Reading Anna Freud

What place do Anna Freud’s ideas have in the history of psychoanalysis?

What can her writings teach us today about how to work therapeutically
with children? Are her psychoanalytic ideas still relevant to those
entrusted with the welfare of infants and young people?
Reading Anna Freud provides an accessible introduction to the writings of
one of the most significant figures in the history of psychoanalysis. Each
chapter introduces a number of her key papers, with clear summaries of
the main ideas, historical background, a discussion of the influence and
contemporary relevance of her thinking, and recommendations for further
reading.
Areas covered include Anna Freud’s writings on:

• The theory and practice of child analysis and ‘developmental therapy’

• The application of psychoanalytic thinking to education, paediatrics and
the law
• The assessment and diagnosis of childhood disorders
• Psychoanalytic research and developmental psychopathology

Nick Midgley draws on his extensive experience as a child psychotherapist

and a teacher to bring Anna Freud’s ideas to life. He illustrates the remarkable
originality of her thinking, and shows how analytic ideas can be used not
only in child psychotherapy, but also to inform the care of children in families,
hospitals, classrooms, residential care and the courtroom.
Reading Anna Freud will be of interest to child therapists, child analysts and
psychoanalysts, as well as others working in the field of child and adolescent
mental health, such as clinical psychologists, child psychiatrists and educational
psychologists. It also has much to offer to those entrusted with the care of
children in a wide range of settings – including teachers, nurses and social
workers – for whom Anna Freud was always keen to demonstrate the value
of a psychoanalytic approach.

Nick Midgley trained as a child and adolescent psychotherapist at the Anna

Freud Centre, where he now works as a clinician and as Programme Director
for the MSc in Developmental Psychology and Clinical Practice. Nick
has written articles on a wide range of topics and is joint editor of Minding
the Child: Mentalization-based Interventions with Children, Young People and
their Families (Routledge, 2012) and Child Psychotherapy and Research: New
Directions, Emerging Findings (Routledge, 2009).
 THE NEW LIBRARY OF PSYCHOANALYSIS
General Editor: Alessandra Lemma

The New Library of Psychoanalysis was launched in 1987 in association with

the Institute of Psychoanalysis, London. It took over from the International
Psychoanalytical Library which published many of the early translations of
the works of Freud and the writings of most of the leading British and
Continental psychoanalysts.
The purpose of the New Library of Psychoanalysis is to facilitate a greater
and more widespread appreciation of psychoanalysis and to provide a forum
for increasing mutual understanding between psychoanalysts and those
working in other disciplines such as the social sciences, medicine, philosophy,
history, linguistics, literature and the arts. It aims to represent different trends
both in British psychoanalysis and in psychoanalysis generally. The New
Library of Psychoanalysis is well placed to make available to the English-
speaking world psychoanalytic writings from other European countries and
to increase the interchange of ideas between British and American
psychoanalysts. Through the Teaching Series, the New Library of Psychoanalysis
now also publishes books that provide comprehensive, yet accessible,
overviews of selected subject areas aimed at those studying psychoanalysis
and related fields such as the social sciences, philosophy, literature and
the arts.
The Institute, together with the British Psychoanalytical Society, runs
a low-fee psychoanalytic clinic, organizes lectures and scientific events
concerned with psychoanalysis and publishes the International Journal of
Psychoanalysis. It runs the a training course in psychoanalysis which leads
to membership of the International Psychoanalytical Association – the
body which preserves internationally agreed standards of training, of
professional entry, and of professional ethics and practice for psychoanalysis
as initiated and developed by Sigmund Freud. Distinguished members of
the Institute have included Michael Balint, Wilfred Bion, Ronald Fairbairn,
Anna Freud, Ernest Jones, Melanie Klein, John Rickman and Donald
Winnicott.
Previous general editors have included David Tuckett, who played a very
active role in the establishment of the New Library. He was followed as
general editor by Elizabeth Bott Spillius, who was in turn followed by Susan
Budd and then by Dana Birksted-Breen.
Current members of the Advisory Board include Liz Allison, Giovanna di
Ceglie, Rosemary Davies and Richard Rusbridger.
Previous Members of the Advisory Board include Christopher Bollas,
Ronald Britton, Catalina Bronstein, Donald Campbell, Sara Flanders,
Stephen grosz, John Keene, Eglé Laufer, Alessandra Lemma, Juliet Mitchell,
Michael Parsons, Rosine Jozef Perelberg, Mary Target and David Taylor.
 ALSO IN THIS SERIES

Impasse and Interpretation Herbert Rosenfeld

Psychoanalysis and Discourse Patrick Mahony
The Suppressed Madness of Sane Men Marion Milner
The Riddle of Freud Estelle Roith
Thinking, Feeling, and Being Ignacio Matte Blanco
The Theatre of the Dream Salomon Resnik
Melanie Klein Today: Volume 1, Mainly Theory Edited by Elizabeth Bott
Spillius
Melanie Klein Today: Volume 2, Mainly Practice Edited by Elizabeth Bott
Spillius
Psychic Equilibrium and Psychic Change: Selected Papers of Betty Joseph Edited by
Michael Feldman and Elizabeth Bott Spillius
About Children and Children-No-Longer: Collected Papers 1942–80 Paula
Heimann. Edited by Margret Tonnesmann
The Freud–Klein Controversies 1941–45 Edited by Pearl King and Riccardo
Steiner
Dream, Phantasy and Art Hanna Segal
Psychic Experience and Problems of Technique Harold Stewart
Clinical Lectures on Klein & Bion Edited by Robin Anderson
From Fetus to Child Alessandra Piontelli
A Psychoanalytic Theory of Infantile Experience: Conceptual and Clinical
Reflections E Gaddini. Edited by Adam Limentani
The Dream Discourse Today Edited and introduced by Sara Flanders
The Gender Conundrum: Contemporary Psychoanalytic Perspectives on Feminitity
and Masculinity Edited and introduced by Dana Breen
Psychic Retreats John Steiner
The Taming of Solitude: Separation Anxiety in Psychoanalysis Jean-Michel
Quinodoz
Unconscious Logic: An Introduction to Matte-Blanco’s Bi-logic and its Uses Eric
Rayner
Understanding Mental Objects Meir Perlow
Life, Sex and Death: Selected Writings of William Gillespie Edited and
introduced by Michael Sinason
What Do Psychoanalysts Want?: The Problem of Aims in Psychoanalytic Therapy
Joseph Sandler and Anna Ursula Dreher
Michael Balint: Object Relations, Pure and Applied Harold Stewart
Hope: A Shield in the Economy of Borderline States Anna Potamianou
Psychoanalysis, Literature & War: Papers 1972–1995 Hanna Segal
Emotional Vertigo: Between Anxiety and Pleasure Danielle Quinodoz
Early Freud and Late Freud Ilse Grubrich-Simitis
A History of Child Psychoanalysis Claudine and Pierre Geissmann
Belief and Imagination: Explorations in Psychoanalysis Ronald Britton
A Mind of One’s Own: A Psychoanalytic View of Self and Object Robert A
Caper
Psychoanalytic Understanding of Violence and Suicide Edited by Rosine Jozef
Perelberg
On Bearing Unbearable States of Mind Ruth Riesenberg-Malcolm
Psychoanalysis on the Move: The Work of Joseph Sandler Edited by Peter
Fonagy, Arnold M. Cooper and Robert S. Wallerstein
The Dead Mother: The Work of André Green Edited by Gregorio Kohon
The Fabric of Affect in the Psychoanalytic Discourse André Green
The Bi-Personal Field: Experiences of Child Analysis Antonino Ferro
The Dove that Returns, the Dove that Vanishes: Paradox and Creativity in
Psychoanalysis Michael Parsons
Ordinary People, Extra-ordinary Protections: A Post Kleinian Approach to the
Treatment of Primitive Mental States Judith Mitrani
The Violence of Interpretation: From Pictogram to Statement Piera Aulagnier
The Importance of Fathers: A Psychoanalytic Re-Evaluation Judith Trowell and
Alicia Etchegoyen
Dreams That Turn Over a Page: Paradoxical Dreams in Psychoanalysis Jean-
Michel Quinodoz
The Couch and the Silver Screen: Psychoanalytic Reflections on European Cinema
Andrea Sabbadini
In Pursuit of Psychic Change: The Betty Joseph Workshop Edited by Edith
Hargreaves and Arturo Varchevker
The Quiet Revolution in American Psychoanalysis: Selected Papers of Arnold
M. Cooper Arnold M. Cooper. Edited and Introduced by Elizabeth L.
Auchincloss
Seeds of Illness and Seeds of Recovery: The genesis of suffering and the role of
psychoanalysis Antonino Ferro
The Work of Psychic Figurability: Mental States Without Representation César
Botella and Sára Botella
Key Ideas for a Contemporary Psychoanalysis: Misrecognition and Recognition of the
Unconscious André Green
The Telescoping of Generations: Listening to the Narcissistic Links Between
Generations Haydée Faimberg
Glacial Times: A Journey through the World of Madness Salomon Resnik
This Art of Psychoanalysis: Dreaming Undreamt Dreams and Interrupted Cries
Thomas H. Ogden
Psychoanalysis and Religion in the 21st Century: Competitors or Collaborators?
David M. Black
Recovery of the Lost Good Object Eric Brenman
The Many Voices of Psychoanalysis Roger Kennedy
Feeling the Words: Neuropsychoanalytic Understanding of Memory and the
Unconscious Mauro Mancia
Constructions and the Analytic Field: History, Scenes and Destiny Domenico
Chianese
Projected Shadows: Psychoanalytic Reflections on the Representation of Loss in
European Cinema Edited by Andrea Sabbadini
Encounters with Melanie Klein: Selected Papers of Elizabeth Spillius Elizabeth
Spillius
Yesterday, Today and Tomorrow Hanna Segal
Psychoanalysis Comparable and Incomparable: The Evolution of a Method to
Describe and Compare Psychoanalytic Approaches David Tuckett, Roberto
Basile, Dana Birksted-Breen, Tomas Böhm, Paul Denis, Antonino Ferro,
Helmut Hinz, Arne Jemstedt, Paola Mariotti and Johan Schubert
Time, Space and Phantasy Rosine Jozef Perelberg
Rediscovering Psychoanalysis: Thinking and Dreaming, Learning and Forgetting
Thomas H. Ogden
Mind Works: Techniques and Creativity in Psychoanalysis Antonino Ferro
Doubt Conviction and the Analytic Process: Selected Papers of Michael Feldman
Michael Feldman
Melanie Klein in Berlin: Her First Psychoanalyses of Children Claudia
Frank
The Psychotic Wavelength: A Psychoanalytic Perspective for Psychiatry Richard
Lucas
Betweenity: A Discussion of the Concept of Borderline Judy Gammelgaard
The Intimate Room: Theory and Technique of the Analytic Field Giuseppe
Civitarese
Bion Today Edited by Chris Mawson
Secret Passages: The Theory and Technique of Interpsychic Relations Stefano
Bolognini
Intersubjective Processes and the Unconscious: An Integration of Freudian, Kleinian
and Bionian Perspectives Lawrence J. Brown
Seeing and Being Seen: Emerging from a Psychic Retreat John Steiner
Avoiding Emotions, Living Emotions Antonio Ferro
Projective Identification: The Fate of a Concept Edited by Elizabeth Spillius and
Edna O’Shaughnessy
Creative Readings: Essays on Seminal Analytic Works Thomas Ogden
The Maternal Lineage Edited by Paola Mariotti
Donald Winnicott Today Edited by Jan Abram
Symbiosis and Ambiguity: A Psychoanalytic Study Edited by John Churcher,
José Bleger and Leopoldo Bleger
Psychotic Temptation Liliane Abensour
The Theory and Technique of Psychoanalytic Supervision: The Sao Paulo Clinical
Seminars Antonino Ferro
 TITLES IN THE NEW LIBRARY OF PSYCHOANALYSIS
TEACHING SERIES

Reading Freud: A Chronological Exploration of Freud’s Writings Jean-Michel

Quinodoz
Listening to Hanna Segal: Her Contribution to Psychoanalysis Jean-Michel
Quinodoz
Reading French Psychoanalysis Edited by Dana Birksted-Breen, Sara Flanders
and Alain Gibeault
Reading Winnicott Lesley Caldwell and Angela Joyce
Initiating Psychoanalysis: Perspectives Bernard Reith, Sven Lagerlöf, Penelope
Crick, Mette Møller and Elisabeth Skale
Infant Observation Frances Salo
Reading Anna Freud Nick Midgley

TITLES IN THE NEW LIBRARY OF PSYCHOANALYSIS

‘BEYOND THE COUCH’ SERIES

Under the Skin: A Psychoanalytic Study of Body Modification Alessandra Lemma

Engaging with Climate Change: Psychoanalytic and Interdisciplinary Perspectives
Edited by Sally Weintrobe
THE NEW LIBRARY OF PSYCHOANALYSIS:
TEACHING SERIES
7

General Editor: Alessandra Lemma

Reading Anna Freud

Nick Midgley
First published 2013
by Routledge
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Simultaneously published in the USA and Canada
by Routledge
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Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2013 N. Midgley
The right of Nick Midgley to be identified as author of this work has been
asserted by him in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
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Trademark notice : Product or corporate names may be trademarks or
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without intent to infringe.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Midgley, Nick, 1968–
Reading Anna Freud / Nick Midgley.
p. cm.
Includes bibliographical references.
ISBN 978-0-415-60099-6 (hardback) — ISBN 978-0-415-60100-9 (pbk.)
1. Freud, Anna, 1895–1982. 2. Psychoanalysts. 3. Developmental
therapy for children. 4. Child analysis. I. Title.
BF109.F73M53 2012
150.19'52092—dc23
2012009162

ISBN: 978–0–415–60099–6 (hbk)

ISBN: 978–0–415–60100–9 (pbk)
ISBN: 978–0–203–09598–0 (ebk)

Typeset in Bembo
by Refi neCatch Limited, Bungay, Suffolk
 This book is dedicated to Audrey Gavshon, my fi rst clinical supervisor on
the Anna Freud Centre training in child psychotherapy, as well as all those
who taught on the course over the years

And to the memory of

Pat Radford (1921–2012) and Elisabeth Young-Bruehl (1946–2011)
 CONTENTS

Acknowledgements xii
Anna Freud: a chronology xiv

1 Introduction: Anna Freud, her life and work 1

2 Psychoanalysis with children 18

3 The application of psychoanalytic ideas to education 32

4 The Ego and the Mechanisms of Defence 54

5 The Hampstead War Nurseries 69

6 Psychoanalytic research and the observation of children 83

7 The psychoanalytic treatment of adults 101

8 The assessment and diagnosis of childhood disturbances 118

9 Developmental psychopathology 130

10 Child analysis and developmental therapy 145

11 Psychoanalysis and paediatrics: The care of children in hospital 166

12 Children and family law 182

13 Conclusion: The legacy of Anna Freud 197

Bibliography 205
Index 222

xi
 ACKNOWLEDGEMENTS

My understanding of Anna Freud’s thinking owes a great deal to the talented

clinicians and teachers who taught me on my training as a child psychotherapist
at the Anna Freud Centre between 1996 and 2002; as well as to the children
and families I’ve worked with, who helped me to appreciate what those ideas
mean in practice.
A number of people have commented on drafts of chapters or have
discussed their memories of Anna Freud with me at various points. I would
like to thank: Flavia Ansaldo, Liane Aukin, Michela Biseo, Philip Graham,
Angela Joyce, Sebastian Kraemer, Mary Lindsay, Norka Malberg, Graham
Music, David Norgrove, Reiko Oya, Alejandra Perez and Anne-Marie
Sandler. I am also extremely grateful to Alessandra Lemma, the series editor
of the New Library of Psychoanalysis, and to my editors at Routledge, Kate
Hawes and Kirsten Buchanan.
For permission to reproduce Anna Freud’s work, I would like to thank
Charlotte Bruton and the Marsh Agency, who gave permission on behalf of
the Estate of Anna Freud for me to quote extensively from the Selected Writings
of Anna Freud. The directorial team of the Anna Freud Centre kindly agreed
to pay the cost of this.
Although none have been reproduced here in full, some sections or
paragraphs in this book have been previously published as parts of articles I
have written about Anna Freud’s work. Thanks are due to:
Taylor and Francis Ltd ( [Link] for permission to
reproduce sections from ‘The “Matchbox School” (1927–1932): Anna Freud
and the idea of a psychoanalytically informed education’, Journal of Child
Psychotherapy, 34/1 (2008): 23–42 © Association of Child Psychotherapists.
Sage Publications, for permission to reproduce sections from ‘Test of Time:
Anna Freud’s Normality and Pathology (1965)’, Clinical Child Psychology and
Psychiatry, 16/3 (2011): 475–482 © Sage Publications.
John Wiley & Sons, Ltd., for permission to reproduce sections from ‘Anna
Freud: The Hampstead War Nurseries and the role of the direct observation
of children in psychoanalysis’, International Journal of Psycho-Analysis, 88/4
(2007): 939–960.

xii
 The American Psychoanalytic Association, for permission to reproduce
sections from ‘Peter Heller’s A Child Analysis with Anna Freud : The significance
of the case for the history of child psychoanalysis’, Journal of the American
Psychoanalytic Association, 60/1 (2012): 45–70.

Acknowledgements xiii
 ANNA FREUD: A CHRONOLOGY

Year Biography Key publications

1895 Born, December 3rd, in Vienna, Studies on Hysteria (by Sigmund
Austria. Sixth child of Martha Freud and Josef Breuer)
and Sigmund Freud
1911 Graduates from her high school,
the Cottage Lyceum
1914 Visits England for the first time.
Begins her apprenticeship as a
teacher. First World War begins
1917 Suffers from tuberculosis, requiring
period of recuperation
1918 Attends the International
Psychoanalytical Association
Congress (Budapest) for the first
time. Begins first analysis with
Sigmund Freud
1919 Stops teaching and takes up a post
in the Psychoanalytische Verlag, as
assistant. Volunteers at Bernfeld’s
Baumgarten Children’s Home
1920 Sophie, Anna’s sister, dies. Attends
IPA Congress in the Hague, where
Hug-Hellmuth gives a talk on child
analysis
1921 Friendship with Lou Andreas-
Salomé begins
1922 Becomes a member of the Vienna ‘Beating Fantasies and
Psychoanalytic Society Daydreams’

xiv
Year Biography Key publications
1923 Begins working psychoanalytically
with children. Sigmund Freud
diagnosed with cancer. Death of her
nephew, Heinele
1924 Attends ward rounds at Psychiatric
Clinic of Vienna General Hospital
1925 Begins teaching a seminar on the
technique of child analysis at the
newly founded Vienna
Psychoanalytic Institute. Dorothy
Burlingham and her children move
to Vienna
1926 Helps to found the Zeitschrift für
Psychoanalytische Pädagogik
( Journal for Psychoanalytic
Education)
1927 Becomes General Secretary of the Introduction to the Technique of
IPA. Establishes the ‘Matchbox Child Analysis
School’. Attends symposium on
child analysis in London
1928 First meeting of the ‘The Theory of Child Analysis’
‘Kinderseminar’ (seminar on
child analysis)
1929 Alongside Melanie Klein, speaks
at the IPA Congress in Oxford on
child analysis
1930 Buys cottage in the Semmering Four Lectures on Psycho-Analysis
with Dorothy Burlingham for Teachers and Parents
1932 The ‘Matchbox School’ closes
1935 Becomes director of the Vienna
Psychoanalytic Training Institute.
Edits special issue of Psychoanalytic
Quarterly on child analysis
1936 The Ego and the Mechanisms of
Defence
1937 Establishes the Jackson Nursery.
Lou Andreas-Salomé dies

Anna Freud: a chronology xv

Year Biography Key publications
1938 Austria annexed by the German
Reich. Jackson Nursery closes.
Escapes from Vienna with her
family and arrives in London
1939 Second World War begins.
Sigmund Freud dies
1941 With Dorothy Burlingham,
establishes the Hampstead War
Nurseries. Minna Bernays
(aunt) dies
1942 Start of the Freud–Klein debates Young Children in War-Time: A
in the British Psychoanalytical Year’s Work in a Residential War
Society Nursery (with Dorothy
Burlingham)
1943 War and Children (with Dorothy
Burlingham)
1944 Infants without Families: The Case
for and against Residential
Nurseries (with Dorothy
Burlingham)
1945 The War Nurseries close. Helps to ‘Indications for Child Analysis’
found the ‘Psychoanalytic Study of
the Child’. Falls ill with pneumonia
1946 Addresses meeting of UNESCO ‘Freedom from Want in Early
Education’
1947 With Kate Friedlander, establishes
the Hampstead Child Therapy
Training Course
1949 August Aichhorn dies. First post- ‘Notes on Aggression’
war IPA Congress takes place in
Zurich
1950 First visit to the US. Ernst Kris ‘The Significance of the
sets up a laboratory at the Yale Evolution of Psychoanalytic
Child Study Center Child Psychology’

xvi Anna Freud: a chronology

Year Biography Key publications
1951 Martha Freud dies. Buys a ‘The Contribution of
cottage in Walberswick with Psychoanalysis to Genetic
Dorothy Burlingham Psychology’; ‘Observations on
Child Development’; ‘An
Experiment in Group
Upbringing’ (with Sophie
Dann)
1952 The Hampstead Child Therapy ‘The Role of Bodily Illness in
Course and Clinic opens. Delivers the Mental Life of Children’
the Harvard Lectures on second
visit to US
1953 Sieg fried Bernfeld dies
1954 Start of Hampstead Index project. ‘Problems of Technique in Adult
Dorothy Burlingham sets up Analysis’; ‘Psychoanalysis and
kindergarten for blind children education’; ‘The Widening Scope
of Indications for Psychoanalysis’
1955 ‘The Concept of the Rejecting
Mother’
1956 Celebrations of centenary of ‘The Assessment of Borderline
Sigmund Freud’s birth. Cases’
Hampstead Clinic expands to
include second house
1957 Ernst Kris dies ‘The Contribution of Direct
Child Observation to
Psychoanalysis’
1958 Ernest Jones dies ‘Child Observation and
Prediction of Development’;
‘Adolescence’
1960 Melanie Klein dies ‘Discussion of John Bowlby’s
Work on Separation, Grief, and
Mourning’; ‘Entry into Nursery
School’
1961 Invited to join the Yale Law ‘Answering Pediatricians’
School as a Visiting Lecturer Questions’
1962 ‘The Assessment of Pathology
in Childhood’; ‘The Theory of
the Parent–Infant Relationship’

Anna Freud: a chronology xvii

Year Biography Key publications
1963 Visits Yale Law School for first
time
1965 Gives paper on obsessional ‘Children in the Hospital’;
neurosis at the IPA Congress in Normality and Pathology in
Amsterdam Childhood
1966 Becomes Honorary President of ‘Psychoanalysis and Family
European Psychoanalytic Law’; ‘A Short History of Child
Federation Analysis’
1967 Awarded CBE by the Queen. ‘About Losing and Being Lost’;
Willi Hoffer and Martin Freud ‘Comments on Psychic Trauma’
both die
1968 Hampstead Clinic expands to ‘Indications and
include a third house. First Contraindications for Child
volume of The Writings of Analysis’
Anna Freud published
1969 ‘Adolescence as a
Developmental Disturbance’;
‘Difficulties in the Path of
Psychoanalysis’
1970 Ernst Freud and Heinz ‘The Infantile Neurosis’; ‘The
Hartmann die Symptomatology of Childhood’
1971 Returns to Austria for first time
since 1938 for opening of the
Freud Museum and to attend
IPA Congress in Vienna
1972 ‘The Widening Scope of
Psychoanalytic Child
Psychology, Normal and
Abnormal’
1973 Elected honorary president of the Beyond the Best Interests of the
IPA. Hampstead Clinic refused Child (with J. Goldstein and A.
official status as a training clinic Solnit)
by IPA
1974 ‘Beyond the Infantile Neurosis’;
‘A Psychoanalytic View of
Developmental
Psychopathology’

xviii Anna Freud: a chronology

Year Biography Key publications
1975 Begins to suffer from chronic iron ‘On the Interaction between
deficiency anemia. Manna Pediatrics and Child
Friedmann retires as head of the Psychology’
Nursery School at the Hampstead
Clinic
1976 Clifford Yorke and Hansi ‘Changes in Psychoanalytic
Kennedy appointed co-directors Practice and Experience’;
of the Hampstead Clinic ‘Dynamic Psychology and
Education’
1978 Her sister, Mathilde, dies. Bulletin ‘The Principal Task of Child
of the Hampstead Clinic Analysis’; ‘A Study Guide to
established, edited by Joseph Freud’s Writing’
Sandler
1979 First Scientific Colloquium of the ‘Child Analysis as the Study of
Hampstead Clinic takes place. Mental Growth, Normal and
Dorothy Burlingham dies Abnormal’; Before the Best
Interests of the Child (with
J. Goldstein and A. Solnit)
1980 Marianne Kris dies The Technique of Child Analysis:
Discussions with Anna Freud
(with J. Sandler, H. Kennedy
and R. Tyson)
1982 Anna Freud dies, October 9th ‘The Past Revisited’
1984 Hampstead Clinic re-named the
Anna Freud Centre

Anna Freud: a chronology xix

1 INTRODUCTION
Anna Freud, her life and work

Introduction: The curriculum vitae of a lay analyst

Anna Freud was born in Vienna in 1895, the sixth (and last) child of Sigmund
and Martha Freud. From the very beginning, her life was inextricably linked
with the history of psychoanalysis: she was born in the year that her father
published his first major work (with Josef Breuer), Studies on Hysteria, and she
made her first appearance in the psychoanalytic literature before the age of
five, when her dream about eating strawberries was included in The
Interpretation of Dreams (Freud, 1900). By the age of 14 she was already sitting
in on the meetings of the Vienna Psychoanalytic Society and listening to the
discussions taking place between Freud, Adler, Rank, Ferenczi, Jung
and others; she was in her own analysis with her father at the age of 22;
and by the age of 26, having already worked as an elementary school teacher
for a number of years, she was herself accepted as a member of the Society,
and soon took up senior positions in both the Vienna Society and the
International Psychoanalytical Association (IPA). For the rest of her life
Anna Freud was to maintain a position at the forefront of the psychoanalytic
movement, becoming Honorary President of the IPA in 1973, a position
that she retained until her death in 1982. When the City University of
New York conducted surveys among American psychiatrists and
psychoanalysts in 1971, in which they were asked to nominate their most
‘outstanding colleague’, Anna Freud’s name was at the top of both polls
(Peters, 1985: xiv).
Yet despite this acclaim, Anna Freud was in certain respects a very private
person. She never wrote a memoir of her life, despite the many requests for
her to do so. When speaking with her old friend and colleague, Muriel
Gardener, about the idea of writing an account of her life, she told her that
‘there is too much feeling bound up with the past, and above all the part of
the past in which others would be interested’ (quoted by Gardiner, 1983: 65).
However, at various points she did speak or write about certain key memories
and experiences (most often when writing the many tributes to friends and
colleagues who passed away prematurely), and she has been well-served by
her biographer, Elisabeth Young-Bruehl, who has written a masterly account
of her life and times (Young-Bruehl, 1988/2008).

Introduction 1
What kind of person was Anna Freud?

As the youngest of six children, all born within eight years of each other,
Anna Freud struggled to get attention when growing up, and she was
especially jealous of her sister, Sophie, two years older than her and always
considered the ‘beauty’ in the family. In later years, Anna Freud spoke with
feeling about the childhood experience of ‘being left out by the big ones, of
being only a bore to them, and of feeling bored and left alone’ (quoted by
Young-Bruehl, 1988/2008: 37). Within a year of her birth, her aunt, Minna
Bernays, came to live in their spacious home at 19 Berggasse in Vienna,
becoming, in a certain sense, a second mother to Anna and her siblings; but
in her memories of her early childhood, it was her nurse, Josefine, who was
remembered with the greatest warmth and affection.
From her childhood, Anna felt closer to her father – who took delight in
his ‘naughty’ little girl – than to her mother. Although a good student at
school, Anna’s passion as a child was in making up stories, which in adolescence
turned into a tendency to daydream as she created elaborate worlds inspired
by her favourite authors, such as Karl May and Rudyard Kipling. (The analysis
of the ‘nice stories’, which she elaborated endlessly, was later to become the
material for her first publication, ‘Beating Fantasies and Daydreams’ [1922]).
At the age of 15 she completed her schooling, leaving her with a lifelong
consciousness that she lacked the classical education provided to her brothers.
But she never lost her voracious interest in learning – including the learning
of languages, for which she showed a particular talent.
Although she had a number of suitors, Anna Freud never married, and she
lived with both her parents until their deaths. Once he had been diagnosed
with cancer in 1923, Sigmund Freud famously described Anna as his
‘Antigone’ – the child who, in Sophocles’ telling of the tale, led the blinded
Oedipus out of Thebes and accompanied him until his death at Colonus.
Anna Freud has been justly described as ‘her father’s daughter’ (Dyer, 1983),
but this does not mean that she did not have her own life. She had a series of
important friendships with mother-like figures, starting with Lou Andreas-
Salomé, who acted as both a mentor and friend throughout Anna Freud’s
young adulthood. In the mid-1920s Anna Freud began a lifelong friendship
with Dorothy Burlingham, a wealthy American who had come to Vienna
with her four children to escape a difficult marriage and to seek therapeutic
help for her children. Dorothy became Anna’s companion – escaping with
her to London in 1938 when Freud and his family were forced to flee Vienna,
and working alongside her until Dorothy’s death in 1979. Anna Freud became
almost a surrogate mother to Dorothy’s children, and Dorothy and Anna
shared a number of holiday homes, where they would swim, take long walks
and ride horses when the opportunity arose.
Although Anna Freud did not write a memoir of her early life, it is now
widely accepted that the case vignette of ‘the young governess’ in The Ego

2 Reading Anna Freud

and the Mechanisms of Defence (1936) is a disguised self-portrait. As a child, the
governess had been very demanding:

She wished to have and to do everything that her much older playmates
had and did – indeed, she wanted to do everything better than they and to
be admired for her cleverness. Her everlasting cry of ‘Me too!’ was a
nuisance to her elders.
(1936: 134)

As a young adult, however, what struck those who met the young governess
was ‘her unassuming character and the modesty of the demands which she
made on life’ (p. 134). She was unmarried and childless, dressed somewhat
shabbily, and avoided competition with others whenever possible. Although
careless of herself, the governess took an interest in the love life of her women
friends and colleagues, to whom she often acted as a confidante and match-
maker; she also ‘displayed a lively interest in her friends’ clothes . . . [and] was
devoted to other people’s children, as was indicated by her choice of profession’
(p. 135). The case vignette shows how the governess is in certain respects
‘too good’, dealing with her own jealousy and envy by displacing those
feelings onto others and appearing to surrender her own needs. But rather
than repression, Anna Freud shows how the governess actually ‘gratified her
instincts by sharing in the gratification of others’, using the mechanisms of
projection and identification (p. 137). She describes this particular combination
and use of defence mechanisms as a form of ‘altruistic surrender’, used to
overcome the remnants of the young child’s ‘narcissistic mortification’:

It was only after analysis [that] she found that she ardently desired to live
long enough to furnish her new home and to pass an examination which
would secure her promotion in her profession. Her home and the
examination signified, though in a sublimated form, the fulfi lment of
instinctual wishes which analysis had enabled her to relate once more to
her own life.
(p. 146)

If the governess is a self-portrait, then Anna Freud’s capacity to analyse her

own characteristic defences also helped her to modify them, so that as she
grew older she was able to enjoy attention, even if she remained an intensely
private person. Those who trained under her, or worked alongside her at the
Hampstead Clinic in the 1960s and 1970s, remember Anna Freud as an
impressive and inspiring figure, but one who was somewhat shy and awkward
in more informal, social situations. (The exception to this was when she was
speaking to children, where many remark on her extraordinary capacity to
engage them and make them at ease with her.) But despite her apparent
formality, Anna Freud had a great passion for life itself, and she always enjoyed

Introduction 3
the challenge of taking on new tasks and solving new problems; of meeting
new people and finding ways to communicate with those whom she
encountered. Indeed, she worked tirelessly; retirement was an option she
never seriously considered.
Anna Freud’s commitment to her work, however, did not stop her from
maintaining other interests. She loved being by the water, and was over
eighty when she swam in the sea for the last time (Yorke, 1983b); she kept
several much-loved dogs in her home, owned and rode a horse, and enjoyed
going walking in the mountains and in the Irish countryside where she and
Dorothy Burlingham owned a cottage. She had a passion for knitting,
crocheting and weaving (she kept a loom in her home in London, and many
of the rugs and cushions in her house were home-made); she read crime-
fiction and detective stories at an incredible rate; and she took great delight
in the music of Mahler, Brahms and Mozart, among others (Valenstein,
1983).
Among those who knew her directly, friends and colleagues most often
commented on her phenomenal memory and clarity of thought; the delight
she took in speaking and listening to children; her dedication to work and to
psychoanalysis; her stoicism and courage in the face of adversity; and her
liveliness and curiosity about the world. They also focus on her wit and
humour, which does not often appear in her professional writing but might
be seen as a remnant of her childish ‘naughtiness’.

