To meet expectations, the analyst must not only identify current childhood disorders and restore the picture of their course in the past, but also predict to the maximum possible the prospects for treatment, which means restoring mental health and maintaining it. Such a look into the future is impossible without the described details of developmental processes, as well as without determining the personal properties that have a decisive influence on the maintenance or disruption of mental balance, the source of which should be sought either in the innate constitution or in the earliest experiences of the individual. These properties are hallmark The “I” of the individual, since the “I” plays the role of an intermediary between the external world and the personality, its internal authorities. Such of them as the attitude of the “I” towards displeasure and deprivation, the ability to sublimate, the attitude towards fear, the correctness of the development process and other progressive tendencies are of the greatest importance.
Overcoming displeasure (capacity for frustration) and the tendency to sublimation
The child’s chances of remaining (or becoming) mentally healthy largely depend on the extent to which the child’s “I” is able to endure deprivation, that is, overcome the displeasure caused by circumstances. Perhaps no one exhibits more individual differences than the youngest. Some children cannot tolerate any delay, any restriction in the satisfaction of instinctual desire and respond with all manifestations of anger, rage, displeasure and impatience; substitute satisfactions are rejected by them as insufficient. After this, nothing short of fulfilling the original desire can satisfy them. Typically, such resistance to submission to often inevitable necessity begins already in infancy and manifests itself first in the area of oral desires, and then spreads to other areas at a later time. But there are children who, unlike the first ones, are much easier to satisfy. They endure the same instinctive restrictions without such indignation, are more willing to accept substitute satisfactions that reduce desires, and usually retain these early acquired attitudes for later years.
Diagnosticians have no doubt that the internal balance in children of the first type is much more endangered than in the second. Forced to keep under control great amount displeasure, childish "I." if necessary, begins to use the most primitive auxiliary means and methods of defense, such as renunciation or projection, as well as such primitive methods of withdrawal as outbursts of anger, rage and other affects. From these auxiliary means, the further path leads to pathological compromise formations in the form of neurotic, dissocial and perverted symptoms.
Children of the second type have much more opportunities to neutralize and transfer their instinctive energy to satisfactions that are limited and quite achievable. This ability to sublimate provides invaluable assistance in the struggle to maintain or restore mental health.
Overcoming Anxiety
Analytical knowledge proves that fearless children do not exist, and at different genetic stages, various forms of fear are present as normal accompanying phenomena. (For example, the stage of biological unity of mother and child corresponds to the fear of separation, the constant object - the fear of deprivation of love, the Oedipus complex - the fear of castration, the formation of the "Super-I" - a feeling of guilt.) However, for determining forecasts, it is not the form that matters, first of all and the intensity of fear, but the ability to overcome it, on which mental balance ultimately depends and which is present in different amounts in different individuals.
Children who use transferences at every manifestation of fear are at particular risk of neurosis.
Their “I” is forced to repress and renounce all external and internal dangers (all possible sources of fear) or to project all internal dangers onto the external world, from which those, returning, cause even greater fear, or to phobically avoid any threats of fear and all kinds danger. The desire to avoid fear at any cost becomes an attitude that takes over early childhood and later the adult life of an individual and ultimately leads to neurosis due to the excessive use of defense mechanisms.
The prospects for an individual’s mental health are much better when the “I” does not avoid fear, but actively fights against it, finding protection in understanding, logical thinking, active changes in the external world and aggressive opposition. Such an “I” is able to overcome a large amount of fear and do without excessive defensive, compromising and symptomatic formations. (The active overcoming of fear should not be confused with overcompensation in children, since in the first case the “I” protects itself directly from the impending danger, and in the second - from its phobic avoidance.)
O. Isakover, explaining the example of the most fearful child actively overcoming fear, says: “The soldier is also scared, but this is not important to him.”
The relationship between tendencies towards progress and regression
Despite the fact that throughout childhood the mental apparatus contains aspirations directed forward and backward, this does not mean at all that their relationships with each other are the same for all individuals. We know that for some children, everything new causes joy: they rejoice at a new dish, increased mobility and independence, movements that take them away from their mother to new faces and playmates, etc. For them, nothing is more important than becoming " big”, to be able to imitate adults, and everything that at least approximately corresponds to this desire compensates for all the difficulties and obstacles encountered along the way. In contrast, for other children, every new movement means, first of all, a rejection of old sources of pleasure and therefore causes fear. Such children have difficulty weaning, often perceiving such events as shock. They are afraid of parting with their mother and their familiar environment, they are afraid first of strangers, then of responsibility, etc., in other words, they do not want to grow up.
