!
50602%7#!$*!7#$<&!1647#)2*2<46$6?!"Z0*(4E:$Y0E402%!:)<<)ZEB1!):!2! 60Y0%0<4!&$6(B%30&!7#$<&!
"46)*_!/>![+,,\^>!50602%7#!$*!7#$<&!1647#)2*2<46$6?!(Z0*(4E:$Y0E402%!:)<<)ZEB1!):!2!60Y0%0<4!&$6(B%30&!7#$<&>! N">#+@B&"!&,-%&/$%#)?@+&'(A?-"@+@BA,)?&/(("?)@,)"+& .d! plm ?!\-\E].>!!! L)*2D4_!/>_!G!"2%D0(_!@>![-\\g^>!/%0&$7()%6!):!)B(7)90!$*!7#$<&!1647#)2*2<46$6?!=!%0(%)6107($Y0!6(B&4!):!dgP! 72606!2(!(#0!=**2!L%0B&!80*(%0>! N">#+@B&"!&,-%&/$%#)?@+&'(A?-"@+@BA,)?&/(("?)@,)"+O&ll _!+dEdd>!! >-001(3 ! The history and current state of research at the Anna Freud Centre reports the evolution of a database that has methodically recorded and systematically organized data from over 750 cases of children referred to the Centre over a forty-five-year period. A long-term follow-up of a small sample of these children suggests the kinds of long-term benefits that can be gained when an individual is treated with intensive psychoanalysis as a child. As an example, the author presents clinical material from the analysis of an eight-year-old along with follow-up interview data twenty-five years later to demonstrate the efficacy and the outcome of a child psychoanalysis and critically discusses the value of distinguishing two different models of psychoanalytic treatments – the “classical model” and the “mental process model”. The long tradition of research at the Anna Freud Centre, as well as the extensive Hampstead Index database 2 of methodically recorded and systematically organized observations from the analysis of children dating back to at least 1960 provided the material, technical, and epistemological support to respond to this challenge. Fonagy, Target and their collegues at the Centre designed and systematically conducted an empirically sound study of the outcome and efficacy of child analysis (for a description of this study and its methodology, see Fonagy and Target 1996). This entailed a systematic file review of 763 cases treated in psychoanalysis or psychotherapy at the Anna Freud Centre. By studying the case records they sought to identify children who had had a successful psychoanalytic outcome and then determine the characteristics of the child or the analysis that contributed to that success. The children who seemed to gain the most from psychoanalysis, judging by their improved adaptive capacity at the completion of their analysis, were those who presented with severe social and emotional psychopathology, such as difficulties in relating to peers, problems with affect regulation, low frustration tolerance, distortions of self-image, fragile reality contact, and idiosyncratic and magical thinking. To support the impression that these more disturbed children had actually the most to gain from psychoanalysis, they designed and conducted a twenty-five-year follow-up study. In the course of their file review, the team at the Anna Freud Centre began to recognize that the children with serious pathology had in common a difficulty in differentiating other people’s thoughts and feelings from their own. Consequently they were unable to create representations of the self with specific thoughts and feelings and representations of others with thoughts and feelings separate from and different from their own. This limited them socially, as they were unable to reflect on or anticipate another’s response and so could not choose appropriate action. They could not empathize with others or imagine themselves in another person’s shoes. In the course of this file review, the research team observed that the techniques that seemed to be effective with the more disturbed children differed from the standard defense and conflict interpretation techniques typically used with neurotic children. They realized that an implicit model of psychoanalytic treatment was often being used with these children instead of—or in addition to—the explicit classical model. This observation led them to delineate two discrete models for the
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