Klein’s clinical technique

“The very fact that the analysis gets into contact with deep-lying unconscious anxieties gives the patient a feeling of being understood and therefore revives hope” 

Melanie Klein
Red crayon drawing by one of Klein's child patients
Drawing by one of Melanie Klein’s child patients.

Freud once remarked that, ‘It is a regrettable fact that no account of psychoanalysis can reproduce the impressions received by the analyst as he conducts it.’  However, Klein’s detailed, session-by-session account of her analytic treatment in 1941 of a 10-year-old boy known as ‘Richard’ brings us very close to this sort of experience.

Written by Klein in the third person, and annotated with a wealth of reflections on her theoretical understanding, her feelings about her patient, and her technical dilemmas during and after sessions, Narrative of a Child Analysis brings the reader right inside the consulting room:

Mrs K. had prepared some little toys and a writing-pad, pencils, and chalks on a table, with two chairs by it. When she sat down, Richard also sat down, paying no attention to the toys and looking at her in an expectant and eager way, obviously waiting for her to say something. She suggested that he knew why he was coming to her: he had some difficulties with which he wanted to be helped. (Klein, 1961)

‘Richard’

Richard is 10, and has been sent to Pitlochry in Scotland to escape the bombing of London during the Blitz. He is suffering from intense anxiety and is unable to attend school. The analysis has to take place in a makeshift consulting room – a girl guides’ hut – with a backdrop of turbulent war and air raids on London.

Photo of the inside of the Girl Guides hut where Klein analysed Richard
The Girl Guides hut in Pitlochry, Scotland, where Klein analysed ‘Richard’ in 1941.

As they negotiate these challenges, Klein and Richard establish a touching, lively relationship with obvious affection developing between them. Richard is articulate and eager to discuss what is on his mind. From the first session we see Klein taking seriously his immediate worries and preoccupations – and the trauma of the war raging in Europe is never far from either of their minds. But what she also takes up with him, from the very beginning, are his unconscious phantasies and anxieties, including those revealed in his feelings about her. Klein was convinced that direct interpretations of both the positive and negative feelings were crucial for genuine analytic work to take place, and that this included transference interpretations – with children just as with adults.

Read more about Klein’s time in Pitlochry...

Example of Klein’s work: interpreting a drawing

It is her 12th session with Richard, and he has made a drawing including one of a series of ‘starfishes’. She interprets the picture as follows:

Drawing of a ship, U-boat and starfish by ‘Richard’, from his 12th session with Klein.

Mrs K. interpreted that the hungry starfish, the baby, was himself; the plant, Mummy’s breast which he wished to feed from. When he felt like a greedy baby, who wanted his mother all to himself and could not have her, he became angry and jealous and felt he attacked both parents. This was represented by the U-boat, which would ‘probably’ attack the ship. He was also very jealous of John because, as Mrs K.’s patient, he received time and attention from her. The analysis stood now for being fed. He had said that everything which went on under water had nothing to do with the upper part. This meant that greed, jealousy, and aggression were not known to one part of his mind, they were kept unconscious. In the top part of the drawing, divided off from the lower half, he expressed his wish to unite his parents and to have them happily together. These feelings, of which he was quite aware, were experienced in what he felt to be the upper part of his mind.

In her characteristically direct way, Klein explains to Richard how his drawing reveals the intense dramas going on in different layers of his mind. Through her careful description of his internal struggles you can see how she stays closely in touch with both his conscious worries and his unconscious phantasies; both his aggression and his desire to protect his loved ones. As she saw it, the task for us all from infancy onwards is to navigate such conflicting feelings of love and hate.

Modern readers, even those well versed in psychoanalysis, may be shocked by the matter-of-fact way Klein talks to Richard about his anxieties, particularly sexual or sadistic phantasies. She doesn’t mince her words when interpreting his fears of being castrated, devouring his mother’s insides, being attacked by a distorted image of his father’s penis, longing to have babies with his Mummy, and so on. Some might think that talking to a child in this way might simply increase his anxiety. Klein was convinced that the only way to provide relief would be to get in touch with and then to verbalise the child’s worst fears and most troubling phantasies, however mad or frightening they sounded. She also believed, as most analysts do today, that making the unconscious conscious is inevitably painful, but that in the longer term having one’s worst fears understood and verbalised brings huge relief, to children and adults alike.