It is easiest to make a clinical conclusion about which of these types a certain individual belongs to, most easily when observing the overcoming of life circumstances that require great courage from a child, such as a serious illness of the body, the birth of a new child in the family, etc. Children who have the desire towards progress is stronger than regressive tendencies, often a long period of illness is used to mature the “I”, they feel like an “older” brother or “older” sister in relation to the newborn. If the tendencies towards regression are stronger, then during illness the child becomes even more “infantile” than he was before, and begins to envy the newborn baby, because he wants to return to the state of a baby.
These differences have implications for prediction. The pleasure that a child of the first type experiences with successful progress contributes, in turn, to maturation, development and adaptation. In children of the second type, at each stage, there is a constant danger of stopping their development and creating fixation points; their balance is easily disrupted, and their tendency to return very easily turns into a starting point for the emergence of fear, defense and neurotic destruction.
The picture of development from the point of view of metapsychology
Each example of a psychoanalytic study of a child provides many facts regarding the physical and mental, all sides and layers of the personality, facts relating to the past or present, the external or internal world of the child, factors of harmful and beneficial influence, successes and failures, fantasies and fears, defensive processes, symptoms, etc. Whatever the subject discovers deserves attention, even if confirmation of the information received is possible only with further work. However, not a single fact taken by itself can be considered without connection with the rest of the material. As analysts, we are convinced that the fate of human development is determined not only by heredity, but also by inherited qualities in interaction with experienced events, that organic disorders (physical defects, blindness, etc.) lead to a variety of mental consequences, depending on the environmental influence to which child, and from the mental aids that are at his disposal to overcome his own difficulties. Whether fears (see above) should be regarded as pathogenic depends, rather, not on their type and strength, but on the form and way in which the child processes them. Attacks of rage and outpouring of feelings must be assessed differently, based on whether they arise spontaneously on the path of development or are obtained through imitation and identification with the object world. Traumatic influences on a child cannot be read from the manifested life history, since they do not depend on the objective importance of the event, but on its subjective impact on each individual child. Courage and cowardice, selfishness and generosity, rationality and recklessness, depending on the life environment, chronological age, phase of development and genesis, acquire different meanings. Individual areas of clinical material and the connections extracted from them with the whole personality are identical only in name. In fact, they are no more suitable for use in individual diagnosis than they are for comparison with supposedly identical personality elements in other individuals.
The task of the research analyst is to organize an organic connection within the available material, that is, to bring it dynamically, energetically, economically and structurally to a metapsychological point of view. As a result, the picture of the child’s condition corresponds to the synthesis or splitting of the diagnosis into its analytical components.
Such genetic pictures can be obtained at various points in time - during a diagnostic study, during analytical treatment, at the end of treatment. Depending on this, they serve various purposes - making a general diagnosis (the main goal), confirming or criticizing it on the basis of material revealed during analysis, assessing the therapeutic effectiveness of analytical methods in terms of the improvement obtained in treatment.
To obtain a “metapsychological picture of development,” it is first necessary to ascertain external facts regarding symptoms, patient descriptions, and family history. This is the first attempt to estimate the estimated significance of environmental influences. The description then moves on to the inner life of the child, ordered according to the structure of his personality, the dynamic relationship of forces between authorities, the relationship of forces between “It” and “I”, adaptation to the external world and genetic hypotheses arising from the manifested material. The resulting schematic representation looks something like this:
Approximate outline of a metapsychological picture of development
I. Reasons for the study (developmental disorders, behavior problems, delays, anxiety, symptoms, etc.).
II. Description of the child ( appearance, manners, behavior).
III. Family situation and childhood history.
VI. Presumably significant environmental influences, both positive and negative.
V. Data on the development process.
A. Development of instincts:
1. Libido. Need to research:
a) development of libido:
whether the child has reached a phase appropriate for his age (oral, anal-sadistic, phallic, latent period, prepuberty), in particular, whether the transition from the anal phase to phallic sexuality has been successful;
whether the achieved phase of development has a dominant position;
whether the child at the time of the study is at the highest stage of development achieved, or whether there is a regression to earlier positions;
b) distribution of libido:
whether there was a distribution of libidinal fillings between the child himself and the object world;
is there enough narcissistic filling (primary and secondary narcissism, filling of the bodily “I”,
"I" and "Super-Ego") to ensure one's own feelings; how much it depends on object relations;
c) libido of the object:
whether the stage corresponding to chronological age has been achieved in the stage-by-stage sequence of object relations (narcissistic, based on the type of adjacency and support, object constancy, pre-oedipal, goal-limited, pubertal-conditioned);
whether the child is retained at a given stage, or regression to earlier stages is observed;
whether the form of the object relationship corresponds to the achieved or regressively obtained phase of libido development.
