Hampstead Clinic Research Articles

The value of direct child observation in a therapeutic parent-toddler group, for students of psychoanalysis

ABSTRACT Starting in Vienna in the 1920s, Anna Freud’s first tentative attempts at observing children became a crucial component of the ‘double approach’ which integrated direct child observation with psychoanalytic reconstruction. This approach enabled the detailed study of unfolding developmental processes and the construction of a theory of normative as well as pathological child development. Direct child observation was an integral component in the curriculum of the Psychoanalytic Master’s degree at Anna Freud’s Hampstead Clinic (later, the Anna Freud Centre) in London. The process, experience and value of observation for students of psychoanalysis is described, focussing on observers in a therapeutic parent-toddler group. The experience of observing or being observed is discussed from the perspective of staff facilitating the group, students, parents and children.

Observing, playing and supporting development: Anna Freud’s toddler groups past and present

This paper describes an approach to working therapeutically with parents and toddlers in groups as practiced at the Anna Freud Centre. By intervening early to prevent later disturbance, the parent–toddler groups continue the tradition begun by Anna Freud in the Jackson Nursery in Vienna, the War Nurseries in and around London, and the Hampstead Clinic following the Second World War. Common features include the commitment to working with children and their parents, to observation, training and research, and to finding techniques that address developmental needs, delays and disturbances. Just as children select the specific therapeutic elements they need from a classical child analytic setting, parents and toddlers select what they need from what Anna Freud described as the various ‘therapeutic possibilities’ provided by the parent–toddler groups. The parent–toddler relationship is supported during a period which is crucial for future development, difficulties are identified and addressed before they become entrenched, and, where necessary, timely referrals are made to clinical services on the basis of the trusting relationships developed between the staff and parents in the groups.

Discussion of Berta Bornstein's “The Analysis of a Phobic Child”

Bornstein's paper is a true psychoanalytic study of a child, if ever there was one. The fine tracing and discussion of the technical detail, together with the clarity and exposition of the theoretical underpinning make it a truly deep and thorough study and a model for those of us doing this work and trying to understand what indeed we do and why. I should say that although I have read the writings of the (then) Hampstead Clinic's borderline workshop (Kut Rosenfeld and Sprince, 1965), I had not read this outstanding paper by Berta Bornstein, and I wish I had done so long ago. I shall begin with some comments about psychoanalytic theory and then go on to discuss Bornstein's abundant and fascinating analyses of technique. I shall conclude with some observations on the child's psychopathology.

Phenomena of Childhood Trauma and Expanding Approaches to Early Intervention

Throughout my career, psychoanalytic training has always served three invaluable roles or functions. It has been central to conducting all of my clinical work with patients – whether in consultations, psychoanalysis or psychotherapy; informs all of the teaching and supervision I do as a professor of child and adult psychiatry at the Yale School of Medicine; and it has been the basis for developing new treatment approaches that might benefit a substantial number of children and families who are deeply impacted by trauma that results from their exposure to violence and other catastrophic events. The fact that these children and families were both rarely recognized and rarely seen in our consulting rooms or clinics led to the development the Child Development-Community Policing program (CDCP), a psychoanalytically informed collaboration between law enforcement and mental health professionals (Marans, 1996, Marans et al., 1995). The CDCP program involves the cross-training of both professional groups – clinicians learn about the work and role of police officers as sources of order and safety, while police officers learn about the principles of development as a context for considering the impact of the events that require their presence on the lives of children and families. Over the years, the CDCP program has led to new methods of responding collaboratively to potentially traumatic events that occur in homes and neighborhoods (Marans, Smolover, & Hahn, 2012) and has been replicated or served as model for similar law enforcement–mental health partnerships in numerous communities around the United States and abroad. The notion that psychoanalytic principles could be applied to settings beyond the consulting room was not new. My training at the Hampstead Clinic and earlier exposure to psychoanalysis and its applications while growing up made me especially aware of the enormous contributions made by psychoanalysts – Anna Freud, Dorothy Burlingham, August Aichorn, Sally Provence, Sam Ritvo, Edith Jackson, James and Joyce Robertson, Al Solnit, Dale Meers, Mel Lewis, Selma Fraiberg to name but a few – who increased both the recognition and breadth of response to the needs of children whose optimal development was at greatest risk. Copyright © 2013 John Wiley & Sons, Ltd.