Aggression and guilt in childhood: interpreting play

Drawing by Klein's patient Richard
A drawing by Melanie Klein’s child patient, ‘Richard’.

Richard suffers from huge anxiety about disasters befalling the people he loves – including Klein herself. Like many children who come to psychotherapy, in his play Richard often acts out scenes which end in catastrophe. Here is an extract from the middle of his analysis: 

Richard made various groups of the little figures: there were two men together, then a cow and a horse in the first truck, and a sheep in the second. Then he arranged the little houses to form a ‘village and a station’. He made the train run round and into the station. As he had left too little space, the train knocked over the houses, and he put them up again. He pushed the other train (which he called an ‘electric’ train) and a collision ensued. He became very upset and made the ‘electric’ train run over everything. The toys piled up and he spoke of it as a ‘mess’ and a ‘disaster’. In the end only the ‘electric’ train was left standing up.

After this Klein speaks to Richard about what he feels as an internal catastrophe, caused by his own anger and destructiveness. She saw his consequent distress as an indication of a deep despair that his violent, hateful feelings towards a loved object inside his own mind have led to terrible damage, and that he won’t have enough love or internal resources to put things to rights.

A photo of painted wooden cars from the 1920s, like those used by Klein with her child patients
Painted wooden toys from the 1920s, like those used by Klein with her child patients.

All children have a tendency to fear deep down that when bad things happen it must be their fault. Klein understood this as a confusing mental state, in which guilt about their own aggressive thoughts and feelings are compounded with actual damage to themselves or members of their family. For some, like Richard, this leads to such intense anxiety that they become inhibited in key areas of their life.

Talking to children about their anxieties

Anyone working with children in psychoanalysis or psychotherapy will recognise this scene, where the consulting room has been trashed and the child is filled with despair. Klein was one of the first clinicians to show that getting hold of these deep-rooted fears can bring immense relief to children who have got into such a desperate state.

You can see in her work with Richard how such interpretations, made with empathy and compassion, offer relief of the most profound kind, which is the relief of feeling deeply understood. Like Freud, Klein believed that only through having one’s darkest impulses and phantasies understood comes the hope of repairing damage and bringing back loving feelings:

“The very fact that the analysis gets into contact with deep-lying unconscious anxieties gives the patient a feeling of being understood and therefore revives hope.”

Reassurance

Klein did not believe that, in a clinical setting, ‘reassurance’ for its own sake was helpful to the child. In fact, she believed that it did a disservice to the integrity of the analytic relationship. Although children might seek direct answers, physical comfort or sympathy, Klein believed that, in analysis, true comfort came from addressing the most immediate and most frightening feelings in the room.

At times she describes making mistakes, falling into the easier role of providing short-term comfort or reassurance when Richard asks for it. But after each such episode it is clear that Richard becomes more anxious rather than less, feeling that his aggressive feelings have been smoothed over.

Klein explains that even her child patients could recognise when she was colluding with defences against pain, offering superficial reassurance rather than staying with the painful reality; and in these moments she felt she had let them down, diminished their trust in her, and increased their sense of loneliness. Again, child therapists today may well recognise these dilemmas in their work with vulnerable children.

Ending treatment, and the revival of hope

As the treatment proceeds Richard himself communicates growing gratitude and lessening anxiety as his conflicts and inner turbulence are brought into the open, and he increasingly expresses his love and appreciation of Klein in a moving way. After one interpretation he tells her, ‘There is one thing I know and that is that you will be a lifelong friend of mine.’  By the end of the treatment, which for practical reasons was limited to only four months, Richard is not completely cured, but he has already become significantly less anxious, is able to attend school at least for a while, and is described by his parents as being more affectionate with them.

In Narrative of a Child Analysis the colourful relationship between patient and analyst is brought to life, providing a fascinating first-hand account of Klein’s clinical work. As it was written at the very end of her life, Richard’s material is portrayed through the lens of her now fully developed theories of emotional development and its roots in infancy, including concepts such as the paranoid-schizoid and depressive positions, projective identification, oedipal anxieties and the links between love, guilt and reparation. Narrative also provides the foundation and blueprint for future generations of theoreticians and practitioners who have continued to develop and evolve psychoanalytic psychotherapy with children.

Read about Klein’s legacy in the world of contemporary child psychotherapy…