Between two cities: Vienna and London

Anna Freud’s life can be divided into two periods. For the fi rst 43 years of
her life she lived and worked in Vienna, and this time and place has been
aptly described as the ‘cradle of her creativity’ (Yorke, 1983c: 15). In 1938,
following Hitler’s entry into Austria (the Anschluss), she escaped to England
with her elderly father, who died in London the following year. Anna Freud
lived in London for the following 45 years, until her death in 1982. One life
in Vienna, and another in London:

Between the two phases came the Anschluss ; and it was the dislocation in
terms of geography and circumstance that formed the dividing line. The
work itself, in spite of the tragic upheaval, was a continuum.
(Yorke, 1983c: 15)

Whenever Anna Freud spoke about her life in Vienna, especially of the
years following the First World War, when she was part of the newly
expanding psychoanalytic movement, she conveyed her sense of the
excitement of being part of something momentous. She came of age at an
exciting moment in both European and psychoanalytic history. After

4 Reading Anna Freud

qualifying as a psychoanalyst in 1922, she found herself living in an Austrian
society – ‘Red Vienna’ – emerging from the horrors of the war, but brimming
with ideas about the creation of a better society. Looking back on her life,
Anna Freud was later to write:

Back then in Vienna we were all so excited – full of energy: it was as if a

whole new continent was being explored, and we were the explorers, and
we now had a chance to change things.
(quoted by Midgley, 2007: 939)

From the mid-1920s, the young people around Anna Freud – a mixture of
dreamers, radicals and utopians – gathered together to form a ‘Kinderseminar’
(children’s seminar; Cohler, 2008) – named not simply because they were
exploring the new field of child analysis, but also because they were considered
to be in their ‘analytic infancy’ by the more senior analysts in the Vienna
Psychoanalytic Society (A. Freud, 1967a[1964]: 513). It was here that the first
ideas about the technique of child analysis emerged, while Melanie Klein, in
Berlin, was developing equally significant – but radically different – ideas
about the psychoanalytic treatment of children (see Chapter 2, this volume).
The excitement of opening a whole new field for psychoanalysis was palpable.
A member of the ‘Kinderseminar’ working with Anna Freud at the time, Anna
Maenchen, recalled many years later how someone once complained that the
seminar discussions of members’ clinical work often continued until 2 a.m.
– Anna Freud had simply smiled, and said: ‘Sleep? What is it?’ (Maenchen,
1983: 61).
Looking back on her early career in Vienna at a conference organised by
the Yale Child Study Center in 1966, Anna Freud summed up the key
elements that had shaped her professional life. She wrote:

I have been especially fortunate all my life. From the very beginning,
I was able to move back and forth between practice and theory. I started
out as an elementary school teacher. I changed from that to the field of
analysis and child analysis. From then on, I moved constantly back and
forth, from the theoretical study of these problems to their practical
application.
(1967b[1964]: 225)

For her theoretical education, Anna Freud had been listening to the discussions
of her father and his colleagues at their ‘Wednesday meetings’ for some
time before she began to read his work as an adolescent. The early 1920s
was an exciting period for psychoanalysis, with Freud’s own papers, Beyond
the Pleasure Principle (1920a), The Ego and the Id (1923) and Inhibitions,
Symptoms and Anxiety (1926[1925]) bringing in a whole new perspective
on the mind (the ‘structural theory’ and the concept of the death drive, as

Introduction 5
well as new ideas about the role of the ego), while at the same time Freud’s
colleagues both challenged and developed his ideas in works such as The
Psychology of the Unconscious ( Jung, 1912), The Development of Psychoanalysis
(Ferenczi and Rank, 1923) or The Trauma of Birth (Rank, 1924). Anna Freud
learnt about all of these developments at first hand, through both private
discussions and public seminars. She also experienced two periods of
analysis with her father, first in 1918 and then again in 1924 – the influence
of which has been hotly debated by later commentators. (For a balanced
view, see Young-Bruehl, 1988/2008, chap. 3.) Like many of her
generation, Anna Freud’s education as a ‘lay analyst’ (i.e. one who does not
have a medical qualification) did not follow a set programme, as she later
explained:

[O]ur training took place at a period before the official psychoanalytic

training institutes came into being. We were trained by our personal
analysts, by extensive reading, by our own, unsupervised efforts with our
first patients, and by lively interchange of ideas and discussion of problems
with our elders and contemporaries.
(1967a[1964]: 511)

Alongside this theoretical education, Anna Freud’s practical experience in

the 1920s and 1930s came first from teaching school for five years and then
by gaining a range of clinical experience with both adult and child patients.
At the same time, she worked alongside Siegfried Bernfeld at his Baumgarten
‘camp school’ for children made homeless by the First World War, and in
1926 she set up her own experiment in education, the ‘Matchbox’ School
(also referred to in the literature as the Hietzing School or the Burlingham/
Rosenfeld School) (Midgley, 2008a). She also began giving lectures on child
analysis as part of the Vienna Psychoanalytic Training course and, in a series
of talks commissioned by the Board of Education of the City of Vienna,
began to explore the application of psychoanalytic ideas to the wider
community of childcare professionals, especially teachers (see Chapter 3).
Regular seminars for nursery school workers followed, and to these ventures
was added, in 1937, an experimental nursery for toddlers from some of the
poorest parts of the city – the Jackson Nursery. With colleagues, including
August Aichhorn and Willi Hoffer, Anna Freud also established a Course for
Educators at the Vienna Training Institute:

Here, teachers from nursery schools, elementary schools, and high schools
were introduced in careful, consistent, and painstaking manner to the
principles of psychoanalytic child psychology and to their relevance for the
understanding, upbringing, and teaching of children of all ages. The results
of this instruction are open to view in many valuable articles published in
the Zeitschrift für psychoanalytische Pädagogik of which Willi Hoffer soon

6 Reading Anna Freud

 became editor. The alumni of the Vienna Course for Educators can still be
found in responsible positions in the children’s field all over the world, and
quite especially in the United States.
(A. Freud, 1966a: 51)

Other than her work on the technique of child analysis in the late 1920s,
Anna Freud’s first ‘excursion from the clinic to theory’ (1967a[1964]: 514)
was her study of the defence mechanisms of the ego, which led to the
publication of her first major work, The Ego and the Mechanisms of Defence, in
1936 (Chapter 4, this volume). By this stage, however, the rise of fascism in
Europe meant that the very survival of psychoanalysis – and of the analysts
still living in Central Europe – was at stake. After a dangerous period during
which she was briefly arrested by the Gestapo, Anna Freud and her family
escaped first to Paris, and then on to London. She rarely discussed this
experience in her published writings, but at a memorial meeting in 1979 for
Ernest Jones – the President of the British Psychoanalytical Society in the late
1930s – she recalled:

In March 1938 Hitler and his army entered Vienna and this marked the
end of peace for us and many others. Ernest Jones, moved by his concern
for my father and prompted by his duty as President of the International
Psycho-Analytical Association travelled to Vienna immediately to convince
himself of the seriousness of the situation. He found everybody deeply
troubled, the Vienna Psychoanalytic Society dissolved, the Psychoanalytic
Press invaded, its books confiscated. No one, with the possible exception
of my father, needed convincing that for the Jewish members of the Society
emigration was the only feasible solution. But the numbers were large and
the question was not easy to solve as to how to fi nd entry permits for them
into countries many of them as unwilling as they are now when it is a
question of receiving the Vietnam emigrants.
This, then, was the moment when Ernest Jones did the near-impossible.
He persuaded the Home Secretary to issue permits not only for my
father and his nearest family, but also to his personal doctors, to the family
help, and beyond this to a number of his psychoanalytic co-workers, the
Bibrings, the Kris and the Hoffers: altogether a list of some eighteen
adults and six children. I have always had enormous appreciation for
this achievement. I had, if possible, even more admiration for another
task which he undertook. It cannot have been easy to persuade the
British Society to open their doors to the influx of members from Vienna,
i.e. to colleagues who held different scientific views from their own and
could only be expected to disrupt peace and internal unity. I never knew
how he did it; I was also careful not to ask too much. In any case, it
happened.
(1979d: 350–351)

Introduction 7
 Anna Freud brought with her to London some of the furniture and toys
that had been used in the Jackson Nursery, and following the outbreak of the
war she quickly put these to good use, setting up a Children’s Rest Centre,
which soon grew and developed into the Hampstead War Nurseries (Chapter
5, this volume). Despite the huge dislocation that occurred at this mid-point
in her life (and despite the death of her father in 1939, which was a devastating
loss for her as both a daughter and a psychoanalyst), Anna Freud ultimately
created a sense of continuity between what had gone before and what
followed her exile to London. As she later explained:

World War II prompted us in England to create a direct heir to the Jackson

Nursery in Vienna, i.e., the much enlarged, residential war nurseries
known under the name of the ‘Hampstead Nurseries’ where more than
80 war babies and young children were housed from 1939–1945 and,
incidentally, provided an unprecedented and unending source of
observational material for all of us who shared in the care of them.
(1974b: x)

At the end of the war, the Hampstead Nurseries closed; however, their
place was soon taken by the Hampstead Child Therapy Course (in 1947), to
which a Clinic was added in 1952 (Pretorius, 2012). The Hampstead Clinic
(renamed the Anna Freud Centre after her death) became the home for all of
Anna Freud’s major activities in the post-war years. As well as offering
psychoanalytic treatment for children (between 50–70 children were usually
in treatment at any one time), the Clinic offered an intensive psychoanalytic
training for those wishing to work with children (Green, 2012) and ran a
Nursery and a Well-Baby Clinic, as well as therapeutic groups for toddlers
(Zaphiriou Woods and Pretorius, 2010). This also provided a link once again
between theory and practice, thanks to a series of research projects and study
groups led not only by Anna Freud but also by colleagues including Dorothy
Burlingham, Humberto Nagera, Joseph Sandler, Hansi Kennedy and many
others. The opportunity to develop links between practice and research, and
to explore the possibility of carrying out valid research in psychoanalysis ‘in
the absence of laboratory conditions, quantification of results, the setting up
of control groups, and other limitations’ (1974b: xi), was a key part of Anna
Freud’s motivation in developing this new project (Chapter 6, this volume).
She explained:

It was the wish to provide such missing facilities which led to the building
up of the departments of the Hampstead Course and Clinic. At least so far
as child analysis is concerned, the various facets of psychoanalysis are
treated there as if they were on a par, and students are from the beginning
of their training systematically introduced to psychoanalysis as a method of
treatment; as a tool to use for exploration and study; as a theory in need of

8 Reading Anna Freud

 scrutiny and expansion; as a body of knowledge capable of application to a
wide number of needs in the community.
(A. Freud, 1966a: 58)

Alongside her many collaborators at the Hampstead Clinic and beyond,

Anna Freud spent the last 30 years of her life building on the innovations and
discoveries she had made in the pre-war years and during her time working
in the Hampstead War Nurseries. Throughout this period, she continued to
practice as an adult analyst and fought hard to preserve some of the key
elements of ‘classical psychoanalysis’, which she believed were at risk of being
lost or neglected (Chapter 7, this volume). Based on her own clinical work
with children, as well as that of her colleagues and students, she also became
increasingly interested in what lies ‘beyond the infantile neurosis’ (to use the
title of one of her papers, which in itself was an echo of the title of her father’s
famous work – S. Freud, 1920a). While paying tribute to her father’s work,
Jean Murray points out how this title also marks Anna Freud’s own distinctive
contribution: ‘For Freud, what lay beyond the pleasure principle was the
death instinct . . . but for Anna Freud, what lay beyond the infantile neurosis
was a developmental psychopathology’ (Murray, 1994: 49).
Anna Freud was, as Elisabeth Young-Bruehl puts it, ‘the great
developmentalist’ (Young-Bruehl, 1988/2008: 11). Having investigated the
growth and development of the ego during the first period of her professional
life, Anna Freud broadened her vision in the later years in order to examine
every aspect of the child’s development:

Maintaining the balance between clinical and applied psychoanalytic work

[gave] evidence of my spread of interest from pathology to normality in
childhood; to careful assessment of the various developmental stages and
their dependence on the interaction between the appropriate environmental
and internal factors; to diagnostic statements based on metapsychological
assessments of the immature personality; to a schema of diagnostic
categories that are divorced from adult psychopathology and linked
exclusively to the degree of deviation from the expected norm in childhood.
(1974b: xi)

The various projects that she was involved in at the Hampstead Clinic
culminated in her second major work, Normality and Pathology in Childhood
(1965a), in which she set out her key ideas about assessment and diagnosis of
childhood disorders (Chapter 8, this volume) and about developmental lines
and developmental psychopathology (Chapter 9, this volume). These
developments had major implications for the technique of child analysis and
led her in the last years of her life to articulate some of the clinical concepts
that were to become central to what is now termed ‘developmental therapy’
(Chapter 10, this volume).

Introduction 9
 The work at the Hampstead Clinic continued a tradition that had
begun in ‘Red Vienna’ in the 1920s – the application of psychoanalytic
thinking and understanding to wider social concerns. From the start, Anna
Freud had not only been interested in offering analytic treatment to a small
number of children from relatively privileged backgrounds. She and her
colleagues realised that relatively few people could ever be helped directly
by analysis, and, unlike some of her contemporaries, she did not believe
that every child would benefit from analytic treatment. But she did
believe that what psychoanalysis was learning about the mind could have a
profound influence on the way children were cared for in a whole range of
settings, and throughout her life she explored the various applications
of psychoanalysis to other settings where children were cared for. In
Vienna, this included her work with children made homeless by the First
World War (Baumgarten), and with toddlers of poor working mothers
(the Jackson Nursery), as well as with teachers in the progressive ‘Hort’
schools. Once in the UK, as Erik Erikson has noted, she quickly devoted
her efforts ‘to the emotional rehabilitation of German children saved
from concentration camps and of bombed-out English children’ (Erikson,
1983: 54), and after the Hampstead Clinic established services, she was once
more in charge of an organisation that worked on many different fronts
simultaneously:

This introduced me again to the whole range of problems: of day care in

nurseries for normal children and for handicapped (that is, blind) children;
of well baby clinics and of out-patient treatment of problem children,
mostly neurotic. This had two advantages for me personally. It provided
an opportunity to maintain a close connection between theory and practice,
to check constantly on theoretical ideas by practical application, and to
widen practical handling and practical measures with the growth of
theoretical knowledge. It also had another advantage. Having worked in
day care, in residential care, and in outpatient care, I had all the vested
interests combined inside myself. If they conflicted with each other, they
conflicted in me, and I could argue them out with myself without hurting
anybody’s feelings when finding that one or the other was better or worse
than the rest.
(A. Freud, 1967b[1964]: 227)

In the 1960s and 1970s, Anna Freud became especially interested in the
question of how psychoanalytic understanding could be used to help children
in hospitals (see Chapter 11, this volume) as well as children involved with
the family law and childcare system, whether because they had been neglected,
abused or abandoned, or because they were the victims of acrimonious
divorces and separations (see Chapter 12, this volume). These projects in the
later years of her life fulfi lled a long-standing desire to explore the application

10 Reading Anna Freud

of psychoanalytic thinking to the wider world of children. Anna Freud
herself captures the aspiration eloquently:

Our dream was the dream of psychoanalysis – all it had to offer: not only
individuals, but schools and universities and hospitals and the courts and
the ‘reform schools’ that worked with ‘delinquents’, and social service
agencies. We had many dreams then, many hopes – we had ideals we
wanted to see realized.
(quoted by Coles, 1992: 152)

In undertaking this work, Argelander rightly says that Anna Freud might
best be described, throughout her life, as an ‘Advocate of the Child’, whose
aim was ‘to help the child to be understood as an infant personality and to be
taken seriously, to criticize damaging educational measures and to try to alter
them and to be prepared to help the child through treatment [where necessary]’
(Argelander, 1983: 36). In the personal memories of Anna Freud that were
published after her death, the characteristic that perhaps appears most
commonly is her ability (or encouragement) to see things from the child’s point
of view. Nancy Brenner, for example, who worked as a teacher at the Hampstead
Clinic Nursery school, remembered when she had been complaining about a
three-year-old girl who had suffered a traumatic separation from her mother
six months earlier, but who was evoking very negative feelings from all the
teachers because of the way she constantly tried to show off in front of visitors
to the school. Brenner reports how Anna Freud (or ‘Miss Freud’, as she was
always known) asked her quietly: ‘But what can we expect when this child
was separated from her mother at just the time she still desperately needed to
be with her?’ (Brenner, 1983: 94) – a comment that Brenner reports was
enough to help her see this child in a more empathic way. One of Anna
Freud’s colleagues from Yale, Joseph Goldstein, who worked with her on the
application of psychoanalytic ideas to family law, sums this up very well:

Miss Freud taught us to put childish things before, not behind us. She
taught us to place ourselves in a child’s skin and to try to think a child’s
thoughts and feel a child’s feelings about being ‘removed from a known
environment to an unknown one’; about his ‘residence being divided
evenly between two [warring] parents’; or about having to visit an absent
parent on ‘prescribed days and hours’.
(Goldstein, 1983: 28)

Anna Freud as a teacher and a writer

Anna Freud was many things – a clinician, a theorist, an editor, a fund-

raiser, a committee member and the director of a number of major

Introduction 11
organisations. But perhaps more than anything else, Anna Freud was a
teacher. She began her professional life teaching in a classroom, and once she
became a psychoanalyst she quickly became involved in teaching at the
Vienna Training Institute. Her earliest publications (Introduction to the Technique
of Child Analysis from 1927 and Four Lectures on Psycho-Analysis for Teachers and
Parents, published in 1930) were both based on lectures she had given, and
many of the papers gathered in her collected Writings are based on talks that
she gave around the world. The Hampstead War Nurseries quickly took on
an educational element when Anna Freud decided to offer training to the
nurses who worked there, and this later transformed into the Hampstead
Child Therapy Course, where several generations of child analysts were
trained.
Anna Freud’s talents as a teacher were commented on by many of those
who knew her or worked alongside her. James Robertson, for example, was
one of the staff at the Hampstead War Nurseries, before going on to make his
own major contribution through his work looking at the effects of separation
on young children. He remembers:

Whatever Anna Freud taught us she could illustrate from the children in
our care. It was teaching which held us enthralled, as we experienced
attributes of Anna Freud which are often spoken of – the simplicity and
clarity, the beauty of her use of English, the absolute control over her
material.
(Robertson, 1983: 19)

What was true of her adult students was also true of her child ones. W. Ernest
Freud was taught by Anna Freud in the ‘Matchbox’ School when he was a
young child, and he remembered how she ‘had the rare gift of being able to
identify and empathize intuitively with us children and an endearing habit of
seeing the world through a child’s eyes herself . . . It enabled her to ask
questions in a way a child would readily understand . . . [In her classes] we
thought the world was open to us. She made us want to do things we might
otherwise never have thought of doing’ (W. E. Freud, 1983: 7). Forty years
later, as a teacher on the Hampstead Child Therapy Course, Anna Freud
retained the same capacity to help people become interested in learning. A
colleague remembers her often leaning her head to one side and saying: ‘This
is interesting, this is exceptional, let’s investigate this’ (Bon, 1996: 224), while
a former student on the Hampstead Child Therapy Course captures the
quality of Anna Freud’s thinking well when describing the ‘ubiquitous
presence of her interest’:

I remember Miss Freud’s quiet attentiveness was punctuated by frequent

sudden slight head movements – perhaps internal Yeses, Nos, Buts . . .
perhaps thoughts, feelings, and comments bursting forth bodily. Then,

12 Reading Anna Freud

 when she spoke, her thoughts were delivered clearly, steadily, and
deliberately in a very slightly high-pitched girlish tone. Somehow, it
was magically conversational and commanding – perhaps like a great story-
teller . . . Somehow, in this concentration of effort and economy of
expression, she reduced everything to its maximum.
(Penman, 2012: 380)

For Anna Freud herself, teaching was also a form of learning: both learning
how to communicate in a way that is clear, plain and fitting to the particular
audience she was facing (whether a classroom of six-year-olds, a seminar
room full of exhausted nurses or teachers, or a lecture hall packed with
experienced psychoanalysts), but also learning about her subject, and learning
about her own thoughts and ideas. In conversation with Robert Coles, Anna
Freud once remarked:

When I write, I think the teacher in me comes out: I’m all ready to catch
the attention of those I want to reach – ready to do that by the way I
present the material to them. Before I write a word down, I talk to myself.
I want to know what I’m trying to (hope to) accomplish by what I’m going
to say . . . What I have in mind is – well, my question to myself: what is
the exact essence of what you’re going to write, a sort of bottom-line
summary.
(quoted by Coles, 1992: 174)

Anna Freud was famous as a lecturer for her ability to speak without notes.
At most she would have with her only a slip of paper on which she had jotted
down the main topics she planned to cover (Rangell, 1984), but once on a
platform she would speak ex tempore, displaying an encyclopaedic knowledge
of psychoanalytic theory and a phenomenal memory of all the children who
were under her care at any one time. Most of the papers in her collected
Writings are based on lectures she gave, but they would only be written down
after she had delivered them – often during her long summer holidays at the
cottage in Ireland that she owned with Dorothy Burlingham, her lifelong
companion.
After moving to London, Anna Freud wrote all of her papers in
English – a language that she had first determined to learn after Ernest
Jones and A. A. Brill had visited her father in 1908, and she had been
frustrated at being unable to follow their conversation. By 1920 she was able
to give a lecture at the IPA Congress in fluent English, and by the time
she emigrated to the UK she was already confident with her written
English. She quickly developed the capacity to write with the ‘disarming
lucidity’ (Wallerstein, 1984) that she had displayed in her earlier, German-
language works, and she wrote all her post-war papers directly in English.
She would judge her own writings by the same dictum that she often repeated

Introduction 13
to others: ‘If the thought is clear, the words will be clear’ (quoted by Vas
Dias, 1983: 91).
Yet writing was by no means a simple transcription of what had been said
in her lectures, nor was her style as plain as she sometimes suggested. In
conversation with Robert Coles, Anna Freud explained:

For me, writing is a way of examining my thinking, and getting it ‘straight’

– learning what I think, and then sharing it with colleagues and friends
and anyone who should happen to read what I’ve written.
(quoted by Coles, 1992: 163)

Her writing was also something that she invested in emotionally: ‘I

feel towards [my writings] as a good mother feels towards her infant’,
she once wrote to a colleague (quoted by Young-Bruehl, 1988/2008:
319–320). As a child, Anna Freud had been an avid writer – and reader – of
poetry, with a special affection for the works of Goethe and Rilke. She
also created elaborate fantasy stories, often of a heroic nature – the
interpretation of which was a focus of her own analysis and formed the
core of her very first publication, ‘Beating Fantasies and Daydreams’ (1922).
W. Ernest Freud remembered, from his childhood in Vienna, ‘the many
evenings when we would all sit round the fire and [Anna] would tell
us stories – usually her own stories, made up on the spur of the moment’
(W. E. Freud, 1983: 7), and it is not hard to see her professional writing as in
some senses a continuation – she might have said a ‘sublimation’ – of this
earlier activity.
Except for her two best-known works – The Ego and the Mechanisms of
Defence (1936) and Normality and Pathology in Childhood (1965a) – Anna Freud’s
writings are not easily accessible. Many of the lectures she gave were not
published at the time, and when they were prepared for publication at a later
date they often appeared in specialist journals. The Writings of Anna Freud, an
eight-volume collection of her works published between 1966 and 1981 by
International Universities Press, is not widely available, and it was only the
single-volume Selected Writings by Anna Freud, edited by Ekins and Freeman
(1998), that made her work more widely available to the general public. The
lack of access to her writing is a great loss to the psychoanalytic community,
as well as to those concerned with the welfare of children more generally. As
Jean Murray (1994) has put it:

Perhaps her greatest gift was her ability to make the most difficult concepts
clear and simple and to demystify the excessively academic and often dense
language of psychoanalysis. When one sets out to write in simple and
elegant language, one always runs the risk of having one’s work considered
an over-simplification of complex topics; but as any good teacher knows,

14 Reading Anna Freud

 the ability to express difficult topics simply is the mark of a knowledgeable
mind.
(pp. 52–53)

The layout of this book

Each chapter of this book focuses on a few key papers by Anna Freud, related
to a certain major theme in her work. The chapters are organised in a roughly
chronological order, to enable a sense of the development of her thinking;
however, certain themes inevitably run across her whole professional life, so
in most chapters there are references to work from earlier or later periods.
Anna Freud often gave a number of lectures that approached the same topic
from slightly different angles, depending on her audience, so rather than
focus on a single paper in each chapter, I refer to a number of her writings on
related topics.
The primary aim of this book is to introduce the interested reader to the
main aspects of Anna Freud’s writing and her key ideas in a number of fields.
Some historical and biographical context is given, as appropriate, but this
book does not pretend to be a biography of Anna Freud, nor does it give a
full picture of all the contemporary psychoanalytic (or other) ideas that were
developing alongside her work. Each chapter ends with a section that draws
out some of the influences of her work on more recent thinking, and the final
chapter of the book addresses the legacy of Anna Freud’s work more generally.
As much of Anna Freud’s writing is out of print or not easily available, I
have tried to quote quite substantially from her own writings, in order to
give the reader as full a sense as possible of her own voice as a writer. However,
with the exception of her early writings, Anna Freud rarely gave clinical
examples to support her ideas, and did not publish any extended case-study
reports, so where necessary I have drawn on published clinical material
written by Anna Freud’s many colleagues and collaborators, especially those
from the Hampstead Clinic, to illustrate some of the key ideas. As this book
will make clear, Anna Freud herself considered her own thinking to have
very much emerged from a collaboration with colleagues first in Vienna,
then in the Hampstead War Nurseries, and finally with those who worked
alongside her at the Hampstead Clinic (and beyond), so I hope it will feel
appropriate that the work of some of her colleagues is presented in this book
as a way of illustrating Anna Freud’s ideas.
As many of her papers were fi rst given as lectures, and only later published,
I have followed the system used in the Writings of Anna Freud, in giving both
the publication date (in parentheses) and the date when the paper was first
written (in square brackets) when the two are different, e.g. Anna Freud
(1974[1954]).

Introduction 15
 FURTHER READING

The eight-volume Writings of Anna Freud d includes most (but not all) of her
papers and was published by the International Universities Press between
1966 and 1981. They are divided chronologically, as follows:

Vol. 1. Introduction to Psychoanalysis: Lectures for Child Analysts and

Teachers s (1922–1935)
Vol. 2. The Ego and the Mechanisms of Defence e (1936). (Revised
edition: 1966 [US], 1968 [UK])
Vol. 3. Infants without Families: Reports on the Hampstead Nurseries
(1939–1945)
Vol. 4. Indications for Child Analysis and Other Papers
s (1945–1956)
Vol. 5. Research at the Hampstead Child-Therapy Clinic and Other
Paperss (1956–1965)
Vol. 6. Normality and Pathology in Childhood: Assessments of
Developmentt (1965)
Vol. 7. Problems of Psychoanalytic Training, Diagnosis, and the
Technique of Therapy y (1966–1970)
Vol. 8. Psychoanalytic Psychology of Normal Developmentt (1970–1980)

Ekins and Freeman (1998) produced a single-volume Selected Writings by

Anna Freud d, published by Penguin, which includes a good general introduction
and very brief introductions to each of the papers included.
The single most valuable book about Anna Freud is the biography by
Elisabeth Young-Bruehl, Anna Freud: A Biography y, first published in 1988
and with a second edition released in 2008. This gives a comprehensive
account of Anna Freud’s life as well as discussing all of her major published
works. Other important book-length studies of Anna Freud and her work
include the works of Peters (1979, translated into English, 1985), Dyer (1983),
Sabler (1985, in German), Coles (1992), Yorke (1997, in French) and
Edgcumbe (2000). The works by Yorke and Edgcumbe are both written
by colleagues who worked alongside Anna Freud at the Hampstead Clinic,
and as such they give a valuable first-hand account of Anna Freud’s
thinking and her approach during the post-war years. A more recent book
edited by Malberg and Raphael-Leff, The Anna Freud Tradition n (2012),
gives a marvellous flavour not only of Anna Freud as a person (written by
colleagues who worked or trained with her), but also the legacy of her work,
especially the clinical and applied work that she promoted at the Hampstead
Clinic.
Among the best shortt introductions to the work of Anna Freud are essays by
Edgcumbe (1983), Solnit and Newman (1984), Lebovici (1984, in French),
Murray (1994), Miller (1996) and Ekins and Freeman (1998). Introductions to
specific areas of her work are included in the ‘Further Reading’ sections of
subsequent chapters.

16 Reading Anna Freud

 Following Anna Freud’s death, there were memorial editions of the Bulletin
of the Hampstead Clinicc (Vol. 6, part 1, 1983), the International Journal of
Psychoanalysis s (Vol. 64, part 4, 1983) and the Psychoanalytic Study of the
Child
d (Vol. 39, 1984). As well as appreciations of her work, these editions also
include many personal memories and tributes to Anna Freud. To celebrate the
centenary of her birth, the Psychoanalytic Study of the Child d (Vol. 51, 1996)
and the Journal of Child Psychotherapy y (Vol. 21, part 3, 1995) also published
special editions devoted to the work of Anna Freud, which include a number of
personal accounts by those who knew and worked with her. Memoirs by
Maenchen (1985), Menaker (1989), Sophie Freud (1988), Furman (1995) and
Bon (1996) also give a sense of Anna Freud’s personality in different contexts
and at different stages in her life. The book by Coles (1992), based on a series
of discussions with Anna Freud in the late 1960s, captures the sense of her as
a person and a thinker very well.
Barbara Peltzman (1990) wrote a valuable work, Anna Freud: A Guide to
Research h, which provides full details of all Anna Freud’s published and
unpublished writings and is an essential resource for scholars interested in the
work of Anna Freud.

Introduction 17
2 PSYCHOANALYSIS WITH
CHILDREN

KEY WRITINGS

1927 Introduction to the Technique of Child Analysis

1928 ‘The Theory of Child Analysis’
1930 Four Lectures on Psycho-Analysis for Teachers and Parents
1945 ‘Indications for Child Analysis’
1966 ‘A Short History of Child Analysis’

The origins of child analysis

Among the many contributions that Anna Freud made to the field of
psychoanalysis, perhaps the role that she is best known for today is as one of
the pioneers of child analysis. Having trained and worked as a primary school
teacher herself, it was not surprising that she was interested in applying the
findings of psychoanalysis to work with children. Anna Freud herself reached
adulthood at the very moment at which the psychoanalytic community was
beginning to focus on the question of how its fi ndings could influence the
upbringing of children, and she was ideally placed to take a leading role in
this new field.
Why did psychoanalysts in the early 1920s become so interested in the
topic of child analysis? One could suggest that such an interest arose almost
inevitably from the focus within adult analysis on early infancy as the root of
neurosis. Following the publication of his Three Essays on the Theory of
Sexuality (1905), which included a chapter on infantile sexuality, it became a
necessity for Freud to find empirical support for his ideas about ‘polymorphous
perversity’, the castration complex and the Oedipus complex through direct
observation of infants and children. As early as 1902, he had been asking
his colleagues to collect observations of their own and other children, but it
was only with the publication of the ‘Analysis of a Phobia in a Five-Year-
Old Boy’ (‘Little Hans’) in 1909 that child analysis can truly said to have
been born.
‘Hans’ was only two years old when his father, Herbert Graf, who was a
member of the Vienna Psychoanalytic Society, began making regular

18 Reading Anna Freud

observations of his development, which were discussed by Sigmund Freud
and his colleagues; however, these observations took on a new significance
when the boy was five, when he developed a phobia about horses. Freud
encouraged the boy’s father to conduct a series of analytically informed
conversations with his son, discussing his dreams, his symptoms and especially
his preoccupation with questions about sex and sexuality. In this way, the
first psychoanalysis of a child took place, leading to a deeper understanding
of the infantile roots of neurosis and helping the young Hans to overcome his
phobia of horses.
Freud himself downplayed the importance of this study in terms of the
therapeutic possibilities of child analysis, claiming that this situation was an
exceptional one and that the case should not be used as an argument for a
wider application of psychoanalysis with children (Freud, 1909). It was left
to others, such as Hermine Hug-Hellmuth, to follow the implications of
Freud’s work and to try to develop a specific model of analytic work
with children (see Geissmann and Geissmann, 1998). Hug-Hellmuth’s
paper, ‘On the Technique of Child Analysis’ (1921), delivered at the IPA
Congress in 1920, set the stage for a remarkable period of creativity in the
field over the following decade. Among the audience listening to that paper
were Anna Freud and Melanie Klein, both relative newcomers to the world
of psychoanalysis, but both already thinking about how these revolutionary
ideas could be applied to working with children. Following Hug-Hellmuth’s
untimely death in 1924, it was left to these two pioneers to take a lead
on this work, resulting ultimately in the development of two distinct
‘schools’ of child analysis: one based in Vienna, organised around the work
of Anna Freud, and the other based in London, based around the work of
Melanie Klein.