“There Has Never Been Anything Like a Classical Child Analysis”: Clinical Discussions with Anna Freud, 1970–1971

This paper reports on a series of clinical discussions with Anna Freud, faculty and trainees at the Hampstead Clinic in 1970-1971. Anna Freud's comments are published here for the first time. The meetings concerned the nature and use of relationships in work with children who do not have a well-defined neurosis. If parochial borders are erased among the domains of upbringing, education, and psychoanalysis, potential therapeutic fertility and strength can increase. The clinical material in the paper makes it possible to explore the old and new aspects of the treatment relationship, such as the transferential, the externalization of the self-representational, the developmental, and so forth. This is a personal account of a formative experience during training.

The Hampstead Clinic at Work

Minutes of the Hampstead Clinic's Diagnostic Profile Research Group during a fifteen-month period (1964-1965) are reviewed and discussed. A wide range of topics were considered and discussed, with a special focus on the affective life, object relations, and ego function of atypical children in comparison to the early ego functions and differentiation of normal and neurotic children. These lively clinical and theoretical discussions and their implications for therapeutic work with a wide range of children, demonstrate the multifaceted leadership and contributions of Anna Freud as teacher, clinician, and thinker, and of the Hampstead Clinic as a major center for psychoanalytic studies.

The History and Current Status of Outcome Research at the Anna Freud Centre

In past decades there have been impressive systematic studies of the outcome of the psychoanalysis across groups of patients and analysts, but the studies carried out to date have almost all been with adult patients. There is very little information even on the short-term outcome of psychoanalytic treatment for children. The information that does exist has largely emerged from the research tradition of the Anna Freud Centre (formerly the Hampstead Clinic) in London. The paper surveys the early studies and details the current program of research at the AFC, providing a review of fifteen years of work on the outcomes of child psychoanalytic therapy.

A Way of Looking at Things: Selected Papers From 1930 to 1980 by Erik H. Erikson

A Way of Looking at Things: Selected Papers From 1930 to 1980 by Erik H. Erikson

Memories of a ‘qualified student’

Abstract The author writes a personal memoire of her experience as an early trainee at the Hampstead Clinic. She continues with reminiscences of over thirty years of contact with Anna Freud.

Can We Dispense with Defense?

