Psychoanalysis 3. FreudMain subject: Personal development
Research methods: Analysis of clinical cases,
free association method, dream analysis,
reservations, etc.
Basic concepts:
levels of the psyche (consciousness, preconsciousness,
unconscious), personality structure (Id, Ego, SuperEgo), psychological defense, sexual energy
(libido), sexual instinct, life instinct,
death instinct, stages of psychosexual development,
erogenous zones, pleasure principle, principle
reality, the Oedipus complex, the Electra complex,
identification, conflict, residual behavior,
fixation, genital character

Mental development from the standpoint of classical psychoanalysis 3. Freud

The foundations of the psychoanalytic approach to understanding the development of the psyche in ontogenesis were laid by 3. Freud.

Mental development = process
complicating the sphere of attraction,
motives and feelings, development
personality, its complication
structures and functions.

three levels of mind
consciousness
unconscious
preconscious

The unconscious level of the psyche is a receptacle for the instinctive needs of the body, drives, primarily sexual and aggressive

The unconscious level of the psyche
- receptacle of instinctive needs
organism, drives, in the first place
sexy and aggressive.
The unconscious initially resists
society.
Personal development - adaptation (adaptation)
individual to the external social world,
alien to him, but absolutely necessary.

Three structural components of personality
It
I
Super-I

Oh n o (Eid)

primitive core of personality;
it is innate
is unconscious and
obeys the principle
pleasure.
contains congenital
impulsive drives (instinct
Eros of life and the death instinct
Thanatos) and makes up
energy basis
mental development.

10. I (Ego)

- rational and in principle
conscious part
personality. occurs as
biological maturation
between 12 and 36 months
life and guided
reality principle.
The job of the ego is to explain
happening and build
human behavior is
to his instinctive
requirements were
satisfied and
social restrictions and
consciousness would not be
violated.
Assisted by ego
conflict between individuals
and society throughout life
should weaken.
I (ego)

11. Sver x - I (Super - Ego)

Super-I
(Super - Ego)
as a structural component
personality is formed last,
between 3 and 6 years of age.
represents the conscience, the ego-ideal and strictly controls
compliance with the standards adopted in
this society.

12.

The foundation of personality is laid
early childhood experiences,
conflict between id and superego

13. Periodization of age development 3. Freud - psychosexual theory of personality

Periodization of age
development 3. Freud -
psychosexual
personality theory
"Three Essays on the Theory of Sexuality" (1905):
man is born with some
sexual energy (libido), which
strictly defined sequence
moves to different areas of the body (mouth,
anus, genitals)

14. Stages are a kind of steps on the path of development, and there is a danger of "getting stuck" at one stage or another, and then the components of children's sex

Stages of personal development
oral
anal
phallic
latent
genital
Stages - it's their own
kind of steps on the way
development, and there is
danger of getting stuck
on one or the other
stages, and then
children's
sexuality can
become prerequisites
neurotic
symptoms
subsequent life.

15. Oral stage (from birth to 18 months)

Main source
pleasure connects
with satisfaction
main organic
needs and includes
actions related to
breastfeeding:
sucking, biting and
swallowing.
The mother awakens in the child
sexual attraction, teaching
love him. Optimal
degree of satisfaction
(stimulation) in oral
zone (thoracic
feeding, suckling)
lays the foundations
healthy self
adult personality.

16.

Too much parental tenderness
accelerates puberty and makes
child "spoiled", dependent.
Lack of stimulation - adult
will use as ways
adaptation to the surrounding world demonstration
helplessness, gullibility, will need
constant approval of their actions with
sides.

17.

Fixation on the oral-sadistic phase, s
teething when
emphasis shifts to
biting and chewing actions
leads to things like this
as an adult person
love for disputes, cynical consumer attitude towards
to others, pessimism.
Attachment libido
to the oral zone sometimes
is also preserved
adult and gives about himself
know residual
oral behavior - overeating, smoking,
nail biting,
chewing gum, etc.

18. Anal stage (from 1 - 1.5 to 3 years)

Associated with the rise of the ego
Anal eroticism is associated, according to Freud, with pleasant
sensations from the work of the intestines, from excretory
functions, with an interest in their own faeces.
At this stage, parents begin to teach the child
use the toilet for the first time presenting him
the demand to give up the instinctive
pleasure.
The right educational approach is important (attention
to the condition of the child, encouragement, support
neatness)

19. Phallic stage (3-6 years old)

the child often looks at
examines his genitals,
shows interest in issues
associated with having children and
sexual relations.

20.

Oedipus complex -
boy
is found
desire to "possess"
mother and eliminate
father.
Identification with
father (imitation
intonations,
statements,
deeds,
borrowing norms,
rules, settings)
promotes
emergence of the superego, or conscience,
last component
personality structures.
The Elektra complex
girls self-identification with
same-sex parent
- mother and
gravity suppression
to the father.
Girl magnifying
resemblance to mother
receives
symbolic
"access" to your
father.

21. Latent stage (from 6 - 7 years to 12 years)

Sexual lull, before
the beginning of adolescence.
The energy reserve is directed to
non-sexual goals and activities
- study, sports, knowledge,
friendship with peers
mostly of their gender.
Freud emphasized
the significance of this break in
sexual development
human being as a condition for
higher
human culture.

22. Genital stage (12-18 years old)

Stage due to biological maturation in
puberty and the final psychosexual
development.
A rush of sexual and aggressive urges, a complex
Oedipus is reborn on a new level. Autoerotism
disappears, it is replaced by interest in another
sexual object, partner of the opposite sex.
Normally, in adolescence, there is a search for a place in society,
choosing a marriage partner, creating a family.
One of the most significant tasks of this stage is
liberation from the authority of parents, from attachment
to them, which provides the necessary for the cultural process
contrast between old and new generations.

23. Freud was convinced that everything essential in the development of a personality occurs before the age of five, and later a person is already only a “function

Thus, childhood was interested in 3. Freud
as a period that will reshape the adult
personality.
Freud was convinced that everything essential
in personality development occurs before the age of five
age, and later the person is only
"functioning", trying to get rid of the early
conflicts, so no special stages
he did not distinguish adulthood.

24. The value of the psychoanalytic concept

Valuepsychoanalyst
scientific concepts
It is a dynamic development concept,
it shows a complex range
experiences, unity of soul
human life, its irreducibility to
individual functions and elements.
The importance of childhood, the importance and
longevity of parental
influence

25. The most important aspect of the psychoanalytic approach can be considered the idea of ​​sensitive attention to the child, the desire to see beyond the outwardly ordinary e

The most important aspect of the psychoanalytic approach can be
consider the idea of ​​sensitive attention to the child, the desire
to see behind his outwardly ordinary words and actions
questions that really bother or embarrass him.
K.G. Jung critically remarks: "We must take
children as they are
reality, one must stop seeing
them only what we would like to see in them,
and in educating them, one must conform not to
dead rules, but with natural
direction of development"

26. Further development of the psychoanalytic direction in psychology is associated with the names of C. Jung, A. Adler, C. Horney, A. Freud, M. Klein, E. Erickson

Further development
psychoanalytic trend in
psychology is associated with the names of C. Jung,
A. Adler, K. Horney, A. Freud, M.
Klein, E. Erickson, B. Bettelheim, M.
Mahler and others.

27. A. Freud (1895-1982)

Her writings:
"Introduction to Children's
psychoanalysis" (1927)
Norm and pathology in
childhood "(1966), etc.

28. A. Freud believed that in the psychoanalysis of children:

You can and should use common
with adults analytical methods:
hypnosis, free association,
interpretation of dreams, symbols,
parapraxia (silence, forgetfulness),
resistance analysis and transfer.
It is necessary to take into account the uniqueness
child analysis techniques

29. New technical methods

Transformation analysis,
endured
affects
child
(instead of grief - a cheerful mood,
instead of jealousy - excessive tenderness)
Analysis of animal phobias, features
school and family behavior of children
Analysis of children's play

30. In the psychoanalysis of a child, the external world has a much stronger influence on the mechanism of neurosis than in an adult. The outside world, he is brought up

In the psychoanalysis of the child, the external world renders
much stronger influence on the mechanism
neurosis than in adults. The outside world,
educational influences - powerful
ally of the child's weak self in the fight against
instinctive tendencies.

31. English psychoanalyst Melanie Klein (1882-1960)

32.

The focus was on
spontaneous play activity of the child
(specially created conditions:
the therapist gives the child a mass
small toys, "a whole world in
miniature" and gives him the opportunity
free to act within an hour).
Action is more characteristic of a child,
than speech
Observing different reactions
child, behind the "stream of childish play" (and
especially for manifestations
aggressiveness or compassion) the main method of studying the structure
child's experiences.

33.

The game may appear
various emotional
states: feelings of frustration and
rejection, jealousy of members
families and related
aggressiveness, feelings of love or
hatred for the newborn
fun to play with a friend,
opposition to parents
feelings of anxiety, guilt and
desire to remedy the situation.
regular expression
child patient
interpretations of his behavior
helps him deal with
emerging difficulties and
conflicts.

34. Modern psychoanalysts on the development and upbringing of children

35. J. Bowlby

Attachment theory: mother is not important
just because it satisfies
primary organic needs
child, in particular satisfies hunger, but
the main thing is that she creates the first for the child
affection
Various disorders of the primary
emotional bond between mother and
child, "attachment disorder"
pose a risk of personal injury
problems and mental illness
(for example, depressive states).