Anna Freud and the technique of child analysis

Having given up teaching to concentrate on psychoanalysis full-time, Anna

Freud saw her first child patient in 1923 – an adolescent girl with a severe
obsessional neurosis (A. Freud, 1967a[1964]). Over the following three years
she worked intensively with ten children, all aged between six and 11 years
old, who had been referred to her with a wide range of difficulties, from
anxiety and aggression to obsessional symptoms and ‘delinquency’ (Dyer,
1983: 58). The results of her thinking about this intensive period of analytic
practice were published in 1927, in her landmark work, Introduction to the
Technique of Child Analysis (also known as the Four Lectures on Child Analysis).
In that book, based on a series of lectures that she had given the previous
year, Anna Freud used the clinical experience she had gained to set out the
basic principles by which she believed a child analysis could take place. In
particular, she stressed the fact that child analysts needed to take into account

Psychoanalysis with children 19

the fundamental difference between adults and children – that is, that the
‘adult is – at least to a considerable degree – a mature and independent being,
while the child is immature and dependent’ (A. Freud, 1927: 5). While other
aspects of her approach to child analysis changed over time, this essential
point remained unchanged. In 1965, she wrote that:

. . . owing to their immaturity, children lack many of the qualities and

attitudes which, in adults, are held to be indispensable for carrying out an
analysis: that they have no insight into their abnormalities; that accordingly
they do not develop the same wish to get well and the same type of
treatment alliance; that habitually their ego sides with their resistances;
that they do not decide on their own to begin, to continue, or to complete
treatment; that their relationship to the analyst is not exclusive, but includes
the parents who have to substitute for or supplement the child’s ego and
superego in several respects. [The] history of child analysis is more or less
synonymous with the history of efforts to overcome and counteract these
difficulties.
(A. Freud, 1965a: 29)

The lectures that Anna Freud gave in 1926 formed the basis of her 1927
book and were her first attempt to address these ‘difficulties’, and so it was
appropriate that she began the fi rst lecture by addressing the question of what
kind of preparation children need for an analytic treatment. She argued that
some form of preparatory period was necessary to help make the child
‘analyzable’, and she described the importance of helping the child gain
confidence in the analyst, becoming an ally while simultaneously helping the
young person to gain some insight into his or her own disturbance.

The ‘preparatory period’ of treatment

Anna Freud’s concept of the ‘preparatory period’ caused a great deal of

controversy when she first wrote about it in the 1927 book. In making this
proposal for a period that preceded the start of fully analytic work, Anna
Freud was addressing the reality that most children do not choose to enter
analysis, and some may not even consider that they have a problem. Anna
Freud was greatly influenced in her approach to this problem by the work of
August Aichhorn (1925), who had found creative ways to engage with what
he termed ‘wayward youth’ – young people who were out of the control of
their families and were engaged in criminal and delinquent behaviour. Anna
Freud had closely observed the work that Aichhorn had done in engaging
with these young people at the residential home he ran in Oberhollabrunn,
and she believed that analysts working with children could draw on his
experience and approach.

20 Reading Anna Freud

 Before the work of analysis with a child can begin, Anna Freud
suggested in 1927, the therapist needs to gain the trust of the child and
help the child to gain some insight into his or her own disturbance. She gave
the example of a difficult little girl of seven, whose behaviour disturbed
everyone but herself. Anna Freud describes how she separated off the
girl’s ‘badness’ and personified it, giving it a name of its own. Eventually
the girl ‘began to complain to me of this newly created person and
obtained insight into the amount of suffering she endured on account
of her’ (p. 15) – thus making her ready for analysis. In the case of a very
rejecting and mistrustful ten-year-old boy, Anna Freud spent the fi rst part of
the treatment presenting herself as ‘an ally against his surroundings’. She
showed him how to make complicated knots; proved herself useful to him
by offering to type up the stories he invented; and even helped him to
escape punishment for his misdeeds by intervening with the parents. ‘My
attitude’, she wrote, ‘was like that of a fi lm or novel meant to attract
the audience or reader by catering to their baser instincts’ (p. 12), until the
boy had got to a point where there was ‘a tie strong enough to sustain
the later analysis’ (p. 14).
Anna Freud was strongly criticised at a symposium on child analysis,
which took place in London in 1927, for introducing these ‘non-analytic’
elements into the treatment of children. During the symposium, Melanie
Klein argued that ‘it is a grave error to ensure for ourselves a positive
transference from the patient by employing such measures as Anna Freud
describes . . . It would appear obvious that after this “breaking-in” she
will never wholly succeed in establishing a true analytic situation’ (Klein,
1927b: 343).
In later years, Anna Freud was herself to revise her view of the preparatory
period. Influenced especially by the work of Berta Bornstein (1945), she
came to believe that a great deal of what she was aiming to do in preparing
the child for analysis could be achieved by means of ‘defence analysis’ – that
is, a focus on the child’s resistances and typical means of defending against
anxiety. Nevertheless, she never changed her view that the child analyst
had to work hard to establish herself as an ally to the child in order to make
a therapy successful. Following the work of Zetzel (1956) and others, this
later came to be discussed in terms of establishing a ‘therapeutic alliance’ – a
concept that is now recognised as being a key predictor of successful outcome
in psychotherapy with both children and adults (Shirk, Karver and
Brown, 2011). Anna Freud’s ideas about how to build a relationship with
children were not only relevant to child analysts. As Raymond Dyer
has pointed out, ‘teachers, childcare officials, prospective adopters, and all
those who need to meet difficult, anxious, and distrustful children may
benefit enormously from these methods which . . . may still be valuable
whenever actual analytical or prescribed therapeutic intervention is not
required’ (Dyer, 1983: 72).

Psychoanalysis with children 21

Comparing adult and child analysis

In the second of her 1927 lectures Anna Freud examined some of the ways in
which one can work analytically with children, taking the technique of adult
analysis as her starting point and looking at what has to change in the light
of the child’s developmental stage. Beginning by outlining the various modes
of communication in the treatment of adults – conscious recollection, the
reporting of dreams, free association and the manifestation of transference
phenomena – Anna Freud then asks which of these elements can be adapted
to the treatment of children. Although she believed, for example, that the
technique of dream analysis could be translated quite directly from adult to
child analysis, she suggests that the child’s incapacity to fully free associate
has profound implications for technique. Although she recognised the great
value of attending to play, drawings and children’s daydreams, the relative
absence of free association – the ‘fundamental rule’ of psychoanalysis – was
seen by Anna Freud as having profound consequences, which were not
entirely addressed by the ‘play technique’ that Klein and others were
developing (A. Freud, 1927: 35).
Anna Freud suggested, therefore, that child analysis could only really be
offered for children who had already entered ‘latency’ (approximately six
years old or above), where verbal expression was already established and
where internal confl icts between wishes and the internal censorship had
already become a structured part of the personality. Before that age, she
believed that analysts should work to ameliorate the environment, primarily
through work with parents and nursery school teachers, in order that the
development of neurotic disturbance could be prevented before it had become
truly internalised. In her 1928 paper on child analysis, she gives the example
of a one-and-a-half-year-old girl suffering from phobic attacks of anxiety.
Anna Freud notes that the parents had been quite excessive in their attempts
to enforce their cleanliness demands on the young girl, who had consequently
become anxious and fearful of being rejected by her parents, leading to
anxious pleas not be sent away whenever someone knocked at the door.
Work with the parents to help them understand the child’s fear of a loss of
love led them to modify their way of dealing with the child and postpone
toilet training. On doing this, while reassuring the child that they still loved
her even when she wet herself, the parents soon reported that the child had
become calm and free of anxiety. Such therapeutic success, in Anna Freud’s
eyes, meant that the psychoanalyst’s focus for children under the age of five
should be working with parents and nursery school teachers rather than
direct analytic work with children.
In Introduction to the Technique of Child Analysis, Anna Freud makes a clear
distinction between the work of the child analyst and that of the parent, but
she also emphasises the importance of working with the parents of a child in
treatment. It is, after all, the parents who usually bring a child to treatment;

22 Reading Anna Freud

the parents who are in the best position to provide a history of the child’s
early development; the parents who (in private practice) pay for treatment
and decide whether or not it will continue; and the parents whose care the
child will return to once the analysis has ended. She thus attached great
importance to building an alliance with the parents of a child in treatment,
and in her own clinical practice – while respecting the confidentiality of the
child–analyst relationship – she met regularly with the parents of her child
patients and clearly used these meetings to try to influence the way in which
parents related to their children. She saw this as especially important in cases
where the child’s resistance manifests in the form of a negative transference,
which might lead him or her to ‘play off analyst against home’. At such
moments, a parent–therapist alliance is crucial. ‘In the ideal case’, she wrote,
‘we share our work with the persons who are actually bringing up the child;
just as we share with them the child’s affection and hostility’ (1927: 46).

The role of transference in child analysis

Anna Freud’s third lecture in her Introduction to the Technique of Child Analysis
(1927) specifically examined the role of transference in therapy with children.
Although she recognised the value of the positive transference (especially
what her father had referred to as the ‘positive unobjectionable transference’,
i.e. a basic sense of goodwill and trust) and recognised that transference as
resistance had to be analysed, Anna Freud was more cautious about the value
of working with the negative transference. ‘We know that with an adult we
can work for prolonged periods of time with a negative transference’, she
wrote, ‘which we turn to account through consistent interpretation and
reference to its origins. But with a child negative impulses towards the analyst
– however revealing they may be in many respects – are essentially disturbing
and should be dealt with analytically as soon as possible’ (p. 41). Anna Freud
gives the example of a time in the treatment of a six-year-old girl when she
herself appeared in her young patient’s imagination ‘in all sorts of degrading
roles – as a beggar, as a poor old woman, and once just as myself but standing
in the middle of my room with devils dancing around me’ (p. 43). From
Anna Freud’s perspective, these degrading representations appeared following
some analytic investigation of the girl’s masturbation, because the analyst had
become a ‘dangerous and feared tempter’, receiving ‘all the expressions of
hatred and repulsion with which at other times [the child] regards [her] own
forbidden instinctual impulses’ (p. 41). Once those impulses and the defences
against them had been interpreted fully, the negative transference receded
and the analytic work continued.
But should such manifestations of hostility or affection really be regarded
as transference? Anna Freud suggests that the child’s continuing dependence
on his ‘real’ objects (the parents or primary carers) means that a full

Psychoanalysis with children 23

transference neurosis is not possible, at least for younger children. From her
perspective, a child could not be expected to make ‘new editions’ of early
object relations, when those early object relations were still such a significant
part of the child’s everyday reality. Although the child will display all kinds
of positive and negative impulses towards the analyst, Anna Freud believed
that this should not be considered as a ‘transference neurosis’ in the way that
it would be seen in the case of a (relatively) independent adult patient.

Psychoanalysis and/or education: The case of the ‘devil girl’

Anna Freud’s final lecture in the 1927 book was perhaps the most controversial,
dealing as it did with the question of the child’s superego and the degree to
which the child analyst should take an educational role alongside the more
classical analytic one. Anna Freud suggested that in early childhood the
superego was only partially developed, and the child was still largely
dependent upon his or her caregivers to maintain a sense of right and wrong.
This view of early development had implications for technique. Whereas in
adult analysis the interpretation of repressed wishes was expected to lead to
the re-emergence of forbidden impulses in conscious life, so that the ego
could develop an increasing capacity to manage such impulses (‘where id
was, there ego shall be’, as Sigmund Freud had put it), Anna Freud believed
that children’s minds were not yet sufficiently developed to enable them to
successfully deal with the ‘return of the repressed’ on their own. Anna Freud
therefore argued that the child analyst had to take a dual role, ‘to analyse and
to educate, that is to say, in the same breath he must allow and forbid, loosen
and bind again’ (p. 65).
This dual role is best illustrated in the case of the ‘devil girl’, which is
referred to at several points in the 1927 lectures. (The case has been
reconstructed from comments scattered throughout Anna Freud’s early
writings by Peters, 1985: 71–78.) This child came into analysis at the age of
six, with an ‘unusually severe’ obsessional neurosis, alongside an ‘acute
intelligence and keen logical powers’ (A. Freud, 1927: 8). Upon being asked
why she had been sent to see an analyst, the girl replied: ‘I have a devil in me.
Can it be taken out?’ (p. 8). Anna Freud assured her that it could – but that
it would probably take a great deal of hard work and she ‘would have to do a
lot of things which she would not find at all agreeable’ (p. 8). On agreeing to
this condition, the analysis began.
Anna Freud makes reference to this patient when discussing her ideas
about the preparatory period (p. 9), her use in treatment of dream analysis
(p. 27) as well as daydreams and drawings (p. 31), and her understanding of
obsessional symptoms (p. 34). But Anna Freud’s lengthiest discussion of the
‘devil girl’ comes in her fourth lecture, where she is discussing the dual role
of the analyst, to both analyse and educate. In that lecture, she describes how,

24 Reading Anna Freud

in the course of the child’s treatment, interpretations of repressed wishes got
the child to the point of ‘allowing her “devil” to speak’ (p. 61). Following
this, a large number of anal fantasies emerged, which the girl expressed with
ever-increasing boldness as treatment progressed and the analyst maintained
a non-judgemental stance. Soon, however, problems began to be reported at
home, where her behaviour became so intolerable to her carers (she was not
living with her parents at the time) that treatment almost broke down. ‘I had
changed an inhibited, obsessional child’, remarks Anna Freud, ‘into one
whose “perverse” tendencies were liberated’ (p. 63).
Faced by the child’s angry caregivers, Anna Freud acknowledged that she
had ‘made a mistake, in crediting the child’s superego with an independent
inhibitory strength which it did not yet possess’ (p. 63). In these circumstances,
Anna Freud took on a more educational role, insisting that the girl could
exhibit such behaviour in her analytic sessions, but not elsewhere; if not, the
treatment would have to be ended. The girl accepted this restriction, although
the price to be paid was that she ‘again turned from a naughty and perverted
child into an inhibited and apathetic one’ (p. 64). In the remaining stages of
the treatment, Anna Freud found herself moving between interpreting the
repressed wishes and helping the ‘devil girl’ to fi nd ways to control her
impulses as they emerged from repression, until the child herself could learn
to ‘steer a middle course between the two’ (p. 65).

The 1927 symposium on child analysis

Anna Freud’s lectures on technique, published in German in 1927, became

the focus of a symposium on child analysis in London held later the same
year, where Melanie Klein and a number of her colleagues responded to
Anna Freud’s ideas. Various aspects of the technique of child analysis were
addressed and disputed, including the need for a preparatory period and the
relative importance of play and transference in the psychoanalysis of children.
The symposium also discussed the possibility of analysing children under the
age of five or six, as child analysts in London had already begun to do.
But the most fundamental disagreement that Klein and her colleagues had
with Anna Freud was over whether the child analyst should play an
‘educational’ role of any kind with his or her patient – and this technical
disagreement ultimately rested on a fundamental difference in their
understanding of the nature of early superego development and the timing of
the Oedipus complex.
For Anna Freud, the Oedipus complex was not resolved until latency, at
which point the child’s sense of right and wrong becomes truly internalised
through the agency of the superego. Up until that point, Anna Freud believed,
the child’s prohibition of forbidden impulses was still largely dependent on
the real, parental figures. In the 1927 symposium, Klein and her colleagues

Psychoanalysis with children 25

disputed this view. They argued for the fundamental identity of child and
adult analysis, seeing the child analyst’s role as being to analyse the very early
oedipal situation, as it developed during the fi rst year of the child’s life in the
infant’s relationship to the maternal breast. Since this early relationship
included deeply aggressive phantasies and profound anxieties about
annihilation, Klein believed that the child analyst had to address the profound
anxieties that quickly emerged in treatment, in the form of the negative
transference. Rather than trying to build a positive relationship, in Klein’s
view, the child analyst should take up the child’s hostility and violent
transference phantasies from the very start of treatment; rather than helping
the child to control his or her impulses, the child analyst should interpret
only the deepest and most primitive anxieties, thereby helping to modify a
well-formed, but very primitive, superego; and rather than stressing the
limits of how a child can communicate in analysis, Klein and her supporters
emphasised the value of play as a direct route to the deepest, most unconscious
layers of the child’s mind (Klein, 1927b).

Klein’s case of ‘Erna’: A response to Anna Freud

In her 1927 paper, Klein was especially critical of Anna Freud’s work with
the so-called ‘Devil Girl’. In responding to this case, Klein makes reference
to her own treatment of a six-year-old child (‘Erna’), who suffered from
similar obsessional symptoms and ‘marked asocial tendencies in all her
relations’ (1927b: 362). Like Anna Freud’s patient, this child showed a marked
‘cleavage of personality into “devil and angel”’, and the process of analysis
‘naturally liberated enormous quantities of affect as well as anal-sadistic
impulses’, leading to rages, tantrums and violent behaviour, both within and
outside the treatment. ‘I came to the same conclusion as Anna Freud’, Klein
explains, ‘that the analyst must have made a mistake.’ However, she goes on:

Only – and here is probably one of the salient and fundamental differences
in our views – I concluded that I had failed somehow on the analytic side,
and not on the educational. I mean that I had failed to resolve the resistances
completely in the analytic hour and to release in its fullness the negative
transference.
(p. 363)

Klein goes on to explain how she understood the ‘devilish’ behaviour of her
patient quite differently to Anna Freud. Whereas Anna Freud had seen this
behaviour as a release of previously repressed impulses, which therefore had to
find a new way of being controlled, Klein suggests that the excited behaviour
actually reflected deep-seated anxiety. For Klein, this anxiety-driven explosion
of hostility was driven by Erna’s rivalry and death-wishes towards her mother,

26 Reading Anna Freud

deriving from the very earliest oedipal situation. Such death-wishes produced
enormous anxiety, which was then manifested in the explosive behaviour
both at home and in treatment. For Klein, the solution to such behaviour was
deeper analytic work, interpreting the hostility related to the primitive
Oedipus complex. ‘In my view’, she concludes, ‘it was not a question of
directing her to a painful mastery and control of the impulses liberated from
repression. What was needed was rather to subject to a further and fuller
analysis the motive-force behind these impulses’ (p. 364). In failing to take
this route, suggests Klein, ‘Anna Freud . . . stopped and ceased to press the
analysis any further just at the point . . . where it really meant clearing up the
whole Oedipus situation. . . . On the contrary, she confi ned her investigations
to superficial conscious or pre-conscious strata’ (p. 364).

Anna Freud’s ‘The Theory of Child Analysis’ (1928[1927])

Anna Freud’s paper on ‘The Theory of Child Analysis’, originally presented

at the IPA Congress in 1927 and published the following year, was her fi rst
opportunity to set out her view of child analysis in the light of the severe
criticisms presented at the symposium in London earlier that year; it was also
her last major statement on the technique of child analysis for almost 20
years. For these reasons alone, it is a significant paper in the early history of
child analysis.
Anna Freud begins the paper by acknowledging the great interest that
child analysis had attracted in recent years, and she restates its significance
from a broader perspective: as a means of confirming hypotheses that first
emerged from the analytic treatment of adults; as a means of adding to our
knowledge of the child’s mind; and finally as a means of influencing the
upbringing of children. Anna Freud then turns to the issue of what kind of
technique is best suited to the analysis of children, making reference to
Melanie Klein and the introduction of the ‘play technique’ (Klein, 1927a).
She raises the question of the ways in which child analysis is (or is not)
different to the analysis of adults, and the controversy around the educational
role of the child analyst.
The core of the paper involves the presentation of two clinical vignettes,
one of an 11-year-old boy with a strong feminine identification and a
preoccupation with death; the second, the treatment of the ‘devil girl’, already
discussed above. In the first case, Anna Freud demonstrates, by means of
interpretive work on a fantasy daydream that the boy brings to treatment,
that his symptoms can be understood in relation to oedipal anxieties, which
the boy dealt with only when he had ‘surrender[ing] his love for the mother
and allowing himself to be forced into the feminine attitude’ – thereby taking
on a feminine identification and sustaining his father ‘as an object of his
homosexual love’ (1928[1927]: 166). The boy’s preoccupation with death

Psychoanalysis with children 27

could be understood in relation to his death-wishes towards the father, and
the whole means of treatment ‘differs in no way from that of an adult’ (p. 166).
In the case of the little ‘devil girl’, Anna Freud provides us with a more
detailed understanding of the oedipal dynamics underlying her symptoms
than she had done in her 1927 book. In contrast to Klein, Anna Freud
emphasises how the girl went through ‘a period of early passionate love for
her father’ (1928[1927]: 167). This love had been disappointed, however,
with the birth of a sibling, leading the girl to surrender the genital phase in
favour of ‘a full regression to anal sadism’ and to develop a profound hostility
towards her mother – ‘hatred of her, because she had taken the father from
her; hatred, because she had not made her a boy; and finally, hatred, because
she had borne the child whom my little patient herself would willingly have
brought into the world’ (pp. 167–168). Such hostility, however, came into
confl ict with her underlying love for her mother, leading to it becoming split
off (along with the anal sadism that accompanied it) in the form of the ‘devil’
thoughts, which stood in contrast to her ‘diminished and restricted personality’
(p. 168):

Thus her daily life was increasingly taken up with reaction formations, acts
of contrition, and reparation for the deeds of the split-off wickedness. We
might say that the ambitiously conceived and urgent effort to retain her
mother’s love and to be socially conforming and ‘good’ had failed miserably;
it had simply resulted in an obsessional neurosis.
(p. 169)

In this 1928 paper, Anna Freud offers a way of understanding the girl’s
difficulties that recognises the hostility to the mother (an aspect that Klein
had accused her of neglecting) but locates it firmly within a ‘classical’ oedipal
configuration, implicitly rejecting Klein’s emphasis on the first year of life
and the primitive death-wishes against the mother. Such a theoretical
understanding helps to justify the technical approach that Anna Freud then
took in her treatment of the girl. As she had done in her 1927 book, Anna
Freud goes on to describe the way in which this girl’s repressed instincts were
liberated in the course of treatment, and the way in which she, as a therapist,
was obliged to move between an analytic and an educational stance. Anna
Freud concludes by reasserting her belief that child analysis is identical to adult
analysis, in so far as it involves the making conscious, by means of
interpretation, repressed instinctual impulses; however, it is fundamentally
different to adult analysis, in so far as it must take into account the child’s
immaturity and the relative weakness of the superego, which is still largely
dependent on the external world. For this reason, Anna Freud concludes, the
child analyst must play a dual role – keeping one eye on the child’s internal
world and the other eye on his or her external reality, being equally skilled
at intervening at both levels.

28 Reading Anna Freud

What role does play have in child analysis?

One of the key debates between Klein and Anna Freud concerned the role of
children’s play in the practice of child analysis. In her 1927 book, Anna Freud
had suggested that one of the main obstacles to analytic work with children
was the relative inability of children to follow the fundamental rule of
psychoanalysis – free association. For Melanie Klein, this was not seen as a
significant obstacle, as ‘children are so much dominated by their unconscious
that it is really unnecessary for them to deliberately exclude conscious ideas’
(1927b: 351). For Klein, in other words, the child’s natural means of
expression, especially drawing and play, was a more than adequate substitute
for free association, as it provides the child analyst ‘with a rich abundance of
material and gives us access to the deepest strata of the mind’ (p. 352).
There is no doubt that Anna Freud failed to appreciate the value of play in
child analysis in her early work, and that in the 1927 book she was too eager
to maintain an exact parallel with the treatment of adults (including the use
of the couch). But Anna Freud’s reasons for not emphasising the use of play
were complex, and her statement that children’s play should not be seen as
equivalent to the free association of adults has been frequently misunderstood.
Anna Freud agreed with Klein that play probably gave a more direct access
to the child’s unconscious fantasy life than the adult’s free association ever
could; her concern was precisely that, as she put it in 1936, this would be
therapeutically retrogressive:

The dreams and daydreams of children, the activity of their phantasy in

play, their drawings and so forth reveal their id-tendencies in a more
undisguised and accessible form than is usual in adults. . . . But when we
dispense with the fundamental rule of analysis, the confl ict over its
observance also disappears, and it is from that confl ict that we derive our
knowledge of the ego-resistances when we are analysing adults. . . . There
is therefore a risk that child-analysis may yield a wealth of information
about the id but a meagre knowledge of the infantile ego.
(1936: 40–41)

Anna Freud’s concern, therefore, was that a focus on the unconscious

phantasies that emerge through play would bypass the child’s immature ego,
just as hypnosis had bypassed the ego of the adult in the early work of Freud
and Breuer (Freud, 1895), quickly accessing forgotten, unconscious memories
but not allowing the analyst to see how these were dynamically repressed by
the censorship of the ‘ego’. The result of the early work using hypnosis was
that the therapeutic results were initially dramatic, but most patients quickly
developed new symptoms once the influence of the doctor had waned. The
ego, we might say, had not been helped to develop new ways of dealing with
the repressed material. From Anna Freud’s perspective, the child analyst

Psychoanalysis with children 29

should be equally interested in the repressed instinctual drives (which play
reveals very clearly) and the unconscious working of the ego (which play, she
argued, mostly bypasses). Without such a dual focus, Anna Freud feared that
there was a danger of returning to the ‘pre-psychoanalytic’ days where Freud
had not been able to help his patients to integrate recovered memories into
their whole personality. Such an emphasis, she believed, was one-sided and
did not give full attention to the areas of confl ict within the mind.
In her later work Anna Freud increasingly acknowledged the value of the
‘play-technique’ that Klein had introduced, but her caution about the child
analyst attempting to bypass the infantile ego in aiming always for the
‘deepest strata of the mind’ remained, as will be seen in her work on the ego
and the mechanisms of defence (see Chapter 4).

The legacy of Anna Freud’s approach to child analysis

In the years following the publication of the Introduction to the Technique of

Child Analysis and the 1928 paper, Anna Freud’s influence on the emerging
field of child analysis was profound. Many young analysts from all over
Europe came to present cases and discuss technique at the Vienna Children’s
Seminars that Anna Freud organised, and among those who attended at
various points were Marianne and Ernst Kris (who later worked at the Yale
Child Study Center), Wilhelm Reich (who at the time was developing his
ideas about ‘character armour’), Heinz Hartmann (who became one of the
leading figures in the field of ‘Ego Psychology’ in post-war America), and
Berta Bornstein (whom Anna Freud considered one of the most gifted and
important child analysts of that generation). In addition, visitors from all over
Europe attended the seminars, including many who were to go on to have a
great impact on the field of psychoanalysis, such as Alice Balint (from
Budapest) and Margaret Mahler (who later developed the idea of the
‘separation–individuation’ stage in toddlers). The work that Anna Freud and
her colleagues were doing soon came to be known as the Continental (or
Vienna) School of Child Analysis, as distinct from the English School that
grew up around Melanie Klein in London.
Following the virtual destruction of European psychoanalysis in the 1930s,
after the rise to power of Hitler, many of those who had worked with Anna
Freud emigrated to the US, and her ideas about child analysis were to have a
major influence on the work that developed there in the post-war years,
especially in child centres such as those at Yale and Cleveland (A. Freud,
1966a). Her ideas were later to be taken up again in Europe, but in the UK,
where Anna Freud herself was based from 1938 onwards, her approach to
child analysis had much less influence, primarily due to the prominence of
Melanie Klein’s ideas and the impact that this approach had on the emerging
field of child psychotherapy, especially through the training at the Tavistock

30 Reading Anna Freud

Clinic. The so-called Controversial Discussions, which began in London in
1942 (see Chapter 7), only widened the gap (both conceptually and personally)
that had already been established at the time of the 1927 symposium on child
analysis, leading Anna Freud to withdraw from regular involvement with the
British Psychoanalytical Society in the post-war years. Her influence on child
analysis in the UK, including the many developments that her work
underwent in the years after 1928 (see Chapter 10 ), was mostly confined to
the Hampstead Child Therapy Clinic (now the Anna Freud Centre), which
Anna Freud established in 1952 and where she worked and trained child
analysts for the rest of her life.

FURTHER READING

Anna Freud’s own paper, ‘A Short History of Child Analysis’ (1966a) gives
a very vivid sense of Vienna in the 1920s and the excitement that was
associated with the emerging field of child analysis. She briefly discusses
Klein’s approach and talks about some of the contributions that child analysis
can make to the field.
Although Anna Freud did not publish any detailed case histories of her work
with children, in 1990 Peter Heller published a remarkable book, A Child
Analysis with Anna Freud d, based not only on his memories but also on Anna
Freud’s own treatment notes, which she sent him towards the end of her life.
Heller was in analysis with Anna Freud for three years, starting in 1929 when
he was nine years old. The book consists of the detailed notes that Anna
Freud kept on the treatment – including all the drawings and poems that Heller
produced at the time – alongside Heller’s own memories and ‘free associations’
to the clinical material. Heller was also a student at the ‘Matchbox’ School that
Anna Freud established, so the book gives a unique insight into the world of
child analysis in Vienna at that time (see Midgley, 2012).
The secondary literature on Anna Freud’s early approach to child analysis is
extensive, but among the best works are those of Dyer (1983), Miller (1996),
Edgcumbe (2000), and Young-Bruehl (1988/2008).
For the differences between the approaches to child analysis of Anna Freud
and Melanie Klein, including the 1927 symposium on child analysis, see
Likierman (1995), Viner (1996), Donaldson (1996), Salomonson (1997), de
Oliviera Prado (2001), Holder (2005) and Midgley (2012).

Psychoanalysis with children 31

3 THE APPLICATION OF
PSYCHOANALYTIC IDEAS
TO EDUCATION

KEY WRITINGS

1930 Four Lectures on Psycho-Analysis for Teachers and Parents

1934 ‘Psychoanalysis and the Upbringing of the Young Child’
1946 ‘Freedom from Want in Early Education’
1949 ‘Nursery School Education: Its Uses and Dangers’
1952 ‘Answering Teachers’ Questions’
1954 ‘Psychoanalysis and Education’
1960 ‘Entrance into Nursery School: The Psychological Pre-requisites’
1962 ‘The Emotional and Social Development of Young Children’
1966 ‘Interactions between Nursery School and Child Guidance Clinic’
1976 ‘Dynamic Psychology and Education’
1979 ‘The Nursery School from the Psychoanalytic Point of View’
1982 ‘The Past Revisited’

Introduction

Of all the applications of psychoanalysis to various fields, perhaps none has

been as important – or as fraught – as the application of psychoanalytic
insights to education. From the moment at which Sigmund Freud identified
the infantile roots of adult neurosis, it followed naturally that analysts would
want to find ways to intervene early in life, in order to prevent the development
of disturbance itself. Among the first generation of Freud’s followers, however,
there was uncertainty about whether psychoanalytic treatment could be
adapted to the needs of very young children, and, even if it could, whether
psychoanalytic treatment could ever be made available to more than a small
number of children.
The conclusion appeared to be obvious: psychoanalytic understanding
should be applied to the actual upbringing of children, both by influencing
parents and also by collaboration with teachers and schools, in order to
develop new, less ‘pathogenic’ ways of raising children. In 1925, Sigmund
Freud himself declared:

32 Reading Anna Freud

 . . . none of the applications of psycho-analysis has excited so much interest
and aroused so many hopes, and none, consequently, has attracted so many
capable workers as its use in the theory and practice of education. It is easy
to understand why, for children have become the main subject of
psychoanalytic research, and have replaced in importance the neurotics on
whom its studies began. Analysis has shown how the child lives on, almost
unchanged, in the sick man as well as in the dreamer and the artist. . . . It
is not surprising, therefore, that an expectation should have arisen that
psychoanalytic work with children would benefit the work of education,
whose aim it is to guide and assist children upon their forward path and to
shield them from going astray.
(Freud, 1925: vii)

Freud confessed that he saw the question of the application of psychoanalysis

to education as ‘the most important of all the activities of psychoanalysis’, yet
one which he had ‘scarcely concerned [himself ] with’ in his own professional
practice (quoted by Field, Cohler and Wool, 1989: 961). He left it to his
daughter, Anna – who first trained and worked as a nursery school
teacher before becoming a psychoanalyst – to try to work out what a
‘psychoanalytically informed pedagogy’ would look like, both in theory and
in practice. Although Anna Freud only practiced as a school teacher for a
relatively short period of time, she spent a significant proportion of her
professional life working with teachers in schools and nurseries, and she
participated in a number of educational experiments in which she tried to
test out her ideas and learn from them what worked – and what did not.

Psychoanalysis and education: The early history

Although Anna Freud’s work was one of the earliest systematic applications
of psychoanalytic ideas to the school setting, it was by no means the first such
attempt. In the early years of psychoanalysis, however, contributions primarily
focused on offering a critique of existing educational practices and tended to
deal almost exclusively with the issue of ‘sexual enlightenment’ (e.g. Freud,
1907; Ferenczi, 1908; Jones, 1910). Both Ferenczi and Jones, for example,
focus on the harmful aspects of repression, especially repression of infantile
sexual curiosity. In so doing their work proved to be sympathetic to an
anti-authoritarian strain that emerged most clearly in Europe at the end
of the First World War, when many people turned against the ‘old’ systems
that had failed to prevent Europe from descending into war. As Ekstein
and Motto (1969: 6) have noted, ‘the basic contribution of psychoanalysis
to education [in these early years] was a protest against the old forms
of society. . . . Progressive education was seen as a liberation of the
instincts.’

The application of psychoanalytic ideas to education 33

 Looking back many years later on these early attempts to provide a
psychoanalytic perspective on education, Anna Freud (1954c: 319) was to
describe it as a ‘period of optimism’, in which neurotic disturbance was
blamed primarily on inappropriate parental actions – the prohibition of
sexual expression, the ban on sexual curiosity, castration threats, the abuse of
parental authority, etc. At this time, most psychoanalysts believed that the
simple removal of such prohibitions could lead to the removal of infantile
neuroses entirely. These hopes, Anna Freud noted in retrospect, ‘were
excessive and led to a series of disappointments’ (p. 319). In their one-sided
emphasis on freedom from repression, they failed to consider the whole child
or the essentially divided nature of the human mind, which will always be
faced by internal confl icts.
These early efforts were also of limited value because few of them were
based on real experience of applying psychoanalytic ideas to an educational
setting. The first generation of psychoanalysts such as Freud, Jones and
Ferenczi had little experience of direct work with children and no experience
either as teachers or of working in schools. Anna Freud, however, belonged
to the first generation of psychoanalysts – many of them women – who had
a background in education and later trained analytically, often continuing to
combine the two activities. As Ekstein and Motto (1969: 8) have observed,
psychoanalytic pedagogy and child analysis, ‘sociologically speaking, derived
from the same social matrix, the teaching profession’, and many women in
the 1920s, who were originally kindergarten or elementary school teachers,
became the first child analysts. Such a sociological context had a profound
impact on the development of this field – and this was never more true than
in the case of Anna Freud herself.