Can We Dispense with Defense? The Analysis of Defense: The Ego and the Mechanisms of Defense Revisited. ]. Sandier with A. Freud. New York: International Universities Press, 1986. (556 pp.) Toward the end of her life, Anna Freud participated in a series of discussions with Joseph Sandier, at which her most influential work, The Ego and the Mechanisms of Defense (published 40 years previously) was reconsidered. These meetings were attended at different times by a number of other psychoanalysts, mostly from the Hampstead Clinic, who also made occasional contributions to the discussions. The content of these meetings was recorded verbatim, and this book consists of edited transcriptions, each chapter of the original work being discussed in turn, with an introduction by Joseph Sandier. At first sight this format seems promising. It is rare to have access to someone's reflections on their early mature work, and Anna Freud emerges as modest, witty, and, despite Sandler's frequent urgings, reluctant to be forced into doctrinal nitpicking. She even enlivens the proceedings with an occasional genteel sideswipe at Klein. But before one has read many pages, the cosiness and smugness of the discussion become suffocating and it becomes clear that one is eavesdropping on a meeting of disciples rather than attending a scientific debate. Apart from some anecdotal references to individual cases, the discussion is largely concerned with the need to tidy up some of the many contradictions or unclarities of the original text. This task makes relatively little headway, however, in the face of the almost flippant psychoanalytic pragmatism with which Anna Freud defends any concept that is capable of application somewhere. Thus the reconsideration leaves the topographic and structural models coexisting, while the unconscious as a system and the unconscious mental processes remain blurred. The Ego and not the person is the chief actor on the stage. Unrepentent reification rules. The discussion as to whether the Id feels comfortable when invading Ego territory, or whether the Ego has any innate friendliness towards the Id, to balance this hostility (p. 284), betrays only the mildest awareness of the limited value of counting angels on pinheads. The hermetic feel of the discussion is further heightened by the absence of any serious consideration of other views, even from within psychoanalysis, so that, for example, object relations theory and the phenomenon of projective identification are scarcely alluded to, and the recent development in, or debate about, the self, in the psychoanalytic theory of personality, is mentioned only in passing. We are left, then, with the original text, with the familiar list of defenses described in quasi-military metaphors, although with an added emphasis from Anna Freud to the effect that, of course, they always occur in combination, and with much evidence from the discussion of the slipperiness of these concepts, even when employed by like-minded discussants. For example, I myself have always had some difficulty with the concept of sublimation, although I recognize that a drive theory requires an explanation of some sort for constructive and altruistic behavior. The example given did not help me, however. It is an account of a strip cartoon (p. 69), evidently a favorite of Freud pere, which describes the following scene: A girl on a village green is leading a flock of geese. A traveler stops and talks to the goose girl, recognizes her intelligence, and arranges for her to attend higher education. In the final picture we see the girl again on the village green, now leading a file of school children. But if this is sublimation, what was the girl's original libidinal interest in geese? Nonetheless, ambiguous and nonexclusive though they are, the "mechanisms" have served generations of therapists as a descriptive framework with which to make sense of clinical phenomena, which would suggest that, in the consulting room, they offer some accessible maps at an appropriate level of abstraction. …

