Studies of child analysis practice in the U.S.

Hoffman, L, Karush, R. K., Garfinkle, M. S., Roose, S. P., & Cherry, S. (2009). A cros-sectional survey of child and adolescent analysts in New York City. Journal of the American Psychoanalytic Association, 57(4), 911-917.

Merchant, A., & Hoffman, L. (2013). Raising the curtain: Conversations with child and adolescent analysts In M. O'Loughlin (Ed.), The Uses of Psychoanalysis in Working with Children's Emotional Lives (pp. 341-352). New York Jason Aronson.

Summary

There have been continued questions about the viability of the field of psychoanalysis, especially Child and Adolescent (C/A) analysis. Given the low number of child and adolescent analytic patients, the question must be asked, "Is C/A analytic education and analytic treatment relevant to adult analytic education and, more importantly, to the general mental health treatment of children?” Although there have been many scientific communications about the relevance of C/A analysis to adult analysis, there remains a lack of appreciation of the potential of C/A analysis even by the adult analytic community and in the general mental health field.

In order to understand the problem more clearly and in quantifiable terms, this work is an expansion of prior work by others such as Abrams (1979) that reported that nationally, there was a mean of 2.2 C/A cases per C/A analysts. The first step in our research was to conduct a survey which was reported in JAPA titled, A Cross-Sectional Survey of Child and Adolescent Analysts in New York City (JAPA, 2009, pp 911-917).  This survey demonstrated that the majority of graduate child and adolescent analysts did not have active C/A analytic practices. As a result we developed a semi-structured interview to see if we could identify those factors that contribute to the development of a variety of career paths for C/A analysts.

The interview was divided into three parts:

Demographic and Questions about Professional Experiences

Factual questions about practice and education, incidents or moments in treatment with child, adolescent, and adult analytic/therapy patients and

Personal and social histories of the analysts themselves.

20 Graduate Analysts from Child and/or Adolescent Training programs from NYC and from other parts of the USA were interviewed (recorded with a high level recording device to allow for acoustic analysis). The audio-taped interviews were transcribed and analyzed using the measures of the Referential Process developed by Bucci and Maskit and colleagues. (See Measures of the Referential Process, ODR second edition for details of procedures) .

Demographics

13 males and 7 females; 6 were child psychiatrists, 10 were psychiatrists, and 4 were in other mental health professions.12 were from NYC and 8 from other parts of the USA. Practice: Total number of analytic patients (3 or more times a week): 3.35 per C/A Analyst (compared to 3.2+/-2.6 in the Cross-sectional survey). Number of C/A analytic patients .5 per C/A Analyst (compared to .9+/-1.2 in the Cross-sectional survey). The group was divided into C/A analysts who currently treated C/A analytic patients (8) and those who did not (12).

Analysis of narratives

Thus far we have found that (1) emotional engagement in talking about playing in childhood and continued through adulthood is related to having a C/A analytic practice; (2) a suggestion (which needs to be further corroborated) that C/A who are more emotionally engaged (as evidenced by their high WRAD language) show greater variability in their intensity/loudness of voice; and (3) that all C/A analysts, regardless of their current status of working vs not working with C&A analytic patients, often described their C/A analytic education to have a remarkable impact on the way they understand adult patients, and/or the way they work with patients. The data needs to be further analyzed including completion of acoustic analysis, systematic utilization of the CCRT, and further systematic evaluation of the individual narratives.

Evaluation

If one considers C/A analytic education and treatment relevant to the mental health treatment of children, future generations of analysts need to be educated so that C/A analytic insights can be applied and continue to evolve in a scientific manner. This study can help us understand (1) who is attracted to the field of C/A analysis; (2) who is most likely to be effective as a C/A analyst; (3); how can these qualities be taught to other C/A analysts and C/A students; and (4) can one generalize the findings of this study to all analysts and all students of psychoanalysis, to enable them to engage more patients in analytic treatment

Contact

Leon Hoffman, MD

Email: hoffman.leon@gmail.com

Autor(s) and Affiliation: Leon Hoffman, Wilma Bucci, Bernard Maskit, Sean Murphy: Pacella Parent Child Center, Research Divison, The New York Psychoanalytic Society and Institute