‘Red Vienna’ and radical education

During the years in which Anna Freud was training as a teacher – almost
directly coinciding with the period of the First World War (1914–1918) –
education in Vienna was itself going through something of a revolution, as
the old Austro-Hungarian empire was overthrown and replaced by the
socialist experiments of the First Republic. Under the pre-war monarchy,
Viennese schools had operated according to what Gruber (1991) has described
as the ‘three cardinal goals of education’: to create submissive subjects; to
accept the hierarchical upper and lower orders; and to support the military
and the church. As Anna Freud was later to recall:

The educational doctrines from which we departed at the time were

one-sided and narrow ones. . . . Actually, it needed the experience with
undernourished and badly housed war children on the European continent
to convince people that a child’s mind does not function independently of

34 Reading Anna Freud

 his body . . . [and] that children were not to be thought of merely as
beings by themselves, but to a large extent as products of their family
backgrounds.
(1976b[1964]: 308–309)

In the immediate aftermath of the First World War, faced by the combination
of social breakdown and a fervent desire to build a new world, educational
reform became a priority across Europe. Nowhere was this more so than in
Vienna, where a popular wave of unrest led to the overthrow of the old
regime and the election victory of the Social Democratic Party in 1919. For
the new government, educational reform became a top priority, and although
the reforms introduced by the undersecretary for education, Otto Glöckel,
were not completed before the government fell, Glöckel himself became
chairman of the Viennese educational council in 1922, where he introduced
some of the most radical educational reforms seen in Europe to this day.
It is not hard to see why there would have been a considerable degree of
sympathy with these educational reforms among the early Viennese
psychoanalysts, many of whom also had strong socialist or liberal sympathies.
The radical reforms of education – understood as one aspect of a wider child
welfare programme – meant that many of the most idealistic and enthusiastic
young people in Vienna chose to train as teachers. A significant proportion
of these same young idealists were naturally attracted to psychoanalysis and
wished to bring together their interest in educational reform with their
enthusiasm for this new ‘science of the mind’, which promised to revolutionise
the way people thought about the psychology of the child.

Anna Freud’s early educational influences: Montessori,

Bernfeld and Aichhorn

Anna Freud’s own memories of her time working as a school teacher (between
1914 and 1920) make it clear that she cherished her time in the classroom,
which she saw as a wonderful opportunity for ‘learning twice’: ‘one learns as
one prepares for one’s students, and then one learns from them’ (Coles, 1992:
53). She had a reputation for maintaining excellent discipline in the classroom,
but was at the same time experienced by her pupils as ‘an oasis of warmth and
enthusiasm in the midst of their dreary, difficult wartime lives’ (Young-
Bruehl, 1988/2008: 76). As a teacher, Anna Freud clearly embraced the
progressive, ‘child-centred’ approach that was transforming education during
the post-war years, inspired primarily by the work of the Italian pedagogue,
Maria Montessori. Montessori’s work was hugely influential in the period
following the First World War. Indeed, according to a letter that Sigmund
Freud wrote to Montessori in 1917, his daughter Anna considered herself
‘one of your disciples’ (E. Freud, 1960: 320).

The application of psychoanalytic ideas to education 35

 It is not hard to see why the young Anna Freud would have been attracted
to Montessori’s work. As Anna Freud (1976b: 5) saw it, Montessori was the
first to recognise that the child’s interest in the material to hand in the
classroom could develop freely, rather than being overly prescribed by adults,
so that ‘joy in the success of one’s own work came into its own as a suitable
impetus’ for learning, and ‘freedom within carefully placed limits’ could
become the new principle of education – with radical implications for
practice. Montessori, however, had little sympathy with psychoanalysis,
despite direct attempts by her Viennese followers to mediate an alliance
between the two movements (Kramer, 1976).
Far more influential in helping Anna Freud to appreciate how psychoanalysis
could contribute to the work of schools was the work of two pioneers working
at the intersection of these two fields in Vienna in the post-war years: Siegfried
Bernfeld and August Aichhorn. Near the end of her life, Anna Freud
(1976[1974]b: 308) recalled that she was ‘lucky to share with both pioneers
their first attempts to apply psychoanalytic knowledge to [the problems of
education]’. Very different in their temperaments and their approaches,
Bernfeld and Aichhorn were both important mentors and colleagues to Anna
Freud, and what she learned from their educational experiments was crucial
to her own development as an educational thinker and practitioner.
Although close in age to Anna Freud herself, by the time the First World
War had ended Siegfried Bernfeld was already well-established as an
educational reformer, journal editor, President of the Association of the
Jewish Youth of Austria, leader of a Jewish self-defence force and the founder
of a progressive training college for teachers. He had also been attending the
meetings of the Vienna Psychoanalytic Society since 1913, where he had
become attracted to the idea of applying Freud’s insights into human nature
to the task of progressive education. Helen Deutsch, writing many years later
in her Memoirs, described him as:

the very incarnation of the Don Quixote type . . . tall and gaunt, with an
ugliness that impressed one as beauty [. . .] a spell-binding speaker who
converted many enthusiastic young followers to his ideology.
(quoted by Peters, 1985: 61)

One of those enthusiastic young followers was Anna Freud, who had already
begun working part-time in a day-care centre for working-class children,
and in the post-war years began to volunteer for the American Joint
Distribution Committee for Jewish War Sufferers (‘the Joint’, for short),
which supported work with orphaned and homeless Jewish children. At this
point Bernfeld had just published The Jewish People and Its Youth (1919), in
which he outlined a model of progressive education within a classless society
(later to have significant influence in the kibbutz movement) and managed to
persuade the Joint to fund a Jewish residential school on the site of a former

36 Reading Anna Freud

military hospital barracks. The Baumgarten Children’s Home opened its
door in August 1919 to around 240 war orphans between the ages of three
and 16.

The ‘Baumgarten experiment’

Anna Freud always paid tribute to the Baumgarten experiment – in many

ways a forerunner of Anna Freud’s own Hampstead War Nurseries in the
1940s – and was later to describe it as the ‘fi rst experiment to apply
psychoanalytic principles to education’ (1968c: 7). Bernfeld himself described
the experiment in his book, Kinderheim Baumgarten: A Report on a Serious
Attempt at New Education (1921), in which he described the basic principles on
which the Baumgarten was to operate. Passionate that childhood should be
seen as a period of life in its own right, rather than merely a preparation for
adulthood, Bernfeld wanted to offer a corrective to the neglect that these
children had suffered during the war, in a setting dictated by the child’s
innate capabilities rather than by the adult world’s expectations and demands.
He hoped for an educational setting where children could be helped rather
than controlled, be given an opportunity for psychological difficulties to be
expressed rather than suppressed (Paret, 1973: xix).
While Bernfeld had ambitious aims for his new education project, a fuller
and more honest account of the ‘Baumgarten experiment’ was written many
years later (in 1965) by a young assistant who came to work with Bernfeld,
before going on to become a close colleague of Anna Freud’s and a leading
figure in the psychoanalytic movement: Willi Hoffer. Having turned up one
day in October 1919 as a volunteer to help build some cages for rabbits and
chickens in the school yard, Hoffer quickly found himself acting as a teacher
in the school and then – when Bernfeld himself fell ill – taking over primary
responsibility for the running of the home.
In his account of the Baumgarten – which closed after less than six months,
after a series of confrontations between the staff, students and administrators
of the home – Hoffer describes the bewilderment that these young, traumatised
children displayed when confronted by adults who positively refused to tell
them what to do, and who invited the children themselves to take a leading
role in the organisation of their own lives. Bernfeld established a system of
parliamentary sessions, which all the children attended; in the absence of any
established forms of discipline, ‘court-meetings’ were set up among the
children, and a group of 12–14-year-olds formed their own ‘police force’,
which dealt with the frequent outbreaks of violence with their own ‘harsh
disciplinary treatment’.
Bernfeld and his colleagues recorded detailed observations of all of these
unfolding events (again, an inspiration for Anna Freud’s own Hampstead
War Nurseries), some of which formed the material for a fascinating

The application of psychoanalytic ideas to education 37

psychoanalytic account of group dynamics which prefigures many later
explorations of such phenomena (Hoffer, 1922). Although a failure in many
respects, Hoffer noted that anyone who met the children from the Baumgarten
after they had been there a few months would have agreed that they no
longer presented as ‘institutional children’, with all the restrictions on
personality development that such a term implies. In Bernfeld’s own
psychoanalytic terms, the repressed libido of a group of deprived and
traumatized children, which had previously been fi xated at a narcissistic
level, had been released, allowing the tentative formation of a group of
self-respecting young people.
Nevertheless, the sudden collapse of the Baumgarten experiment was a
blow to the ideals of a psychoanalytically informed education. Anna Freud
(1968c: 7) was later to describe this ‘difficult venture’ as a ‘disheartening
experience . . . which turned Bernfeld into a skeptic’; her own view was that
the Baumgarten experiment had taught psychoanalytic educators the difficult
lesson that ‘all educational work, regardless of its direction, has far-reaching
limitations’ (1978a: 272). This was an important lesson to learn for those
psychoanalysts who had perhaps taken a rather over-optimistic view of how
psychoanalysis could be used to transform both education and childhood
itself.

Anna Freud, Aichhorn and the work with ‘wayward youth’

With Bernfeld no longer actively engaged, the task of taking forward the
practical application of psychoanalytic ideas to educational practice fell to
August Aichhorn, Anna Freud’s other important mentor and an equal to
Bernfeld in both his energy and his determination to develop new models of
education, imbued with the principles of psychoanalysis. Unlike Bernfeld,
Aichhorn was somewhat older than Anna Freud and had already established
himself as a respected teacher and pedagogue before he became interested in
psychoanalysis in the post-war years (Schowalter, 2000). As director of two
institutions for ‘delinquent’ boys – the Oberhollabrunn (between 1918 and
1920) and St Andrä (from 1920 to 1922) – Aichhorn revolutionised the
residential treatment of young people with severe personality and conduct
disorders, and he turned to psychoanalysis in order to help formulate many
of the intuitions that he had already established. His book, Wayward Youth,
was first published in 1925 (with a foreword by Sigmund Freud) and gradually
became a best-seller (for a while the book was more widely known in the US
than Freud’s own masterpiece, The Interpretation of Dreams, 1900), influencing
a whole generation of workers with young delinquents.
According to Anna Freud (1951b: 628), Aichhorn’s arrival in the Vienna
Psychoanalytic Society, with his expertise already established as both an
educator and a re-educator of young people, ‘marked the opening up of a

38 Reading Anna Freud

new field of application for psychoanalysis’. By all accounts, Aichhorn himself
was an extraordinary figure, ‘a man of enormous girth who dressed always in
black, smoked his cigarettes with an elegant holder, and looked . . . like a
Montmartre flaneur’ (Young-Bruehl, 1988/2008: 100). Aichhorn appeared
to have an intuitive ability to engage with young people, in a manner that
had a profound effect on the young Anna Freud, who, in the early 1920s,
would accompany Aichhorn every Friday all around Vienna to observe
the various institutions and welfare arrangements for young delinquents.
Fifty years later, Anna Freud recalled these experiences and the impact they
made on her:

He wasn’t only able to reach children otherwise unreachable; he influenced

a lot of us who weren’t ‘wayward youth’ or ‘neglected youth’. . . . Some
people are ‘natural’ teachers, and Aichhorn was an especially natural one
[. . .] So often teachers are in a hurry to get their students to know
something, to have the right answers: a possession. Aichhorn knew how to
scratch his head and say: Well, we can look at this boy in this way, but we
can also look at him in this way, and there may be other ways, too. He was
challenging us: can you do the same – focus and refocus, shift your angle
of vision, adjust your point of view?
(quoted by Coles, 1992: 46)

In his educational role, Aichhorn rejected the authoritarian, punitive

approach to juvenile delinquency, as well as the view that such behaviour was
a sign of some innate ‘degeneracy’; however, he was equally suspicious of the
‘sentimental’ approach that encouraged ‘unlimited indulgence’ in these
young people, which Aichhorn believed could be equally unhelpful – and
unsuccessful. Instead, Aichhorn saw that the personality structure underlying
the delinquent behaviour needed to be attended to and the most appropriate
treatment/education offered accordingly.
Moving away from the view of delinquency as a primarily neurotic
disturbance, Aichhorn focused especially on delinquency as a manifestation
of arrested personality development, primarily due to deficiencies in the early
parent–child relationship. This marked a radical shift for psychoanalysis
towards a focus on the whole personality (not just the instinctual impulses)
and a recognition of developmental, alongside neurotic, levels of disturbance.
It also forced those who had believed that psychoanalysis should be wholly on
the side of ‘liberation’ that, in Anna Freud’s (1978a) words, ‘the absence of
drive curtailment and moral orientation in childhood did not result in psychic
health as expected, but rather had delinquency as its consequence’ (p. 272).
For Aichhorn, difficulties in the early parent–child relationship meant that
many of the young delinquents whom he encountered in his care had not
gone through the essential process that characterises early education: a gradual
adjustment to the reality principle and social adaptability via a sublimation of

The application of psychoanalytic ideas to education 39

the original asocial impulses. Such a process could only take place under the
influence of a libidinal relationship to an attachment figure, without which
there was little incentive for renouncing the pleasure principle, nor any
basis for the strong identifications required for ego and superego development
(A. Freud, 1951d: 633).
How, then, did Aichhorn approach the treatment of these young delinquents
– and with what consequences? Aichhorn’s experiences are vividly described
in a series of vignettes and case studies in his book, Wayward Youth, where he
explains how initially he encouraged the staff at his institutions – much to
the young people’s surprise – to tolerate the misconduct of their wards, even
when it led to vandalism and the destruction of property (much to the horror
of neighbours living near the home, not to mention some of the staff
themselves). The aim, however, was not to provide a simple ‘liberation’ of
repressed impulses; on the contrary, Aichhorn recognised the importance of
not allowing the delinquent behaviour to triumph but, rather, of establishing
the notion of a higher authority (both external and internal). To help a young
delinquent establish such a sense of a ‘higher authority’ was no easy task,
however, but Aichhorn believed it could only be achieved by supporting the
‘libidinal’ side of the personality. This was an important idea that was to have
a profound influence on Anna Freud, who was later to conceptualise this in
terms of the ‘fusion of libidinal and aggressive drives’. But what did this mean
in practice?
Aichhorn noted that once the delinquent’s aggressive impulses had
exhausted themselves, the repressed longing for love and tenderness, which
he believed remained dormant in these young people, began to manifest itself
once more. Previously aggressive boys became tearful and more vulnerable,
at which point Aichhorn encouraged his staff, each working with a specific
group of boys, to take on a more demanding attitude to those in their care.
In Aichhorn’s terms, a positive transference – a strong, positive emotional
relationship – began to develop with the young person’s worker, who was
now in a position to guide the young person to take the steps in psychic
growth that had not occurred in the early years:

It is above all the tender feeling for the teacher that gives the pupil the
incentive to do what is prescribed and not to do what is forbidden. The
teacher, as libidinally charged object for the pupil, offers traits for
identification that bring about a lasting change in the structure of the
ego-ideal.
(Aichhorn, 1925: 235)

The influence of Aichhorn’s work on Anna Freud’s thinking is obvious in

many respects – not only in her specific understanding of delinquency and
developmental disorders, where she clearly follows Aichhorn’s lead, but also
in her emphasis on the use of the ‘positive transference’ and the analyst’s role

40 Reading Anna Freud

as an ego-ideal in her early (1927) thinking about child analysis itself. But
Aichhorn also provided a corrective to some of the early psychoanalytic
emphasis on the importance of freedom of (instinctual) expression in early
education. As Anna Freud was to explain many years later:

I think it is fair to say that I wanted children to be able to ‘express

themselves’ (who, now, would be against that), but with reservations.
Aichhorn and I saw what happened to children who had not developed
internal controls. . . . Those children have no trouble ‘expressing’
themselves! They are at the mercy of their instincts in a different way
[from] the inhibited or classically ‘neurotic’ child. The symptom formation
may be different, but there is still a problem – and for the schoolteacher, it
is often a more serious problem.
(quoted by Coles, 1992: 41)

Having observed at first hand the educational experiments of Aichhorn

and Bernfeld, and having completed her own training both as a teacher and
as a psychoanalyst, by the mid-1920s Anna Freud was now well-equipped to
begin her life’s work. With Bernfeld, Aichhorn and Willi Hoffer, Anna Freud
formed a weekly study group on education and psychoanalysis, which met
throughout the 1920s, during which period she also offered regular
consultations to teachers working in Vienna’s nursery schools. In 1926, Anna
Freud helped establish a periodical, Zeitschrift für Psychoanalytische Pädagogik
( Journal for Psychoanalytic Education), which continued to be printed until 1938,
and during the inter-war years served as the primary forum in which debates
about the application of psychoanalysis to education could be aired. (In 1945,
the journal was resurrected in a new form in the US as the Psychoanalytic Study
of the Child, edited by Anna Freud, Heinz Hartmann and Ernst Kris.)
The theoretical development of this field was complemented by an
increasing level of active involvement with educational ventures. Anna Freud
was invited by the Viennese Department of Youth to run ongoing seminars
for nursery school teachers working in the city and to give four lectures for
teachers working in schools. Aware of the piecemeal nature of such ventures,
Anna Freud supported Willi Hoffer in establishing the Vienna Psychoanalytic
Training Course for Educators – a psychoanalytic training specifically for
teachers, comparable to that offered for those who wished to train to become
analysts, with a combination of both case discussion and theoretical lectures,
geared specifically to the needs of teachers. All of this work resulted in two
major achievements, one practical, one educational. In 1927 Anna Freud
collaborated in the establishment of a new experimental school, and in 1928
she gave a series of lectures that were soon gathered together as a book, Four
Lectures on Psycho-Analysis for Teachers and Parents (1930). It is these two projects
that together best encapsulate Anna Freud’s ideas about the relationship
between psychoanalysis and education.

The application of psychoanalytic ideas to education 41

Anna Freud and the ‘Matchbox’ School

Always aware that it was only close observation and engagement with
children that would deepen her psychoanalytic understanding, Anna Freud
wanted to have an opportunity to put what she had been learning and
thinking about into practice. That opportunity fi nally came in 1927, when
she was to collaborate in the establishment of a new experimental school,
known variously in the literature as the ‘Hietzing School’ (because of its
location), the ‘Burlingham–Rosenfeld School’ (because of its benefactors) or
the ‘Matchbox’ School (because of its size and design).
The opportunity for Anna Freud to become involved in the practical
running of a school emerged out of her acquaintance with Dorothy
Burlingham, the granddaughter of the famous American jewellery millionaire
Charles Tiffany, who arrived in Vienna in 1925 with her four children, in the
hope that Anna Freud would take her oldest son, Bob, into psychoanalytic
treatment (M. J. Burlingham, 1989: 151). When Burlingham first arrived in
Vienna, however, a more immediate problem was what to do about the
education of her children. As a liberal and progressive woman, she did not
want to send her children to one of the Austrian public schools, which were
still run on largely traditional lines.
In discussion with Anna Freud, the idea gradually emerged to create a
small school, to provide a progressive form of education for the various
children associated with their world – either children who were in analysis
themselves with Anna Freud or one of her colleagues (as Bob soon was), or
else the children of parents with some link to psychoanalysis. Pupils at the
school included, for a time, August Aichhorn’s rather nervous son, Walter,
who was also in analysis with Dorothy Burlingham; Kyra Nijinski, daughter
of the famous dancer (described by her fellow pupil, Peter Heller, as
‘beautifully racy, slightly mustached and dark’: Heller, 1990: xxix); as well as
Anna Freud’s nephew, Ernst Halberstadt-Freud, later to become a renowned
analyst himself. The only problem, as Anna Freud (1980) herself later put it,
was that there was, at the time, ‘no place, no house, and there were no
teachers’ (p. 4).
For a woman of Dorothy Burlingham’s character and means, however, this
was only a small obstacle. First, Eva Rosenfeld – a close friend and colleague
of both Anna Freud and Dorothy Burlingham – offered half of her garden as
a site for the new school (she also cooked lunch for the children in her house
each day when the school first opened), and a Norwegian timber log-cabin
with classrooms on two floors was built following detailed specifications:
hence the name, the ‘Matchbox’ School. Furthermore, it was decided that a
young man, Peter Blos, who had been employed as a private tutor to the
Burlingham children when they fi rst arrived in Vienna, was to be offered the
role of principal teacher at the school; his friend, art student Erik (Homberger)
Erikson, was appointed as a second teacher. Both men would go on to make

42 Reading Anna Freud

significant contributions to the field of psychoanalysis, partly due, no doubt,
to these early formative experiences.
The ‘Matchbox’ School ran for almost five years, until 1932, educating an
elite group of children who never numbered more than twenty. Although
the school was inspired by psychoanalysis, and Anna Freud was, as Erikson
and Erikson (1980) put it, ‘discreetly omnipresent in the whole improvisation’
(p. 4), all those involved maintained a clear distinction between teaching and
clinical analysis, as Sigmund Freud himself had advocated in 1925. Many of
the children at the school were in analytic treatment themselves (several with
Anna Freud), meaning they would disappear off for an hour at some point
during the day; however, while the child’s analyst might sometimes mention
in a staff meeting that a child was, for example, going through a particularly
difficult time, in other respects ‘there was hardly any clinical talk, and
certainly no individual interpretation [by the teachers]’ (p. 5). As Erikson
makes clear, psychoanalytic principles were not applied in ‘any overly
intellectual or modish sense’ (p. 4), but the influence was, in more subtle
ways, pervasive, both directly and indirectly.
Although all the staff shared an interest both in psychoanalysis and in
progressive education, the ‘Matchbox’ School was not free from tensions
among the teachers about how best to approach the running of the classroom.
On the one hand, there was plenty of common ground between psychoanalysis
and progressive education. After all, the idea of ‘child-centred’ education, as
set out by both Montessori and the early psychoanalysts, laid emphasis on the
importance of following the child’s own path and providing a setting as free
from coercion as possible. Such an approach was seen by the psychoanalysts
as a way of avoiding unnecessary repressions, and by the ‘child-centred’
educationalists as a means of fostering the child’s own innate wish to learn.
But in a letter to Eva Rosenfeld in 1929, Anna Freud hinted at some of her
own difficulties with this approach. In the letter, Anna Freud complains of the
teachers at the school (i.e. Blos and Erikson): ‘All they know is compulsion or
liberation from compulsion – and the latter results in chaos.’ The letter implies
that Rosenfeld had suggested that the pupils at the school needed to be forced
to study certain things, even if they were not interested in doing so. Anna
Freud’s response is interesting and makes an important (but subtle) distinction:

We really don’t disagree. I also believe that school must be compulsion.

Our disagreement concerns only one point. I want the children to be made
to want to do what they are supposed to do. You want them to be made to do
what they don’t want to do as well. . . . My example – which you grant – is
Aichhorn.
(Heller, 1992: 112, italics added)

Anna Freud’s reference to Aichhorn makes clear how influenced she was
by his way of working, in which he fostered the young person’s positive

The application of psychoanalytic ideas to education 43

attachment to an adult as a means of providing the child with motivation to
‘renounce’ the pleasure principle and deal with frustration and ‘work’. In
Anna Freud’s letter one can see how she was transferring this idea of
Aichhorn’s to the normal school setting, in order to argue for a ‘middle path’
between compulsion and liberation: the child must be made to want to do
what he or she is supposed to do. For such an approach to be successful, the
teacher must work with both that which has been repressed (the instincts)
and that which is doing the repressing (the defences, the ego). The teacher,
in other words, must offer him/herself as an ego-ideal with whom the child
can identify, so that the child will then willingly comply with social demands
and find a substitute satisfaction through sublimated activities – including
learning itself.

An introduction to psychoanalysis for parents and teachers

While Anna Freud was supporting the work of the ‘Matchbox’ School, she
and August Aichhorn were also invited to give a course of lectures to teachers
and childcare workers by Vienna’s education authorities. Anna Freud’s four
lectures were given to those working in the city’s recently established welfare
centres, the Hort. These centres offered after-hours care for children aged
between six and 14 years, from deprived and under-privileged backgrounds,
and were a key element of the socialist government’s attempt to positively
influence the education of the most vulnerable young people in the city.
Those working in the centres, however, faced many practical challenges,
and Anna Freud’s lectures were intended to help support them in their
challenging work.
Looking back more than 40 years later, in discussion with Robert Coles,
Anna Freud remembered the teachers who attended the lectures:

They were very hard-working . . . they had very demanding jobs – and
like many teachers, they weren’t getting the social approval they deserved.
There they were, doing the most important work imaginable. . . . They
did not need me to come before them and tell them they were all in
trouble psychologically, and the sooner they saw an analyst, the better. . . .
I wanted to explain to them what we had been learning. I remember
August Aichhorn’s advice to me: the teachers have been learning from
children all along, just as we try to do – and if you remember that, they
will receive you warmly.
(Coles, 1992: 45)

This attitude reflects an important aspect of the lectures and much of the
subsequent writing that Anna Freud did. She positions herself, in the lectures,
not as an ‘authority’ with a superior knowledge of children to impart to her

44 Reading Anna Freud

audience, but, rather, as a ‘fellow traveller’, one who understands some of the
challenges faced and is interested to promote a genuine curiosity about
children’s lives and development. While offering insights from her own
psychoanalytic investigations, she does so cautiously, as if to say: ‘This is what
I have seen – how does that fit with what you already know? Does it offer
anything useful to you?’ As she says at the very start of the fi rst lecture:

After you have listened to the four lectures, you will be able to decide
whether you were mistaken in your expectation [that a closer acquaintance
with the new field of psychoanalysis might be able to afford you some help
in your difficult work], or whether I have been able to fulfi l at least some
of your hopes.
(A. Freud, 1930: 74)

The lectures that follow (and the book that was based on them) continue
in this rather informal, conversational style, which became so characteristic
of Anna Freud’s work. Her lectures often begin with actual observations of
children she has encountered, using stories from her own clinical and teaching
practice to introduce new ideas and offer them up for further exploration.
She does not claim to tell the teachers anything about the behaviour of
schoolchildren which they don’t already know; she is simply offering a way
of thinking about, or looking at, this behaviour which may be useful.
The first three lectures in the series offer teachers a psychoanalytic
perspective on the early development of children, covering topics such as
infantile amnesia and the Oedipus complex (Lecture one), infantile instinctual
life (Lecture two) and latency (Lecture three). Along the way she opens up
questions about the nature and aims of education and illustrates how these
have changed through the centuries. She focuses in particular on how
education has responded to the instinctual impulses of children, waging a
‘never-ending battle’ against their direct satisfaction. Adults, she says:

. . . want to replace the child’s pleasure in dirt by disgust for it, shamelessness
by shame, cruelty by pity, destructiveness by care. . . . Step by step
education aims at the exact opposite of what the child wants, and at each
step it regards as desirable the very opposite of the child’s inherent
instinctual strivings.
(p. 101)

Anna Freud’s aim in giving the lectures is neither to condemn nor to support
this battle; rather, it is to show what the consequences of the struggle are for
children’s development and the implications of this for teaching. In anticipation
of the work she was soon going to publish on the role of the ego, she discusses
some of the defences that children begin to develop during the latency period,
including reaction-formations and sublimation. She stresses the importance

The application of psychoanalytic ideas to education 45

of teachers understanding about superego development in order to make
sense of some of the behaviour of children in school, which often reflects the
divisions and struggles within the personality. Such internal divisions and
defences may lead to neurotic inhibitions and hostility to teachers, but they
can also be the basis for the child’s identification with teachers and a sublimated
pleasure in learning itself.

Do all teachers need an analysis?

Anna Freud’s lectures show a profound understanding of the emotional

impact on teachers of working with children, especially those children who
have emotional and behavioural difficulties themselves. From the first lecture,
she recognises that the children who are most likely to attend the Hort ‘bring
with them a set attitude of mind, and may approach the teacher with the
suspicion, defiance or wariness which they have acquired in their earlier
dealings with other adults’ (p. 76). Having set out how psychoanalysis
understands the earliest years of a child’s life, and in particular the Oedipus
complex, she goes on to show how the attitudes formed in the earliest period
of life may, by a process of transference, reappear in the classroom setting:

. . . those who react violently if you exercise the slightest show of authority,
or those who are so cowed that they do not even venture to look you in
the face or to raise their voices in class, have substituted you for their father
and transferred to you either the hostility and death wishes towards him or
the rejection of such wishes, with the resultant anxious submissiveness.
(p. 87)

At the time of giving these lectures, the psychoanalytic understanding of

countertransference was still in its infancy, but Anna Freud nevertheless
shows an acute awareness of how the transferences of the child will in turn
touch on aspects of the teacher’s own unconscious life. She gives the example
of an excellent young teacher who escaped an unhappy home life to become
the governess for three boys. The middle child presented serious educational
problems and was ‘backward in his lessons and appeared very timid, reserved
and dull’ (p. 129); the young governess devoted great energies to bringing
out this boy’s potential, and under her care he began to flourish. The boy
grew increasingly attached to his governess, but on her side she suddenly
began to grow hostile to this child and then rather abruptly resigned from her
post, to the great regret of both the child and his parents.
Anna Freud describes how this teacher came into analysis many years later
and gradually began to understand how her own experience as a child, where
she had felt unloved and unappreciated, had impacted on her work as a
teacher. On taking up her role as governess, she had at fi rst identified with

46 Reading Anna Freud

this ‘backward’ child and devoted to him all the love and care that she had
felt deprived of herself as a child. But the very success of her influence
destroyed this identification and aroused in her great envy for the success and
love he had attained, which in her own life had been denied. Unaware of the
roots of these powerful feelings, the teacher had been driven to re-enact her
own experiences, by rejecting the child as she herself had once been rejected.
Anna Freud comments that in certain respects this teacher’s unconscious
identification with the child actually led to a great educational success.
Perhaps it would be better not to delve too deeply into the unconscious
motivations for this behaviour, lest by doing so one lost a good teacher? But
she goes on:

I feel that these educational successes are too dearly bought. They are paid
for by the failures with those children who are not fortunate enough to
display symptoms or suffering which remind their teachers of their own
childhood. . . . I hold we are justified in demanding that teachers should
have learned to know and to control their own confl icts before they begin
educational work. Otherwise the children merely serve as more or less
suitable material on which to abreact unconscious and unsolved difficulties.
(p. 131)

Did this mean that Anna Freud thought that all teachers needed to be
analysed, and that the aim would be for all of the unconscious motives that
lead us to want to help children should be removed? On the contrary, Anna
Freud emphasised that she was not advocating a personal analysis for every
teacher. Rather, she was wanting to let teachers know that ‘there are times
when a person falls down on the job, and the person doesn’t know why – and
if that keeps happening, then there is something you can do; you can
investigate’ (Coles, 1992: 44–45). Without such an attitude, there is a risk of
educators using the teacher–pupil relationship to try to help themselves rather
than the child:

Since teaching is a profession, [the educator] ought to have an overall

relationship with childhood. A teacher cannot be completely objective,
but once she becomes interested in the processes of childhood, all children
become interesting in a more objective way.
(1952a: 562)

The relation between psychoanalysis and education

The final lecture in her 1930 book, ‘The Relation between Psychoanalysis
and Education’, is perhaps the most important of the four lectures, raising
questions that Anna Freud was to continue to address throughout her working

The application of psychoanalytic ideas to education 47

life. Against some of the more utopian promises made by earlier psychoanalytic
pioneers, she warns that education and psychoanalysis should not ‘demand
too much from one another’, but she also acknowledges that teachers will
come to these lectures seeking ‘practical advice rather than an extension of
theoretical knowledge’ (p. 123).
In contrast to the dominant view of psychoanalysis at the time, which many
people understood to be promoting unfettered freedom of expression, Anna
Freud emphasised that ‘the lack of restraint’ can be as harmful to children as
‘the injurious effect of too great repression’. Although early psychoanalysts had
mostly emphasised the harmful effects of repressive educational systems and
promoted sexual enlightenment as a potential panacea against adult neuroticism,
Anna Freud’s own conclusion is more balanced:

The task of upbringing based on analytic understanding is to fi nd a middle

road between these extremes – that is to say, to find for each stage in the
child’s life the right proportion between drive gratification and drive
control.
(p. 128)

To illustrate her point, she gives the example of a small girl who took an
excessive pleasure in showing herself naked to her siblings, and ‘delighted in
running through the rooms stark naked before going to bed’ (p. 125).
Education stepped in, she explains, to suppress this desire and to promote
feelings of shame and modesty which she would probably carry forward into
her later life. In adulthood, this might lead to certain neurotic inhibitions
that could limit her capacity for a full enjoyment of her potential, and if she
were to seek help, a psychoanalyst would most likely see only the harmful
effects of this early inculcation of shame and guilt. However, Anna Freud,
based on her experience of working with August Aichhorn, also reminds her
listeners of the ‘wayward child’, who ‘does not succeed sufficiently in
inhibiting drive gratification’, and so becomes out of control and ‘wild’
(p. 126). Such lack of controls is equally concerning. Describing the case of
an eight-year-old girl whose behaviour was so impossible at both home and
school that she was constantly being excluded and placed in residential care,
Anna Freud comments:

No one offered the love which would in some way have compensated the
child for giving up the gratification obtained from her own body; nor did
the severe punishments from which the parents expected a restraining
influence fulfi l their purpose.
(p. 127)

The ‘middle way’ that Anna Freud proposed, in which drive renunciation
takes place in the context of a strong attachment to a loved adult, was a model

48 Reading Anna Freud

of development that was to become increasingly important to her thinking
in a range of areas. But at this point, she emphasised, ‘it is too early’ to try to
propose a complete analytically informed model of education. At this stage,
she suggested, the contribution that psychoanalysis could make was in certain
respects more modest: (1) to offer a critique of existing educational methods;
(2) to provide a perspective on the early development of children which
would extend teachers’ knowledge and understanding of the children with
whom they worked; and (3) to propose a model of therapy that could try to
‘repair the injuries which have been infl icted upon the child during
the process of education’ (p. 129). Each of these aims – but especially the last
two – was to form the basis for much of the work that Anna Freud was to
pursue over the following 50 years.