Book Reviews

Abstract Abstract Henry E. Adams and William K. Boardman. Advances in Experimental Clinical Psychology. Elmsford, N. Y.: Pergamon Press, 1971, 219 pages, $11.50. Reviewed by Sol L. Garfield L. B. Ames, R. W. Metraux, and R. N. Walker. Adolescent Rorschach Responses. Rev. Ed.) New York: Bruner/Mazel, 1971, 319 pages, $10.00. Reviewed by Donald B. Colson, Ph.D. Rudolf Arnheim. Toward a Psychology of Art: Collected Essays. Berkeley and Los Angeles: University of California Press, 1972, 369 pages, $3.95. Reviewed by Ray A. Craddick, PhD Harriet Linton Barr, Robert J. Langs, and Robert R. Holt, Leo Goldberger, George S. Klein. LSD: Personality and Experience. New York: Wiley-Interscience, 1972, 247 pages, $10.00. Reviewed by Russell Eisenman Marta Olivetti Belardinelli. Identificazione e proiezione: Natura e caratteristiche. Bologna: Cappelli Editore, 1971, 212 pages. Price not given. Reviewed by Luciano L'Abate Henry B. Biller. Father, Child and Sex Role. Lexington, Massachusetts: D. C. Heath, 1971 xi, 208 pages, $12.50. Reviewed by A. Barclay, Ph.D. Herbert L. Collier. The Psychology of Twins. Phoenix: Herbert L. Collier, Ph.D., Ltd. 1972. 145 pages, no price given. Reviewed by Edward S. Filicky, Ph.D. W. Grant Dahlstrom, George S. Welsh, and Leona E. Dahlstrom. An MMPI Handbook, Volume I: Clinical Interpretation. Minneapolis: University of Minnesota Press, 1972. 507 pages, $18.75. Reviewed by Jerome D. Pauker, PhD Hans J. Eysenck (Ed.). Readings in Extraversion-Introversion, 3 volumes. New York: Wiley Interscience-John Wiley, 1971, 1411 pages, $41.50 set. Reviewed by Eugene J. Loveless, PhD Hans J. Eysenck and Sybil Eysenck. Personality Structure and Measurement. San Diego: Robert Knapp, 1972. 365 pages, no price given. Reviewed by Russell Eisenman Charles A. Kiesler. The Psychology of Commitment. New York: Academic Press, 1971, xii + 190 pages, $9.95. Reviewed by Lita Linzer Schwartz Edgar A. Levenson. The Fallacy of Understanding: An Inquiry into the Changing Structure of Psychotherapy. New York: Basic Books, 1972, 236 pages, $7.95. Reviewed by Lois Ann Levin, Ph.D. Eugene E. Levitt and Aare Truumaa. The Rorschach Technique with Children and Adolescents. New York: Grune and Stratton, 1972, 146 pages, $7.95. Reviewed by Robert Allen, PhD S. R. Maddi and P. T. Costa. Humanism in Personology. Chicago: Aldine-Atherton, 1972, 200 pages. Cloth, $7.75; Paper, $3.75. Reviewed by Ernest Kramer, Ph.D. James F. Masterson. Treatment of the Borderline Adolescent: A Developmental Approach. New York: Wiley & Sons, 1972, 289 pages, $13.50. Reviewed by Leo Goldberger, PhD James F. Masterson. Treatment of the Borderline Adolescent: A Developmental Approach. New York: John Wiley & Sons, 1972, 289 pages, $13.50. Reviewed by Irving R. Stone Peter Mittler (Ed.) The Psychological Assessment of Mental and Physical Handicaps. London: Methuen; New York: Barnes & Noble, 1970, 857 pages, $25.00. Reviewed by Leon J. Whitsell, MD H. Nagera (Ed.). The Hampstead Clinic Psychoanalytic Library. Vol. IV. Basic Psychoanalytic Concepts on Metapsychology, Conflicts, Anxiety and Other Subjects. New York: Basic Books, 1970, 233 pages, $7.50. Reviewed by George Athey, Jr., PhD A. S. Neill. Neill! Neill! Orange Peel! New York: Hart Publishing Co., 1972, 538 pages, $10.00. Reviewed by Irving R. Stone Donald P. Ogdon. Psychodiagnostics and Personality Assessment: A Handbook. Los Angeles: Western Psychological Services, 1967, paperbound, 96 pages, $7.50. Reviewed by Eleanore Kay B. G. Rosenthal, The Images of Man. New York: Basic Books, 1971, 244 pages, $8.95. I. Chein, The Science of Behavior and the Image of Man. New York: Basic Books, 1972, 348 pages, $12.50. Reviewed by Benjamin Beit-Hallahmi Joseph S. Roucek (Ed.). The Slow Learner. New York: Philosophical Library, Inc., 1969, 373 pages, $10.00. Reviewed by Leon J. Whitsell, M.D. Aron W. Siegman and Benjamin Pope (Eds.) Studies in Dyadic Communication. New York: Pergamon Press, 1972, 336 pages, $13.50. Joseph D. Matarazzo and Arthur N. Wiens. The Interview: Research on its Anatomy and Structure. Chicago: Aldine·Atherton, 1972, 183 pages, $9.75. Albert Mehrabian. Nonverbal Communication. Chicago: Aldine·Atherton, 1972, 226 pages, $9.75. Reviewed by David C. Murray

Basic Psychoanalytic Concepts on the Theory of Instincts. The Hampstead Clinic Psychoanalytic Library, Vol. III. By Humberto Nagera, et al. New York: Basic Books, Inc., 1971.136 pp.

Basic Psychoanalytic Concepts on the Theory of Instincts. The Hampstead Clinic Psychoanalytic Library, Vol. III. By Humberto Nagera, et al. New York: Basic Books, Inc., 1971.136 pp.

