How was Child Therapy Created? Freud and Child Psychoanalysis
By Andrew Guthrie, Ph.D.
Sigmund Freud was not only the first psychoanalyst of adults, but he is also considered to be the first clinician who worked psychoanalytically with children. In 1905, he published the Dora case, and although he did not identify her as such, she was an adolescent (Scharfman, 1990). Then, in 1909, Freud supervised Max Graf’s analytic treatment of his five-year-old son, “Little Hans,” by stressing the importance of the acquisition of knowledge of one’s unconscious as the central factor in the analytic process (Geissmann & Geissmann, 1998).
The treatment of Little Hans consisted of Hans recounting his dreams, confiding his theories of sexual practices, and expressing his anxieties and symptoms, while his father explained whatever Hans did not understand. Explanation sometimes included confronting Hans’ repressed desires, for example when Hans said that he does not touch his ‘widdler’ (penis) any more, and his father took him to task for nevertheless still wanting to. Max also elicited associations from his patient (“Tell me what are you thinking about.”), and interpretations were made, in classic fashion, in the transference (“The big giraffe is me . . . ”). Once Max had interpreted Hans’ Oedipus Complex (the connection between Hans’ anger and also fear of his father and his possessive love for his mother) his symptoms began to improve rapidly and he showed a clarity of mind which today we would understand as a gain in insight. Within five months Hans was “cured,” an improvement which occurred in similar fashion to that of adult patients: “Listening to the daily events, dreams, and memories enabled the analyst to elicit associations of ideas which in turn enabled the child to bring back forgotten memories and thus to reconstruct his primal phantasies” (Geissmann & Geissmann, p. 19). Indeed, Freud reported that he learned little that was new from the supervision of this case, as he believed neurosis in adults and children was similar and required no changes in theory or technique.
Due to the successful outcome of this case, it is paradoxical that Freud expressed doubt in his paper, “A History of Infantile Neurosis” (1909), that psychoanalysis could help children: “An analysis which is conducted upon a neurotic child. . .cannot be very rich in material; too many words and thoughts have to be lent to the child and even so the deepest strata may turn out to be impenetrable to consciousness” (p. 123). In the same year, writing to Carl Jung, Freud sounds more positive about the prospects of child analysis: “The therapeutic task consists in demonstrating the sources from which the child derives its sexual knowledge. As a rule, children provide little information but confirm what we have guessed when we tell them” (McGuire, 1974, p. 48).Freud’s ambivalence about the efficacy of psychoanalytic treatment for young children reveals a recurring theme in the history of child psychoanalysis, one that is especially prominent in the years between 1912 and 1923, when its pioneers, Hermine Hug-Hellmuth, Anna Freud, and Melanie Klein, were conceptualizing their first analytic cases.
Although Freud’s model of adult psychoanalysis functioned as the blueprint for child analysts to follow in their construction of a new branch of psychoanalysis, child analysis differed from Freudian analysis in significant ways. The most obvious difference, and the one that is most significant in a discussion of technique, is the communication medium, as it represents a system of symbols and signs, that is used by the patient to express his or her experience. Most adults use the verbal medium to represent their internal and external experiences, and it is self-evident that words are symbols and signs that represent other things, such as feelings, thoughts and things. It is less obvious that a child’s play, the toys they use, and the stories that emerge in play, also symbolize feelings and thoughts, and that playing is the most natural method children use to communicate their internal and external experiences. The notion of play as a meaningful language that can be received and “read” by an observer as a text that contains important clues about the child’s life, was first discovered by Freud in 1920.
Freud was observing his 18 month old grandson respond to the absence of his mother by throwing away whatever small objects he could reach, accompanied with a long “o-o-o-o-o” sound, which his mother translated as ‘away,’ or ‘gone.’ On one occasion, the child discovered a long thread with a spool and threw it behind his bed with a long “o-o-o-o” and greeted its reappearance when pulling it back with an excited “Da!” (‘there’). Freud observed the boy play this game for hours, and emphasized that the second part of the game was obviously more pleasant for him. In addition, the boy observed himself in a mirror before crouching down and making himself disappear. Having observed this example of play, Freud “read” or interpreted the meaning of the play as the boy’s renunciation of satisfaction followed by self-gratification, making objects disappear and reappear that were in his power. Freud concluded that “. . . the disappearance of his mother couldn’t have been a pleasant or even neutral experience. His game satisfied a normally suppressed impulse for revenge. The throwing of the object had the obstinate meaning: “Well go, I don’t need you, I send you away myself”(Maclean and Rappen, 1991, p. 194). The child was then able to master the pain of his mother’s coming and going by pulling the objects back within reach, in essence teaching himself that things that are “gone” can also be “there.”
Freud’s suggestion that the boy’s play was meaningful, that it represented thoughts and feelings, that it was a communication equivalent to the adult’s use of words, and that the event could be “read” by the receiver of the communication and enable one to understand the internal and external worlds of the child, were all important discoveries that signalled the direction that analytic technique could take with children. It was not until Melanie Klein began to develop her play technique in the early 1920s, that Freud’s initial understanding of play was conceptualized into a proper psychoanalytic theory that could be applied in practice.