The importance of working with parents

Although the 1930 lectures were delivered to teachers, the title of the
published version makes clear that Anna Freud was speaking to both teachers
and parents, as she considered that both groups had a crucial role in the
‘education’ of the child. She believed that analytic knowledge could be an
important resource for whoever was responsible for the upbringing of children
– especially mothers. ‘The upbringing of young children is an exacting task’,
she wrote some years later, ‘even under the most favourable circumstances. . . .
Mothers, and especially the mothers of young infants, are expected to
combine in themselves a multitude of skills and virtues which are not often
found together in any human individual’ (1949b: 528).
Given the enormous demands placed on mothers (and parents and carers
generally), Anna Freud saw the need for parents to be given support. She
believed that psychoanalysts should use what they had learned from the
treatment of both children and adults to offer knowledge about ‘mental
hygiene’, comparable to the knowledge about ‘bodily hygiene’ (sterilization,
vaccinations, diet etc.) that had been provided by medicine during the same
period. She argued that psychoanalysis offered the ‘modern’ parent the ‘fi rst
full and coherent account of what happens in the mind of a child during his
first five years’, thereby ‘laying the foundation for the more enlightened and
effective methods of upbringing which are in use in many homes today’
(1949b: 535–536).
As well as writing and lecturing for parents and carers, Anna Freud was a
great supporter of the ‘child guidance’ clinics that were emerging in the US
and Western Europe, and in later years she gave a series of talks in which she
argued that psychoanalysis could help these clinics to offer the kind of support
to parents that could make a significant difference to children’s lives (e.g.
A. Freud, 1960b, 1964). But as time went by, Anna Freud also became more
sceptical about the degree to which psychoanalysis could offer any absolute

The application of psychoanalytic ideas to education 49

prescriptions for ‘good parenting’. She was critical of the way in which
psychoanalysis tended to ‘publicize findings all too often in unsuitable
language or with exaggerated emphasis on the most recent discoveries’
(1960b: 287). In a paper on ‘Psychoanalytic Knowledge Applied to the
Rearing of Children’ (1956a), she noted the way in which psychoanalytic
‘fads’ had led to a series of one-sided recommendations to the general public
– all of which included some important truth, but which taken on their own
were naive or even harmful. At first, she explained, analysts had emphasised
the importance of sexual enlightenment (so as not to create overly severe
repressions); then of limiting parental authority (in order to minimise the
harshness of the superego); and later the danger of ‘maternal rejection’ (which
was seen by some analysts as the root of everything from depression through
to autism). The undue emphasis on this single factor, she noted, ‘caused
much heart-searching and also much self-accusation, especially among the
mothers of abnormal children’ (1955: 591) and so did not contribute to the
long-term well-being of children and families. There was also a danger,
she realised, that by raising false expectations regarding the upbringing of
children, the reputation of psychoanalysis itself could be harmed, and what
was of value could be thrown out along with that which was not.
While never underestimating the capacity to influence child-rearing
practices through education and instruction (as could be seen in the huge
changes that took place during Anna Freud’s lifetime in practices such as
breastfeeding and toilet training), she also kept in mind that the ‘successful
upbringing of a young child . . . depends not on his mother’s objective
knowledge but on her subjective emotional attitudes’ (1960[1959]: 497) and
that, once this is understood, ‘work with a parent ceases to imply a teacher–
pupil attitude and takes on the aspect of a therapeutic relationship’ (1960b:
292). Anna Freud was interested to investigate when parent guidance was
sufficient; when the treatment of a child could lead to changes in the family
dynamics; and when a parent him/herself required therapeutic help. With
younger children, she continued to believe that some of the most valuable
therapeutic work could take place by directly supporting the parents
themselves to help resolve the child’s difficulties.

Conclusion

The work that Anna Freud undertook at the interface of psychoanalysis and
education in Vienna in the 1920s was a product of a particular moment in
European history, but it also laid the foundation for much of her later work.
Anna Freud herself followed the four lectures by establishing regular seminars
for nursery school teachers (conducted jointly with Dorothy Burlingham) as
well as working with Willi Hoffer and others on the psychoanalytic training
for teachers, where she felt they managed to help teachers develop an

50 Reading Anna Freud

understanding of nonverbal communication in the classroom that ‘offered a
key to the children’s confusions, distresses, anxieties, unruliness, and
uncooperativeness, i.e. to behavior problems which remained inexplicable
otherwise’ (1976[1974]b: 309–310).
Emboldened by her successes in working with teachers, in 1937 Anna
Freud went on to set up an experimental day nursery for toddlers from the
most underprivileged areas of Vienna, alongside her colleagues Edith Jackson
and Dorothy Burlingham. The ‘Jackson Nursery’ project was short-lived
owing to the rise of fascism, but it laid the groundwork for the activities that
Anna Freud was to pursue following her emigration to Britain, including the
running of the Hampstead War Nurseries, the Nursery of the Hampstead
Clinic, and her many lectures to teachers and nursery school workers in the
post-war years. ‘What dominated our actions then was the spirit of discovery,’
she wrote later, ‘the wish to open up more and more of the potentialities
which lie dormant in each child, to free intellectual capacities which
had been stifled rather than enhanced by outdated teaching methods’
(1976[1974]b: 311).
One year before her death, at the opening ceremony for the Chicago
Institute for Psychoanalysis, Anna Freud was reminded by her colleague, Dr
George Pollock, that it was 50 years since her lectures for teachers had fi rst
been published in English. Reflecting on this anniversary, she noted that if
an introductory book such as this one has achieved its purpose, then its
message would hopefully have become obsolete, as its teachings were
gradually assimilated into common knowledge. The emphasis on the
importance of the child needing to be fed before he or she could benefit from
education, or that children’s difficulties with learning were not always purely
because of intellectual limitations or a result of ‘being naughty’, are now so
commonplace that they hardly need mentioning. Looking back, Anna Freud
recalled how vastly different teacher–pupil relationships had been in those
days, and how little staff in schools were concerned with the broader
emotional and psychological development of the children for whom they
were responsible. She explained:

I tried to create for the hearers an image of the child as a whole, with his
initial helplessness, his resultant dependencies, his loves, hates, and
jealousies, his developing sexual drive, the battle with the urgency of his
needs and wishes, his successes and failures in the very painful striving for
adaptation to the demands of the environment.
(1982: 260)

She then went on to speculate on how similar or different a set of

introductory lectures would need to have been in 1981, at the time she was
then speaking. She recognised that on the earlier occasion a great deal of
emphasis had been placed on the child’s ‘newly discovered and newly revealed

The application of psychoanalytic ideas to education 51

sexuality’ (p. 260) and that a contemporary psychoanalyst would want to
emphasise a broader understanding of the ‘humanizing process’ that marks
the child’s path from immaturity to maturity (p. 260). This broader
understanding was to be encapsulated in her idea of ‘developmental lines’,
which will be described more fully in Chapter 9, and which Anna Freud
believed could be of enormous benefit to teachers and those charged with the
care of children.
In discussion with Robert Coles in the 1970s, Anna Freud spoke passionately
about the importance of teachers – not just as people who impart knowledge
to their students, but more importantly as adults whose role it is to persuade
children ‘to be interested in the world, to want to learn about it’ (Coles,
1992, p. 31). She believed strongly that many children in psychological
distress did not necessarily need therapy, but could be helped in many ways
by a well-informed and thoughtful teacher. Listening to her speak, Robert
Coles wrote:

After a while I began to realize how strongly committed she felt to the
teachers she had come to know over the years, in Austria and in England,
how respectful she was of their ability to work with children emotionally
as well as intellectually. Not only did she regard herself as a teacher who
had become a child psychoanalyst, but she never, of course, stopped
teaching.
(p. 52)

FURTHER READING

Much of the creative interplay between psychoanalysis and education that

was taking place in Vienna during the 1920s is captured in books by Anna
Freud’s contemporaries, including Aichhorn’s Wayward Youth h (1925),
Bernfeld’s Sisyphus, or The Limits of Education n (1925b) and Hoffer’s
‘Group Development in a School Community’ (1922), which was translated
and reprinted in his collection of papers, Early Development and Education
of the Child d (1981). A general sense of the post-war era in Vienna in the
1920s and the exciting developments taking place is well captured by Gardner
and Stevens (1992) in Red Vienna and the Golden Age of Psychology,
1918–1938 8, and by Gruber (1991) in Red Vienna: Experiment in Working
Class Culture, 1919–1934.
1919–1934 4. Memories of Anna Freud’s own contribution to
this period were assembled in a collection published by the Erikson Institute,
shortly after her death, entitled Anna Freud Remembered d (Piers, 1983).
Anna Freud’s work in the ‘Matchbox’ School is described at length in Peter
Heller’s introduction to Anna Freud’s Letters to Eva Rosenfeld d (1992) as
well as in the introduction to his own 1990 book, A Child Analysis with Anna

52 Reading Anna Freud

Freud d. A full account of the school is given in Midgley (2008a) and in Houssier
(2010, in French). There is no detailed account of Anna Freud’s work in the
Jackson Nursery, although the project is discussed at length in Elisabeth
Young-Bruehl’s biography (1988/2008) of Anna Freud.
Two of the best collections of papers on the subject of psychoanalysis and
education, written clearly in the Anna Freudian tradition, are the volume edited
by Ekstein and Motto (1969), From Learning for Love to Love of Learning g,
Learning,
and a later collection edited by Field, Cohler and Wool (1989), Learning and
Education: Psychoanalytic Perspectives s. For those who read German, the
many papers published in the Zeitschrift für Psychoanalytische Pädagogik
give a flavour of the interaction between these two fields; much of the spirit of
this interdisciplinary journal was maintained in the journal established by Anna
Freud and her colleagues in the post-war years, the Psychoanalytic Study of
the Childd. Some of the contemporary work in schools in the Anna Freudian
tradition is described in papers by Wilson (2004), Malberg (2008), Radford
(2012) and Malberg, Stafler and Geater (in press).
In the UK today, the tradition of the Vienna Psychoanalytic Training Course
for Educators has perhaps been best kept alive at the Tavistock Clinic, where
a course on Emotional Factors in Learning and Teaching has been running for
many years. Based largely on material from this course, the Tavistock Clinic
has published three important collections of papers which show the contribution
that psychoanalysis can make to the classroom setting, one edited by
Salzberger-Wittenberg, Williams and Osborne (1999) on The Emotional
Experience of Learning and Teaching g, a second by Biddy Youell (2006),
The Learning Relationship: Psychoanalytic Thinking in Education,Education n, and a
third edited by Harris, Rendall and Nashat (2011), Engaging with Complexity:
Child and Adolescent Mental Health and Education n. (Sadly, these books
make little reference to the work of Anna Freud and her colleagues.)
For a review of psychoanalytic work in schools in the UK, see McLoughlin
(2009) as well as a themed issue of the Journal of Child Psychotherapy y on the
work of psychoanalytic child psychotherapists in schools (Vol. 34, No. 1,
2008); for a broader psychoanalytic perspective on the classroom, see Bibby
(2010).

The application of psychoanalytic ideas to education 53

4 THE EGO AND THE MECHANISMS
OF DEFENCE

KEY WRITINGS

1936 The Ego and the Mechanisms of Defence

1952 ‘The Mutual Influences in the Development of the Ego and the Id:
Introduction to the Discussion’
1966 ‘Links between Hartmann’s Ego Psychology and the Child Analyst’s
Thinking’
1985 The Analysis of Defence e (with Joseph Sandler)

Introduction

Of all Anna Freud’s works, The Ego and the Mechanisms of Defence is probably
the most widely known today, and it remains the one work by Anna Freud
that is consistently found on the reading list of many psychoanalytic
courses. Unlike her earlier writing on the technique of child analysis, this
book was reviewed very positively when it first appeared (e.g. Fenichel, 1938;
Jones, 1938) and has continued to be popular. Indeed, in the mid-1980s
Robert Wallerstein went so far as to suggest that this work was ‘perhaps the
single most widely read book in our professional literature’ (1984: 66). While
this may not be exactly true today, the statement reflects the fact that the
work has had enormous influence, especially in North America where the
book was acknowledged as ‘a foundation piece for the whole of the modern
era of ego psychology’ (p. 66), equalled only in significance by Heinz
Hartmann’s Ego Psychology and the Problem of Adaptation (1939). The enormous
significance of these two works for psychoanalytic theory and practice,
especially in North America, went undisputed for almost 40 years after their
publication.
Yet when Anna Freud first began work on the material for the book, its
aims seemed altogether more modest. Much of what is included in the fi nal
version began life as a series of lectures that Anna Freud gave from 1929
onwards; when she referred to her work on it in a 1934 letter to Max
Eitington, she described the proposed book as ‘a sort of theoretical base for
the thoughts on puberty’ that she had been developing over the previous few

54 Reading Anna Freud

years (Young-Bruehl, 1988/2008: 203). Although the book retained a focus
on puberty and adolescence, especially in the last two chapters, the central
focus of the book gradually shifted to an examination of the place of the ego
in psychoanalysis itself, and in particular the major role that defence
mechanisms play in the workings of the human mind.
The book as it finally appeared can be seen as having three main sections.
The first part (Chapters 1–5) examines the role of the ego from the perspective
of psychoanalysis and describes the ‘mechanisms of defence’ as a crucial
aspect of the ego’s functioning. The second part (Chapters 6–10) catalogues
and systematises her father’s ideas about the various types of defence
mechanisms and introduces two new ones – ‘identification with the aggressor’
(Chapter 9) and ‘a form of altruism’ (Chapter 10 ). The third part
(Chapters 11–12) discusses the particular role of defence mechanisms during
puberty and adolescence.

The psychoanalytic concept of the ego

Although Sigmund Freud had used the concept of the ‘ego’ (in German, ‘das
Ich’ – literally, ‘the I’) from the beginning of his work, the term took on a
new significance following the publication of The Ego and the Id in 1923,
when Freud introduced his new tripartite (or structural) model of the
mind. In this new way of thinking, the ego stands as the defensive pole of the
personality, alongside the id as the instinctual pole and the superego as
the system of ideals and inhibitions against which the ego was judged.
Unlike his earlier work, where Freud had often used the term ‘ego’ as
synonymous with ‘consciousness’, he now recognised that a large part of the
ego’s activity remained outside consciousness. Freud used the image of the
horse and its rider to describe the relationship between the ego and the id.
While the rider (the ego) is nominally in charge of affairs, he won’t get
anywhere without the cooperation of the horse (the id). The ego therefore
has to try to harness the id’s energy without being overthrown or taken off
in unwanted directions. (Freud also used the image of the constitutional
monarch to describe the ego, and he referred to the way in which it has to
appease the demands not only of the id and the superego, but also of the
external world.)
Within this new way of thinking about the ego, a whole variety of new
functions were attributed to the ego. As Laplanche and Pontalis put it, these
included ‘not only the control of motility and perception, reality-testing,
anticipation, the temporal ordering of the mental processes, rational thought,
and so on, but also refusal to recognise the facts, rationalisation and compulsive
defence against instinctual demands’ (1973: 139). These latter aspects formed
the central focus of Anna Freud’s 1936 publication.

The Ego and the Mechanisms of Defence 55

Beyond depth psychology

In a discussion towards the end of her life, Anna Freud recalled that she
wrote The Ego and the Mechanisms of Defence at a time ‘when the introduction
of the ego as such into psychoanalytic discussion or into the literature was
suspect to most analysts’ (Sandler and Freud, 1985: 6). In the early years of
psychoanalysis, the great discovery was that there was a whole aspect of the
human mind, made up of unconscious thoughts, wishes and fantasies, that
was scarcely known about – especially to mainstream psychology and
psychiatry. It was no coincidence that Sigmund Freud, inspired by the recent
excavations of the city of Troy carried out by Hienrich Schliemann, used the
metaphor of archaeology to describe the work of the psychoanalyst. Like the
archaeologist, the analyst was digging down to the very depths of the mind,
discovering hitherto unknown fragments of our forgotten histories, piecing
things together on the basis of the scraps and fragments that could be drawn
up to the surface . . .
Yet if psychoanalysis, in its earliest days, ‘was pre-eminently a psychology
of the unconscious or, as we should say to-day, of the id’ (A. Freud, 1936: 4),
then this was not to say that it had not always been concerned with the
workings of the ego. In her opening chapter, Anna Freud points out that, as
a therapeutic method, psychoanalysis had always been concerned with both
poles of the personality – the unconscious drives or wishes, and the ways in
which the mind reacts to these wishes, whether by means of censorship (in
dreams) or resistance (in free association) or repression (in the formation of
symptoms). For Anna Freud, in other words, ‘psychoanalysis’ and ‘depth
psychology’ should not be treated as synonymous terms; indeed, our only
knowledge of the hidden depths of the mind is through its ‘derivatives’ as
they appear in our behaviour and in consciousness.
In the second chapter of her book, Anna Freud traces the various interactions
between the ego and the id as they are manifested in free association (where
a pause or break in the chain of associations can be understood as a moment
at which the ego’s resistances have been roused, thereby indicating a point of
confl ict), in dreams (where the disguise that the dream undergoes by means
of the dream-work can be understood as the activity of the unconscious ego),
and in the transference (where the patient will transfer not only his or her
libidinal impulses onto the figure of the analyst, but also his or her typical
means of defence – a fact of great clinical significance, as will be discussed
below).
On the basis of her historical review, Anna Freud redefines psychoanalysis
to give due weight to the working of the ego, especially the unconscious ego
and its defensive activity. She writes:

Since [the publication of The Ego and the Id and other papers from that
period] the term ‘depth-psychology’ certainly does not cover the whole

56 Reading Anna Freud

 field of psycho-analytic research. At the present time we should probably
define the task of analysis as follows: to acquire the fullest possible
knowledge of all the three institutions of which we believe the psychic
personality to be constituted and to learn what are their relations to one
another and to the outside world. That is to say: in relation to the ego, to
explore its contents, its boundaries and its functions and to trace the
influences in the outside world, the id and the super-ego by which it has
been shaped and, in relation to the id, to give an account of the instincts,
i.e. of the id-contents, and to follow them through the transformations
which they undergo.
(pp. 4–5)

Such a vision of psychoanalysis came to be known (somewhat inappropriately,

given Anna Freud’s emphasis on paying attention to all three agencies of the
mind) as Ego Psychology.

The birth of ‘Ego Psychology’

Freud’s Group Psychology and the Analysis of the Ego (1921) and The Ego and the
Id (1923) both had a profound impact on the second generation of analysts
who were entering the field in the early 1920s, as they opened up new aspects
of the psyche hitherto relatively neglected in psychoanalysis. In Anna Freud’s
own words, these works freed the study of the ego from ‘the odium of
analytical unorthodoxy’ (1936: 4). Publications soon appeared on the early
stages of ego development (Klein, Jones), the development of character
(Reich), the synthetic function of the ego (Nunberg) and the concept of the
‘ego boundary’ (Federn) – all of them directly building on this new turn in
Freud’s own investigations of the psyche.
But two works, written almost contemporaneously in Vienna in the 1930s,
were to have more impact on the study of the ego than any other: Anna
Freud’s The Ego and the Mechanisms of Defence (1936) and Heinz Hartmann’s
Ego Psychology and the Problem of Adaptation (1939). In Wallerstein’s words,
these two books were the ‘twin pillars on which all the rest of ego psychology
has been built’ (1984: 71), covering, as they did between them, the ego as
both a defensive organ and an adaptive one. Anna Freud herself saw Hartmann’s
contribution as the more revolutionary one, as it introduced the idea of
aspects of the ego which were not involved with confl ict, and which could
be seen to develop relatively autonomously (1966b: 207). In doing so, she
recalled, Hartmann was aiming ‘to raise the status of psychoanalysis from
that of a depth psychology to that of a general theory of the mind which
impartially embraces depth and surface; id, ego, and superego; in short, the
total of the human personality’ (1965[1964]: 501). For some this was seen as
a betrayal of the radical otherness that psychoanalysis had introduced,

The Ego and the Mechanisms of Defence 57

reducing it to a mere sub-branch of psychology; for others, this was regarded
as the fulfi lment of Freud’s original vision of a psychoanalysis of the human
psyche in its entirely, both healthy and pathological.
Whatever view one takes, the influence of Ego Psychology, as it came to
be known, was immense, especially in North America, where the work of
Anna Freud and of Hartmann, as well as that of the many colleagues who
worked alongside them, became the primary psychoanalytic perspective until
at least the 1970s. The ideas that they introduced ‘marked the transition of
psychoanalysis from being primarily an id or drive psychology, focused on
the vicissitudes of the instinctual drives . . . as the prime movers of behavior,
normal and neurotic, to a period in which the ego was accorded equal
importance and was regarded as the prime shaper and modulator of behavior,
again both normal and neurotic. In America this came to be called the era of
ego psychology’ (Wallerstein, 2002: 136).

The concept of ‘defence mechanisms’

Although Anna Freud’s broader aim in writing this book was to make the
case that psychoanalysis should give equal status to all aspects of the personality,
her more specific contribution regarded one particular aspect of the ego’s
functioning: its role in relation to the mechanisms of defence.
At the start of her fourth chapter, Anna Freud sets out most explicitly what
she meant by this term. The concept of ‘defence’, she notes, had been used by
Freud as early as 1894, where it stood as ‘the earliest representative of the
dynamic standpoint in psychoanalytical theory’ (A. Freud, 1936: 45). By
‘dynamic’, she means the way in which the mind can be seen from the
perspective of competing forces or conflicts: in particular, the ‘ego’s struggle
against painful or unendurable ideas or affects’ (p. 45). It is in the nature of
human existence that we try to turn away or escape from that which causes
us pain or discomfort; in psychological terms, the term ‘defence’ described
the means by which we try to do so.
Freud soon abandoned the term ‘defence’, however, replacing it with the
more specific concept of ‘repression’, to describe a particular mechanism
whereby the mind rids itself of unpleasant or unwanted thoughts – in
particular, instinctual wishes emerging from the unconscious. It was only in
1926, in his key paper on Inhibitions, Symptoms and Anxiety, that Freud
reintroduced the concept of ‘defence’. He explained:

In the course of discussing the problem of anxiety I have revived a concept

or, to put it more modestly, a term, of which I made exclusive use thirty
years ago when I first began to study the subject but which I later abandoned.
I refer to the term ‘defensive process’. I afterwards replaced it by the word
‘repression’, but the relation between the two remained uncertain. It will

58 Reading Anna Freud

 be an undoubted advantage, I think, to revert to the old concept of
‘defence’, provided we employ it explicitly as a general designation for all
the techniques which the ego makes use of in confl icts which may lead
to a neurosis, while we retain the word ‘repression’ for the special methods
of defence which the line of approach taken by our investigations made us
better acquainted with in the first instance.
(1926[1925]: 163)

Once again, a number of colleagues followed Freud in paying greater

attention to these defensive processes, including Reich (1928), Glover (1930),
Klein (1932) and Nunberg (1931), but it was Anna Freud who tried to
systematise the psychoanalytic knowledge of the defence mechanisms and
explain their workings within a broader model of personality development
and psychopathology. Not content with cataloguing the defence mechanisms
which had already been identified in her father’s work (such as repression,
reaction-formation, regression, undoing, isolation, introjection, identification,
projection, turning against the self, reversal and sublimation), Anna Freud
also asked the more profound questions: What is it that the mind is protecting
itself from when it makes use of defensive mechanisms? How do these
mechanisms develop? Are some mechanisms of defence more ‘primitive’ and
some more ‘mature’? Are there other defence mechanisms besides those
already identified by Sigmund Freud? And what is the connection between
defence mechanisms, psychopathology, and mental health and
well-being?

Why does the mind need to use defensive mechanisms?

Although Anna Freud accepted Freud’s defi nition of the mechanisms of

defence as ‘all the techniques which the ego makes use of in confl icts which
may lead to a neurosis’ (S. Freud, 1926: 163), in the course of her book she
actually considerably expands the meaning of the term, looking at the ways
in which the mind protects itself from all kinds of painful or unpleasant
feelings (not just confl icts), both in the course of normal development and in
neurosis.
The area that was already most familiar to psychoanalysis was the way in
which the psyche responds to anxiety related to internal confl icts between an
(unconscious) wish and the part of the mind that rejects such wishes. In
neurosis, this can be understood as ‘super-ego anxiety’, which from Anna
Freud’s perspective forms the basis of all neurosis in adults. As she explains it,
‘some instinctual wish seeks to enter consciousness . . . but the super-ego
protects. The ego submits to the higher institution and obediently enters into
a struggle against the instinctual impulse . . . Its defence is motivated by
super-ego anxiety’ (1936: 58–59).

The Ego and the Mechanisms of Defence 59

 As a way of illustrating the role of superego anxiety in the formation of
neurosis, Anna Freud gives the example of a young woman who, as a child,
suffered intense jealousy and envy towards her mother, creating in her a
fierce hostility. This hostility, however, led to a confl ict in the young girl’s
psyche, as she simultaneously loved her mother and feared her mother’s
revenge for having such hostile thoughts. The child’s aggressive impulses,
therefore, were repressed, leaving her somewhat docile in relation to her
mother.
Such repressed impulses, however, never disappear entirely and constantly
strive to find expression (the return of the repressed). In this woman’s case, it
took the form of a phobia that emerged in adulthood, at a point when new
circumstances challenged the equilibrium that her psyche had achieved at the
time of her ‘infantile neurosis’. The repressed impulses forced their way back
towards consciousness, but once again they caused distress, so that they were
once more repressed and the aggressive impulses were projected into the
outside world, which now carried all the aggression that the woman herself
had tried to obliterate.
Anna Freud suggests that those same instinctual impulses might have been
expressed in the form of excessive tenderness or obsessional ceremonies, if
the woman had an ego that relied more upon defences such as reaction
formation, isolation or undoing. Such defensive mechanisms would have the
same aims – that is, of protecting her from the anxiety related to any outbreak
of aggressive impulses – but the cost might instead be an exaggerated moral
strictness, a reduction of the full range of her personality, and symptoms that
restrict her freedom and peace of mind. The reason why a person will rely
more on one type of defence than another in dealing with internal confl ict is
one that Anna Freud touches on only briefly in this book, but it leads to her
later work on the ‘developmental lines’ of both instinctual and ego functioning
(see Chapter 9 ).

Identification with the aggressor

As well as cataloguing the defence mechanisms already written about in the

psychoanalytic literature, Anna Freud identified a number of ‘new’ defence
mechanisms – the best known of which she called ‘identification with the
aggressor’. She tells us that she first came to appreciate this mechanism of
defence thanks to a story that her colleague, August Aichhorn, told her. He
described a young boy who was constantly in trouble with his teachers for
pulling faces in class. Whenever he was told off or reproved, he would pull
such faces, causing all the other children in the class to burst out laughing.
The teacher wasn’t sure if the boy was simply impertinent or suffered from
some kind of facial tic. On observing his behaviour, Aichhorn realised that
the boy’s grimaces ‘were simply a caricature of the angry expression of the

60 Reading Anna Freud

teacher, and that, when he had to face a scolding by the latter, he tried to
master his anxiety by involuntarily imitating him’ (A. Freud, 1936: 118). The
boy, in other words, quite unconsciously identified with the teacher’s anger,
copied his expression and thereby identified himself with the dreaded external
object.
For Anna Freud, the significance of this story was that it described a process
that, while apparently simple, actually illustrates ‘one of the ego’s most potent
weapons in its dealings with external objects which arouse its anxiety’
(p. 117). Whether it is the child who, on returning from the dentist,
aggressively snaps off the ends of her pencils or the little boy who, having
bumped into a teacher and fallen over and injured himself in the playground,
returns to school the following day dressed up in a military cap and a toy
sword, we can see the way in which the child has identified with some
characteristic of a pain- or anxiety-inducing object and has thereby assimilated
the experience. In certain cases, the anxiety faced may be an internal one, as
in the case of the five-year-old boy in analysis who, whenever material
associated with his masturbation fantasies was touched on, switched from
being shy and inhibited to being fiercely aggressive, playing at being a roaring
lion that was attacking his therapist. As Anna Freud points out, this was not
some innate aggression being expressed, but, rather, an expression of anxiety:
the child feared that he would be punished for his sexual thoughts and wishes,
so in taking on the role of the fierce lion he was merely ‘dramatizing and
forestalling the punishment which he feared’ (p. 124).
The concept of ‘identification with the aggressor’ was significant for a
number of reasons. Not only did it provide a way of understanding the many
games of make-believe and impersonation that children love to play, but it
also provided a way of thinking about children’s aggression which did not
depend on the concept of an innate ‘aggressive drive’ or death-drive. It also
made clear that the mechanisms of defence could be seen as identical whether
someone is dealing with a threat from inside (as in the case of unacceptable
instinctual impulses) or one from outside; in either case, the mechanism is
the same – the threat or danger is identified and the ego activates some form
of defensive manoeuvre, with the aim of reducing the threat and thereby
avoiding pain or pleasure.
Perhaps most importantly, the concept of ‘identification with the aggressor’
can also provide a way of thinking about the normal process of early superego
development. By internalising a threatening object, a child takes the criticism
inside, even if, at this stage, the offence is externalised. So when a toddler
does something naughty and, when accused, points at another child and says
that he did it, this can be seen as a ‘preliminary phase of morality’ (p. 128),
in which a sense of right and wrong is already being established but the
judgement of the superego is not yet turned inwards. As Anna Freud put it
many years later, there may be such a thing as a ‘moral toddler’, but there
probably isn’t a ‘guilty toddler’ (Sandler and Freud, 1985: 412–413).

