Psychoanalytic treatment is best explained through examples. To illustrate how child and adolescent psychoanalysis works and the results achieved, here are three cases:
Tim, the junk collector at age four
Tim had a compulsive need to collect litter such as ice cream wrappings, stones, and cigarette butts. If someone tried to take the litter away from him or clean his room, he became furious and filled with anxiety. At night he often woke up in fear, and did not respond to any parental comfort. Constantly on alert, he continuously tracked the location of his parents in the apartment, and devised ways not to be left alone in his room. He had to go to the bathroom as often as every fifteen minutes, and had sudden, inexplicable outbursts of rage.
At nursery school Tim was provocative towards both children and staff. Over time, the staff found it more and more difficult to like him. In their frustrated efforts to help him, they felt disappointed, despairing and angry. When classmates occasionally attacked him, Tim made no attempt to defend himself nor did he protest.
Tim started psychoanalysis, and quickly became attached to his analyst with a great deal of trust. Through playing and drawing, he was able to tell his analyst, indirectly, of his frightening fantasies. The analyst learned that when Tim was very young, his mother had been forced to leave him in someone else's care. In reaction, Tim became constipated and refused to sit on the potty. Once he returned to his mother, they fought constantly about his bowel movements. In desperation, his mother gave him an enema, an experience that aroused unbearable anxiety in Tim and provoked many fantasies of his inner world being destroyed and flushed down the toilet.
Once his unconscious fears (as expressed in his fantasies) gradually took shape and were addressed through playing, drawing, and talking, Tim’s anxieties diminished and his symptoms stopped.
Jenny, in her own world at eight years of age
Jenny's brother was born when she was five years old. Soon after his birth, her parents drifted apart and began having violent arguments. Several years later, her parents divorced, and Jenny remained with her mother. Jenny became anxious and worried; she and her mother often had difficult and tiring fights. When Jenny started school, she began wetting herself and eating so much that she put on a lot of weight. Her classmates took to bullying her. She could not concentrate on her schoolwork and was a disturbance in the classroom. When more and more of the children in the class started bullying her, she disappeared into a world of fantasy on the floor under her desk. Others began to think her strange.
Jenny began psychoanalysis when she was eight. With the same seeming self-satisfaction of her classroom behavior, she rejected her analyst. But soon the analyst came to understand how worthless and powerless Jenny felt when her parents were completely absorbed by their own conflict. In Jenny's world, the analyst learned, there were only two alternatives. She could be alone under the school desk, with comforting fantasies that she was big and mighty--or she could be with another person and feel small, rejected and alone.
Unlike Jenny the analyst could tolerate rejection and its related emotions. He helped her sort out and understand her situation and her feelings. They became bearable to her. Together with the analyst, she found words for her grief, despair and anxiety-ridden anger. Her relations with her classmates and with adults improved. By learning to accept both appreciation and realistic criticism, she developed a natural self-esteem. Her schoolwork progressed. Today, Jenny is a young woman who lives in a stable and good relationship with a man.
Anna, an outsider at age 13
Anna's father had committed suicide when she was a small girl. The remaining family of mother, brothers and sisters hardly ever discussed this traumatic loss. During Anna’s analysis, it became evident that Anna had hidden all the difficult feelings surrounding the death of her father. In their place, she had built an imaginary world in which she was in contact with a still-living father. The sorrow, anger and other troubling aspects of her father's suicide were pushed out of sight. Her highly charged feelings created such strong pressures that they were released in symptoms of diarrhea and headaches.
Anna was 13 when she began psychoanalysis. For some time, her school had been concerned about her. Anna had been an outsider among her classmates, isolating herself and sinking into her own fantasies. Because she shut herself off from the world and could not concentrate, she had problems keeping up with her schoolwork. Clearly, she was talented, but incapable of letting her intellectual resources flourish.
During her analysis, Anna gradually got in touch with all the difficult feelings connected to her father's absence and the betrayal his suicide represented deep inside. She gained the courage to discuss with her family the possible causes of her father's tragic action.
Anna’s analysis made it possible for her to create a realistic picture of her father. She was able to resume her natural adolescent development and, at last, fully engage in her schoolwork with her talent and intellect. |