36. R. Spitz

The relationship between the child
and mother at an early age
have an impact on
shaping his personality
subsequent
Important concepts such as
"attachment", "security",
establishing loved ones
relationships between children and adults
creation of conditions for establishing
interactions between children and parents
in the first hours after birth.

37. E. Fromm

A mother's love is unconditional:
the child is loved simply because
he is.
Fatherly love - for the most
parts of conditional love, its
need and deserve

38. K. Butner

Influence
videos,
cartoons, games,
the toy industry
inner world of children
constantly growing and
often it can be
rated sharply
negatively

39. F. Dolto

"On the side of the child", "On the side
teenager."
Problems: the nature of memories
childhood, the well-being of the child in
kindergarten and school, attitude to
money and punishment, education
in an incomplete family, the norm and
pathology of parent-child
relationships, in vitro conception.

40. Conclusion

Child psychoanalysis
influence on the organization of work with
children in educational and social
areas to work with parents.
numerous early
interventions, treatment options
relationship between parents and
child", "father - mother - child" for
parents and children of "risk groups"
psychoanalytic therapy centers
children.

41.

Presentation prepared
student of group 673(2n)
Minkina Katya

Attempts to organize work with children from the standpoint of traditional psychoanalysis have encountered real difficulties: children have no interest in researching their past, there is no initiative to turn to a psychoanalyst, and the level of verbal development is insufficient to formalize their experiences in words. At first, psychoanalysts were used as material for interpreting the observation and reporting of parents. A little later, methods of psychoanalysis were developed, aimed specifically at children. Followers of Z. Freud Anna Freud and M. Klein created their own versions of child psychotherapy. A. Freud adhered to the position traditional for psychoanalysis about the child's conflict with the social world full of contradictions. She emphasized that in order to understand the difficulties of behavior, a psychologist must strive not only to penetrate into the unconscious layers of the child's psyche, but also to obtain the most detailed knowledge about all three components (I, it, super-I), about relations with the outside world, about the mechanisms of psychological defense. and their role in personal development. A. Freud adhered to the position traditional for psychoanalysis about the child's conflict with the social world full of contradictions. She emphasized that in order to understand the difficulties of behavior, a psychologist must strive not only to penetrate into the unconscious layers of the child's psyche, but also to obtain the most detailed knowledge about all three components (I, it, super-I), about relations with the outside world, about the mechanisms of psychological defense. and their role in personal development. A. Freud attached great importance to children's play, believing that, having carried away the game, the child will become interested in the interpretations offered to him by the analyst regarding the protective mechanisms and unconscious emotions hiding behind them. A psychoanalyst, according to A. Freud, for success in child therapy must necessarily have authority over the child. Of particular importance is the nature of communication between a child and an adult. The main emotional communication. When organizing research and correctional work with difficult children

(aggressive, anxious) the main efforts should be directed to the formation of attachment, the development of libido, and not to the direct overcoming of negative reactions.; Eng. psychoanalyst M. Klein (1882-1960) developed her own approach to the organization of psychoanalysis at an early age.

The main attention was paid to the spontaneous play activity of the child. M. Klein, unlike A. Freud, insisted on the possibility of direct access to the content of the child's unconscious. She believed that action is more characteristic of a child than speech; the stages of the game are analogues of the associative production of an adult. Psychoanalysis with children, according to Klein, was built mainly in spontaneous children's play, which was helped to manifest itself by specially created conditions. Her play with many toys. A variety of emotional states can manifest themselves in the game: feelings of frustration and rejection, jealousy of family members and accompanying aggressiveness, feelings of love or hatred for a newborn, the pleasure of playing with a friend, opposition to parents, feelings of anxiety, guilt and a desire to correct the situation. So, penetration into the depths of the unconscious, according to

M. Klein, possibly with the use of game technology, through the analysis of anxiety and protective mechanisms of the child. Regularly expressing interpretations of his behavior to the child-patient helps him to cope with the difficulties and conflicts that arise.

Some psychologists believe that the game is healing in itself.

So, D.V. Winnicot emphasizes the creative power of free play in comparison with the game by the rules. The knowledge of the child's psyche with the help of psychoanalysis and play technology has expanded the understanding of the emotional life of young children.

children, deepened the understanding of the earliest stages of development and their long-term contribution to normal or pathological development

psyche during adulthood.

Scientific views

Having become the direct heir to her father's scientific views, Anna Freud primarily developed psychoanalytic ideas about the Self, in fact, founding a new neo-Freudian trend in psychology - ego psychology. Her main scientific merit is usually considered to be the development of the theory of human defense mechanisms - the mechanisms by which the I eliminates the influence of the It. Anna also made significant progress in the study of aggression, but still the most significant contribution to psychology was the creation (this merit belongs to her together with Melanie Klein) of child psychology and child psychoanalysis. She developed methods of working with children, including games, the provisions of psychoanalytic theory were processed by Anna for applied assistance to parents and children in their interaction. Children were Anna Freud's main scientific and life interest, she once even said: “I don't think I'm a good subject for a biography. Probably, my whole life can be described in one sentence - I worked with children! At the end of her life, the scientist, who already had the title of Honorary Professor at many of the largest universities in the world, was attracted by another area related to children - family law, she studied at Yale University, publishing two works in collaboration with colleagues (see Selected scientific works). Along with Melanie Klein is considered the founder of child psychoanalysis.

The development of ego psychology in the writings of Anna Freud

V.V. Starovoitov

Candidate of Philosophical Sciences, Senior Research Fellow, Institute of Philosophy, Russian Academy of Sciences

Anna Freud (1895 - 1982) - the youngest child in the Freud family, received a private pedagogical education and worked as a teacher from 1914 to 1920. During the First World War, she began to study psychoanalysis. Sigmund Freud personally conducted a training analysis of his daughter, although until the early 1920s it was not an obligatory element in the training of psychoanalysts, which further strengthened her attachment to her father, and also affected her scientific position in psychoanalysis - she forever remained a champion of classical psychoanalysis. .Freud. In 1921, A. Freud was admitted to the Vienna Psychoanalytic Association. From 1923 she became involved in child analysis. After emigrating to England in 1938, she was admitted to the British Psychoanalytic Society. In December 1940, together with Dorothy Barlingham, her closest friend and colleague, she organized the "Hampstead Orphanage", where a psychoanalytic study of children was carried out. Here A. Freud develops child analysis as an independent area of ​​psychoanalysis. In 1952, the Hampstead Clinic and child therapy courses were opened under the direction of A. Freud. She herself was repeatedly elected to the position of vice-president of the IPA.

In the early 1920s, pedagogically oriented psychoanalysis began to develop in Vienna. Hermine Hug-Helmuth (1871 - 1924) was the first analyst in Vienna to start a systematic study of children. Anna Freud was also among the child psychoanalysts. In addition to Vienna, another center of child psychoanalysis in those years was Berlin, where Melanie Klein developed the "play method" for the analysis of children, and then the theory of early child analysis. In 1926, M. Klein finally moved to London, where she continued to develop the theory and practice of analyzing children. For many subsequent years, A. Freud was in irreconcilable polemics with M. Klein because of sharp disagreements on issues of child analysis.

Their first correspondence collision took place in 1927, after the publication of A. Freud's book "Introduction to the Technique of Child Analysis", in which she discusses the possibility of changing the analytical technique when working with children.

Speaking about the specifics of the analysis of children, A. Freud highlights the following points:

1. The child does not have the consciousness of his illness and the will to recover. The decision to undergo analysis never comes from the little patient, but is made by his parents. Therefore, the analyst needs a preparatory period in order to create in the child the lack of readiness and consent to treatment. Because of this, the analyst must first of all establish certain emotional relationships between himself and the child.

2. However, after such a pre-analysis stage, the analyst becomes an overly defined face and a poor transfer object.

4. In addition, the parents continue to be the child's love objects in reality and not in fantasy, so he does not feel the need to replace the parents in his experiences with the analyst. As a consequence, the child does not develop a transference neurosis, although some of its components may be present.

5. In view of the foregoing, the child's abnormal reactions continue to play out in the home environment. Therefore, the analyst must be aware of all family relationships. Where, according to A. Freud, circumstances or the attitude of parents exclude the possibility of joint work, the result is the loss of the material to be analyzed. In such cases, A. Freud had to limit himself to the analysis of dreams and daydreams in children.

6. Finally, there is an additional problem when working with children. Since the super-ego of the child is still very closely connected with the persons raising him, that is, in most cases with the parents, the assessment of the unconscious instinctive urges of the child is left to the discretion not of the super-ego, but of his relatives, who, by their excessive severity, prepared the appearance of a neurosis in child. The only way out of this impasse, according to A. Freud, can be for the analyst to occupy the place of the Ego-ideal of the latter while working with the child. However, this becomes possible only if, for the child, the authority of the analyst becomes higher than the authority of the parents.

Child analysts tried to compensate for the lack of free expression by the child of all the thoughts that arise in him by various technical methods. In particular, M. Klein replaced the technique of free association with the technique of play, believing that action is more characteristic of a small patient than speech. She considered each child's play action to be an analog of free association in an adult and accompanied it with her own interpretation. A. Freud criticized such assimilation of play actions to the thoughts of an adult and rejected the presence of transference neurosis postulated by M. Klein in a child.