The Ego and the Mechanisms of Defence 61

Puberty and adolescence

While ‘identification with the aggressor’ was seen as an important defence

mechanism fairly early in development, Anna Freud believed that other
defences would be used only at later points in life, as a result of increasing ego
development. In particular, she thought that adolescence was a crucial period
for the emergence of a range of new defensive processes. As mentioned earlier
in the chapter, The Ego and the Mechanisms of Defence started life as a book that
was going to bring together Anna Freud’s ideas about puberty. Although the
focus of the work changed, it continued to contain within it some important
contributions to psychoanalytic thinking about this important stage of
development, especially in the last two chapters on ‘The Ego and the Id at
Puberty’ and ‘Instinctual Anxiety during Puberty’.
Although the early psychoanalysts paid a great deal of attention to the
importance of sexuality in human development, puberty and adolescence
were – somewhat surprisingly – rather neglected stages of development for
these analytic pioneers. Anna Freud tried to explain this neglect, suggesting
that the discovery of infantile sexuality by this first generation of analysts
meant that ‘the status of adolescence was reduced to that of a period of final
transformations, a transition and bridge between the diffuse infantile and the
genitally centred adult sexuality’ (1958a: 138). If adolescence was seen as
merely a recapitulation of an early stage of infantile sexuality, so the thinking
went, then there was not much need for it to be given analytic attention.
Adolescence, remarked Anna Freud some years later, was ‘a neglected period,
a stepchild, where analytic thinking is concerned’ (1958a: 137).
Having worked alongside both Bernfeld and Aichhorn, who were
fascinated by the challenges of working with (and understanding) adolescents,
Anna Freud had a different view about the significance of this period, even
if she accepted the idea that it was fundamentally a replaying of the confl icts
of early childhood. Being a recapitulation, however, did not lessen its
significance:

While the events of the first five years of life lay the foundation of neurotic
development, it is the experiences in the second decade of life which
determine how much of the infantile neurosis will be reactivated or
retained and will become, or remain a permanent threat to mental health.
(1949d: 96)

In The Ego and the Mechanisms of Defence, Anna Freud focuses specifically
on the struggles of the ego during puberty to master the pressures arising
from the upsurge in instinctual forces. Using a vivid metaphor, she describes
the infantile battle between the ego and the id being terminated by a ‘truce’
at the start of the latency period. However, with the fi rst approach of puberty
hostilities are likely to break out again, as the equilibrium between id and

62 Reading Anna Freud

ego becomes destabilised by the upsurge in instinctual forces, both sexual
and aggressive. Anna Freud therefore saw adolescence in terms of the ego’s
‘struggle for survival in which all methods of defence are brought into play
and strained to the utmost’ (1958a: 140). For many adolescents, this might
result in extreme defences, involving complete rejection of the instincts (such
as can be seen in intellectualisation, asceticism, or eating disorders), but ‘we
find almost invariably a swing-over from asceticism to instinctual excess, the
adolescent suddenly indulging in everything which he had previously held to
be prohibited’ (1936: 170). Such swings, Anna Freud suggests, between
liberty and restraint, or between revolt against and submission to authority,
are characteristic of ‘normal’ adolescence and should not be considered as
pathological.
In her later writing (e.g. A. Freud 1958a, 1969[1966]), Anna Freud
continued to be fascinated by the psychology of adolescence, including the
technical challenges of working analytically with young people and the issues
of adolescent ‘delinquency’ (1949c). In particular, she was interested to
explore the question of when the Sturm und Drang of adolescence was part of
a normal adolescent process, and when it was a signal of ‘true pathology’. She
continued to explore the mechanisms of defence that appeared to be
characteristic of this stage of life (which might manifest themselves in what
she called the ‘uncompromising adolescent’, or the ‘ascetic adolescent’), and
she argued that disruption and disharmony may in itself be a sign of healthy
development. But she also broadened her perspective, focusing not only on
changes in ego organisation or the use of defence mechanisms, but also on
changes in object relations, moral development, social relations and instinctual
drives. As well as offering a sophisticated understanding of this crucial stage
of human development, Anna Freud believed that psychoanalysts needed to
learn when and how to intervene with treatment. But equally importantly,
they needed to know when the young person ‘should be given time and
scope to work out his own solution’ (1958a: 165). She concluded her 1958
paper with her typical combination of good sense, pragmatism and empathy:

. . . it may be [the adolescent’s] parents who need help and guidance so as

to be able to bear with him. There are few situations in life which are
more difficult to cope with than an adolescent son or daughter during the
attempt to liberate themselves.
(1958a: 165)

Defence against instincts and defence against affects

One of the central questions that Anna Freud addresses in The Ego and the
Mechanisms of Defence is what it is that we are defending against when the ego

The Ego and the Mechanisms of Defence 63

makes use of defence mechanisms. Psychoanalysis had always considered
superego anxiety to be of central importance when understanding neurosis
(i.e. confl ict between our wishes and our sense of what we ‘should’ be or do),
but Anna Freud points out that superego anxiety is only one of the triggers
for the ego’s defensive activity – and in childhood it is by no means the
primary one. For young children, she suggests (building on some of the ideas
presented by her father in Inhibitions, Symptoms and Anxiety), the greatest
threat to the ego’s survival comes from ‘objective anxiety’ (a term – in
German Realangst – that Anna Freud later suggested would have been better
translated into English as ‘justified fear’). By justified fear, Anna Freud means
all those very real dangers that threaten the child, from the very earliest fear
of losing the loved object, to the developmentally more sophisticated fear of
losing the love of the object.
But Anna Freud also goes one step further, suggesting that – whatever the
source of the anxiety may be – the mind ultimately defends itself against
unwanted affects, or unpleasant feelings. Whatever the source of the danger
may be – an instinctual impulse or an external threat – the reason it will
activate the ego’s defensive mechanisms is because it is experienced as something
unpleasant or painful. Just like the physiological process of fight or fl ight, the
psyche will seek ways to escape from such unwelcome feeling-states and
make use of any manoeuvres necessary to restore a sense of well-being.
Looking back on her work towards the end of her life, Anna Freud
commented that the emphasis she placed on the ego’s response to affect-
states and justified fear ‘was a more or less heretical revolutionary idea’
(Sandler and Freud, 1985: 264). Following his abandonment of the so-called
seduction theory in the late 1890s, Freud’s theory of neurosis and the
workings of the mind had focused almost exclusively on the way in which
it dealt with internal dangers, especially those that came from the repressed
unconscious. But now Anna Freud’s theory was giving equal status to
dangers of any sort, whether internal or external, by focusing on the affect
associated with a threat. In doing so, she refocused psychoanalysis’s attention
to external realities, such as parental abuse, trauma and neglect, alongside
the dangers associated with instinctual wishes and internal confl ict. The
fact that the mind might respond to these very different dangers in similar
ways (whether by means of turning against the self, projection, or any
of the other defence mechanisms identified) should not disguise the fact
that the ego is making use of such defences to deal with very different kinds
of threats.
This distinction between different kinds of motives for defence supported
her belief, set out in the earlier lectures on the technique of child analysis,
that an assessment of symptoms always needs to take into account the motives
for the pathological behaviour. For younger children in particular, where the
symptom could be based on a ‘justified fear’, they might best be helped by
interventions that attended to the source of fear itself – whether by supporting

64 Reading Anna Freud

the primary relationships or trying to influence the environment in which
the child is growing up. This is not to say that simply altering the child’s
environment is always sufficient. The work of undoing the defensive
structures that have been established over time still needs to happen. In some
cases, this may lead to recognition that the ego’s defensive reactions are based
on a situation that is no longer active, or were even a product of fantasy (A.
Freud, 1936: 69). But in cases where the fear is based on external reality, as
in maltreated or abused children, the focus should be on altering the
pathogenic environment. For younger children, such a change might be
sufficient, suggests Anna Freud; it is only once confl icts have become truly
‘internalised’ that psychoanalytic treatment would be essential to address the
child’s damaged inner world.

The clinical implications of The Ego and the Mechanisms

of Defence

Although The Ego and the Mechanisms of Defence is not primarily a clinical
work, there is a great deal in it that has implications for the practice of clinical
psychoanalysis. Anna Freud makes the point that ‘the task of the analyst [is]
to bring into consciousness that which is unconscious, no matter to which
psychic institution it belongs’ (1936: 30). To focus only on the ‘excavation’ of
repressed wishes and unconscious fantasies would be as one-sided as to focus
exclusively on the patient’s resistances and unconscious defensive activity.
Indeed, the beauty of the core psychoanalytic method, including a focus on
dreams, free association and the transference, is that the latter give access
equally to the activity of the id, the ego and the superego. As Anna Freud
puts it:

The patient is in fact candid when he gives expression to the impulse or

affect in the only way still open to him, namely, in the distorted defensive
measure. I think that in such a case the analyst ought not to omit all the
intermediate stages in the transformation which the instinct has undergone
and endeavour at all costs to arrive directly at the primitive instinctual
impulse against which the ego has set up its defence and to introduce it
into the patient’s consciousness. The more correct method is to change the
focus of attention in the analysis, shifting in the first place from the instinct
to the specific mechanism of defence, i.e. from the id to the ego. If we
succeed . . . the gain in the analysis is twofold. . . . Not only do we fi ll in
a gap in the patient’s memory of his instinctual life . . . but we acquire
information which completes and fi lls in the gaps in the history of his
ego-development . . . the history of the transformations through which
his instincts have passed.
(p. 21)

The Ego and the Mechanisms of Defence 65

 The approach that is being advocated here has come to be known as
‘defence analysis’, although Anna Freud does not use this term as such in the
book. But she gives a very clear example of it in Chapter 3 of the book, based
on her experience of child analysis. Anna Freud describes how a young girl
was referred for therapy because of her acute anxiety attacks and periods of
school refusal. In the early stages of the analysis, the analyst noticed that her
new patient was friendly and cooperative, but that she made no reference
whatsoever to her anxiety attacks. When the analyst made interpretations
related to the anxiety, based on material in the child’s play or associations, the
girl’s attitude to Anna Freud would suddenly transform, and she would
become mocking and contemptuous. At fi rst Anna Freud took these as a sign
of transference, but after more time she came to see that this behaviour was
not connected with the analytic situation per se. Instead, she began to observe
that the girl also responded to the emergence of tender or vulnerable feelings
in herself with the same self-mocking style.
Anna Freud realised that any interpretation of the hidden meaning of the
child’s anxiety (an id-interpretation) would merely have had the effect of
intensifying the little girl’s resistance and her characteristic self-mocking
tone – even if the interpretation were ‘correct’. In other words, it was
necessary to first bring to consciousness the patient’s method of defending
herself against her affects, before the content of the repressed wishes could be
made conscious. Further work on this led to an understanding of the way in
which the girl’s father, from the time she had been very young, had ‘trained
the girl in self-control by making mocking remarks when she gave way to
some emotional outburst’ (p. 39). Such a way of dealing with feelings had
become ‘stereotyped’ for the girl, even without the presence of the father. If
the child’s deeper anxieties were to be made conscious, it was fi rst necessary
to analyse her typical methods of defence against painful affects, whatever
the source of those affects might be.
In the opening chapters of her book, Anna Freud emphasises that the
technical challenge of analysing the defensive activity of the ego, which
might appear to be focused on the more ‘superficial’ parts of the mind, is
significant. After all, the id-impulses fundamentally wish to reach
consciousness and be expressed, which means that in some sense the work of
the analyst to make them conscious is welcomed. For the ego, however (to
risk personification), ‘the analyst comes on the scene as a disturber of the
peace’ (p. 31). The means of defence that it has used, after all, were used in
order to avoid painful feelings (like the little girl who learnt to avoid the
painful feeling of humiliation when her father mocked her expressions of
emotion as signs of weakness). Bringing such defensive activity into
consciousness risks reactivating such painful feelings; however, from a
therapeutic perspective, it provides the possibility for the patient to re-evaluate
internal and external reality and to find better and more adaptive means to
deal with what has been found.

66 Reading Anna Freud

 This concentration on the value of ‘defence analysis’, as one part (but not
the whole) of psychoanalytic technique, is perhaps the primary contribution
that Anna Freud makes to clinical technique in this book. But it is by no
means the only contribution. Scattered throughout the work, there are
references to the value of attending to affect in child analysis (especially affect
that does not seem appropriate to the context, as when a child laughs when
someone describes something very sad); she makes passing reference to the
idea that the observing part of the ego can be an ally to the analyst (thus
presaging the concept of the ‘therapeutic alliance’ that was only spelt out
more fully in the 1950s); and she also makes some important points about the
need for ego-supportive work, especially in work with children where the
help they need is to tolerate greater degrees of pain or discomfort without
resorting to familiar defensive reactions (p. 69). This fi nal idea, only hinted
at in the 1936 work, was to become much more central in her later writings
on ‘developmental disturbances’, as we will see in Chapter 9.

The legacy of Anna Freud’s work on the ego and the

mechanisms of defence

As described at the start of this chapter, The Ego and the Mechanisms of
Defence probably had more influence on psychoanalytic thinking, both
immediately and in the subsequent decades, than did any other of Anna
Freud’s writings, and it quickly became a standard text on curricula of
trainings for other professions, such as psychiatry and social work. For many,
it is the only work of Anna Freud’s that they may have read or even come
across. Although the approach and the terminology may have changed, very
few psychoanalysts today would neglect to pay attention to the ego or to pay
close attention to the various ways in which the mind protects itself from
pain and anxiety.
Specific elements of this book have also left a considerable legacy. Her
chapter on ‘Identification with the Aggressor’, for example, introduced a new
concept into the psychoanalytic literature that has continued to be used, and
the term has now entered into common use. In the late 1930s, with the rise
of fascism and the drift towards world war, a way of understanding human
behaviour that could make sense of the violence that normal human beings
were capable of committing, and that could explain the impact on children’s
development of witnessing such violence and destruction, was all too
necessary, and all too relevant. Understanding the impact of domestic and
political violence on children continues to be as important today as it was in
1936, as do the ideas that Anna Freud presents about the early development
of the moral sense.
The 1936 book also had a significant place in Anna Freud’s own
development. As Raymond Dyer puts it:

The Ego and the Mechanisms of Defence 67

 With this original contribution to defence theory, plus the systematic ego
psychological model in which the specific defenses were enumerated, the
ascendancy of the Vienna School of Child Analysis was confirmed. The
school now had not only an effective technical method and an active
membership but also a potent and elegant theoretical model against which
to test its observations and theories. The psychological and scientific
apprenticeship of Anna Freud was now complete.
(Dyer, 1983: 113)

FURTHER READING

Anna Freud refers back to her ideas about the ego and the mechanisms of
defence throughout her work, but the most extensive revisiting of this material
comes in The Analysis of Defence e (Sandler and Freud, 1985), a book based
on discussions between Anna Freud and the staff of the Hampstead Clinic that
took place in 1972–73, organised by Joseph Sandler. The discussions closely
followed the 1936 book, looking at the issues raised by it chapter by chapter.
The final version, published in the form of verbatim accounts of the discussion,
brings Anna Freud’s style of thinking vividly to life and provides some interesting
commentaries on the ideas first presented in The Ego and the Mechanisms of
Defence e. For a clinical illustration of the use of defence analysis and its impact
on psychoanalytic technique, see Gray (1996).
On the topic of Ego Psychology and Anna Freud’s own relationship to it,
her 1966 paper on ‘Links between Hartmann’s Ego Psychology and the Child
Analyst’s Thinking’ is especially clear and informative. Wallerstein (2002)
gives an extremely clear account of the growth and transformation of American
Ego Psychology, demonstrating the breadth of its influence and the role that
Anna Freud’s work played in its development. A critical view of this model of
Ego Psychology was provided by Lacan (1954), while a later critique, based
on the view that this approach presents an outmoded ‘one-person psychology’,
is provided by Greenberg and Mitchell (1983) in their highly influential book on
psychoanalysis and object relations.
Anna Freud’s interest in adolescence led to an important collaboration with
Moses and Eglé Laufer, who established the Brent Adolescent Centre in
London. Among their important publications was Adolescence and
Developmental Breakdown: A Psychoanalytic View w (1984). Anna Freud’s
two colleagues from her work at the ‘Matchbox’ School, Erik Erikson and Peter
Blos, also produced important works on adolescent development, including
Blos’ On Adolescence: A Psychoanalytic Interpretation n (1962) and
Erikson’s Identity: Youth and Crisis s (1994). For Aichhorn’s influence on the
practice of psychotherapy with adolescents, see Houssier (2009) and Houssier
and Marty (2009).

68 Reading Anna Freud

5 THE HAMPSTEAD WAR
NURSERIES

KEY WRITINGS

1942 Young Children in War-Time: A Year’s Work in a Residential War

Nurseryy (with Dorothy Burlingham)
1943 War and Children n (with Dorothy Burlingham)
1944 Infants without Families: The Case for and against Residential
Nurseriess (with Dorothy Burlingham)
1949 ‘Notes on Aggression’
1949 ‘Aggression in Relation to Emotional Development: Normal and
Pathological’
1951 ‘Observations on Child Development’
1955 ‘Special Experiences of Young Children, Particularly in Times of
Social Disturbance’
1958 ‘Discussion of John Bowlby’s Work on Separation, Grief and Mourning’
1973 Reports on the Hampstead Nurseries, 1939–1945 5 (with Dorothy
Burlingham)

Introduction

During the first part of her professional life, up until the point where she
was forced to escape from Vienna because of the rise of fascism, Anna
Freud was one of the leading figures in the new field of child analysis, and,
with her work on the ego and the mechanisms of defence, she made a major
contribution to psychoanalytic theory. Alongside these two major
contributions – and closely related to both – she also dedicated herself to
understanding more about the development of the young child and, in
particular, to finding ways of applying this to the upbringing and education
of young children.
Anna Freud’s work in this field reached its high point in the Vienna years
with the creation of the Jackson Nursery, which opened in 1937. The idea for
the nursery was something quite unheard of at the time, catering as it did for
children under the age of two years. Anna Freud herself described it as
‘something between a crèche and a nursery school’, open to ‘toddlers from
the poorest families in Vienna, their fathers being on the dole and begging in

The Hampstead War Nurseries 69

the streets, their mothers at best doing some work as charwomen’ (quoted by
Young-Bruehl, 1988/2008: 219). But the purpose of the Nursery was not
only philanthropic, but also scientific:

We know something about infants from developmental studies, from

adults’ retrospective reconstructions, and from child analysis with its
microscopic view of the infant’s inner life. What we need to see now are
the actual experiences of the first years of life, from the outside, as they
present themselves. Thorough knowledge of infancy is the goal.
(quoted by Young-Bruehl, 1988/2008: 218)

Although the Nursery ran for almost a year, with some considerable
success, the project was interrupted by the rise of Fascism in Europe. When
Nazi forces occupied Austria in June 1938, Sigmund Freud and his family
fled Vienna – with Anna Freud taking some of the equipment from the
Jackson Nursery, such as a set of specially designed Montessori toys, with her
in her luggage, as if in anticipation of the work that was to come. Soon Freud
and his family had based themselves in the house on Maresfield Gardens in
London, where Freud was to die not much more than a year after his arrival
in Britain.
With the death of her father and the outbreak of the Second World War in
1939, Anna Freud threw herself into work. Conscious of the suffering
experienced by children affected by the war, she and her companion, Dorothy
Burlingham, decided to set up an evacuation centre, the Children’s Rest
Centre, which would be able to care for a small number of children, most of
whom had lost their homes during the ‘London Blitz’, which destroyed large
parts of East London. As the scale of the difficulties facing children in the
cities became apparent, these plans soon began to grow. With financial backing
from the American Foster Parents’ Plan, Anna Freud and her colleagues set up
what came to be known as the Hampstead War Nurseries – a project that was
to transform the lives not only of those children who were cared for in it, but
also of many of those who worked there, including Anna Freud herself.
Among its many other consequences, her experience working with children
in the War Nurseries confirmed Anna Freud’s belief in the importance of the
child’s early attachment to its caregivers for later development and led her to
increasingly emphasise the important ways in which the child’s inner world
(instincts, drives or disposition) interacts with experience in ways that are
decisive for the development of the child’s personality.

The Hampstead War Nurseries and observational research

At the start of 1942, Dorothy Burlingham and Anna Freud began a relatively
modest project to create a Children’s Rest Centre for about 10–12 children

70 Reading Anna Freud

affected by the war. By the middle of 1942, as the project grew, the Hampstead
War Nurseries comprised three buildings – two in London and one in Essex,
just outside the city – caring for approximately 120 children, from small
babies through to latency-age children. Many of the nurses who came to
work there were themselves young refugees from Central Europe, and a
significant number of them went on to train as child analysts and make
significant contributions to child welfare in the post-war years.
Although responding primarily to an urgent need to offer help to young
children and their families who were victims of the London bombings, Anna
Freud was clear from the start that the war-situation – and the creation of a
nursery to care for children affected by that war – was a ‘natural experiment’
that should be made use of to learn more about the development of children
in the earliest years (Edgcumbe, 2000). In defi ning the aims of the War
Nurseries, Burlingham and Anna Freud put the repair of damage already
caused by the war and the prevention of further harm as the primary aims, but
they also named research and training as further aims.
Looking back on her experience in the Hampstead War Nurseries, Anna
Freud described the observational research that was undertaken (perhaps
somewhat over-modestly) as ‘no more than the by-product of intensive,
charitable war work’ (A. Freud, 1951[1950]: 145). Despite this, Anna Freud
recognised that the War Nurseries were ‘ideal for the purposes of observation’:

The variation in the case material made it possible to see children, almost
from birth, in contact with their mothers or deprived of mother care,
breast fed or bottle fed, in the throes of separation or reunited with their
lost objects, in contact with their mother substitutes and teachers, and
developing relations with their contemporaries. The stages of libidinal and
aggressive development, the process and the effects of weaning and toilet
training, the acquisition of speech and of the various ego functions could
be followed closely.
(p. 146)

Many years later, Ilse Hellman, one of the young assistants who worked in
the Nurseries, recalled more precisely the method by which observations
were made. She described how all the staff were encouraged to write down
on index cards observations they made during their daily contact with the
children. These observations were to be written in a strictly non-theoretical
language, detailing as closely as possible the behaviour of the child. Since
they were recorded on index cards, the method of pooling observations was
used, so that a mass of observational material on each child was gradually
built up, and these were used to help deepen the staff ’s understanding of a
particular child and his or her needs.
Every evening, staff would gather for a series of lectures and discussions.
These evening meetings were also used to try to classify and coordinate the

The Hampstead War Nurseries 71

observations made by the staff, and a system of cross-referencing allowed
cards to be brought together in relation to both a particular child and a
particular theme (e.g. separation from parents, or reaction to air raids).
Following a policy first established in the Jackson Nursery, developmental
charts were created for each child, including information about topics such as
weight, feeding and sleep patterns, sexual development, training for cleanliness,
defence mechanisms, the development of the sense of guilt and responsibility,
and object relations. This broad and systematic collection of psychoanalytically
informed data encouraged research on topics such as ‘reactions to the
disruption of family life’, ‘responses to substitute mothering’ and ‘the effects
of group living’, as well as the more detailed elaboration of psychoanalytic
concepts such as psycho-sexual development (Hellman, 1990: 23–24).
The observations collected by all members of staff were made use of
extensively in the ‘Monthly Reports’ on the War Nurseries, written from
February 1941 onwards. These provided a mass of observational details that,
in retrospect, can be seen to form the basis of many of Anna Freud’s theoretical
developments in the post-war period. They also formed the core data for
three publications specifically related to the War Nurseries – Young Children
in War-Time (Freud and Burlingham, 1942), War and Children (Freud and
Burlingham, 1943) and Infants without Families: The Case for and against
Residential Nurseries (Freud and Burlingham, 1944). It was only in 1973,
however, that the complete set of reports from the Nurseries was published,
as Volume 3 of the Writings of Anna Freud.

Reactions to destruction and violence

From the moment of the children’s arrival at the War Nurseries, the members
of staff were able to observe the impact of the war on young children. A
number of children who came to the Nurseries had lost one or both parents
(more often their father) as a result of the war, and those children who had
been alive at the time of the ‘London Blitz’ were familiar with air raids
and – in many cases – came from homes that had been damaged or destroyed
as a result of bombs. Yet, surprisingly, most of the children did not display the
kind of ‘traumatic shock’ that many had predicted, although there were
complex reactions to air raids, depending on the particular child’s own
experiences and his or her stage of development.
Based on observations made by the staff of the Nurseries, Anna Freud
distinguished between five types (or aspects) of air-raid anxiety, thereby
encouraging other observers to discriminate more carefully between anxiety
as a reaction to ‘real’ danger (which she believed could be fairly quickly
overcome) and anxiety that was determined more by the strength of the
child’s own instinctual impulses or stage of superego development. She also
recognised, through her observations, the degree to which a child’s response

72 Reading Anna Freud

to air raids was determined by the reaction of his or her parents – if parents
could provide an ‘auxiliary ego’ to their children, by demonstrating that the
anxieties of the situation could be managed, then children tended to do that
much better themselves (Freud and Burlingham, 1944: 163–172).
Anna Freud also saw the observations as an opportunity to understand more
about the ways in which children in the War Nurseries expressed their reactions
to the various upheavals, traumas and separations that they had experienced so
early in their lives. Whereas adults are more likely to use speech to help process
such complex experiences, Anna Freud describes how children’s modes of
communication are somewhat different. Few children, for example, spoke
about the bombings they had witnessed or the deaths they had experienced
until months, or in some cases years, after the actual events had happened.
War games, however, were ubiquitous, especially games involving air
raids. Such play could be a way of either mastering anxiety, through repetition,
or of denying reality. For example, Bertie, aged 4, who had lost his father in
an air raid, would play frequent games where he would build houses out of
paper and then drop small marbles on them like bombs. But the point of
Bertie’s play was that all the people were saved just in time, and all the houses
that were destroyed were soon rebuilt. Bertie appeared to be denying the
reality of what had happened – but, because this was never entirely successful,
the game was repeated almost obsessively, until a time came, some months
later, when he was finally able to speak about his father’s death (Freud and
Burlingham, 1944: 197).

A psychoanalytic view of aggression

The experience in the Hampstead War Nurseries led Anna Freud to revisit
her ideas about aggression and violence and its place in human nature. In her
‘Notes on Aggression’ (1949[1948]), written a few years after the end of the
war, Anna Freud noted that ‘aggression, destruction, their expressions and
their development have assumed central interest for workers in the field of
education, child psychology, and child therapy’ (p. 60). Describing the way
in which psychoanalysis had tried to make sense of such phenomena, she
reviewed the shift away from the early focus on sexuality to an increasing
appreciation of the importance of understanding aggression alongside it –
first, as one aspect of pre-genital sexuality itself (as in the concept of ‘anal
aggression’); later, as an ‘ego instinct’, in which aggression was used by the
ego as a form of self-preservation when facing threat, the so-called frustration
theory of aggression. It was only with Freud’s (1920a) introduction of the
concept of the life and death instincts, however, that aggression was recognised
as one aspect of a primary instinctual drive, alongside the sexual instincts.
In her 1949 paper, Anna Freud drew directly on her experience in the War
Nurseries, where she and her colleagues had been able to observe in great

The Hampstead War Nurseries 73

detail the aggressive manifestations of young children and the way these
interacted with the violence and destruction going on in the world around
them. In their reports, Anna Freud and Dorothy Burlingham reject the
sentimental view that children’s ‘innocence’ was being destroyed by
witnessing the atrocities of war. As she noted in the 1949 paper, the experience
of the war ‘taught us nothing about aggression which might not have been
learned before’, given the ample evidence of aggression in human relations
throughout human history and the ‘traits of violence, aggression and
destruction’ that have always been part of children’s behaviour (1949[1948]:
61–62). This was not to deny that children should be protected, as much as
possible, from witnessing the horrors of war; however, the reason for doing
so was ‘not because horrors and atrocities are so strange to them, but because
we want them at this decisive stage of their development to overcome and
estrange themselves from the primitive and atrocious wishes of their own
infantile nature’ (Freud and Burlingham, 1973: 163).
Anna Freud accepted the idea of an aggressive drive existing alongside the
sexual drives from the beginning of life, but she understood this somewhat
differently from Melanie Klein. Whereas Klein emphasised the fundamental
confl ict between these two impulses, Anna Freud believed that both impulses
contributed to healthy development, and it was only with development that
the impulses might be experienced as incompatible. For her, therefore, the
primary issue was about how successfully the child was able to achieve a
fusion of the libidinal and aggressive impulses in the course of development,
and for this the strength of early emotional ties was the crucial factor.
In a paper from the same period, Anna Freud describes, for example, those
children who ‘possess [an] uncontrollable, apparently senseless, destructive
attitude’, who ‘wreck their toys, their clothes, their furniture, are cruel to
small animals, hurtful to younger children’ (1949[1947]: 496). She notes that
such traits have been found most especially in those who have grown up in
orphanages or who come from broken homes, or who have had a series of
changing foster carers. In such cases, she argues, the pathological factor ‘is not
to be found in the aggressive tendencies themselves, but in a lack of fusion
between them and libidinal (erotic) urges’ (p. 496). To focus on the aggressive
behaviour, and to try to control it by means of coercion or force, would miss
the point: what these children lack is strong emotional (libidinal) ties to the
adult world. It is only through the development of such ties, she argues, that
the aggressive impulses will be ‘fused’ with the libidinal ones and so come
under some degree of control.

Attachment and separation

What was perhaps most striking to Anna Freud and her colleagues when
children first arrived at the War Nurseries was the reaction of these young

74 Reading Anna Freud

children to a sudden separation from their families. Anna Freud was later to
note that ‘observers seldom appreciate the depth and seriousness of this grief
of a small child’ (Freud and Burlingham, 1973: 183). For example, Carol,
aged 17 months, repeated the words ‘mum, mum, mum’ continually in a
deep voice for almost three days after being separated from her parents. At
first, she would only allow herself to be comforted by sitting on a nurse’s lap
with her head turned away from the unfamiliar adult. ‘Whenever she looked
at the face of the person who held her, she began to cry’ (p. 184).
Common among the children were various regressions to more infantile
modes of behaviour. Young children who had just begun to stay dry at night
before separating from their parents began to wet themselves again; those
who had learnt to curb their aggressive behaviour developed frequent temper
tantrums; and almost all children returned to sucking their thumb or other
‘autoerotic’ behaviour. ‘When the attachment to the parents is destroyed,’
wrote Anna Freud, ‘all these new achievements lose their value for the
child. . . . There is no sense any more in being good, clean, or unselfish’
(p. 201).
With a slightly older child, aged three or four, where ambivalent feelings
are a normal part of the parent–child relationship, separation often seemed an
intolerable confirmation of negative feelings. Billie, aged three-and-a-half,
responded to the separation from his parents by behaving unusually well,
carefully observing all the rules that he had so often broken when at home.
When he heard that his mother had gone into hospital with a bad leg, he
suddenly remembered a time that he had kicked her, and he now worried
whether it was his fault that she had become ill (p. 191). In his case, it was as
if the separation was a punishment for all his bad thoughts and behaviours,
and he now needed to try to compensate for what he had ‘made’ happen, by
overstressing his love. As Anna Freud put it, this ‘turns the natural pain of
separation into an intense longing which is hard to bear’ (p. 189).
Very soon after starting work in the War Nurseries, Anna Freud became
acutely aware – as others, such as Winnicott and Bowlby, were realising too
– that the policy of evacuation, while saving many children from one kind of
danger, was creating other consequences that might be equally harmful to
children: the consequences of broken attachments. With the policy of mass
evacuation of children from major suburban areas such as London, ‘billeted’
children were saved from physical harm, but not from the emotional
consequences of separation from home and family, which policymakers had
been slow to consider.

Anna Freud and John Bowlby on attachment and separation

The view of early development that Anna Freud and Dorothy Burlingham
put forward in their writings about the Hampstead War Nurseries bears some

The Hampstead War Nurseries 75

striking similarities to the work of John Bowlby, whose publications in the
post-war years formed the basis for what is now known as ‘attachment theory’
(Bowlby, 1960a, 1960b).
In his key papers on ‘Grief and Mourning in Infancy and Early Childhood’
(1960a) and ‘Separation Anxiety’ (1960b), Bowlby made frequent references
to the Hampstead War Nurseries, and he used the observations from there to
support his ideas concerning the ‘mourning process’ that young children,
when faced with separation from their primary caregivers, go through,
including the three phases of protest, despair and detachment. However, in
those papers he is critical of Anna Freud’s interpretations of this behaviour,
which led Anna Freud to request an opportunity to respond to his papers,
which she did in two lectures in 1958 and 1960.
In those lectures, Anna Freud (1958–1960) confi rmed that the three stages
of the young child’s reaction to separation that Bowlby identified matched
exactly the observations from the War Nurseries; however, she disputes
Bowlby’s view that she explained such observations by means of the theory
of drive-satisfaction rather than on the basis of the primary importance
of the attachment relationship to the mother. Anna Freud rejects such a
distinction, arguing that from the beginning of life the search for pleasure
(and the avoidance of displeasure) expresses itself via the relationship to
the primary caregiver. Primary narcissism – a term that Bowlby criticises for
implying a period of life during which the infant has no relation to an external
object – actually refers to a period during which the carer is not even
conceived of as a separate person, but is, rather, seen as part of the infant’s
‘internal narcissistic milieu’ (Hoffer, 1952), without her own needs and
desires.
Having addressed what she saw as Bowlby’s misunderstandings of her
theory, Anna Freud goes on to discuss specific features of the child’s reaction
to separation (such as the exact length of mourning a child may experience,
or what steps could best be taken to ameliorate the impact of an inevitable
separation from the mother), confirming Bowlby’s observations in places
and, in others, suggesting disagreements that she hoped further research
would clarify. Anna Freud’s response to Bowlby’s ideas, at a time when they
met with great hostility from many psychoanalysts, was unusually even-
handed. Her most fundamental criticism of his work was that he explained
attachment in purely biological and behavioural terms, rather than attending to
the psychological aspect, which would include the young child’s fantasies and
anxieties related to separation. ‘As analysts’, she said, ‘we deal not with
the happenings in the external world as such but with their repercussions in
the mind’ (1958–1960: 174).
Nevertheless, Anna Freud’s awareness of the likely negative effect of
broken attachments in the Hampstead War Nurseries led to the decision to
involve the absent parents as much as possible. Unlike the typical British
residential nurseries, mothers (and fathers) were given free access to their

76 Reading Anna Freud

children day and night. Mothers were encouraged to live in and work as
housekeepers so that they could nurse their babies; sibling groups were
accepted together; and the buildings were open to visitors at all hours. While
employing mothers in the kitchen and household areas of the nursery
alleviated some practical difficulties of finding staff, it more importantly
enabled some children to remain close to their mothers.
But despite the best attempts to maintain links with parents, the conditions
of war did not always make ongoing contact possible, and many of the now
familiar difficulties of traumatised and institutionalised children began to be
apparent. Despite the care provided, some children showed a delay in their
development in terms of wetting and soiling, aggressive behaviour and
tantrums, or emotional withdrawal and self-stimulation (e.g. headbanging
and masturbation). In particular, the attachment needs of the child – and the
subsequent developments that usually take place as a result of such an
attachment – appeared to be more or less unsatisfied within the residential
setting (Freud and Burlingham, 1944: 559).

The creation of ‘artificial families’

The first year of the Nurseries had illustrated how powerfully early separations
impacted on the development of the children living in residential care. As a
consequence, Anna Freud and Dorothy Burlingham made a decision to
reorganise the Nurseries into ‘artificial families’, with one nurse assigned to
the care of a group of four or five children. In her report soon after this
change was made, Anna Freud noted:

The result of this arrangement was astonishing in its force and immediacy.
The need for individual attachment . . . came out in a rush and in the
course of one week all six families were completely and firmly established.
(Freud and Burlingham, 1973: 220)

With the development of positive relationships to carers, children were

quickly able to overcome developmental delays (such as in relation to feeding
or sleeping) and developed an emotional ‘aliveness’ that is so often absent in
institutionalised children. But the consequences of this reorganisation were
not straightforwardly positive. While noting that the children showed more
animation and became more amenable to educational influence, the creation
of ‘artificial families’ also introduced ‘many disturbing and complicating
elements into nursery life’ (Freud and Burlingham, 1944: 590). ‘Jim’, for
example, would burst into tears every time his own nurse left the room. At
17 months he was clinging, possessive and unwilling to be left alone for a
minute by his nurse-mother, and in her absence he would frequently lie on
the floor sobbing in despair (p. 592).

