This website is offered as an educational tool and a referral resource for children, adolescents and adults for whom analysis is appropriate. NO TREATMENT IS BEING OFFERED AT THIS SITE AND NOTHING SHOULD BE CONSTRUED TO THE CONTRARY. Evaluations of mental health needs should be done with qualified professionals directly. This website, when able, will provide referrals to such mental health professionals. In addition, Dr. Childress will offer in-office consultations, as time allows, make referrals locally in the Chicago land area or, in some cases, on a nation-wide basis. Links to national professional rosters will be provided.
AN OVERVIEW OF THE PROCESS
|PSYCHOANALYSTS ARE FULLY TRAINED MENTAL HEALTH PROFESSIONALS (seasoned practicing social workers, psychologists and psychiatrists, in the main) who have received additional training in analytic technique (a minimum of five years), have undergone their own personal psychoanalysis with a senior analyst, and have conducted sufficient analyses under supervision (usually three to four). Child psychoanalysts, who usually have considerable prior experience working with children before undertaking their analytic training, must undertake additional course work specifically focused on child analytic technique.In addition to conducting adult analysis, they must also analyze under supervision three child and adolescent cases. Upon completion of all requirements these candidates are certified in both child and adult analysis. Individuals in psychoanalytic training are called candidates, and the patients whom they analyze under supervision are called analysands. Those who supervise candidates are referred to as supervising analysts and those who provide a training analysis for candidates are known as training analysts. Training and supervising analysts are senior people who have years of clinical experience following their own training. The training analysis, a personal exploration of the individual candidate’s psychology, is totally confidential and has no bearing on a candidates progression through the educational process. Because there is a training benefit to the candidates, their cases may be seen at reduced fees. Graduate analysts may go into practice, stay at their Institute and teach, and may, with further work, become training and supervising analysts themselves.
THE ADULTS BEING TREATED ARE USUALLY INTELLIGENT, NON-PSYCHOTIC, SELF-REFLECTIVE PEOPLE who find themselves in a recurrent pattern of failed relationships, self defeating behaviors, low self-esteem, or failed opportunities. If analysis is recommended they will be seen 4 to 5 times a week on the analytic couch. The couch is used to support the process of free association—that is saying whatever comes to mind—by decreasing the number of social cues, gestures, and facial expressions that could subtly shift the course of a patient’s associations. Freud’s original metaphor about technique still applies today: one should imagine oneself on a train ride with the analyst but having the window seat—the patient is to describe the terrain that passes by the window which, of course, is the window of the mind. The free thoughts reveal not readily discernable patterns of thought, feelings and behavior predicated on early past experiences which continue to interfere with current life.
SAYING WHAT COMES TO MIND REVEALS THAT THE PAST HAS BEEN ALIVE IN THE PRESENT. In analysis, one is seen four to five times a week, and this frequency allows for greater awareness of one’s own experiences within the analytic setting. Feelings about the analyst’s comments, silence, vacations, etc. highlight meanings brought to the current situation from the past and are recognized as “transferences”. Analysis is the least manipulative opportunity for self-exploration available and the best for making characterologic changes. Being non-directive, much of the sense of support comes from the frequency of sessions and the analyst’s dedication to aiding the patient’s self-exploration. Through analysis, symptoms, painful thoughts, feelings or behaviors which seem thrust upon one, are discovered to be chosen compromises designed to protect the individual from the psychic pain of guilt, humiliation, anxiety or depression. Symptoms are, therefore, not easily given up as they are an attempt at safety as well as a source of pain.
THE TENDENCY TO AVOID FEELINGS OR THOUGHTS IN THE SERVICE OF MAINTAINING SYMPTOMS IS REFERRED TO AS “RESISTANCE”. As with dreams, when resistance is examined, its conflictual organization and the origins of its protective function can be uncovered. In the process of an analysis many uncomfortable thoughts and feelings are recovered which ultimately allow patients to develop a sense of grounded personal continuity from their childhood to the present. It is the alliance with the analyst in the quest for self-understanding which helps the patient to continue the process through painful periods. In the assessment process adults will be seen over a period of time to determine if analysis is the treatment of choice—major contraindications are psychotic episodes, heavy drug dependence, poor impulse control, and poor relationships with people. People on medication may be good candidates for analysis, though the analyst usually does not prescribe the medication, and there may be reason to have a period of work while no medication is being taken.
