For nearly 100 years Melanie Klein’s ideas have provided fertile ground for clinicians and professionals, deepening our understanding of children’s emotional worlds. Theorists such as Donald Winnicott, Wilfred Bion and Edna O’Shaughnessy have brought further insights into the complex psychological dynamics involved in the relationship between babies and their caregivers. Clinicians today continue to use and develop these theories in a wide range of settings, through therapeutic work and consultation with children and families from infancy to young adulthood.
Infant observation and child psychotherapy training
Klein was fascinated by the emotional world of babies, closely observing the way they respond to pleasure, pain and frustration.
“I have seen babies as young as three weeks interrupt their sucking for a short time to play with the mother’s breast or look towards her face. I have also observed that young infants – even as early as in the second month – would, in wakeful periods after feeding, lie on mother’s lap, look up at her, listen to her voice and respond to it by their facial expression; it was like a loving conversation between mother and baby.”Klein, ‘On observing the behaviour of young infants’ (1952)
Esther Bick, a child analyst, first introduced weekly observations of babies as a core component of the Tavistock Clinic’s child psychotherapy training in 1948. Since then the practice of psychoanalytic infant observation has grown rapidly. It remains a key training component for child psychotherapists at the Tavistock and elsewhere, but is now also a core requirement for child and adult psychoanalytic trainings at the Institute of Psychoanalysis, and for many other adult psychotherapy trainings. Infant observation is increasingly used as a training module in a wide range of professional trainings across the UK, parts of Europe and the USA.
- ‘The experience of skin in early object relations’ (Bick, 1968)
- Closely Observed Infants (Miller, 1989)
- Developments in Infant Observation (Reid, 1997)
- Surviving Space: Papers on Infant Observation (Briggs, 2002)
- ‘Melanie Klein and infant observation’ (Sherwin-White, 2017)
Child psychotherapy in the public sector
Child psychotherapists and analysts continue to see children and adolescents in private practice for a range of issues such as anxiety, depression or aggressive behaviour, using a very similar model to that used by Klein with her child patients (read more about Klein’s technique). But modern child psychotherapy in the UK now has a presence across child and adolescent mental health services, social service departments, hospitals, schools, residential units and general practice settings.
- Give Sorrow Words: Working with Dying Children (Judd,1989)
- The Learning Relationship: Psychoanalytic Thinking in Education (Youell, 2006)
- Creating New Families: Therapeutic Approaches to Fostering, Adoption and Kinship Care (Kenrick, 2006)
- ‘Child Psychotherapy in the Baby Clinic of a General Practice’ (Daws, 1999)
- ‘Towards emotional containment for staff and patients: developing a Work Discussion group for play specialists in a paediatric ward’ (Trelles-Fishman, 2019)
- Reflecting on Reality: Psychotherapists at Work in Primary Care (Blake, 2005)
- What Can the Matter Be?: Therapeutic Interventions with Parents, Infants and Young Children (Emanuel, 2008)
Symptoms and diagnoses
Klein’s child patients brought a range of psychological difficulties including obsessional anxiety, paranoia, aggression, night terrors, soiling, inhibitions in learning, and borderline psychosis. Many of them would probably be given mental health diagnoses today.
Contemporary child psychotherapists continue to offer therapy to children who have diagnoses, some of whom may also be receiving medication for conditions such as aspergers, autism, or attention deficit disorder. Young patients today also include those with a range of special needs, learning difficulties and developmental delay.
- Psychotic States in Children (Rustin, 1997)
- Childhood Depression: A Place for Psychotherapy (Trowell, 2011)
- Autistic States in Children (Tustin, 1981)
- Unexpected Gains: Psychotherapy with People with Learning Disabilities (Simpson, 2004)
- The Many Faces of Asperger’s Syndrome (Rhode, 2004)
- Internal Landscapes and Foreign Bodies: Eating Disorders and Other Pathologies (Williams, 1997)
Adversity and trauma
Child psychotherapists also work therapeutically with children and families suffering from extreme adverse events, including the legacy of sexual abuse, neglect and violence. They also work with unaccompanied asylum seekers, refugees, teenagers caught up in gangs, children in state care undergoing multiple placements, self-harming teenagers, victims of torture or patients suffering from acute or chronic medical conditions.
- Live Company: Psychoanalytic Psychotherapy with Autistic, Borderline, Deprived and Abused Children (Alvarez, 1992)
- Psychotherapy with Severely Deprived Children (Boston, 1990)
- ‘Too much to swallow? Some reflections on adolescent overdose’ (Mirvis, 2018)
- Facing It Out: Clinical Perspectives on Adolescent Disturbance (Anderson, 1998)
- Transforming Despair to Hope: Reflections on the Psychotherapeutic Process with Severely Neglected and Traumatised Children (Lanyado, 2017)
- ‘The monster and the ballet dancer: A four-year-old’s view of sexual abuse’ (Hunter, 1986)
Consultation with other professionals
Professionals on the frontline such as doctors and nurses, family lawyers, social workers, youth offending teams, teachers or early years staff may seek out consultation on specific children or situations from psychoanalytically informed clinicians. Klein’s concepts of projective identification, and the impact of transference and countertransference can be particularly helpful for those struggling to understand the disturbing behaviour of vulnerable or traumatised children.
- ‘Exporting the Tavistock model to social services: Clinical consultative and teaching aspects’ (Canham, 2001)
- Engaging with Complexity: Child and Adolescent Mental Health and Education (Harris, 2011)
- Sent Before My Time: A Child Psychotherapist’s View of Life on a Neonatal Intensive Care Unit (Cohen, 2003)
- Work Discussion: Learning from Reflective Practice in Work with Children and Families (Rustin, 2008)
- ‘Psychotherapy with hospitalised children with Leukaemia: is it possible?’ (Emanuel, 1990)
- ‘Developing containment – consulting to residential units’ (Sprince, 2010)
Understanding childhood in society
Various publications have been offered by child psychotherapists which contribute to contemporary discussions of childhood and parenting in the UK, for example:
- The Tavistock’s Understanding Your Child series (Bradley)
- Saying No: why it’s important for you and your child (Phillips, 1999)
- Inside Lives: Psychoanalysis and the Growth of the Personality (Waddell, 2002)
- Thinking About Infants and Young Children (Harris, 1975)
- Through the Night: Helping Parents with Sleepless Infants (Daws, 1989)
- Acquainted with the Night: Psychoanalysis and the Poetic Imagination (Canham, 2003)
- Narratives of Love and Loss: Studies in Modern Children’s Fiction (Rustin, 2001)
- Mirror to Nature: Drama, Psychoanalysis and Society (Rustin, 2002)
Visit the Association of Child Psychotherapists website for more information on the work of child psychotherapists and additional resources. You can train as a child analyst at the Institute of Psychoanalysis, or as a child psychotherapist at the Tavistock.