The Hampstead War Nurseries 77

 Moreover, the introduction of such artificial families raised the possibility
of further separations and losses, as certain staff members left the Nurseries
due to unforeseen circumstances. ‘Reggie’, at two years and eight months,
became lost and desperate after the departure of the woman who had nursed
him since the age of five months, and he refused to look at her when she
came to visit two weeks later. That night, in bed, he sat up and said: ‘My very
own Mary-Ann! But I don’t like her’ (p. 596).
Despite these ‘disturbing and complicating elements’, Anna Freud and her
colleagues pressed on with the idea of caring for children in family-like
groups – doing their best to address such limitations wherever possible, but
appreciating that without such an approach the children’s emotional
development might be permanently damaged. Hannah Fischer, one of the
youngest nurses employed to work in the War Nurseries, remembered years
later how Anna Freud tried to help the members of staff to develop a kind of
‘pedagogic love’ for the children they were caring for, which would be
genuine and yet not in competition with the love of the parents. Fischer
explained:

She meant a particular form of love, which we as educators should be

ready to offer children; so that they feel accepted by, and safe with us; a
type of love, which does not demand love in return – as is natural for
parents – but which just belongs to children. . . . Unlike the love of parents
. . . pedagogic love of the entrusted child is inexhaustible, transferable
from one child to another, from one group to another.
(quoted by Ludwig-Körner, 2012: 19)

The role of the father

It was not simply in relation to mothers that Anna Freud became aware of the
impact of broken attachments. While recognising that the separation from
fathers did not have the same immediate impact on children, the absence of
father-figures in the residential nursery setting was even more absolute than the
absence of mother-figures, and observations made at the time traced the impact
of this absence on the development of identifications, superego development
and object relations among the children in her care (Hellman, 1990: 27). These
observations made it clear that young children often maintained powerful
representations of their fathers, often based on the most fleeting of contacts.
Tony, for example, who came to live at the Nurseries at the age of
18 months, only saw his father two or three times a year, since he was in the
army and mostly fighting overseas. Though he was affectionate during his
visits, he did little to maintain contact between his periods of leave, even
after Tony’s mother died of tuberculosis when Tony was three-and-a-half
years old. Tony had reacted to this news, which his father brought, with a

78 Reading Anna Freud

period of anger and resentment towards his father, although he always ended
the day by asking for a bedtime story about his father, which he would listen
to with great delight, before adding: ‘I do not like my daddy any more.’ By
aged four, this overt hostility had disappeared, and Tony would mention his
absent father’s name continuously in every conversation:

When he picked blackberries, flowers, leaves, he wanted to keep them all

safe for his father. When a child fell down and cried, he would say (referring
to an accident of his father’s): ‘My daddy did not cry when he fell out of the
army lorry, did he?’ When he saw a child run, he would automatically say:
‘My daddy can run much faster.’ . . . He would eat greens though he disliked
them, so as to ‘get strong like my daddy’. . . . Whatever deed of omnipotence
the other children ascribed to God, Tony ascribed to his father.
(Freud and Burlingham, 1944: 644)

Anna Freud did everything she could to encourage fathers to maintain

contact with their children in the Nurseries and visit whenever it was possible,
but she also decided that male figures were vitally important in the children’s
lives, so she invited six young men – all conscientious objectors who had
refused to fight in the war – to come and work in the Nurseries, undertaking
maintenance and gardening while also playing a role in the children’s lives.
One of these young men, James Robertson, who acted as the Chief Social
Worker to the Nurseries, went on to work with John Bowlby in the post-war
years and to make a series of observational fi lms highlighting the impact of
separation on young children’s lives, including a well-known fi lm, A Two
Year Old Goes to Hospital. This documentary, charting the enormous impact
of a week-long separation from her mother when a little girl goes into hospital
for a minor operation, had a huge impact on public policy in the UK,
especially regarding the way hospitals and nurseries considered visiting rights
for parents of children in hospital or in care.

The impact of institutional care

In the second major publication to come out of the Hampstead War Nurseries
experience, Infants without Families: The Case for and against Residential Nurseries
(1944), Anna Freud and Dorothy Burlingham attempted to weigh up what
they had learnt from the War Nurseries experience regarding the issue of
residential and institutional care. This was an issue with important policy
implications, as governments and social care workers had to weigh up the
pros and cons of various alternative types of childcare. It was also an issue that
Anna Freud had been concerned about since her early collaborations with
Aichhorn and Bernfeld, who sought to find ways to care for children in
groups in ways that avoided them becoming ‘institutionalised’.

The Hampstead War Nurseries 79

 In typical fashion, Anna Freud weighed up the evidence carefully, arguing
that the relative pros and cons of residential care compared to family care
depended not only on what aspect of development one was considering, but
also on the particular developmental stage the child was at. So in the very fi rst
months of life, unless she was being breastfed, a baby might well demonstrate
better physical development in a well-run residential nursery than she would
in the average low-income household. So, too, a toddler’s physical development
might well benefit from the greater space and freedom to move about provided
by a residential nursery when compared to one brought up in a small,
one-bedroom flat. In terms of language development, however, or toilet
training, the same toddler would be likely to benefit more from having the
one-to-one attention of a caregiver, given that the child’s development in
such areas depends so greatly on the formation of emotional ties.
Indeed, it was in relation to the child’s emotional development, or those
aspects of development (such as the inhibition of aggression) that depend on
strong emotional ties, where Anna Freud concluded that residential care was
most lacking. Despite the good care provided in the Hampstead War Nurseries,
some children still showed delays in their development in terms of wetting
and soiling, aggressive behaviour and tantrums, or emotional withdrawal and
self-stimulation (e.g. headbanging and masturbation). Anna Freud concluded
that, while the physical and intellectual needs of the children were being met
– often in ways that were ‘superior’ to home life – it was the emotional needs
of the child that were most likely to suffer in a residential setting. In particular,
the attachment needs of the child – and the subsequent developments that
took place as a result of such an attachment – were more or less unsatisfied
within a residential setting (Freud and Burlingham, 1944: 560).
The creation of ‘artificial families’ had gone some way towards addressing
these needs, but it was Anna Freud’s belief that all such alternative forms of care
for young children would ultimately be judged on ‘whether we can succeed in
creating or in conserving for the children their proper emotional relationships
with the outside world’ (Freud and Burlingham, 1973: 131). As the workers in
the Hampstead War Nurseries had found out, working to maintain such
emotional relationships in many ways made the task of caring for these young
children more difficult, as for example when a nurse whom one of the children
had grown attached to had to leave her job, or even take time off. Such situations
might almost seem to be ‘re-traumatising’ for a child who had already suffered
previous separations or losses. Anna Freud recognised that such powerful
emotional reactions on the part of children to their attachment figures were
often used as an argument against family arrangements in the nursery or, indeed,
in other settings concerned with the well-being of young children. But she
argued powerfully for the benefits – indeed, the necessity – of such an arrangement:

When choosing between the two evils of broken and interrupted

attachments and an existence of emotional barrenness, the latter is the more

80 Reading Anna Freud

 harmful solution because . . . it offers less prospect for normal character
development. . . . In reality, it is not the absence of irrational emotional
attachments which helps a child to grow up normally, but the painful and
often disturbing process of learning how to deal with such emotions.
(Freud and Burlingham, 1944: 596, 594)

Conclusion

The Hampstead War Nurseries, first and foremost, had a profound impact on
the lives of the children who attended it between 1941 and 1945. Those who
had worked in the Nurseries were determined to make sure that the children
they had cared for were carefully reintegrated with their families once the
war ended, and Anna Freud was rightly proud of the fact that almost all
the children who had been in their care did manage to reintegrate with their
families successfully. In addition, the nurses who had cared for the children
during the war were encouraged by Anna Freud to maintain contact with
the children, whenever possible, and Anna Freud continued to send Christmas
cards and small presents to all the ex-Nurseries children for many years.
But the work in the Hampstead War Nurseries also had a profound legacy
for psychoanalysis itself. It was in response to the wish by many of the former
workers in the War Nurseries to continue their study of psychoanalysis that
Anna Freud decided to establish the clinical training at what became known
as the Hampstead Child Therapy Clinic (now the Anna Freud Centre), and
many of the nurses took this training and went on to work at the Clinic in
the post-war years (Pretorius, 2012).
In terms of Anna Freud’s own thinking, the experience of the War Nurseries
not only provided her with many ideas about the appropriate methodologies
for psychoanalytic research (see Chapter 6, this volume), but also provided her
with a set of data that convinced her of the need to take a developmental
approach to childhood psychopathology, based on a perspective that took into
account the whole range of children’s needs – from physical care, to basic
health, intellectual stimulation and emotional attachments. The experience in
the War Nurseries also convinced Anna Freud – if she had not known it
before – of the central importance of the early relationship to the mother and
the profound impact of disturbances to this relationship, especially through
experiences of separation and traumatic loss. As she recalled many years later:

We had experience with young children, of course – but we’d never worked
with them in the midst of a war that had come right to them: bombs
dropping, parents hurt or killed, danger everywhere. We didn’t know what
might be in store for us. We fell back on ourselves – that’s what happened.
We asked ourselves what we knew about children, ‘the bottom line’, and we
came up with the important needs that children everywhere have: attachment

The Hampstead War Nurseries 81

 to a person, a parent; a climate of emotional stability around them – people
who are solid and sensible; and an educational influence that is also solid,
and is aimed at helping the child grow both intellectually and emotionally.
Now all that sounds controversial . . . [but] remember, fifty years ago what
we said wasn’t so much common knowledge or ‘common sense’ as it is
today. When I hear someone say, ‘Oh, yes, naturally,’ to something we say
at Hampstead, I smile to myself: I’m glad, and I also feel a little pride – we’ve
managed to expand the critical mass of ‘common sense’.
(quoted by Coles, 1992: 160)

FURTHER READING

A number of staff who worked at the Hampstead War Nurseries have recorded
their memories of the experience, including Sophie Dann (1995) and Hansi
Kennedy (1995; see also Miller and Neely, 2008). Ilse Hellman, one of the
workers in the Hampstead War Nurseries, described her experiences of
working in the Nurseries in her book, From War Babies to Grandmothers
(1990). In some cases, where later disturbances emerged among the children
who had attended the Hampstead War Nurseries, analytic treatment was
offered at the Centre for both therapeutic and research purposes. Hellman’s
book is a fascinating record of this follow-up work.
Anna Freud drew on the data from the War Nurseries for many of her post-
war publications, among them works on the establishment of feeding habits
(1947) and infantile feeding disturbances (1946a); two papers on aggression
(1949[1947] and 1949[1948]); one on the effects of war on children’s
development (1955); and a paper on instinctual drives and their bearing on
human behaviour (1953[1948]). More broadly, the influence of the work in the
War Nurseries can be seen in almost all of Anna Freud’s writings in the post-
war years, especially in her focus on the role of early attachments. Although
the theoretical differences with Bowlby meant that this work was developed
alongside (rather than in relation to) attachment theory, Anna Freud’s criticism
that Bowlby neglected the internal-world aspect of attachment has largely
been addressed by the second generation of attachment theorists, especially
through the work of Mary Main and her focus on ‘internal working models’ and
the shift to the level of representation (Main, Kaplan and Cassidy, 1985). This
paved the way for the exciting integration between attachment theorists and
psychoanalysts working in the Anna Freudian tradition, as illustrated by
Fonagy (2001) and Green (2003), among others.
The secondary literature on the Hampstead War Nurseries is extensive.
Among the many papers that discuss this important part of Anna Freud’s work,
detailed accounts can be found by Cohler and Zimmerman (1997), Midgley
(2007), Young-Bruehl (1988/2008) and Ludwig-Körner (2012).

82 Reading Anna Freud

6 PSYCHOANALYTIC RESEARCH
AND THE OBSERVATION OF
CHILDREN

KEY WRITINGS

1950 ‘The Significance of the Evolution of Psychoanalytic Child Psychology’

1951 ‘The Contribution of Psychoanalysis to Genetic Psychology’
1951 ‘Observations on Child Development’
1951 ‘An Experiment in Group Upbringing’ (with Sophie Dann)
1957 ‘The Contribution of Direct Child Observation to Psychoanalysis’
1958 ‘Child Observation and Prediction of Development: A Memorial
Lecture in Honour of Ernst Kris’
1957–
7 ‘Research Projects of the Hampstead Child-Therapy Clinic (1957–
1960 1960)’

Introduction

Many critics have commented on the rather uneasy relationship between

psychoanalysis and science – or between psychoanalysis and research more
generally. Anna Freud herself had no academic training, and never considered
herself to be a researcher in any formal sense of the word, but she did believe
that psychoanalysis had a considerable contribution to make to the
understanding of the mind and human behaviour; in her professional life she
was, as Anne-Marie Sandler has put it, a ‘promoter and facilitator of
psychoanalytic clinical and conceptual research’ (A.-M. Sandler, 1996: 282).
Some have gone further, indeed, to suggest that she was a ‘pioneer in the
development and use of additional research techniques to augment and
complement the psychoanalytic method’, and that her contribution in this
respect is the ‘least attended to and most insufficiently appreciated’ aspect of
her legacy (Lustman, 1967: 810–811).
If her approach to psychoanalytic research was innovative, Anna Freud’s
aims as a psychoanalytic researcher were very much in line with the work of
her father: not so much to try to assess the effectiveness of psychoanalytic
therapy, but, rather, to develop a deeper understanding of the workings of the
mind and of human behaviour. Such an aim is shared by many non-analytic
philosophers and psychologists, but Anna Freud was clear about what she
believed the particular contribution of a dynamic psychology could be.

Psychoanalytic research and the observation of children 83

Following Hartmann and Kris, she suggested that a complete psychoanalytic
investigation of behaviour should comprise three aspects or perspectives: ‘the
description of a specific reaction as the outcome of an interplay of forces
(dynamic); the tracing back of its occurrence to earlier situations (historical);
and the exploration of the questions when, why, and how this particular form
of behaviour was first established (genetic)’ (A. Freud, 1951a: 126).
Psychoanalysis is not the only discipline that addresses these questions, but its
unique blend of practice and metapsychological thinking means that it has a
particular contribution to make, and in the post-war years Anna Freud was
especially concerned with trying to articulate an appropriate methodology
for psychoanalytic research, which went beyond the traditional use of the
clinical case report.
In her commitment to systematic research, which was a defining feature of
her work as a psychoanalyst, Anna Freud therefore put herself at odds with
the majority of psychoanalysts in her day, for whom any attempt to introduce
methods not belonging to the analytic encounter itself was treated with
suspicion. But this is not to say that she was simply advocating that
psychoanalysis should adopt the model of research promoted by mainstream
psychology and psychiatry at the time. Anna Freud did not accept the
parameters of mainstream academic research, in which measurement,
experimental control and statistical analysis were dominant, and Popper’s
ideas about the role of ‘falsification’ (Popper, 1959) as central to the scientific
method were highly influential.
Instead, Anna Freud argued for a research methodology that was appropriate
to the psychoanalytic method itself. In a series of lectures during the 1950s and
1960s, she tried to establish her own definition of ‘psychoanalytic research’ – a
model that was both developed and tested in the work she did at the newly
established Hampstead Clinic. To understand this approach, however, it is first
worth examining the context in which Anna Freud was working and, in
particular, the debates around the ‘scientific’ status of psychoanalysis and the
degree to which it could make any significant contribution to the wider field
of developmental psychology.

Psychoanalysis and academic psychology

In a wide-ranging lecture delivered at Clark University in 1950 (where she

received an honorary doctorate, as her father had done before her in 1909),
Anna Freud reviewed the place of psychoanalysis within the wider scientific
field. She began by looking back to the time when her father had been invited
by Stanley Hall to give a series of lectures at Clark University – the first time
that Freud’s work had been honoured and acknowledged by an academic
institution in this way. She recalled how, at that time, psychoanalytic ideas
were ‘criticized as unscientific, fantastic, and unworthy of the interest of

84 Reading Anna Freud

serious academic workers’ (1951a: 110), but she also recognised that this
disregard at least allowed the new field of psychoanalysis to develop
undisturbed, free to develop its techniques and its scientific language without
reference to more academic forms of knowledge.
With the growing interest in psychoanalysis, however, and the corresponding
engagement of analytic workers with fields more traditionally associated with
psychiatry (such as the treatment of psychotic patients), relations between
psychoanalysis and academic psychology began to develop – especially in
relation to the study of early development. In Vienna, for example, important
developments were taking place in the 1920s in terms of the systematic
observation of infants and young children. Charlotte Bühler, the fi rst
professor to set up a Department of Child Development in Europe, organised
a year-long research study based on the 24-hour-a-day observation of 69
infants brought up in an institutional setting. Among her research students
was Ilse Hellman, later to work with Anna Freud in the Hampstead
War Nurseries, as well as others who went on to have distinguished
psychoanalytic careers, including René Spitz and Esther Bick, who played
such a crucial role in introducing infant observation to the Tavistock
Clinic in London.
The development of observational studies of infants and young children
was to have an impact on psychoanalysis from the start, despite the fact that
many early psychoanalysts were openly disparaging about the work of the
‘baby watchers’. As early as 1905, in meetings of the Vienna Psychoanalytic
Society, Sigmund Freud had been calling for the use of direct observation of
children to complement psychoanalytic investigations of early childhood
sexuality, and the first significant results of this complementary approach
were seen with the publication of the case study of Little Hans (1909). The
first psychoanalytically informed, observational study of early child
development was published a few years later (Hug-Hellmuth, 1913), bringing
together Freud’s ideas with contemporary non-analytic data about early
childhood in a form that was to greatly influence Anna Freud and her
colleagues working in Vienna at the time (Steiner, 2000).
But it was not until the 1920s, the very point at which Anna Freud began
her professional career, that the direct observation of infants and young
children and the emerging findings of psychoanalysis began to be more fully
integrated. Bernfeld’s Psychology of the Infant (1925a) was described by Susan
Isaacs, at the time of its translation in 1929, as ‘one of the most important
books on child psychology published in the English language’, because of its
attempt to gather together the descriptive data of infant behaviour recorded
by the late-nineteenth-century ‘baby watchers’ to create a ‘coherent whole’
on the basis of psychoanalytic theory (Isaacs, 1930). In 1933 de Saussure
made a comparative study of the theories of Piaget and Freud, while the
pioneers of personality studies were influenced by psychoanalysis in the
development of projective tests, such as the Rorschach Test (Exner, 2002) or

Psychoanalytic research and the observation of children 85

the Thematic Apperception Test (Murray, 1938). Certain academic
psychologists, such as Robert Sears (1943), also began to design experimental
tests of key psychoanalytic concepts, in order to try to establish ‘scientific’
evidence for concepts such as the Oedipus complex or the mechanisms of
defence, while psychoanalysts such as Hartmann, Kris and Loewenstein
(1946, 1949) tried to reformulate psychoanalytic theory in the context of
mainstream academic psychology.
Anna Freud herself made it clear in her lecture that she did not have any
academic training and was in no way an academic psychologist, but she did
recognise that the two fields share a certain key concern: ‘to see the present in
terms of the past, to explain present-day behaviour and present-day experience
as an evolution of possibilities given at some past date’ (1951a: 118). But while
this core concern was the same, the procedure by which the two try to
investigate this phenomenon is fundamentally different. For academic
psychologists, Anna Freud suggested, the primary means of investigation is
the ‘artificial laboratory situation’, where the focus has primarily been on
normal development and the observation of overt behaviour. In this setting,
the worker is likely to make use of some kind of apparatus for measuring and
recording reactions, excluding his own personality as much as possible by
means of the isolation of key variables, which will be measured and then
quantified. The analyst, on the other hand, tries to identify the unconscious
background to the conscious phenomena in the context of the analytic session;
his focus is often on pathological behaviour; his instrument is the impressions
formed in his own mind and his subjectivity, and he ‘evaluates his findings
qualitatively according to his personal judgment’ (p. 121).
Anna Freud gives the example of frustration in childhood and the way in
which the two disciplines might investigate this behaviour. The academic
psychologist, she suggests, would be most likely to create a laboratory
situation in which he would measure a child’s reaction when a desired toy is
shown to him or her but then withheld. Such an experiment would be
easily replicable, and allow comparison between different variables (e.g. the
child’s age and his or her capacity for frustration-tolerance), but it may not
tell us a great deal about how this frustration-tolerance would translate
into everyday life. The psychoanalyst, however, might proceed by means of
the analytic treatment of a child who had experienced the early loss of his
mother. Such a setting is far less ‘controlled’, making it harder to isolate
specific variables and establish correlations between them, but it might
provide deeper insight into how children deal with frustration in real-world
settings. As she explains:

The disappointment, anger, fury, despair or indifference which a child

may show in face of the withdrawn toy do not really permit us to predict
how the same child will react when faced with the loss of an important
love object. Since major life situations cannot be set up in the laboratory,

86 Reading Anna Freud

 there seems, so far, no way for the academic worker to approach their
measurement.
(1951a: 120)

Given these fundamental differences in approach, Anna Freud suggests, it is

not surprising that there was considerable distrust of psychoanalysis among
academic psychologists, or that ‘representatives of the two fields often fail to
understand each other’s meaning’ (p. 122), especially as relatively few analysts
had (or still have) academic research training. Nor was it easy, as Anna Freud
put it in another paper, for analysts ‘to keep the right balance between an
over strict isolationism, which leaves psychoanalysis stranded, and an
overeager collaboration, which threatens the analyst’s own professional and
scientific image and ideals’ (1969b: 133). Under such circumstances, how can
the analytic researcher steer a steady path between the Scylla of scientific
reductionism and the Charybdis of analytic isolation (Midgley 2004)?

The role of observation

Anna Freud’s solution to the dilemma set out above was to propose a different
approach to psychoanalytic research. Her experience, first with the Jackson
Nursery in Vienna and then with the Hampstead War Nurseries in London,
convinced her of the value of observation as a form of psychoanalytic inquiry
into child development. She believed that such work, when organised
systematically, had the potential to make a significant contribution to a
‘genetic psychology’ (i.e. a psychology that provides a model of the genesis –
or origins – of psychological functioning), a field that she considered to be on
the ‘borderland between psychoanalysis and developmental psychology’
(1951a: 138).
In the words of Mayes and Cohen (1996), Anna Freud was ‘at her natural
bent an observer of children, and her observational skills, colored by a
psychoanalytic environment, were honed pragmatically . . . on the one hand,
she argued for meticulous, carefully recorded observations of children’s
moment-to-moment activities and behaviors; on the other, she felt that one
of the dangers of academic psychology was the risk of deriving meaning
solely from conscious behaviours with little to no understanding that one
behaviour might have multiple unconscious determinants’ (pp. 119–120).
Defence mechanisms were a good example of the kind of phenomenon that
could easily be identified through the observation of children’s behaviour, as
when a young boy, struggling with sibling rivalry after the birth of a baby
brother, insisted on staying up late at night listening to his baby sibling’s
breathing, ‘lest he might die in his sleep’ (A. Freud, 1936: 16). Yet to see this
as an example of ‘reaction formation’ already implies that the observation is
informed by certain theoretical ideas. As Anna Freud herself noted, many of

Psychoanalytic research and the observation of children 87

those things ‘discovered’ by direct observation were only seen once the
observers themselves had been analytically trained; indeed, the most vital
facts of early childhood had remained unnoticed by observers until they had
been reconstructed from analytic work (1951[1950]: 148).
For this reason Anna Freud considered the type of observation undertaken
by analytically informed observers to be somewhat different from the standard
empirical approach used in developmental psychology research, in which ‘the
quantitative (e.g. frequency or duration) and qualitative (e.g. intensity) aspects
of specific behaviours (e.g. crying and fussing) [are recorded using a
prearranged schema] at every instance of a specific situation (e.g. separation)’
(Mayes and Cohen, 1996: 121). In presenting the rather different approach
taken towards research in the War Nurseries, which she described in strikingly
modern terms as a type of ‘action research’, Anna Freud explained:

The observational work itself was not governed by a pre-arranged plan. In

emulation of the analyst’s attitude when observing his patient during the
analytic hour, attention was kept free-floating, and the material was
followed up wherever it led. . . . Observations such as those described here
are not ‘objective’ in the true sense of the word, in any case. The material
which presents itself is seen and assessed neither by an instrument, nor by
a blank and therefore unprejudiced mind, but on the basis of pre-existent
knowledge, preformed ideas and personal attitudes (although these should
be conscious in the case of the analyzed observer).
(1951[1950]: 147–148)

Anna Freud saw the advantage of the analytically informed observer

making use of what she called ‘involuntary and accidental experiments’
(1950: 623) – in other words, situations that fate has thrown up, which
provide opportunities to understand a phenomenon that is outside normal
experience. The ‘natural experiment’ created by the mass evacuation of
children at the start of the Second World War led to the work of the War
Nurseries, which allowed Anna Freud and her colleagues to study the impact
of being raised in a group setting, as well as the impact of early separation –
much as Michael Rutter and his colleagues 40 years later were to use the
terrible situation of the infants raised in orphanages in Romania, who had
received almost no stimulation during their earliest years, to study their
ongoing development as a way of investigating the long-term impact of
profound neglect in the early years (Rutter and the ERA Study Team, 1998).
As such, Anna Freud believed that the relevance of the War Nurseries research
went far beyond its immediate time and setting, as she made clear in her
introduction to the 1973 publication of the reports on the War Nurseries. ‘It
is true,’ she wrote, ‘that the opportunity to carry out the study was afforded
us by a war charity . . . and that the observed conditions were accompaniments
of the war of 1939–1945.’ She added:

88 Reading Anna Freud

 But the part played in them by the war itself was no more than that of a
precipitating and aggravating agent. Infants are orphaned or torn away
from their families for a variety of reasons such as death, illness, accident,
divorce, financial disaster, i.e. through circumstances which occur at all
times and in all strata of society. Wars merely favour and multiply the
dissolution of family units and thereby bring into greater prominence the
harmful effect of such breakdowns on the individual child.
(A. Freud, 1973: xvii–xviii)

What Anna Freud was offering, then, was a study not simply of the impact
of war on children but, more broadly, of the ways in which loss, separation
and the breakdown of families impact on the emotional and psychological
development of young children.

An experiment in group upbringing: Child survivors of the

concentration camps

A further opportunity for Anna Freud to study the impact of war on children
arose immediately after the war ended. In the spring of 1945, six German-
Jewish children who had been raised in the Ward for Motherless Children at
the Tereszin (Theresienstadt) Concentration Camp were flown to England and
accommodated at a specially designed reception camp in Windermere. The
workers in the camp quickly realised that the six children, all aged between
three and four years, would not tolerate being separated, and ideally they
needed some sort of peaceful community where for a period of time they could
adapt to their new lives in England, before any placements were considered.
With financial backing from the Foster Parents’ Plan for War Children,
which had supported the Hampstead War Nurseries, Anna Freud and her
colleagues set up a country house in Sussex, ‘Bulldogs Bank’, to care for these
six children. The home was staffed by Sophie and Gertrud Dann, sisters who
had both worked in the War Nurseries, with support from one relief worker
and supervision from Anna Freud and Dorothy Burlingham. The extraordinary
account of these six children is told in a paper by Anna Freud and Sophie
Dann, first published in 1951, ‘An Experiment in Group Upbringing’.
On their arrival at Bulldogs Bank, the children’s development was seen to
be disturbed in a whole range of ways. Their speech was delayed, they were
extremely aggressive, had difficulties eating anything but starchy foods and
sweets, were barely able to play, and displayed very limited knowledge of the
world. They showed almost no interest in adults beyond their role as
need-providers, but they had very powerful bonds as a group – demanding
equal treatment, passing on food and displaying a marked absence of the
rivalry and jealousy that one would expect to see among a group of children
of this age.

Psychoanalytic research and the observation of children 89

 In this ‘experiment staged by fate’ (A. Freud and Dann, 1951: 225), Anna
Freud and her colleagues made systematic observations of all aspects of the
children’s behaviour, in order to try to understand how this extreme of
deprivation in the early years of life impacted on the children’s development.
Given the impossibility of separating out the impact of one aspect of their
early experience from any other, Freud and Dann believed that such a study
‘has little or nothing to offer the experimental psychologist’; what it does
help, however, is ‘to create impressions which either confirm or refute the
analyst’s assumptions concerning infantile development – impressions which
can be tested and in their turn confi rmed or rejected in detailed analytic
work with single individuals’ (p. 225).
To take one example, the initial indifference that the children showed to
the world of adults gradually shifted, but their first positive attitudes to their
caregivers was not the usual demanding, possessive behaviour that children
of this age would usually show to their carers (p. 187). Instead, Sophie and
Gertrud began to be treated with the same concern as the other ‘siblings’, as
if they were members of the group. When visiting a sweet shop, for example,
all the children demanded that Sophie be given a sweet (as they had been),
and, when it fell from her mouth on the walk home, they were ‘as upset as if
they had lost one of their own sweets’ and insisted on giving her a replacement
one when they reached home an hour later (p. 188). The adults, in other
words, were included in the group as equal members, and it was only later
that individual personal attachments to adults appeared – demonstrated by
possessiveness, clinginess, distress about separation – although even then
‘they lacked the intensity and inexorability which are among the main
characteristics of the emotional life at this age’ (p. 191).
The observation of the ‘high degree of identification with each other’s
needs’, alongside the way in which the children ‘were able to attach their
libido to their companions and the group as such’ (p. 227), allowed Anna
Freud to draw some conclusions about the impact of the lack of care-giving
in the first years of life. As Freud and Dann note, these children were
‘hypersensitive, restless, aggressive, difficult to handle . . . but they were
neither deficient, delinquent, nor psychotic’ (p. 229). As such, they appear to
have found a way of expressing their libidinal and attachment needs in such
a way that they were able to stay in touch with reality and retain a capacity
for development. Whether such development could be sustained – or in what
way the children’s early experience would influence later stages of their
development – was a question that Freud and Dann suggested needed to be
the basis for further research.
For reasons of both personal care and professional interest, Anna Freud was
very committed to maintaining contact with children who had been in her
care, in order to understand more about the long-term consequences of early
experience. The children who were cared for in Bulldogs Bank were all adopted
– except for one child, Paul, who was taken into residential care by Anna

90 Reading Anna Freud

Freud’s colleague, Alice Goldberger – and Anna Freud maintained contact
with some of them for many years, if the adoptive parents would allow it.
In a very moving book, Love Despite Hate, Moskovitz (1983) interviewed
all of the children who had attended Bulldogs Bank (as well as a number of
other children who had been rescued from the concentration camps and
brought to Britain) when they were adults in their early forties. Based on
these interviews, certain common characteristics emerged. One was the great
‘burden of loss’ concerning parents whom these children hadn’t known and
didn’t remember, a ‘hunger for some link’ that made several of them seek out
their histories later in life. Another was a ‘haunting anxiety about belonging’.
Many of them struggled to feel part of their adoptive families, had a sense of
themselves as outsiders, and described themselves as being difficult as
teenagers. As adults, religion had become important as a way of feeling that
they belonged – in most cases through connections to Judaism and Israel, but
in one girl’s case through being born again as a Christian. Despite many
challenges, all six of the former Bulldogs Bank children displayed an
‘affirmation of life’ and a ‘stubborn durability’ in their interviews as adults,
which appears to contradict some of the more fatalistic views about the
impact of early deprivation on later development. As Anna Freud put it in a
different context: one may not be able to make up for deficiencies that
occurred in the earliest years of life, but, through a good foster- or adoption-
placement, it appears that one can support a child to build up new
ego-structures that may help her to better manage the ‘gaps’ that she may
always carry with her.
Alongside these ‘natural experiments’, Anna Freud also supported the
development of more systematic observational and longitudinal research,
such as the work of Rene Spitz (1945) on hospitalism, or Margaret Ribble’s
(1943) study of the early psychological needs of infants. Some time later,
Anna Freud gave encouragement to her former colleague from Vienna,
Margaret Mahler, in her studies of the ‘separation–individuation stage’ in
toddlers (1975). Most of all, she admired the project undertaken by Ernst
Kris at the newly formed Yale Child Study Center, whose longitudinal study
of early child development was probably the inspiration for the general
orientation of the Hampstead Clinic towards the longitudinal study of
development (Young-Bruehl, 1988/2008: 338). This resulted in projects
such as a study led by Dorothy Burlingham (1972), investigating the
development of blind children, that tried to systematically observe the impact
of visual impairment on the child’s earliest stages of emotional and social
development.
It was on the basis of these examples of research that Anna Freud came to
the conclusion, by the early 1950s, that ‘the eventual meeting of academic
and psychoanalytic research interest will take place, at some future date, not
in the realm of psychoanalytic work itself, but in this auxiliary, secondary
field of analytically directed observational child study’ (1951a: 142). This

Psychoanalytic research and the observation of children 91

remark proved to be well-founded, as the period from the 1970s onwards saw
a gradual increase of sophistication in observational research in the field of
developmental psychology, which led to an integration of psychoanalytic and
developmental research and thinking in the work of developmental
psychologists such as Stern (1985) and Brazelton and Tronick (1980), among
many others.