2. Aggression. Needs to be explored; What forms of manifestation of aggression does the child operate on:
a) a quantitative indicator, i.e. whether it is present or absent in the clinical picture;
b) an indicator of type and form, corresponding to the phase development on the part of the libido;
c) focus on the outside world or on oneself.
B. Development of the “I” and “Super-ego”. Need to research:
a) the mental apparatuses at the disposal of the “I” are in good working order or damaged;
b) how efficient are the functions of the “I” (memory, reality check, synthetic function, secondary process); if there are disorders, what are they - genetically or neurotically determined; formed simultaneously or not; what is the IQ;
c) how developed is the defense of the “I”: directed against a certain instinctive derivative (must be specified) or against instinctive activity and instinctive satisfaction in general;
whether it corresponds to chronological age (the existing defense mechanisms are too primitive or, conversely, matured too early);
protective activity is divided evenly into a large number of mechanisms or limited to a small number of them;
whether protective activity is effective or ineffective, primarily against fear; maintains or recreates balance between authorities; there is a possibility of internal mobility, or it is suppressed, etc.;
whether it is dependent or independent from the objective world, and to what extent (formation of the “Super-I”, awareness, external conflicts);
d) to what extent the functions of the “I” are secondarily damaged by the protective activity of the “I” (what are the losses in the ability to achieve success associated with maintaining instinctive defense and mastering instincts).
VI. Genetic data on fixation and regression points.
According to our point of view, a return to genetically determined points of fixation is the basis of all infantile neuroses and many infantile psychoses. Therefore, one of the most important tasks of the diagnostician is to detect them in the child’s background with the help of the following manifested phenomena:
a) certain properties of behavior, the instinctive background of which is known to the analyst; they are an external manifestation of processes occurring in the depths of the mental apparatus. The clearest example of this kind is the emerging picture of an obsessive neurotic character, in which such properties as neatness, love of order, economy, punctuality, skepticism, indecisiveness, etc., indicate a conflict in the anal-sadistic phase, and thus provide a point of fixation at this point. Other pictures of characters or modes of behavior similarly reveal points of fixation in other areas or at other levels. (The child’s pronounced concern for the life and health of his parents, brothers and sisters indicates special conflicts associated with the infantile desire for death; fear of taking medications, certain difficulties in nutrition, etc. indicate an ongoing defensive struggle with oral fantasies; such a property of the “I” ", as shyness, indicates rejected exhibitionism in "It"; homesickness indicates the presence of a long-standing ambivalent conflict, etc.);
b) children's fantasies, which, when favorable conditions are sometimes discovered in a clinical study, but more often become available to the diagnostician through testing. (It often happens that as difficult as access to the fantasy life is in the first study, so rich is the material of conscious and unconscious fantasies in analytical processing, when the patient's pathogenic background is completely clarified.);
c) symptoms for which the connection between the unconscious background and the manifest form of manifestations is typical, which even allows, as in the case of obsessive neurosis, to draw conclusions about repressed processes from the picture of symptoms. However, one should not exaggerate the number of such symptoms, since many of them, for example lying, cheating, enuresis, etc., are not a source of information during a diagnostic study, because they arise on a very different instinctive background.
VII. Dynamic and structural data on conflicts.
The normal development of a child is influenced by conflicts occurring between the external and inner world, on the one hand, and between internal authorities, on the other, just like his pathology. The diagnostician needs to understand these counteractions and structure the dynamic processes into a diagram:
a) as external conflicts between the child’s personality as a whole and the object world (the accompanying fear of the object world);
b) as deeply conscious conflicts between the “It” and the instances of the “I”, which absorb (deeply realize) the demands of the environment (the accompanying feeling of guilt);
c) as deep internal conflicts between contradictory and uncoordinated instinctual impulses (unresolved ambivalence, love-hate, activity-passivity, masculinity-femininity, etc.).
From the form of the conflict that determines the life of each individual child, we can conclude:
1) about the maturity of the structure of his personality (the degree of independence from the objective world);
2) about the severity of violations in the personality structure;
3) about methods of influence that can lead to improvement or cure.