In response to the publication of the book "Introduction to the Technique of Child Analysis", analysts working under the direction of M. Klein in London held a symposium at which A. Freud's views on the analysis of children were sharply criticized. In particular, they believed that transference neurosis did not occur in A. Freud's work because of the introductory phase of analysis that she introduced. They also emphasized the need to use play technology because play is less reprehensible for a child when he cannot produce free associations due to certain fears. In addition, according to the views of M. Klein, the Super-ego, and after it the Oedipus complex, is formed in a child in the first or second year of life, which is why she rejected the pedagogical approach to the analysis of the child, characteristic of A. Freud.

Subsequently, A. Freud made changes to the technique of child psychoanalysis, starting to study everything that could cause repression and other defense mechanisms in a child: fantasies, drawings, emotions, finding in them the equivalent of free associations, which made the pre-analysis stage redundant. At the same time, A. Freud continued to consider the symbolic interpretation of children's play given by M. Klein as rigid, stereotypical, not taking into account the unknown components of the ego, which resulted in a distorted idea of ​​the child's personality. A. Freud herself argued that the path to the child's Id lies through the elaboration of the Ego's defenses.

In her second book, "The Ego and Defense Mechanisms" (1936), A. Freud systematized everything that was known at that time about the action of the defense mechanisms used by the Ego. In addition to repression, she included in this list regression, isolation, projection, introjection, transformation into opposites, sublimation, reactive formation, etc. This systematization significantly expanded the understanding of the protective and synthesizing functions of the Ego, since, according to A. Freud, there is no antithesis between development and protection, since all "defense mechanisms" serve as both internal restrictions on drives and external adaptation.

As for the technique of treatment, it was built by A. Freud in accordance with the model of intrapsychic conflict, where everything that was not new was described as transference. Based on this understanding of transference, she emphasized its spontaneity. Her point of view completely coincided with that of Freud, who also believed that the transference was not created by the doctor.

Freud's understanding of the repetition compulsion as a biological attribute of living matter, providing an explanation for the omnipresence of the transference phenomenon, led to an emphasis on the spontaneity of transference as created exclusively by the patient, and, consequently, to the model of intrapsychic conflict and the standard technique of one-person psychology. The cornerstones of psychoanalysis - transference and resistance - were laid at the foundation of an idealized scientific impartiality. This led to "interpretative fanaticism", when everything that happened in the analytic situation was considered primarily as a manifestation of transference, which led to a clear inequality between the omnipresent object - the analyst, and the unequal subject - the patient. This disparity grew as a result of the analyst's genetic interpretations, which led to the patient's perception of the analyst as someone who knew all about his past, including the origin of the resistance. At the same time, the judgment about what is true and what is a distortion of "truth" was left entirely to the analyst's discretion.

However, later, in the 1954 article "Expansion of Indications for Psychoanalysis", A. Freud finally raised the question of whether some aggressive reactions of patients, usually considered as transference, could not be caused by a categorical denial of the fact that the analyst and the patient how adults are in real personal relationships. Thus, she came to the conclusion that not everything in analysis is "transference".

General view of the problem

The process of transition from all kinds of deviations that are within the normal range to a real pathology occurs smoothly and depends more on changes in the quantitative ratio than on qualitative differences. In accordance with our psychoanalytic ideas, the mental balance of a person is based, on the one hand, on the relationship of his internal instances, and on the other hand, on the relationship of his personality as a whole to the outside world, that is, on connections that are subject to constant fluctuations. Instinctive energy spontaneously increases or decreases depending on what phase of development the individual passes through. So, for example, in the latent period, it weakens, in puberty - an increase, in menopause also an increase. If the instances of the "I" and "Super-I" are under pressure, the forces of the "I" and the influence of the "Super-I" decrease, just as it happens in a state of fatigue, during physical illness and in old age. If, due to the loss of the object or other deprivations, the possibilities of satisfying desires are reduced, their distribution increases. In this regard, 3. Freud argued that "we are not able to draw a sharp line between "neurotic" and "normal" children and adults; "disease" is a purely practical summary concept, and it is necessary that predisposition and experience converge and reach such a summation that will be sufficient to overcome a certain threshold. Thus, all the time, many individuals pass from the class of healthy to the class of neurotic patients, although a much smaller number of them make this way in the opposite direction ... "(1909).

Since these provisions are valid for a person of any age, "for children as well as for adults", then the border between healthy and sick, normal and abnormal in the first case is no easier and no more difficult to draw than in the second. The picture of the essence of childish nature described above shows that the balance of forces between the id and the ego is in constant fluctuation, that adaptation and protection, favorable and painful influences penetrate each other, that each advance from one stage of development to another brings with it the danger of stops, delays, fixations and regressions, that the instinct and the "I" develop at different rates and therefore can introduce disorder into the movement along separate lines of development, that temporary regressions can turn into long-term states, finally, that it is hardly possible to estimate the number of negatively influencing factors, that undermine or disturb mental balance.

The currently available classification systems can do little to help the diagnostician, who is obliged to understand these phenomena, and therefore he is in a very difficult position.

Currently, child analysis is moving in many different directions. Having created its own prescriptions, despite numerous difficulties and obstacles, the technique of child analysis freed itself to a large extent from the basic rules of adult analysis. Theoretical discoveries have been made that are a new contribution to analytic knowledge as they go beyond the mere confirmation of materials reconstructed from adults. Only when it comes to the classification of phenomena does the child analyst continue to use the diagnoses that are accepted in adult analysis, psychiatry and criminology, thus taking a conservative position and adopting long-established forms for his work, which are clearly not enough to make a correct diagnosis, prognosis and choice of treatment method, as they are poorly suited to the conditions of modern childhood psychopathology.

Differences between descriptive and metapsychological ways of thinking

The descriptive way of thinking in classifying both childhood and adult disorders is contrary to the metapsychological way of thinking, since the first is based on the similarity and difference of the symptoms that manifest, and the second on the comparison of the hidden causes behind them. Only at first glance, the classification of disease states in the description seems satisfactory. In fact, in this case, it is not at all about deepening ideas and not about finding significant differences between individual states, which are so necessary for us. Therefore, an analyst who is content with this kind of diagnostic thinking will inevitably confuse his own therapeutic and clinical views, built on other principles, and will be misled.

We will prove this with examples: attacks of rage, passion for travel, fear of separation, etc. are diagnostic terms that combine under one name the most diverse states of the disease (clinical pictures), which are similar or even identical in their behavior and symptoms, but require completely different therapeutic effects, since they belong to completely different analytical categories in their metapsychological structure.

So the phenomenon called a fit of rage in children has three completely different meanings. For example, for the youngest, they usually mean nothing more than a motor-affective process, appropriate for this age, of withdrawing instinctive excitations, for which there is no other way out yet. This symptom disappears of itself without treatment, as soon as the "I" of the child is so mature that other possibilities of substitution open up for instinctive processes (especially in speech). But the same symptoms can also mean that manifestations of hatred and aggression against the objective world cannot manifest themselves in their entirety and therefore are directed back to the child’s own body and objects available to him (self-harm, banging his head against the wall, breaking furniture, etc.). . P.). In this case, the transferred affect must become conscious, connections with its causal goal must again be formed. A third interpretation of these symptoms is that the alleged rage is actually a fit of fear. If something prevents phobic children from carrying out their protective actions or avoidance (suppression of agoraphobia when a phobia of school attendance appears), they react to this with violent outbursts of fear, which an unskilled observer may not distinguish from ordinary attacks of rage and rage, perceiving them as a manifestation of aggression . However, unlike the latter, such conditions can be eliminated only by two types of measures - by restoring phobic protection, that is, by avoiding fear-causing circumstances, or by analytically determining the causes of fear, interpreting and resolving them.

Approximately the same can be said about the so-called wandering of children (vagrancy, running away from home, school "truancy", etc.). We find the same symptom under different circumstances and in different interpretations. Some children run away from home if they are abused in the family or their libidinal attachment to the family is unusually weak; some skip school (wander around the street instead) if they are afraid of teachers or classmates, do poorly in school, or want to avoid censure and punishment. In both these cases, the cause of the symptom is external and can be eliminated by a change in the external conditions of life. In other children the cause of the same symptom lies in the inner life. They fall under the influence of an unconscious impulse and usually try to find an object of love in the past. From the point of view of the description, it is true that they "run away", but metapsychologically their wandering is purposeful, even if the goal set by the "It" before them is nothing more than the embodiment of desires. In such cases, therapy requires an internal change through analytical interpretation and translation of the unconscious desire into a conscious one, and any external intervention will not be successful.

Although similar objections can be raised against the very common diagnosis of separation anxiety, there is little to be objected to its current use in many children's clinics, where a wide variety of conditions are also indicated without reservation. Although, from a metapsychological point of view, there is no similarity between the fear of separation in young children and the school fear of latent children or the nostalgia of children separated from their families and living in a boarding school. In the first case, we are talking about a violation of a biologically justified need (unity with the mother), to which the child responds with fear and despair; in this case, nothing can help better than reuniting with the mother, or at least introducing a substitute persona. In the second case, the cause of fear lies in the emotional ambivalence of the child. In the presence of parents, love and hate balance each other, in their absence, the fear is intensified that the hostile forces of the death desire of the parents can actually harm them, and the child seeks to save them from himself, clings to the parents. In this case, the symptom may recede only before an analytical understanding of the emotional conflict, and reunion with the parents or unhindered cohabitation with them will be only superficial reassurance.