THE CHILDREN THAT ARE ASSESED ARE YOUNGSTERS WHO ARE STRUGGLING WITH ANXIETY IN A SIMILAR FASHION TO THE ADULTS—these early struggles may be the prototype for adult conflict constellations. Again, symptoms are not unwanted thoughts, feelings or behaviors thrust upon them but, rather, chosen compromises designed to protect them from feelings of guilt, humiliation, anxiety and depression. Adolescents, in their struggles for accommodation to pubertal changes and the upsurge of childhood conflicts amidst their struggles for autonomy, offer a more challenging task—these young people often feel that the problems they are facing come from outside themselves from parents, teachers, authorities, society, etc. While adults better understand the process of an analysis and more easily develop an alliance that helps them manage trying times in treatment, children and adolescents usually do not. This piece must be supplied by the parents; work and an alliance with parents are essential to child treatment though the extent to which this is necessary varies with the developmental stage of the child patient.
ALTHOUGH ADOLESCENT PATIENTS WHO WANT TREATMENT MAY BE INTERVIEWED INITIALLY, it is more usual that the parents are met with first. Central issues with adolescents are confidentiality and their developmental thrust towards separation and individuation. Diagnostic sessions with a younger child are not begun until an alliance with the parents is established. In the course of an initial contact it may be determined that current parental experiences (eg. over-anxious parent, divorce, grief over loss of a loved one) may indicate that the work should be with the parents. This is almost always the case with children under three years of age. Parents need to have an understanding of the overall treatment process (see Post WORKING WITH PARENTS…). For treatment to come to a satisfactory conclusion, parents must know that it is common for the symptoms they were most concerned about to disappear once treatment has begun and for the conflicts that led to the symptoms to be brought by the child into the analyst’s office and into the treatment.
PARENTS NEED TO BE FAMILIAR WITH SOME OF THESE MATTERS, SO THEY CAN AVOID PREMATURELY INTERRUPTING THE TREATMENT—analytic endings should come from within the analysis as old conflicts are re-solved. Similarly, they should know that around vacations (many analysts still take August off) a child may pull resources together and appear to require no further treatment, leading the parent to withdraw the child from analysis. If treatment is prematurely discontinued, it is most likely that the old symptoms will reappear—perhaps in a new form. Upon the return of the analyst from an absence, it is likely that within the analysis the child will regress and work on the deeper issues of loss, individuation and separation. (adults experience this as well, but there are no parents needed to support their treatment during distressful times).
FOR BOTH ADULTS AND CHILDREN progress may be monitored by the way they manage vacation and weekend interruptions. While the couch is not used by children, except to jump on, sleep on, or hide behind, their free associative actions are still central to the treatment process. In work with children attention is paid to free play—the child’s selection of play material and script for the play are treated as equivalent to an adult’s free association, thereby revealing internal and unconscious conflict. In the same fashion as is done with adults, the analyst attempts to comprehend and extrapolate meaning from the play that mirrors prior experience and to bring it into the present moment.
CHILDREN ARE USUALLY NOT SEEN BEFORE PARENTS ARE INTERVIEWED, although there are analysts whose custom it is to see the child first no matter the age. In the initial interview both parents are seen together—if possible even with divorced parents. Perhaps it is most important to do this with divorced/divorcing parents as the analyst must not give the impression of taking sides but rather needs to be seen as supporting that desire on both parents part to see that the child does well. Treatment really needs to take place on neutral ground so that both parents can support the process out of their shared love for the child. The best predictor of a successful outcome of treatment can be measured by the degree of support given by both parents.
AREAS OF CONCERN ARE DISCUSSED WITH BOTH PARENTS WITH THE ANALYST ADDRESSING THEIR DIFFERENCES OF VIEWS. Both parents are asked to describe the pregnancy (and context) and the major developmental landmarks —from Apgar scores on through walking, talking, cuddlies, toilet training, separations, illnesses, losses, and discovery of sexual differences. Then each parent is individually met with to give their own history, to “grow themselves up in story” allowing the analyst to discern what they bring to the parenting process (sometimes a parent’s transference from his/her childhood onto a child may clearly affect parenting attitudes).
IF THE ANALYST DETERMINES THAT TREATMENT OF THE CHILD MAY BE WARRANTED AND SUPPORTED BY BOTH PARENTS, it is then that the child first meets the analyst for a period of time—followed by a further meeting with the parents to give them the analyst’s recommendations—which could be analysis, psychotherapy, parental guidance, or referral for additional consultation. Further evaluation could be found indicated and could include, among others, psychopharmacologic, psychoeducational, or neurological evaluations. If the parents are willing to pursue analysis or therapy as indicated, treatment is begun or a referral is made. You might see also: About Psychoanalysis:APsaA