psychoanalytic treatment of emotional disturbance in children. The first, the classical model, involved insight and the modification of unconscious mental representations through interpretations of conflict, defense, and transference. The second, which they called the “mental process model,” focused primarily on what came to be known as mentalization, the process of reflecting on the thoughts, feelings, and mental states of self and others. By presenting detailed material from the analysis of an eight-year-old named Peter along with follow- up interview data twenty-five years later, the author provides a convincing explication of the need for and effectiveness of psychoanalysis for some severely disturbed children. She describes her therapeutical challenge to find alternative strategies of intervention after she figured out that the classical model of treatment – interpretation of unconscious conflict aimed at promoting insight – was not helpful and did not lead to elaboration or the introduction of new material in this case. The strategy the author developed in treating Peter was to focus on verbalizing his feelings and mental states, using Katan’s notion (1961, p. 185) that verbalization of affect leads to some measure of control. This analysis predated Fonagy, Target, and their colleagues’ work on mentalization . The author maintained that such verbalization increases ego strength by enabling the individual to distinguish between wishes and fantasies on the one hand, and reality on the other. By consistently labelling Peter’s feelings, and making links to his actions and subsequent feelings, Peter might in time be able himself to label and think about his mental states. To enable Peter to feel that he could control his feelings instead of his feelings controlling him became the goal of therapy. Perhaps Peter was one of those cases that alerted the research team to the use of implicit treatment techniques and that led them eventually to differentiate the mental process model. The outcome of Peter’s treatment, examined by a follow-up interview twenty-five years later, can be described as a positive, considering the emotional state he presented as a seven-year-old. @)15-1.*$# Although epistemological difficulties have discredited the case study as a research method for evaluating the efficacy of psychoanalysis, combining the richness of a case study with empirical research data shows how the two methods together can convincingly demonstrate the effectiveness of psychoanalysis with certain types of severely disturbed children. Child analysis requires a considerable investment of time and money but the cost is minuscule weighed against the cost of maintaining someone like Peter on lifetime disability, not an inconceivable trajectory for someone with the emotional challenges he presented. The Anna Freud Centre research team concluded that the effort and cost of early and intensive psychoanalytic treatment for children like Peter is particularly justified because they have the most to gain from psychoanalysis. G$#.1/.\!
Prof. Phyllis Tyson. Seattle Psychoanalytic Society and Institute 4020 E Madison St, Suite 230, Seattle, WA 98112 Email: phyllis@tysonz.com. Website: www.spsi.org
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