For analytical thinking and therapeutic action, a description of the symptomatology that manifests itself in this and similar cases is clearly not enough.

Differences in diagnostic terminology between children and adults

On the one hand, the diagnostic designations we use relating to various mental disorders in adult life have nothing to do with the numerous types and varieties of developmental disorders, and on the other hand, they do not distinguish between genetically determined symptoms and those caused by conflict. However, in the field of child psychopathology, such immediate differences play a paramount role. Thus, regardless of the stage of development at which they appear, it is impossible to consider as completely normal or abnormal such phenomena as lying or cheating, aggression or the desire for destruction, perverted activities, etc.

Lie

The question may be how to determine the moment after which it can be said with certainty that the child is "lying", that is, the falsification of the truth takes on the character of a symptom in him and comes into conflict with what others expect from the child. Of course, the need for truth, as we understand it, appears only after he has passed through a number of preliminary stages of development and is not present in a child from his very birth. There is nothing unnatural in the fact that a small child prefers what causes pleasant sensations, neglecting everything unpleasant and refusing to perceive irritants imposed on him that cause discomfort and fear. So, in this case, he behaves in exactly the same way as older children or adults when deceiving. But it is necessary for the child analyst (or diagnostician) to understand the difference between the primitive attitude towards truth at an early age, due to the dominance of the pleasure principle and the primary process over the child, and the later symptoms of lying. The analyst is justified in using the term "false" only when the reality principle and rational thought have reached a certain maturity, and the child, despite this, continues to falsify the truth.

In some children, the process of maturation of these "I" functions is delayed, and therefore, even at an older age, they continue to lie. Other "I" develop according to their age, but due to some failures and disappointments, they retreat to the previous primitive stages of development. This refers to liars-dreamers who try to protect themselves from real troubles with the help of infantile methods of fulfilling desires. At the opposite end of the line are children whose self-functions are themselves normal, but who have other than genetic reasons for avoiding the truth. In this case, the motives can be fear of adults, of censure and punishment, as well as greed, megalomania, etc. It is quite obvious that it makes sense to limit the use of the term "lie" to these last examples of "dissocial" lies.

In children's analytical practice, this phenomenon is most often encountered not in its pure form, but in a mixed form, consisting of renunciations, lies-fantasies and dissocial lies. Thus, the diagnostician has the opportunity to distinguish between individual constituent elements and determine the contribution to symptom formation, corresponding both to the processes of maturation and development, and to experiences.

Theft

As with lying, certain genetic developmental stages must be passed through before a given term can acquire diagnostic meaning.

The desire of children to appropriate for themselves everything that their desire is directed to is usually attributed to the "oral greed" of this period. But on closer examination, this behavior is explained in two ways: it also corresponds to the pleasure principle, as a result of which the child, without thinking, appropriates everything that gives pleasure, and just as automatically provides the outside world with everything that causes trouble. It also corresponds to the age-specific inability to distinguish between self and object. As we know, an infant or small child treats the mother's body as if it were his own, plays with her fingers and hair in no other way than in autoerotica, or provides her with parts of her own body for play. The fact that small children can alternately bring the spoon to their mouth and to their mother's mouth is often misinterpreted as spontaneous early generosity, when in fact it is a consequence of the lack of boundaries of the "I" and nothing else. It is this confusion between the Self and the object world, which leads to a willingness to give, that turns each baby into a storm for someone else's property, despite all his innocence.

At first, in the understanding of the child, there is no concept of "mine" and "yours", which in later life is the basis of honesty. It develops very slowly and in stages, with a gradual increase in the independence of the "I". First of all, the child begins to own his own body ("I" - the body), then the parents, then - the transitional objects that are still filled with a mixture of narcissistic and object libido. Together with a sense of ownership in the child, there is also a tendency to protect his property with all his might from any outside influence. Children understand what it means to "lose" their own much earlier than they acquire the ability to reckon with someone else's property. For him to realize this, it is necessary to understand that the people around him protect their property no less than he does his own. And such an understanding can arise only on the condition of further expansion and deepening of relations with the outside world.

But, on the other hand, the development of the concepts "mine" and "yours" is not enough to have a decisive influence on the behavior of the child; this is opposed by powerful desires for appropriation of property. He is tempted to steal: oral greed, analogenic tendencies to have, hold, collect and accumulate, need for phallic symbols. The foundations of honesty are laid with the help of educational influences and the following requirements of the "Super-I", which are in constant and difficult opposition of the "I".

Whether or not a child can be diagnosed diagnostically and socially with the word "thief", indicating that he is "cheating", depends in the end on many conditions. Such a separate action can be provoked by a delay in the child's "I" on the way to achieving its independence, insufficiently formed object relations between the outside world and the "I", too infantile "Super-I". Because of such reasons, undeveloped and mentally retarded children cheat. If development proceeds normally, then such actions may be due to temporary regressions. In such cases, cheating is a temporary phenomenon and disappears with further development. Prolonged regressions in each of these relationships lead to cheating as a compromise formation in the form of a neurotic symptom. If the child cheats because his "I" is not able to dominate the normal, age-appropriate desires for appropriation, then such actions indicate insufficient adaptation to the moral requirements of the outside world and are a "dissocial" symptom.

In practice, as in the case of lies, etiological mixed formations are more common than the pure forms described above; we are usually dealing with the combined effects of developmental delays, regressions, and defects in the ego and superego combined. The end result is that all cheating returns to the causal unity of "mine" and "yours," self and object, as evidenced by the fact that all dissocial children first of all steal from their mother.

Criteria for assessing the severity of the disease

There is no doubt as to whether mental disorders occurring in childhood should be taken lightly or seriously. In adult life, in such cases, we proceed primarily from three criteria: 1) the picture of the symptom; 2) the forces of subjective suffering; 3) the degree of violations of vital functions. None of these points of view can be acceptable for children's life for obvious reasons.

1. As we already know, the symptoms in the years of development do not mean the same thing as later, when we “orient ourselves in making a diagnosis” by them (3. Freud, 1916-1917). Far from always (as happens later) childhood delays, symptoms and fears are the result of pathological influences. Often these are simply concomitant phenomena of normal developmental processes. Regardless of the amount of excessive demands that a certain phase of development places on the child, symptom-like phenomena can still occur, which, in a reasonable environment, disappear as soon as adaptation to a new stage occurs or its peak is passed. No matter how much we examine these phenomena, even such momentary disturbances are not easy to understand: they correspond to warnings about the vulnerability of the child. Often they disappear only externally, that is, they can reappear in the form of new disorders at the next stage of development, leaving behind scars that can serve as starting points for later symptomatic formation. But it still remains true that in a child's life, sometimes even obviously serious symptoms can disappear. Often, as soon as the parents come to the clinic, phobic avoidances, obsessive neurotic caution, sleep and eating disorders are rejected by the child simply because they are more afraid of diagnostic tests than the underlying fantasies. That is why the symptomatology changes or disappears soon after the start or during treatment. But in the end, symptomatic improvement means something even less for a child than for adults.

2. The same is true of subjective suffering. Adults decide on treatment if the mental suffering from the disease becomes unbearable. This cannot be said about children, since the factor of suffering in them in itself says little about the severity of a mental disorder or the presence of it. Children are less affected than adults by their symptoms, with the exception of states of fear, which are difficult for the child to bear. So, for example, phobic and obsessive neurotic measures that serve to avoid fear and displeasure are quite desirable for the child, and the corresponding restrictions on normal life interfere more with the adult environment than with the patient himself. Malnutrition and refusal of food, sleep disturbances, rabies attacks, etc. are justified from the position of the child and only in the eyes of the mother are undesirable phenomena. The child suffers from them only as long as the world around him prevents him from manifesting them in their entirety, and therefore sees the source of suffering in the intervention of adults, and not in the symptom itself. Even such embarrassing symptoms as bedwetting and fecal incontinence are sometimes considered insignificant by the child himself. Neurotic delays often lead to the withdrawal of the entire libido from fearful activities and thus to a restriction of the interests of the "I", which hides the loss of activity and desire for profit. Children with pronounced disabilities - autistic, psychotic or mentally retarded - cause great suffering to parents, as they practically do not feel their disturbed state.

Other grounds also make it impossible to determine the severity of a mental disorder. Children suffer much less from their psychopathology than from genetically determined circumstances, such as refusals, demands and difficulties of adaptation, which are caused by dependence on the objective world and the immaturity of their mental apparatus. The sources of fear and trouble in early childhood are the inability to satisfy one's own bodily needs and instinctive desires, unwillingness to be separated, inevitable disappointments in unrealistic expectations; in the next (oedipal) phase, it is jealousy, rivalry and fear of castration. Even the most normal children cannot be "happy" for a long time, and therefore they often have tears, anger and rage. The better the child develops, the more affectively he responds to the manifestations of everyday life. We also cannot expect that children, like adults, will naturally master their emotions, succumb to their influence, become aware of them and come to terms with circumstances. On the contrary, when we observe such compliance, we begin to suspect that something is wrong with the child, and we assume either organic damage, or a delay in the development of the "I", or an excessive passivity in instinctive life. Small children who leave their parents without protest, most likely due to internal or external reasons, are not sufficiently connected with them libidiously. Children for whom the loss of love is not a hindrance may be in a state of autistic development. If there is no sense of shame, then the "Super-I" does not develop: the forced price that each individual must pay for the higher development of his own personality is painful internal conflicts.