Book review

Abstract Abstract Cecile Beizmann. Handbook for Scorings of Rorschach Responses. New York: Grune & Stratton, 1970, 244 pages, $9.50. Reviewed by Henry Hoey Donald S. Marshall, & Robert C. Suggs, (Eds.). Human Sexual Behavior. New York: Basic Books, 1971. 302 pages, $10.00. Reviewed by Russell Eisenman Calvin S. Hall & Gardner Lindzey. Theories of Personality. 2nd ed., New York: Wiley, 1970, 622 pages, $9.95. Reviewed by Eric C. Theiner Mary R. Haworth. The CAT. New York: Grune & Stratton, 1966, 322 pages. $10.75. Reviewed by Russell Eisenman Milton Kramer (Ed.). Dream Psychology and the New Biology of Dreaming. Springfield, Illinois: Charles C. Thomas, 1969, 459 pages, $17.00. Reviewed by Thomas W. Allen Humberto Nagera (Ed.). Basic Psychoanalytic Concepts on the Theory of Dreams. The Hampstead Clinic Psychoanalytic Library, Vol. II. New York: Basic Books, 1969. Reviewed by Dr. Rose Palm Mortimer Schiffer. The Therapeutic Play Group. New York and London: Grune & Stratton, 1969. 214 pages, $8.75. Reviewed by Irving R. Stone James O. Palmer. The Psychological Assessment of Children. New York: James Wiley & Sons, Inc., 1970. 474 pages, $12.50. Reviewed by Max R. Reed

Basic Psychoanalytic Concepts on the Libido Theory.

This slender volume initiates the Hampstead Clinic Psychoanalytic Library, appropriately celebrating Miss Anna Freud's 75th birthday. This promising scholarly series is, to begin with, an attempt to define psychoanalytic concepts in terms of their origins in Freud's writings. Based on six years of effort by a large team of analytic collaborators under the leadership of Humberto Nagera (and backed up by a distinguished panel of senior consultants), this important lexicographic work will appear in four volumes: the book under review thus constitutes but a fraction of the whole. The reviewer's task is inevitably too difficult when it involves focusing on such a fragment; in this case, the editor has provided no assistance through describing the overall schema of his project. It is only from the publisher's dust jacket that one learns about the three volumes that will complete this set and their titles; this clue is, however,

The Psychoanalytic Study of the Child, vol 21.

The annual publication of The Psychoanalytic Study of the Child has become a significant landmark in psychoanalysis. The current edition, No. 21, deserves its place in this excellent series. These volumes are addressed primarily to those interested in the theoretical exposition of psychoanalysis in general and of child psychoanalysis in particular. Several of the articles are intimately involved with points of theory and practice that are of interest only to the limited professional groups to which they are addressed. Nevertheless, in the present volume there are some contributions of interest to internists. Anna Freud's A Short History of Child Analysis places this rapidly developing field into historical perspective and, despite its brevity, points to some directions for the future. Characteristically, she does not do justice to the importance of her own work at Hampstead Clinic in London. Wolfenstein's presentation, How is Mourning Possible? serves not only to outline the pertinent

Some conceptual problems involved in the consideration of disorders of narcissism

Abstract In a number of different areas of work at the Hampstead Clinic research groups have been concerned with the progressive refinement of psychoanalytic concepts in their application to clinical material. In particular, the procedure of systematic indexing of psychoanalytic case material (Sandler, 1962) and the routine application of Anna Freud's Diagnostic Profile (Anna Freud, 1963), have thrown up problems relating to the conceptual tools at our disposal for the evaluation of what can, broadly speaking, be called “disorders of narcissism”.

The ego-ideal in the treatment of children and adolescents.

THE CONCEPT of ego-ideal has undergone many vicissitudes since first introduced by Freud in 1914. 1 As Sandler and his colleagues 2 at the Hampstead Clinic have summarized, much of this confusion is inherent in the variation in terminology used by Freud and the analytic pioneers as they progressed in their understanding of the components of the human personality. With the recent upsurge of interest and investigation of the super-ego and its facets, much discussion has evolved around the necessity of or benefit from retaining the concept of ego-ideal as distinct from that of the super-ego. In the view of the Hampstead group, 2 the term ego-ideal covers a number of aspects of the personality which should be functionally differentiated at all ages. Hartman and Lowenstein 3 maintain that the ego-ideal is merely part of the super-ego continuum and that the earlier role of