VIII. General properties and positions.
To make a forecast about whether a particular child has the possibility of spontaneous recovery from a disorder or the prospect of treatment success, it is necessary to pay attention to the following characteristics of his personality and behavior patterns:
a) the child’s position in relation to refusals. If he tolerates refusals worse than one would expect at his age, then this means that fear is stronger than his “I” and the child finds a way out in the sequences of regression, defense and symptom formation leading to illness. If refusals are tolerated better, it is easier for the individual to maintain his internal balance or restore it after a violation;
b) the child’s ability to sublimate instinctive impulses. There are strong individual differences in this area. In cases where it is possible to use targeted and neutralized substitute satisfactions, they compensate the child for inevitable disappointments in instinctive life and reduce the possibility of pathological destruction. An important goal of treatment is to release the restricted sublimating ability;
c) the child’s attitude towards fear. It is necessary to distinguish between the tendency to avoid fear and to actively overcome it. The first, rather, leads to pathology, and the second is a sign of a healthy, well-organized and active “I”;
d) the relationship between advancement and regression in the processes of child development. If forward aspirations are stronger than recurrent tendencies, the prospect of maintaining health or self-healing is better than in the opposite case: strong breakthroughs in development help the child fight his symptoms. When regressive aspirations take precedence and the child clings to archaic sources of pleasure, resistance to treatment also increases. The balance of forces between these two tendencies in the individual child manifests itself in the form of a conflict between the desire to become “big” and the reluctance to give up infantile positions and satisfactions.
For a final generalization, the diagnostic systems used so far are not enough. Required special scheme, which primarily evaluates the relationship of various disorders to development and the degree of their deviation from the normal process. To do this, the diagnostician must select one of the following positions:
1) apart from some difficulties in satisfying bodily needs, attitude towards the outside world and in the child’s daily behavior, the processes of his development themselves are not damaged, which means the violation remains within the normal range;
2) the scale of the disturbances found in the clinical picture of symptom formation corresponds to the effort aimed at overcoming specific genetic difficulties, which means that with further advancement to the next steps of the development line they will be eliminated spontaneously;
3) there are instinctive regressions to previously acquired points of fixation, their prolonged exposure creates internal conflicts that lead to infantile neuroses and character disorders;
4) the ongoing instinctual regressions lead to regressions of the “I” and “Super-Ego”, to infantilism, etc.;
5) there is damage to existing inclinations (through organic disorders) or to the constitution acquired in the first year of life (through deprivation, failure, physical illness, etc.), which harm the development process, prevent the formation and separation of internal authorities from each other, leading to to defective, developmentally delayed, and even atypical clinical pictures;
6) some inexplicable processes of organic, toxic or mental origin have a destructive effect on existing personal acquisitions, which is expressed in loss of speech, inhibition of instincts, impaired sense of reality, etc., thus inhibiting the entire development process, causing infantile psychoses , autism and similar pathologies.
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Differences
1. A. Freud denied the presence of countertransference in child psychotherapy, M. Klein considered it important (especially for children who do not yet speak)
2. A. Freud believed that children’s play cannot be interpreted, since it reproduces reality, and M. Klein interpreted the game, since she believed that symbolic manifestations also take place in the game
3. A. Freud believed that it was necessary to collect anamnesis from parents, it was necessary to maintain a positive relationship with them, and by influencing the parents, the child’s condition could be changed; M. Klein believed that psychoanalysis should adapt the child to existing relationships in the family, and interaction with parents, including history taking, is useless and even harmful.
4. A. Freud was very careful about interpretation in general and sexualized interpretations in particular, believing that such interpretations can destroy the relationship between the child and parents; M. Klein strives to give interpretations to the child’s behavior and play, and although she also considered it unacceptable to destroy the relationship between the child and the parents, she considered it necessary to work through the emerging conflicts.
5. A. Freud worked with children with developed speech function (senior preschool age); M. Klein worked with children from 2.5 to 3 years old.
6. For A. Freud, the goal of therapy was to strengthen the “I” and develop the superego; for M. Klein, the goal of therapy was to weaken the superego, since it was in its severity and severity that she saw the source of internal conflict, and the weakening of the superego would lead to the harmonization of the child’s personality.
7. According to A. Freud, psychoanalysis also has a pedagogical aspect, when the analyst takes the place of the weak superego; for M. Klein, the child’s super-ego is too strong in relation to the child’s weak ego and therefore its strengthening through the pedagogical role of the analyst is not necessary.