We must admit that the feeling of subjective suffering, however paradoxical it may sound, is present in every normal child, and in itself is not the basis for pathological development.

3. Also deceptive is the third factor, which is decisive for adults, in violation of achievements in children's practice. It has already been noted above that achievements in childhood are not constant, but change due to temporary regressions from stage to stage, from genetic direction to genetic direction, day by day, hour by hour. There are no firm criteria for judging when fluctuations between progress and regress can be considered phenomena of normal life. Even when the deterioration in function lasts for a very long time and the external environment becomes disturbed, it is diagnostically risky to characterize a child as "delayed" or "retarded" on such grounds.

We also do not know which of the children's achievements has the right to be called "vital." Despite the fact that games, learning, the free activity of fantasy, the warmth of objective relationships, the ability to adapt are very important for a child, they cannot even be compared in significance with such fundamental concepts as "ability to love" and "working capacity". Returning to my earlier hypothesis (1945), I will repeat the statement that only the ability to develop normally, to go through the stages outlined according to the plan, to form all aspects of the personality and to fulfill the requirements of the outside world in an appropriate way deserves the definition of "vital" for a child's life. As long as these processes proceed relatively unhindered, we need not worry about the symptoms that arise. The need for treatment arises in a child only when this development begins to be inhibited.

Developmental processes as diagnostic criteria

At the present stage, diagnostic categories based on points of view other than genetic and psychological ones are clearly not enough to understand childhood disorders. Only when the diagnostician is freed from them, he will be able to abstract from symptomatology and begin to study what genetic levels his patient has reached regarding the "It", "I" and "Super-I", how far the structuring of his personality has advanced, i.e. the process isolation of these internal instances from each other; whether psychic phenomena are still under the dominant influence of the primary process or are already at the stage of the secondary process and the reality principle; whether in general the development of the child corresponds to his age, "ripens earlier" or "lags behind", and if so, in what respect; how much the pathology has affected or threatens to affect developmental processes; whether regression is present in the process of development, and if so, when, to what extent and up to what points of fixation.

Only such an examination makes it possible to assess the influence of important factors on the psychopathology of childhood, to link normal developmental processes, deviations from them, and mental health disorders with each other.

Mismatches in the development of "It" and "I"

We may reasonably expect that pathological consequences are felt when different parts of the personality develop at different speeds. The best-known clinical example of this kind is the etiology of obsessional neurosis, where the "I" and "Super-I" in their formation outstrip the advances in instinctive life. For this reason, high moral and aesthetic qualities coincide with relatively primitive instinctive urges and fantasies. This causes conflicts, prompting the "I" to obsessive and also conflicting actions. According to 3. Freud: “I don’t know how risky it will look if ... I suggest that the temporary advance in the development of the “I” in relation to the development of the libido should cause a predisposition to obsessive neurosis” (1913). Later regression can also lead to such a result, as will be shown below.

Not less often, and perhaps even more often, the reverse process occurs today - a slowdown in the development of the instance of "I" with normal or premature instinctive development. The object relations, as well as the functions of the "Superego", are too underdeveloped in such "autistic" and borderline children to be able to control the primary and aggressive impulses. As a result, at the anal-sadistic stage there is no ability to neutralize libido and aggression, to create reaction formations and sublimations important for the character; at the phallic stage there are no contributions from the ego to the organization of oedipal object relations; in puberty, the "I" comes to sexual maturity without the ability to form emotional formations that preceded it at the genital stage.

Based on this, we can conclude (Michaels, 1955) that the premature development of the "I" leads to internal conflicts and, as a result of them, to neuroses; premature instinctive development leads to defective and instinctive formation of character.

Mismatches between genetic lines

As shown above, mismatches between genetic lines are within the normal range and become the starting point for violations only when they exceed the expected results.

If this happens, both parents and teachers feel equally helpless. Such children turn into unbearable family members, interfere with others in the classroom, in children's games they constantly look for quarrels, are undesirable in any society, cause indignation everywhere, and at the same time, as a rule, they are unhappy and dissatisfied with themselves.

They also do not fit into any of the usual diagnostic categories of clinical investigation, and it is only when viewed from the point of view of genetic lines that one can understand their abnormality.

It also became clear to us that the achieved stages on various lines of development are in no way interconnected with each other. High mental development can be combined not only with poor results in the intellectual field, but also with the lowest steps on the way to emotional maturity, bodily independence and social relations with older comrades. Such discrepancies lead to artificially rationalized instinctive behavior, to excessive fantasies, failures in the education of neatness, in other words, to a mixed symptomatology, difficult to distinguish in its etiology. Usually such cases are qualified in descriptive diagnoses as "prepsychotic" or "borderline".

A mismatch is also found between the line from play to work, on which the child's development is retarded, and the line towards emotional maturity, social adjustment, and bodily independence, on which advancement is quite age-appropriate. Such children enter clinical research because of academic failures that cannot be explained either by their mental development or by their school behavior, which remains quite adequate for a certain time. In such cases, the researcher's attention should be focused precisely on the area where there are no expected correspondences between "It" and "I" on a specific line of development - on the transition from the pleasure principle to the reality principle, on insufficient mastery and modification of pregenital aspirations, on a belated displacement of pleasure. from the successful solution of problems to whether there is regression in all or only certain areas, etc.

Such cases in the descriptive diagnosis are referred to either as "intellectual disorders", which is fundamentally wrong, or, responding only to the external side of the phenomenon, as "insufficient concentration."

Pathogenic (permanent) regressions and their consequences

As noted above, regressions are harmless and even desirable as long as they are transitory (the level of development reached before them can be spontaneously re-achieved). They become pathogenic if the damage caused by them in itself causes a neoplasm inside the personality, which means that their consequences are long enough for this in time.

In any part of the mental apparatus, regressions of both types may appear.

Indirectly, the state of instinctive derivatives worsens if the regression begins in the "I" or "Super-I", lowering the achievements of both structures to a lower level. Such injuries in the "I" and "Super-I" have negative consequences for the mastery of instincts, violate the protective ability and cause breakthroughs from the side of the "It" into the organization of the "I", which lead to instinctiveness, emotional outbursts and irrational behavior, change beyond recognition picture of the child's character. Usually, research reveals that the reasons for such a fall in personality are experiences that the “I” could not overcome (fear of separation, painful rejections from the object of love, disappointments in the object, leading to the breakdown of identifications (Jacobson, 1946), etc. .), and therefore they found embodiment in fantasy.

The second possibility is that the regression begins on the part of the id, and the instances of the 'I' confront the immediate primitive instinctive derivatives with which they are forced to re-encounter in some way.

Such a clash may consist in the fact that instinctive regression itself causes regressions of the "I" and "Super-I", that is, the "I" begins to reduce its requirements in order to maintain agreement with instinct. In this case, the internal balance is preserved, and the consequences of instinctive regression in relation to the "I" are justified. But for such a neoplasm one has to pay with a decrease in the direction of infantilism, dissociality and instinctiveness of the personality as a whole. The depth of the pathological disturbance depends on how strong the return movements in instinct and in the "I" are, to what point of fixation the latter reach, which of the achievements of the "I" are preserved at the same time, and at what genetic level such an internal upheaval again comes into balance.

The confrontation between the "I" and the degraded instinct can also take reverse forms, which are better known to us from analysis. If the "I" and "Super-I" reaches a high development in children ahead of time, then the so-called secondary autonomy of the achievements of the "I" (Hartmann, 1950) is formed - such a degree of independence from instinctive life that gives them the opportunity to tear away from themselves instinctive regressions as hostile selves. Such children, instead of following the newly resurfaced pregenital and aggressive impulses and admitting the fantasies corresponding to them into consciousness, develop fear, strengthen instinctive defenses and, if this fails, find refuge in a compromise between instinct and ego. In such cases, we observe internal conflicts leading to symptom formation, from which hysterical fear, phobias, nightmares, obsessive symptoms, ceremonials, delays and other characteristic infantile neuroses arise.

In clinical work with boys who have degraded from the phallic (oedipal) to the anal-sadistic stage due to the fear of castration, we find striking examples of the difference between the justified and hostile to the ego consequences of instinctive regression.

Boys with Type 1 Deviations, who have their "I" and "Super-I" in reverse motion, become less neat and more aggressive than before, or return to more dependence on their mothers (lose independence), become passive and lose masculinity. . In other words, they again develop tendencies and properties that are characteristic of the pregenital sexuality and aggressiveness of the point of fixation in question, without internal contradiction.

In children with deviations of the second kind, when the formed "I" is quite enough to protect with the help of fear and guilt from the consequences of instinctive regression, the specific pathological consequence depends on which instinctive element against which the protest of their "I" is most manifested. In those cases where manifestations of anality, sadism and passivity are equally energetically reflected by the instances of the "I", symptomatology is most widespread. When condemnation of the "I" is directed only against sloppiness, there is excessive neatness, an obsessive desire to wash, etc. When manifestations of aggression and sadism are first reflected, own achievements are suppressed as a result and an inability to compete appears. When passive-feminist aspirations are most feared, there is an increased fear of castration or uncompensated aggressive masculinity. In all cases the consequences - symptoms or characters - are neurotic.

It is worth noting that, from analytic experience with adults, it is known that in neuroses, in the end, the "I" is also subject to various regressions. Renunciation, magical thinking, passivity and other obsessive-neurotic protective forms reduce the function of the "I" especially to a low level. However, this kind of regression of the "I" is the effect of the crash, not its cause; in this case, the decline is related only to the achievements of the "I", and the requirements of the "Super-I" remain without violations. Rather, on the contrary, the neurotic "I" does everything possible to fulfill the requirements of the "Super-I".

Conflicts and anxiety during diagnosis

On the way from the causal unity of the personality to its composition from the instances of "It", "I", "Super-I" and the structure of the personality, each individual passes through a series of phases in the course of normal development. First of all, the previously undifferentiated mental mass is subdivided into "It" and "I", that is, into two areas of action, which have different goals, intentions and methods of functioning. The first division is followed by the second stage in the "I", i.e., the division of this instance into the "I" itself and into the "Super-I" and the ideal "I" standing above it, which perform a critical and guiding function in relation to the "I". ".

In research, with the help of phenomena that manifest themselves in two ways, namely, by a special type of conflict and the fears associated with them, it is possible to establish how far the child has gone ahead or, on the contrary, has lagged behind along this path.

In childhood, we distinguish three types of conflict: external, deeply conscious and internal.

The external conflicts that take place between the whole personality of the child and the object world arise every time the surrounding world interferes and interferes with the child's impulses, postponing, limiting or forbidding their implementation. Until the child masters his instinctive impulses, that is, until his "I" coincides with the "It" and barriers have not yet been established between them, he is not able to overcome such influences of the surrounding world. External conflicts are the hallmark of childhood, the period of immaturity; we are justified in characterizing an individual as "infantile" if they remain or are regressively reborn at a later time. There are different types of fears associated with this form of conflict and evidence of its existence, which differ depending on the age and level of development of the child; common to them is that their sources are located in the outside world. Their stage-by-stage sequence in time is approximately as follows: fear of death with the loss of maternal care (fear of separation, fear of losing an object during the period of biological unity of mother and child), fear of losing love (after establishing a constant love relationship to the object), fear of criticism and punishment (during the anal-sadistic phase, in which the child projects his own aggression onto the parents, from which the fear of them increases), fear of castration (during the phallic-oedipal phase).

The second type of conflict is deeply conscious. They appear after the child, through identification with the parents, turns their demands into his own, and his "Super-I" already perceives parental authority to a greater extent. Conflicts that arise in matters of the fulfillment of desires or refusals differ little from conflicts of the previous type. However, collisions and disagreements in this case no longer occur externally between the child and the object, but in his inner life between mental instances, where the “I” falls to resolve the dispute between instinctive desire and the demand of the “Super-I” in the form of guilt. Until the feeling of guilt disappears, the investigating analyst has no doubt that the child has reached the "Superego" by creating steps in the "I".

The third type of conflict is internal conflict. Basically, they differ in that the external world does not play any role for them - neither direct, as in external conflicts, nor indirect, as in conscious ones, - role. Internal conflicts arise because of the genetically determined relationship between the "It" and "I" and differences in their organization. Instinctive derivatives and affects of the opposite kind, such as love and hate, activity and passivity, masculinity and femininity, coexist without enmity with each other as long as the "It" and the primary process own the mental apparatus. They become intolerable to each other and come into conflict as soon as the "I" matures and tries by means of a synthetic function to include in its organization the resisting contents. Even where the content of the "It" does not resist qualitatively, but only increases quantitatively, this is perceived by the "I" as a threat and leads to an internal conflict. This leads to the emergence of fears of a special kind, threatening the mental balance of the individual in a special way. But, unlike fear of the outside world or feelings of guilt, they are born in the depths and usually betray their presence not during a diagnostic examination, but only during an analytical treatment.

The above division of conflicts and fears into external, conscious and internal significantly helps the diagnostician in classifying and assessing their strength of conflicts caused by childhood disorders. This also explains why, in some cases, changes in the external conditions of life are sufficient for recovery (cases of the first kind, when conflicts are pathogenically influenced by the outside world), why cases of the second kind that require analytical help, with the cause of the disease consisting in conscious internal conflicts, without much difficulty are subject to change, and why in cases of the third kind, when we are dealing with internal instinctive conflicts, particularly complex actions and very lengthy analytical efforts are required (according to Freud, 1937 - "endless" analyzes).

General characteristics and their significance for diagnoses and prognosis

In order to meet expectations, the analyst must not only determine the existing childhood disorders and reconstruct the picture of their course in the past, but also predict, to the maximum extent possible, the prospects for treatment, which means the restoration and maintenance of mental health. Such a look into the future is impossible without the described details of the developmental processes, as well as without determining the personal properties that have a decisive influence on the maintenance or violation of mental balance, the source of which should be sought either in the innate constitution or in the earliest experiences of the individual. These properties are a hallmark of the "I" of the individual, since the "I" plays the role of an intermediary between the external world and the personality, its internal instances. Such of them as the setting of the "I" for displeasure and deprivation, the ability to sublimate, the setting for fear, the correctness of the development process and other progressive tendencies are of the greatest importance.

Overcoming displeasure (capacity for frustration) and tendency to sublimate

The extent to which the child's "I" is able to endure deprivation, that is, to overcome the displeasure caused by the circumstances, largely determines the child's chances of remaining (or becoming) mentally healthy. Perhaps in no one individual differences are more pronounced than in the smallest. Some children cannot bear any delay, any restriction in the satisfaction of instinctive desire, and respond with all manifestations of anger, rage, displeasure and impatience, substitute satisfactions are rejected by them as insufficient. After that, nothing but the fulfillment of the original desire can satisfy them. Usually such resistances to submission to often inevitable necessity begin already in infancy and manifest themselves first in the area of ​​oral desires, and then spread to other areas and at a later time. But there are children who, unlike the first, are much easier to satisfy. They endure the same instinctive limitations without such disturbance, more willingly accept substitute satisfactions that reduce desires, and usually retain these early acquired attitudes for later years.

Diagnosticians have no doubts that the internal balance in children of the first type is much more endangered than in the second. Forced to keep a huge amount of displeasure under control, the childish "I." if necessary, he begins to use the most primitive auxiliary means and methods of defense, such as renunciation or projection, as well as such primitive methods of withdrawal as outbursts of anger, rage and other affects. From these adjuvants, the further path leads to pathological compromise formations in the form of neurotic, dissocial and perverted symptoms.

Children of the second type have much more opportunities to neutralize and transfer their instinctive energy to satisfactions that are limited and quite achievable. This ability to sublimate is an invaluable aid in the struggle to maintain or restore mental health.

Overcoming feelings of anxiety

Analytical knowledge proves that fearless children do not exist, and various forms of fear are present as normal accompanying phenomena at various genetic levels. (For example, the stage of biological unity of mother and child corresponds to the fear of separation, the constant object - the fear of deprivation of love, the oedipal complex - the fear of castration, the formation of the "Super-I" - the feeling of guilt.) and the intensity of fear, but the ability to overcome it, on which mental balance ultimately depends and which is present in different individuals in different volumes.

Children who, at every manifestation of fear, use transferences, are in particular danger of neurosis.

Their "I" is forced to displace and renounce all external and internal dangers (all possible sources of fear) or to project all internal dangers onto the external world, from which they, returning, cause even greater fear, or else to phobically avoid any threats of fear and all kinds of fear. danger. The desire to avoid fear at any cost becomes an attitude that takes over at the beginning of childhood, and later the adult life of the individual and eventually leads to neurosis due to the excessive use of defense mechanisms.

The prospects for an individual's mental health are much better when the "I" does not avoid fear, but actively fights it, finding protection in understanding, logical thinking, active changes in the external world and aggressive opposition. Such an "I" is able to overcome a large amount of fear and do without excessive protective, compromise and symptomatic formations. (The active overcoming of fear should not be confused with the overcompensation of children, since in the first case the "I" protects itself directly from the imminent danger, and in the second - from its phobic avoidance.)

O. Isakover, explaining the example of active overcoming of fear by the most timid child, says: "The soldier is also scared, but this is not important for him."

Correlation between trends towards progress and regression

Despite the fact that throughout childhood there are forward and return aspirations in the mental apparatus, this does not mean at all that their relationship with each other is the same for all individuals. We know that for some children, everything new causes joy: they rejoice at a new dish, increased mobility and independence, movements that take them away from their mother to new faces and playmates, etc. For them, nothing is more important than becoming " big", to be able to imitate adults, and everything that even approximately corresponds to this desire compensates for all the difficulties and obstacles encountered on the way. In contrast, in other children, each new movement means, first of all, the rejection of the old sources of pleasure and therefore causes fear. Such children are hardly weaned, often perceiving such events as shock. They are afraid of parting with their mother and their familiar environment, first they are afraid of strangers, then responsibility, etc., in other words, they do not want to grow up.

It is easiest to make a clinical conclusion about which of these types a certain individual belongs to when observing the overcoming of life circumstances that require great courage from a child, such as a serious illness of the body, the birth of a new child in the family, etc. Children who have a desire to progress is stronger than regressive tendencies, often a long time of illness is used for the maturation of the "I", they feel like an "elder" brother or "elder" sister in relation to a newborn. If the tendency to regress is stronger, then during the illness the child becomes even more "infantile" than before, and the newborn baby begins to envy, because he wants to return to the state of the baby.

These differences matter for forecasting. The pleasure that the child of the first type experiences in successful advances, in turn, contributes to maturation, development and adaptation. In children of the second type, at every stage there is a constant danger of stopping development and creating points of fixation, their balance is easily disturbed, and the tendency to return very easily turns into a starting point for the appearance of fear, defense and neurotic destruction.

The picture of development from the point of view of metapsychology

Each example of the psychoanalytic study of the child provides a multitude of facts about the body and mind, all aspects and layers of the personality, facts relating to the past or present, the external or internal world of the child, factors of harmful and beneficial influence, successes and failures, fantasies and fears, protective processes, symptoms, etc. Everything that the subject discovers deserves attention, even if the confirmation of the information received is possible only under the condition of further work. However, no single fact in itself can be considered without connection with the rest of the material. As analysts, we are convinced that the fate of human development is determined not only by heredity, but also by inherited qualities in interaction with experienced events, that organic disorders (physical defects, blindness, etc.) lead to a variety of mental consequences, depending on the environmental influence to which child, and from the mental aids that are at his disposal to overcome his own difficulties. Whether fears (see above) should be regarded as pathogenic depends, rather, not on their type and strength, but on the form and way in which the child processes them. Attacks of rage and outpourings of feelings must be regarded differently, based on whether they arise spontaneously on the path of development or are obtained by imitation and identification with the objective world. Traumatic influences on a child cannot be read from the revealed life history, since they do not depend on the objective importance of the event, but on its subjective influence on each individual child. Courage and cowardice, greed and generosity, rationality and recklessness, depending on the life environment, chronological age, phase of development and genesis, acquire different meanings. Separate areas of clinical material and the connections with the integral personality extracted from them are identical only in name. In fact, they are as little suitable for use in individual diagnosis as they are for comparison with supposedly identical personality elements in other individuals.

The task of the investigating analyst is to organize an organic connection within the existing material, that is, to bring it dynamically, energetically, economically and structurally to a metapsychological point of view. As a result, the picture of the child's condition corresponds to the synthesis or splitting of the diagnosis into its analytical components.

Such genetic pictures can be obtained at various points in time - during a diagnostic study, during an analytical treatment, at the end of a treatment. Depending on this, they serve various purposes - making a general diagnosis (the main goal), confirming it or criticizing it based on the material revealed during the analysis, evaluating the therapeutic effectiveness of analytical methods in terms of the improvement obtained in the treatment.

In order to get a "metapsychological picture of development" it is first necessary to ascertain the external facts about the symptoms, the patient's descriptions, and the family history. This is the first attempt to assess the supposed significance of environmental influences. The description then proceeds to the inner life of the child, ordered according to the structure of his personality, the dynamic correlation of forces between instances, the correlation of forces between the id and the ego, adaptation to the external world, and genetic hypotheses arising from the emerging material. The resulting schematic representation looks something like this:

Approximate plan of the metapsychological picture of development

I. Reasons for the study (developmental disorders, behavioral problems, delays, anxieties, symptoms, etc.).

II. Description of the child (appearance, manners, behavior).

III. Family background and childhood history.

VI. Presumably significant environmental influences, both positive and negative.

V. Data on the development process.

A. Development of instincts:

1. Libido. Need to research:

a) development of libido:

whether the child has reached an age-appropriate phase (oral, anal-sadistic, phallic, latency, prepuberty), in particular, whether the transition from the anal phase to phallic sexuality has successfully occurred;

whether there is a dominant position of the achieved phase of development;

whether the child is at the time of the study at the highest stage of development achieved, or whether there is a regression to early positions;

b) distribution of libido:

whether there has been a distribution of libidinal fillings between the child himself and the object world;

is narcissistic filling enough (primary and secondary narcissism, filling of the body "I",

"I" and "Super-I") to ensure their own feelings; how much it depends on object relations;

c) object libido:

whether the stage corresponding to chronological age has been reached in the stage-by-stage sequence of object relations (narcissistic, according to the type of adjunction and support, constancy of the object, pre-oedipal, goal-limited, puberty-conditioned);

whether the child is retained at this stage, or regressions to earlier stages are observed;

whether the form of the object relation corresponds to the phase of libidinal development reached or regressively obtained.

2. Aggression. Needs to be explored; what forms of manifestation of aggression does the child operate with:

a) a quantitative indicator, i.e., is it present or absent in the clinical picture;

b) an indicator of the type and form, corresponding to the phase development on the part of the libido;

c) focus on the outside world or on oneself.

B. Development of "I" and "Super-I". Need to research:

a) the psychic apparatuses at the disposal of the "I" are working or broken;

b) how good are the functions of the "I" (memory, reality check, synthetic function, secondary process); if there are violations, then which ones are genetically or neurotically determined; formed simultaneously or not; what is the coefficient of intellectual development;

c) how developed the defense of the "I" is: directed against a certain instinctive derivative (it is necessary to indicate) or against instinctive activity and instinctive satisfaction in general;

whether it corresponds to the chronological age (too primitive or, conversely, the existing defense mechanisms have matured too early);

protective activity is divided evenly into a large number of mechanisms or is limited to a small number of them;

effective or ineffective protective activity, primarily against fear; maintains or recreates the balance between instances; there is a possibility of internal mobility, or it is suppressed, etc.;

is it dependent or independent of the objective world, and to what extent (the formation of the "Super-I", awareness, external conflicts);

d) how secondarily the functions of the "I" are damaged by the protective activity of the "I" (what are the losses in the ability to achieve success associated with maintaining instinctive defense and mastering the instincts).

VI. Genetic data on fixation and regression points.

According to our point of view, the return to genetically determined fixation points is the basis of all infantile neuroses and many infantile psychoses. Therefore, one of the most important tasks of the diagnostician is to detect them in the prehistory of the child with the help of the following manifested phenomena:

a) certain properties of behavior, the instinctive background of which is known to the analyst; they are an external manifestation of processes occurring in the depths of the mental apparatus. The clearest example of this kind is the emerging picture of an obsessive neurotic character, in which properties such as neatness, love of order, frugality, punctuality, skepticism, indecisiveness, etc., indicate a conflict of the anal-sadistic phase, and thus give out a fixation point. at this point. Other pictures of characters or ways of behaving similarly give out points of fixation in other areas or on other steps. (The child's pronounced concern for the life and health of his parents, brothers and sisters speaks of special conflicts associated with an infantile death wish; fear of taking medication, certain nutritional difficulties, etc. indicate an ongoing defensive struggle with oral fantasies; such a property "I ", as shyness, indicates the rejected exhibitionism in "It"; homesickness indicates the presence of a long-standing ambivalent conflict, etc.);

b) children's fantasies, which, under favorable conditions, are sometimes discovered in a clinical study, but more often become available to a diagnostician through testing. (It often happens that as difficult as access to fantasy life is in the first study, so rich is the material of conscious and unconscious fantasy in analytic processing, when the patient's pathogenic background is fully clarified.);

c) symptoms, for which a connection between the unconscious background and the manifest form of manifestations is typical, which even allows, as in the case of obsessive neurosis, to draw conclusions about repressed processes from the picture of symptoms. However, one should not exaggerate the number of such symptoms, since many of them, such as lying, cheating, enuresis, etc., are not a source of information during a diagnostic study, because they arise on a very different instinctive background.

VII. Dynamic and structural data on conflicts.

The normal development of the child is influenced by conflicts occurring between the external and internal world, on the one hand, and between internal instances, on the other, just like his pathology. The diagnostician needs to understand these counteractions and structure dynamic processes into a scheme:

a) as external conflicts between the child's personality as a whole and the object world (accompanying fear of the object world);

b) as deeply conscious conflicts between the "It" and instances of the "I", which absorb (deeply realize) the requirements of the environment (an accompanying feeling of guilt);

c) as deep internal conflicts between contradictory and inconsistent instinctive urges (unresolved ambivalence love-hate, activity-passivity, masculinity-femininity, etc.).

From the form of the conflict that determines the life of each particular child, we can conclude:

1) about the maturity of the structure of his personality (the degree of independence from the objective world);

2) the severity of violations in the personality structure;

3) about methods of influence that can lead to improvement or cure.

VIII. General properties and positions.

To make a prediction about whether a particular child has the possibility of spontaneous recovery from a disorder or the prospect of success in treatment, it is necessary to pay attention to the following personality traits and behaviors:

a) the position of the child in relation to refusals. If he tolerates rejection worse than he should have expected at his age, then fear is stronger than his "I" and the child finds a way out in the sequences of regression, defense and symptom formation leading to illness. If refusals are better tolerated, it is easier for the individual to maintain his inner balance or restore it after a violation;

b) the ability of the child to sublimate instinctive urges. There are strong individual differences in this area. In cases where it is possible to use goal-limited and neutralized substitute satisfactions, they compensate the child for the inevitable disappointments in instinctive life and reduce the possibility of pathological destruction. An important task of treatment is the release of the pinched sublimating ability;

c) the child's attitude to fear. It is necessary to distinguish between the tendency to avoid fear and to actively overcome it. The first rather leads to pathology, and the second is a sign of a healthy, well-organized and active "I";

d) the relationship between progress and regression in the developmental processes of the child. If forward thrusts are stronger than backward tendencies, the prospect of maintaining health or self-healing is better than otherwise: strong developmental spurts help the child fight his symptoms. When regressive tendencies take precedence and the child clings to archaic sources of pleasure, resistance to treatment also increases. The balance of power between these two tendencies in the individual child manifests itself in the form of a conflict between the desire to become "big" and the unwillingness to give up infantile positions and satisfactions.

For a final generalization of the diagnostic systems used so far, it is not enough. A special scheme is needed, in which, first of all, the relation of various disturbances to development and the degree of their deviation from the normal process are assessed. To do this, the diagnostician must select one of the following positions:

1) except for some difficulties in meeting bodily needs, in relation to the world around and in the daily behavior of the child, the processes of its development are not damaged in themselves, which means that the violation remains within the normal range;

2) the disturbances found in the clinical picture of symptom formation correspond in their scale to the effort aimed at overcoming specific genetic difficulties, which means that with further advancement to the next steps of the line of development, they will be eliminated spontaneously;

3) there are instinctive regressions to previously acquired points of fixation, their prolonged exposure creates internal conflicts that lead to infantile neuroses and character disorders;

4) the ongoing instinctive regressions lead to regressions of the "I" and "Super-I", to infantilism, etc.;

5) there are damages to existing inclinations (through organic violations) or a constitution acquired in the first year of life (through deprivation, refusals, bodily illness, etc.), which harm the development process, prevent the formation and separation of internal instances from each other, leading to to defective, retarded, and even atypical clinical pictures;

6) some inexplicable processes of organic, toxic or mental origin have a destructive effect on already existing personal acquisitions, which is expressed in loss of speech, inhibition of instincts, impaired sense of reality, etc., thus inhibiting the entire development process, causing infantile psychoses , autism and similar pathologies.

Attempts to organize analytical work with children from the positions of traditional psychoanalysis ran into real difficulties: children do not have a pronounced

interest in the study of one's past, there is no initiative to turn to a psychoanalyst, and the level of verbal development is insufficient for

putting your feelings into words. At first, psychoanalysts mainly used as material for the interpretation of observation and

parent messages.

Later, methods of psychoanalysis were developed, aimed specifically at children. Freud's followers in the field of child psychoanalysis A. Freud and M.

Klein created their own, differing versions of child psychotherapy.

A. Freud (1895-1982) adhered to the position traditional for psychoanalysis about the child's conflict with the social world full of contradictions. Her writings

Introduction to Child Psychoanalysis (1927), Norm and Pathology in Childhood (1966) and others laid the foundations of child psychoanalysis. She emphasized that for

understanding the causes of difficulties in behavior, the psychologist must strive to penetrate not only into the unconscious layers of the child's psyche, but also to obtain

the most detailed knowledge about all three components of the personality (I, It, Super-I), about their relationship with the outside world, about the mechanisms of psychological

protection and their role in personality development.

A. Freud believed that in the psychoanalysis of children, firstly, it is possible and necessary to use analytical methods common with adults on speech material:

hypnosis, free association, interpretation of dreams, symbols, parapraxes (silences, forgetting), analysis of resistances and transference. Secondly, she

She also pointed to the peculiarity of the technique of analyzing children. Difficulties in applying the method of free association, especially in young children, may partly be

overcome through the analysis of dreams, daydreams, daydreams, and drawings, which will reveal the tendencies of the unconscious in an open and accessible

form. A. Freud proposed new technical methods that help in the study of the Self. One of them is the analysis of the transformations undergone by affects

child. In her opinion, the discrepancy between what was expected (according to past experience) and demonstrated (instead of chagrin - a cheerful mood, instead of jealousy -

excessive tenderness) of the child's emotional reaction indicates that protective mechanisms are working, and thus it becomes possible

penetrate into the I of the child. A wealth of material on the formation of defense mechanisms at specific phases of child development is provided by the analysis of phobias.

animals, features of school and family behavior of children. So, A. Freud attached great importance to children's play, believing that, carried away

play, the child will also be interested in the interpretations offered to him by the analyst regarding defense mechanisms and unconscious emotions,

hiding behind them.

A psychoanalyst, according to A. Freud, for success in child therapy must necessarily have authority over the child, since the child's Super-Ego

relatively weak and unable to cope with the urges released as a result of psychotherapy without outside help. Of particular importance is

the nature of the child’s communication with an adult: “Whatever we start to do with the child, whether we teach him arithmetic or geography, whether we educate him

or subjected to analysis, we must first of all establish certain emotional relationships between ourselves and the child. The harder the work

which is ahead of us, the stronger this connection should be, ”stressed A. Freud. When organizing research and corrective work with

difficult children (aggressive, anxious), the main efforts should be directed to the formation of attachment, the development of libido, and not to direct

overcoming negative reactions. The influence of adults, which gives the child, on the one hand, hope for love, and on the other hand, makes one fear

punishment, allows him to develop his own ability to control the inner instinctive life within a few years. At the same time, part

achievements belongs to the forces of the I of the child, and the rest - to the pressure of external forces; correlation of influences cannot be determined.

In the psychoanalysis of a child, A. Freud emphasizes, the outside world has a much stronger influence on the mechanism of neurosis than in an adult. Children's

the psychoanalyst must necessarily work on the transformation of the environment. The external world, its educational influences are a powerful ally

weak I of the child in the struggle against instinctive tendencies.

English psychoanalyst M. Klein (1882-1960) developed her own approach to the organization of psychoanalysis at an early age. The focus was on

spontaneous play activity of the child. M. Klein, unlike A. Freud, insisted on the possibility of direct access to the content of children's

unconscious. She believed that action is more characteristic of a child than speech, and free play is the equivalent of an adult's flow of associations;

the stages of the game are analogues of the associative production of an adult.

Psychoanalysis with children, according to Klein, was built mainly on spontaneous children's play, which was helped to manifest itself by specially created conditions.

The therapist gives the child a lot of small toys, "the whole world in miniature" and gives him the opportunity to act freely for an hour.

The most suitable for psychoanalytic play equipment are simple non-mechanical toys: wooden male and female figures of different

sizes, animals, houses, hedges, trees, various vehicles, cubes, balls and sets of balls, plasticine, paper, scissors, non-sharp

knife, pencils, crayons, paints, glue and rope. The variety, quantity, miniature sizes of toys allow the child to express his

fantasies and use the experience of conflict situations. The simplicity of toys and human figures makes them easy to incorporate into story

moves, fictional or prompted by the real experience of the child.

The game room should also be equipped very simply, but provide maximum freedom of action. In it, for play therapy,

a table, some chairs, a small sofa, some pillows, a washable floor, running water, and a chest of drawers. Game materials of each

The child is stored separately, locked in a specific box. This condition is intended to convince the child that his toys and playing with them will be known.

only to himself and the psychoanalyst.

Observation of the various reactions of the child, the "stream of childish play" (and especially the manifestations of aggressiveness or compassion) becomes

the main method of studying the structure of the child's experiences. The undisturbed course of the game corresponds to the free flow of associations; interrupts and

Inhibitions in games are equated with breaks in free associations. A break in the game is seen as a defensive action on the part of the ego,

comparable to resistance in free association. A variety of emotional states can manifest themselves in the game: a feeling of frustration and

rejection, jealousy of family members and accompanying aggressiveness, feelings of love or hatred for the newborn, the pleasure of playing with a friend,

opposition to parents, feelings of anxiety, guilt and the desire to correct the situation.

Prior knowledge of the child's developmental history and of the symptoms and impairments present helps the therapist in interpreting the meaning of the child's play.

As a rule, the psychoanalyst tries to explain to the child the unconscious roots of his game, for which he has to show great ingenuity,

to help the child realize which of the real members of his family are the figures used in the game. At the same time, the psychoanalyst does not insist on

that the interpretation accurately reflects the experienced psychic reality, it is rather a metaphorical explanation or an interpretative sentence,

put forward for testing.

The child begins to understand that there is something unknown (“unconscious”) in his own head and that the analyst is also participating in his game. M. Klein

gives a detailed description of the details of psychoanalytic game technique with specific examples.

So, at the request of her parents, M. Klein conducted psychotherapeutic treatment of a seven-year-old girl with normal intelligence, but with a negative

attitude towards school and academic failure, with some neurotic disorders and poor contact with the mother. The girl did not want to draw and

communicate actively in the therapist's office. However, when she was given a set of toys, she began to replay her anxious relationship with

classmate. It was they who became the subject of the psychoanalyst's interpretation. After hearing the therapist's interpretation of her game, the girl became

trust him more. Gradually, in the course of further treatment, her relationship with her mother and her school situation improved.

Sometimes the child refuses to accept the therapist's interpretation and may even stop playing and throw away the toys when he hears that his aggression

directed at a father or brother. Such reactions, in turn, also become the subject of interpretation by the psychoanalyst.

Changes in the nature of a child's play can directly confirm the correctness of the proposed interpretation of play. For example, a child finds in a box with

a figurine soiled with toys, which symbolized his younger brother in the previous game, and washes it in a basin from traces of his former aggressive

intentions.

So, penetration into the depths of the unconscious, according to M. Klein, is possible using game technology, through the analysis of anxiety and protective

child's mechanisms. Regularly giving the child patient interpretations of his behavior helps him cope with the difficulties that arise and

conflicts.

Some psychologists believe that the game is healing in itself. So, A.V. Winnicott emphasizes the creative power of free play in comparison

with a game by the rules (game).