A return to clinical case study research

Having made such a powerful case in her work up until the early 1950s for
the value of the direct observation of children, Anna Freud turned back once
more to the method that had always been seen as the core of psychoanalytic
research: the clinical case study (see Midgley, 2007). Speaking at the IPA
Congress in 1957, Anna Freud looked back at her attitude to observational
research expressed in the immediate post-war years, and explained:

When I took part in the Stockbridge Symposium [in 1950], I came fresh
from several years of work in a children’s institution which offered
opportunities for long-term observations of children on an almost twenty-
four hour basis [i.e. the War Nurseries]. Naturally, I was impressed by the
additions to our insight, especially with regard to the processes of
maturation, which such an opportunity provides. . . . To the present
discussion, on the other hand, I come from several years’ work in a
children’s clinic which gives me the possibility to follow the analytic
treatment of large numbers of children’s cases of all ages and descriptions.
I am, therefore, under the fresh impression of the overwhelming advantage
of the analytic method itself over all other methods of observation and, as
analysts tend to be, inclined to look down on all other ways and means of
gaining access to the child’s mind.
(1957b: 96–97)

Anna Freud gives the example of childhood trauma to show how

psychoanalytic research could benefit by an integration of both analytic and
observational data. In a 1958 lecture she argued that analytic treatment of
those who had been victims of early childhood trauma revealed that there
was no such thing as a traumatic ‘event’; rather, experiences in later life (by
the process that Freud had described as deferred action) seemed to determine
which experiences were to retrospectively gain significance as ‘traumatic’
(1958[1957]: 131). Yet she also showed how actual observations of early
history could lead to a different understanding of trauma memories in adult
analytic treatments. She noted that infants may often repeat an action
hundreds of times that in later life may be represented as one traumatic event.
She observed that, although ‘as analysts we realize that past experience is

92 Reading Anna Freud

telescoped in this manner, we are in danger of underestimating the extent of
the phenomenon, when not reminded of it by the result of direct observation’
(1951[1950]: 157).
Despite her ongoing commitment to observational research, from the
mid-1950s onwards Anna Freud repeatedly acknowledged the immense
advantages of the analytic encounter as a setting for furthering our
understanding of the mind – a setting in which the processes of transference
and interpretation lead to increasingly deeper levels of material being brought
to the surface in a way that direct observation rarely has access to (1953: 287).
Moreover, in the years after the war, analyses of children such as ‘Martin’
(Hellman, 1990: 31–54), who had been infants in the War Nurseries, led
Anna Freud to appreciate how many aspects of early infantile experience
could not have been appreciated by direct observations, even of the most
careful and psychoanalytic type.

The case of ‘Martin’ and the role of the absent father

‘Martin’ joined the Hampstead War Nurseries at 16 months of age, having

been separated from his mother at the age of four months and placed in a very
unsatisfactory foster home (Hellman, 1990: 32). He was illegitimate and had
never known his natural father, but as Martin reached his fourth birthday
he became very fond of one of the male workers in the Nurseries, whom he
would often imitate. Martin would walk around wearing a cap or a helmet,
speak in a deep voice and refer to himself as ‘Big Bill’. This young boy
appeared to be using this man as a figure of identification to help consolidate
his own masculine identity. However, it was noted that – unlike other
fatherless children in the Nurseries – Martin never made any reference to his
real father, or asked questions about him.
Based on the observations in the War Nurseries, Anna Freud and her
co-workers noted that, where children were growing up without a father, they
often created fantasy fathers who in their imagination were both fantastically
good or terribly evil and violent. But in Martin’s case, the elaboration of such
fantasies only became apparent when, after the war had ended, he was referred,
aged nine, for psychoanalytic treatment at the Hampstead Clinic because of an
eating disturbance, antisocial behaviour and an inhibition in his learning
which meant that he had hardly learned to read or write (p. 50).
Martin soon let his analyst know that he found it difficult to concentrate
in school because he was so preoccupied with his daydreams – ‘there are so
many, it will take a whole year,’ he told her. The profusion of fantasy material
that Martin went on to elaborate, much of it related to his absent father, was
in striking contrast to the lack of verbalised fantasy observed in his earlier
childhood, which could only now be understood as a reaction against the
intensity and terrifying nature of these thoughts.

Psychoanalytic research and the observation of children 93

 In a series of fantasies elaborated in his analytic treatment, about dead men,
ghosts and corpses, Martin expressed his feelings about his unknown father, as
well as very primitive anxieties about parental sexuality. His analysis, alongside
the concurrent parent work with his mother, gradually led to a freeing up of his
learning inhibitions and an overall resumption of development. But what
seemed clear to Anna Freud was that, while there were obvious continuities
between the observational data from the Nurseries and certain aspects of the
analytic material that emerged in treatment, the nature of Martin’s defences as a
child – as well as the inherent limitations of a purely observational approach –
had ‘blurred the picture of his fantasies and his fundamental depression’ (p. 54).
Without the opportunity to investigate Martin’s fantasy world by means of
analytic treatment, much of what came to be understood about his complex
relationship to his absent father would never have been understood – no matter
how carefully his development had been observed.

Observation and reconstruction: The ‘double approach’

In appreciating the way in which analytic reconstruction could enrich direct

infant observation, as well as the way in which observation could enrich
analytic understanding, Anna Freud ultimately called for a ‘double approach’
(1958[1957]), in which the integration of the two kinds of data – direct and
reconstructed – was to the ultimate benefit of psychoanalysis. She argued that
the incorporation of observational data was essential if psychoanalysis was to
develop a fully integrated ‘psychoanalytic child psychology’, and that this
approach would lead to a better understanding of the typical sequences of
child development, especially in regard to the earliest, pre-verbal stages of
development.
In order to illustrate her point, Anna Freud gives the example of the infant’s
reaction to the depression and emotional withdrawal of the mother early in life,
making reference to the observational work of Ribble (1943), Fries (1946) and
Spitz (1945). Although arguing that the impact of early experiences of separation
and neglect was first discovered through analytic reconstruction, Anna Freud
suggests that the ‘addition of the observational to the reconstructive method
has raised this discovery, in the course of less than twenty years, from the status
of a hypothesis to that of a near-certainty’ (1958[1957]: 121). Combining these
two approaches not only increases our knowledge; it also lends added credibility
to our findings, because the two methods can ‘check up on each other’.
The impact of this double approach can be seen clearly in Anna Freud’s
own work, both in the creation of the Provisional Diagnostic Profi le and,
more especially, the concept of developmental lines (A. Freud, 1965a). It was
here that Anna Freud created her most complete synthesis of observational
data with the findings of analytic reconstruction, in order to produce a
psychoanalytically informed, observationally based way of assessing

94 Reading Anna Freud

development which could be used by both analysts and other workers involved
in the care of young children (see Chapter 8 ).
The influence of the double approach can also be seen in the post-war activities
of child development centres such as the Yale Child Study Center, as well as in
the clinical and research activities of the Hampstead Clinic itself. Anna Freud set
out her vision for a clinic that had a ‘fourfold orientation’ – towards training,
therapy, research and prevention (A. Freud, 1957a) – with each of these activities
informing and enriching the others. For example, observations of four young
twins in the Hampstead War Nurseries was later complemented by psychoanalytic
treatment during adolescence, allowing sophisticated interpretation, among
other things, of the way in which external events during childhood had been
elaborated in internal reality, as well as the process leading to the formation of
cover memories and the distortion of memories by later developmental processes
(Burlingham, 1963). Alongside this, the existence of a baby clinic, a number of
toddler groups and a nursery within the Hampstead Clinic – all of which
collected observations of a large number of children, some of whom later went
on to receive analytic treatment at the Clinic – allowed a continuing interaction
between direct observational data and that derived from analytic treatment,
with valuable results (e.g. Burlingham, 1972).

Challenges to using the clinical setting as a method

of research

Although Anna Freud valued ‘the lucky chance that in psychoanalysis the
method of therapy is identical with the method of inquiry [which] conferred
the potential of a research case on every patient who entered psychoanalysis
for his private therapeutic purposes’ (1959: 122), she also came to believe that
there were serious limitations to the way in which psychoanalysts had used
the clinical setting as a method for research. She acknowledged that the case
reports written by analysts may be selective in what they report and are often
idiosyncratic in how they are written. She noted with some sympathy that
‘analysts have often been reproached for taking no interest in planned research
and the methods serving it; of making their discoveries haphazardly and
incidentally; of not choosing their material according to plan; of working as
individuals and not as teams; and of allowing their case material to drift out
of sight without follow-up’ (1959: 122).
If psychoanalysis was to address these criticisms, while making best use of the
unique opportunity provided by what her father had called the ‘inseparable
bond’ of cure and research inherent in the practice of psychoanalysis
(S. Freud, 1926: 256), then Anna Freud believed analysts had to work together
in a systematic way. But as Joseph Sandler was later to comment, ‘the mere
accumulation of records, however accurate and illuminating, does not constitute
research’ (Sandler, 1962: 315). Something more was needed that could act as an

Psychoanalytic research and the observation of children 95

appropriate method of research for psychoanalysis. The creation of the Hampstead
Clinic provided Anna Freud with an opportunity to explore what this could be.
As the clinic was dedicated to both treatment and research (as well as
training and prevention), Anna Freud saw the opportunity at the Hampstead
Clinic to develop models of clinical research that would overcome some of
the limitations of psychoanalytic inquiry until that date. In a 1960 paper she
focused on two particular opportunities that a clinic-based research study
would have: the opportunity for the pooling of clinical material, and the
planned selection of cases:

Pooling of material and planned case selection are . . . used to counteract

disadvantages for research which are inherent in analytic work, such as the
comparative absence of specialization and the impossibility of setting up
experiments.
(1957–1960: 11)

Anna Freud gives as an example of planned case selection a study of the

development of motherless children. In this study, children who had been
separated from their mothers at birth or in the fi rst two years of life were
taken into analysis (at different ages) in order to test the hypothesis that
‘continual absence of mothering from early life onward causes severe
abnormality’ (p. 15). The aim was not so much to prove (or disprove) the
hypothesis, but, rather, to develop a richer understanding of these children’s
experiences. Focus was placed especially on the transference, in order to
understand more about the primitive character of their object ties and the
nature of the substitute ties that they formed to others, and on fi ndings related
to the varying emotional reactions to the loss of mother at different stages in
development and the potentially pathological consequences of this experience
– as well as the ways in which some children had managed quite successfully
despite the loss, suggesting a degree of resilience (p. 15).
From the 1950s onwards, Anna Freud oversaw a whole range of clinical
research projects at the Hampstead Clinic, organised around small study
groups that used the careful selection of cases to explore particular areas.
These study groups included ones looking at children with a ‘borderline’
diagnosis, the psychology of child heroes, identical twins, children with
congenital blindness and the interaction between child and parental mental
health. (For a full list of research projects carried out between 1956 and 1968
at the Hampstead Clinic, see A. Freud, 1969a.)

The Hampstead Index

Simply selecting cases with certain shared features was not enough, however,
if research was to be carried out systematically. According to Anna Freud, the

96 Reading Anna Freud

success of such an approach also depended on the capacity to pool the analytic
material that emerged from each individual treatment in such a way that data
could be compared across different therapies and different therapists. What
was needed, in other words, was a more systematic way of recording data
from the analytic setting.
Anna Freud and her colleagues had already begun to develop such a
method of systematic pooling of data when they started collecting observations
of children on index cards in the Hampstead War Nurseries (see Chapter 4).
In 1954 Dorothy Burlingham proposed that this methodology could be
extended to clinical treatment cases, so that material could be systematically
recorded in weekly notes and bimonthly reports and then categorised by the
therapist under the supervision of a small group of senior analysts (Young-
Bruehl, 1988/2008: 336). This material was then ‘indexed’ under a range of
categories – some of which were predetermined (environmental factors,
object relations, fantasies, defences, etc.) and some of which were added or
developed in the course of the ‘indexing’ process.
The Hampstead Index soon developed, under the leadership of Joseph
Sandler, to become what Anna Freud described as a ‘collective analytic
memory’ – a ‘storehouse of analytic material which places at the disposal of a
single thinker and author an abundance of facts gathered by many, thereby
transcending the narrow confines of individual experience and extending the
possibilities for insightful study for constructive comparisons between cases,
for deductions and generalizations, and fi nally for extrapolations of theory
from clinical therapeutic work’ (1965b: 484–485). But the process soon
raised some fundamental problems. The first was the question of what
constitutes a suitable ‘unit of psychoanalytic observation’ – and this quickly
led to the problem of the conceptual gap that was found between actual
observations of analytic material and the theoretical framework in which that
material was framed. In retrospect, Sandler (1962) described the frustration
and despondency that the clinical research team felt, as they had to
continuously re-index the clinical material in the light of their revised
understanding of key analytic concepts, which were themselves being
constantly revised in the light of new clinical material. Sandler explains:

However, as the manuals gradually took shape, it was realized that what
had originally seemed to be by-products of the Index were in themselves
substantial contributions to psychoanalytic theory. We had been doing
research without knowing it!
(Sandler, 1962: 321)

With this realisation, the analysts at the Hampstead Clinic began to form a
number of study groups dedicated to investigating conceptual and theoretical
issues thrown up by the indexing process itself. Sandler’s own papers on the
concepts of the superego, depression, narcissism and fantasy (Sandler, 1962)

Psychoanalytic research and the observation of children 97

are all examples of conceptual research studies that emerged from the
Hampstead Index project, while Anna Freud’s own papers on topics such as
psychic trauma (1967b[1964]) are equally inspired by the research carried out
by clinicians and researchers who were part of the Hampstead Index project.

Psychic trauma as an example of psychoanalytic research

Anna Freud presented her paper on psychic trauma at a conference organised

by the Psychoanalytic Research and Development Fund in New York in
1964, and in her typical way she carefully examined the concept from a
number of perspectives, in order to try to ‘rescue [the term] from the
widening and overuse which are the present-day fate of many other technical
terms in psychoanalysis’ (1967b[1964]: 222). Starting out from Freud’s
statement that the essence of a traumatic situation is ‘an experience of
helplessness on the part of the ego in the face of an accumulation of excitation,
whether of external or internal origin’, Anna Freud went on to investigate
the phenomenon from the ‘economic’ perspective (i.e. the level of individual
tolerance for excitation) and from a ‘qualitative’ perspective (i.e. the degree
to which the traumatic event is experienced as an annihilation, an
abandonment or a threat of castration). After considering a number of aspects
of psychic trauma, including how children cope with trauma and what is
most likely to promote recovery, she concluded that the essence of a psychic
trauma is an experience that is ‘shattering, devastating, causing internal
disruption by putting ego functioning and ego mediation out of action’
(p. 238).
Although this paper ranges across a wide range of conceptual and theoretical
issues, it is clear that it could not have been written without the careful
observations collected as part of the Hampstead Index. It is perhaps no
coincidence, therefore, that when a group of analytic researchers decided to
draw on the Hampstead Index methodology to undertake a programme of
conceptual research on key psychoanalytic concepts, it was the concept of
psychic trauma with which they began. And their results both confi rm and
elaborate Anna Freud’s own findings (Dreher, 2000).

Conclusion

When the history of psychoanalytic research is discussed, Anna Freud’s

contribution is not often credited. Criticised by some, such as Wallerstein, for
not going far enough in encouraging psychoanalysis to embrace the ‘proper
constraints of science’ (Wallerstein, 1984: 76), for others she appeared to go
too far in the attempt to integrate psychoanalysis with academic psychology
and mainstream science, risking the possibility that what is most unique and

98 Reading Anna Freud

radical about psychoanalysis could be lost in the process of its integration
within a model of ‘psychoanalytic developmental psychology’.
This tension between wanting to preserve what is unique about a
psychoanalytic perspective, while also bringing psychoanalysis into a
relationship with other fields dedicated to the understanding of development
and the mind, runs throughout Anna Freud’s work. Her commitment to
systematic observation and the need to check out theories against practical
experience was also a constant in her professional life. So was her ongoing
acceptance that there is still a huge amount that we do not know or do not
understand about the way the mind works, and that only careful investigation
can move our knowledge forward. As Elisabeth Young-Bruehl, Anna Freud’s
biographer, has put it:

There is a good deal of emphasis now in psychoanalysis on the importance

of research. As a researcher Anna Freud was certainly the great model, fi rst
in the 1930s, then as the codirector with Dorothy Burlingham of
the Hampstead War Nurseries in the 1940s, later the cofounder in the
1950s of the Hampstead Centre, which was for decades the most
important psychoanalytic research centre in the world. . . . [Anna Freud’s]
creativity in finding means for comparing observational data with
clinical data gained from analytic work . . . has ‘borne fruit’ (as she liked
to say) in theories and clinical practices that will take another generation
to elaborate.
(Young-Bruehl, 1988/2008: 474–475)

FURTHER READING

Anna Freud’s commitment to systematic observation as a form of research is

reflected in many of her later works, including research projects looking at the
treatment of adolescents; the study of ‘borderline’ cases; an inquiry into
‘motherless children’; and an analytic study of children who are blind from birth
(A. Freud, 1957–1960). Other psychoanalytic researchers who have been
influenced by Anna Freud’s observational methods include Colonna (1996)
and Hellman (1990). Debates about the value of observation as a method of
psychoanalytic research continue to take place (e.g. Green, 2000), but as a
volume of papers edited by Urwin and Sternberg (2012) makes clear, the
observational approach – especially the use of infant observation – is now a
well-established method of psychoanalytic research.
The importance that Anna Freud gave to such systematic research is
especially highlighted by Lustman (1967) and is reflected in the work of her
younger colleagues, especially that of Joseph Sandler, Howard and Miriam
Steele, Jill Hodges, Mary Target, Peter Fonagy and many others who either

Psychoanalytic research and the observation of children 99

 worked or trained at the Hampstead Clinic, each developing a strong
commitment to psychoanalytic research in the process. Some, such as Peters
(1985), have been critical of the research methods developed at the Hampstead
Clinic during Anna Freud’s own lifetime, arguing that the lack of rigorous
assessments of reliability and validity meant that the ‘results could not
challenge the theory’ (p. 194). Although Anna Freud herself did not especially
encourage the systematic development of outcome research, this has since
developed as a key focus of work at the Anna Freud Centre, as well as for
child psychoanalysis more generally (e.g. Fonagy and Target, 1996; Midgley
and Kennedy, 2011).
Within the broader field, debate continues about the most appropriate
methodology for psychoanalytic research, with some arguing for a greater
integration between psychoanalysis and mainstream psychology (e.g. Fonagy,
2003) and others arguing for the distinctive contribution of psychoanalysis as
a research method in its own right (e.g. Rustin, 2003). The case for a pluralistic
culture in psychoanalytic child psychotherapy research, involving the use of a
range of methodologies to address a range of research questions, is set out in
Midgley et al. (2009).

100 Reading Anna Freud

7 THE PSYCHOANALYTIC
TREATMENT OF ADULTS

KEY WRITINGS

1936 The Ego and the Mechanisms of Defence

1943 ‘Memorandum on Technique’
1954 ‘The Widening Scope of Indications for Psychoanalysis’
1954 ‘Problems of Technique in Adult Analysis’
1955 ‘The Concept of the Rejecting Mother’
1965 ‘Metapsychological Assessment of the Adult Personality: The Adult
Profile’ (with H. Nagera and W. Ernest Freud)
1966 ‘Some Thoughts about the Place of Psychoanalytic Theory in the
Training of Psychiatrists’
1969 ‘Difficulties in the Path of Psychoanalysis: A Confrontation of Past
with Present Viewpoints’
1976 ‘Changes in Psychoanalytic Practice and Experience’

Introduction

Although best known as a child analyst, Anna Freud had a clinical practice
with adult patients throughout her life, and she maintained an ongoing
interest in the theory and practice of adult analysis. Elisabeth Young-Bruehl
(1988/2008: 158) suggests that about one-third of Anna Freud’s case load in
the late 1920s was of adult patients (primarily those in training) and by the
early 1930s she was running a regular seminar where ongoing adult cases
were discussed. Edgcumbe (2000) notes that Anna Freud continued to work
with adult patients until almost the end of her life, adding that although ‘she
wrote relatively little herself about work with adults . . . much of her thinking
was absorbed into the work of Hampstead Clinic Groups studying problems
of adult patients’ (p. 200). Moreover, as an active member of the International
Psychoanalytic Association for over 50 years, Anna Freud closely followed
the debates and controversies within psychoanalysis and contributed her own
views on the technique of adult analysis. Perhaps best known for her defence
of what came to be known as the ‘classical’ psychoanalytic view, Anna Freud
made a distinctive contribution to our understanding of the analytic treatment
of adults, and she never lost her interest in this field.

The psychoanalytic treatment of adults 101

The ‘classical’ analytic view

Anna Freud developed her own ideas about the technique of adult analysis
during the 1920s, at an important period in the early history of psychoanalysis.
Writing in 1954, she explained how ‘the subject of analytic technique and its
legitimate variations has been a fascinating one to me since the times when
I, as a beginner . . . listened to Federn’s descriptions of his variations of
technique for psychotic cases, and to Rank’s and Ferenczi’s explanations of
“active therapy”; and when I witnessed Wilhelm Reich’s exciting and
promising beginnings of so-called strict defence analysis, etc.’ (1954b: 357).
It was also the period when Sigmund Freud had recently introduced the
structural model of the mind, and analysts were in the process of working out
the implications of this theoretical revision for clinical practice.
Although her primary focus was on the application of psychoanalytic
ideas to work with children, Anna Freud was also deeply interested in these
debates about analytic technique with adults. In the early chapters of The Ego
and the Mechanisms of Defence (1936), Anna Freud gave a succinct account of
the development of psychoanalytic technique from the earliest period of
Sigmund Freud’s therapeutic work, and she illustrated its intimate connection
with the psychoanalytic understanding of the mind. In what she termed the
‘pre-analytic period’ (roughly coinciding with the work published by Freud
and Breuer in 1895, the Studies on Hysteria ), Anna Freud shows how the use
of hypnosis as a core technique of treatment put a primary emphasis on
trying to eliminate or overpower the patient’s ego, with the primary aim of
‘the revelation of the unconscious’ (1936: 11). The rationale for such an
approach was that bringing the unconscious into consciousness would cure
the patient’s symptoms; however, as Anna Freud observes, by trying to bypass
the workings of the ego, this part of the mind ‘revolted and began
a new struggle to defend against that element of the id which had been
forced upon it, and so the laboriously achieved therapeutic success was
vitiated’ (p. 12).
A decisive shift in the analytic treatment of adults, according to Anna
Freud, came with the introduction of free association as the golden rule of
psychoanalysis. Although the aim of free association, as with hypnosis, was to
access the unconscious working of the mind as directly as possible, in practice
this proved impossible, as the mind could not help but to put up ‘resistances’.
The analyst’s attention, Anna Freud explains, ‘is now diverted from the
associations to the resistances, i.e. from the content of the id to the activity
of the ego’ (p. 14). What might have appeared at first to be an obstacle
to therapy was quickly seen to be essential to successful treatment. It
was by recognising the means by which the ego had defended itself
against the unconscious wishes that these defences (chiefly among them,
repression) could be undone and a more adaptive solution to the demands of
the unconscious be found. Only once this twofold focus was established,

102 Reading Anna Freud

Anna Freud claims, can we ‘speak of psycho-analysis, as distinct from the
one-sided method of hypnosis’ (p. 15). The techniques of dream-analysis,
working with the transference, etc. were all only technical innovations that
allowed this fundamental new focus on the mind in conflict to be further
extended.
Building on the work that her father had presented in Inhibitions, Symptoms
and Anxiety (1926 [1925]), Anna Freud set out her own particular contribution
to analytic technique: the focus on the ego’s defensive operations as an object
of analysis. She argued that, whereas the id elements actually wish to gain
access to consciousness, the workings of the ego and the superego remain
more stubbornly resistant to the work of the analyst and therefore require
considerable skill in order for their workings to be made conscious so that the
patient can develop a more adaptive means of dealing with his or her
unconscious desires. The task of the analyst, she clarified, was to take a
standpoint equidistant from each of the three agencies (id, ego and superego),
and ‘to bring into consciousness that which is unconscious, no matter to which
psychic institution it belongs’ (1936: 30; italics added).

So it is the analyst’s business first of all to recognise the defence mechanisms.

When he has done this, he has accomplished a piece of ego-analysis. His
next task is to undo what has been done by the defence, i.e. to fi nd out and
restore to its place that which has been omitted through repression, to
rectify displacements and to bring that which has been isolated back into
its true context. When he has re-established the severed connections,
he turns his attention once more from the analysis of the ego to that of
the id.
(p. 15)

Such was the analytic technique set out in The Ego and the Mechanisms of
Defence, which many have seen as leading to a whole new development in the
field of psychoanalysis (see Chapter 4 this volume). But looking back on the
work that she presented in her 1936 book, Anna Freud was keen to emphasise
that this was not intended to be a new departure in terms of analytic
technique:

Actually, this increased emphasis on the analysis of the ego (sometimes

referred to as ‘defence analysis’) brought with it no major changes of
analytic technique. It served merely to stress points which had been made
before, but had not always been implemented seriously enough: that,
during the analytic process, defence has to be interpreted before the id
content which is warded off by it; that to approach id contents without that
precaution amounts to ‘wild’ analysis; that the analyst’s attention has to be
divided equally between content and defence and continually turn from
one to the other; that regression in the transference brings with it not only

The psychoanalytic treatment of adults 103

 the fantasies and anxieties of infantile life but also the modes of functioning
and expression which were characteristic of the past.
(1969b: 143–144)

Each of the points she makes in this quotation emphasises the way in which
the analyst has to pay equal attention to the different agencies of the mind. It
is not enough merely to interpret the unconscious wishes or anxieties, one
also has to recognise how and why the patient is defending him/herself
against these; even when working in the transference, one must keep in mind
that it is not only unconscious wishes that are transferred onto the person of
the analyst, but also the typical defences that are repeated in the relationship to
the therapist. In this way, she says, there is ‘no such thing as either an “id
analysis” or a “defence analysis”; there is only one analytic procedure which
embodies both’ (1954a: 381).

The analytic stance and the problem of technique

As she makes clear in a paper on ‘Problems of Technique in Adult Analysis’

(1954a), the ‘classical’ analytic technique that Anna Freud describes is one
based on certain key analytic assumptions: that the patient’s symptoms can
be understood as the result of an internal confl ict, but that this confl ict
has arisen in the remote past and is not accessible to consciousness; that
these past unconscious experiences can be relived in the transference when
provided with a suitable ‘object’ in the person of the analyst; and that by
analysing the ‘resisting counterforce lodged in the patient’s ego’ (p. 379) one
is able to reactivate the old confl icts, make the patient aware of his or her
typical defences, and thereby allow new solutions to the old confl icts to be
found. Techniques such as free association, the use of the couch, analytic
neutrality, dream interpretation and the interpretation of manifestations
of transference are all simply methods that facilitate this process more
successfully.
In contrast to what she felt was the danger of emphasising one of these
methods as the ‘key’ element of psychoanalysis, Anna Freud showed the way
in which each of the above techniques has a contribution to make to analytic
work with patients in a ‘classical’ psychoanalytic treatment. She recognised
that to carry out an analysis on this basis was a slow and at times laborious
process. ‘Like all analysts,’ she wrote:

I feel at times dissatisfied with the nature of my work, its rigidity, the
restrictions placed upon analyst and patient, the length of time needed for
a cure, etc. In such moods I wish I could drop all rules of procedure and
act impulsively and on my own.
(1954a: 382)

104 Reading Anna Freud

Especially for an analyst in training, still struggling to ‘maintain his human
feeling and understanding while complying with a whole host of complicated
rules’, the temptation may be to throw off such regulations, which might be
seen as too restrictive. Or by contrast, some analysts may hope to ‘hide behind
the rules, to meet the patient not squarely, but protected by a barrier which,
at least in the ordinary run of cases, eliminates the need for independent
action’ (p. 383). But both attitudes, she suggests, will lead to a loss of the true
meaning of psychoanalytic technique. She proposes that elements such as free
association, dream interpretation and the handling of the transference are
best seen as ‘mere tools of treatment’, which at times need to be ‘inspected,
revised, sharpened, perfected and, if necessary, altered’ (p. 383). Anna Freud
always emphasised the importance of flexibility in relation to analytic technique.
Any fundamental alterations to the method of clinical psychoanalysis,
however, should only be carried out when there is sufficient cause, and on the
basis of careful reflection.
Most of all, Anna Freud stressed the importance of working from ‘surface to
depth’, starting with that which is closest to the patient’s own consciousness, and
gradually working ‘down’ from there. Such an investigation should be,
moreover, a shared venture, between two people with a desire to understand –
as well as an acceptance that there are parts of the mind that will resist such
understanding. Anna Freud always positioned herself as an ally to her patients,
albeit one who ‘reserved the right to say what had to be said, an ally who would
not settle for sugar-coating when bitterness had to be acknowledged in the
interest of truth’ (Coles, 1992: 98). Debbie Bellman, in writing of what makes
an Anna Freudian analyst, describes ‘the importance of being human, empathic,
straightforward, and simple, as well as humorous and playful as appropriate’. She
goes on:

I would also emphasize the importance of listening to one’s patients, with

interpretations being merely a form of communication rather than
manifestations of the therapist’s eloquence.
(Bellman, 2012: 369)

Arthur Couch’s memories of an analysis with Anna Freud

Just as Sigmund Freud’s analytic technique is brought vividly to life by the

memories of those who were analysed by him (e.g. Kardiner, 1977; Lohser
and Newton, 1996), so Anna Freud’s analytic technique is perhaps best
captured by the memories of her former analysands, such as Erik Erikson,
who remembered her ‘over-all calm and restrained therapeutic style’ (Erikson,
1983: 51), or Arthur Couch, who came to London to have an analysis with
Anna Freud in the late 1960s, as part of his own training to become a
psychoanalyst.

The psychoanalytic treatment of adults 105

 Couch (1995) emphasises the fact that Anna Freud presented the work of
analysis as a joint endeavour, one in which analyst and patient were working
together. He remembers how she would often use the phrase ‘we are trying
to understand about that’ to emphasise the sense of a shared activity, one
that was based on curiosity, creativity and a considerable amount of courage.
Her use of the word ‘we’ made clear that analytic progress depended on a
strong ‘therapeutic alliance’ between analyst and patient, and to that end
Anna Freud presented herself to her patient as a very real person, who was
natural in her approach. When he first arrived from the US and attended
his first analytic session, Couch remembered how she asked him in a quite
natural way about how he was settling in to life in London, and at other
times would acknowledge when she had seen him giving a presentation at
a meeting or when real life events (such as a fire that broke out at the
Hampstead Clinic during the middle of one of his sessions) intruded on their
work. But this natural style of interaction was mixed with deep analytic
interpretations, always presented in a simple, non-technical language. She
could make, he remembered, ‘complex points with deceptive simplicity’
(Couch, 1995: 159), and she always encouraged him to listen to himself and
to find his own meaning (or interpretations) in the material that he brought
for analysis:

She was just herself; there were no signs of a learned technique, or of any
imposed ‘system’ of rules and unresponsiveness. She was always her real
self and an analyst at the same time, not like a trained professional person
who took on the analytic role in sessions, leaving the real self behind
during the therapeutic work.
(p. 158)

As one would expect from her writings, Anna Freud paid great attention
to Couch’s dreams – sometimes spending a whole session or more on
interpreting a particularly significant dream – and a great deal of time was
spent on reconstructions of childhood events that were important to an
understanding of the person he had become as an adult. What characterised
Anna Freud’s approach, Couch himself came to see, was ‘her determined
effort to help me understand my childhood development and the accompanying
unconscious reactions that influenced my life and character, and by that to
free me from the past’ (p. 162).
But rather more surprising – at least for those who saw Anna Freud as
neglecting the transference – Couch also says that there was a great emphasis
on the transference, and that both his positive and his hostile transference
feelings were an object of analysis. However, Anna Freud made little or no
use of the ‘here-and-now’ transference interpretations, which were becoming
such a central aspect of psychoanalysis in Britain in the post-war years. Couch
makes a point of emphasising that Anna Freud never made what he calls a

106 Reading Anna Freud

‘you mean me’ type of transference interpretation. Instead, transference
phenomena were brought to his attention in the same way as any other
psychic material, as something for analyst and patient to investigate and
explore together, as part of the ongoing work of self-understanding.
Arthur Couch makes clear his admiration for Anna Freud’s style of analysis
and for the degree to which he personally felt helped by his experience of
analysis with her. But he is not uncritical of her way of working, and he
mentions some of the ‘blind-spots’ that he felt Anna Freud displayed in her
work with him. When he was getting married, for example, Anna Freud was
unable to hide her disapproval of his decision to have a religious ceremony.
He also remembered, with regret, a time when he spoke in a way that clearly
hurt Anna Freud’s feelings, and the way in which she expressed this in his
session:

I was talking about choosing furniture and curtains for our new apartment
in Hampstead. I remarked that I preferred very traditional mahogany
furniture and dark curtains, which I was bringing over from America.
I contrasted this style unfavourably with the light wood desks and light
coloured curtains in the Hampstead Clinic. I went on and on about this
difference. For a while Anna Freud said nothing, but towards the end she
made a very unusual comment, saying: ‘I made all those curtains myself.’
The personal nature of her comment took me aback. I was so emotionally
affected that I was silent for some time. Then I said that, regardless of my
tastes, I could see how dedicated and personally involved and proud she
was of the Hampstead Clinic, which she had created . . . [This exchange]
caused me considerable guilt, but also gave me a deep insight into Anna
Freud’s life’s work.
(p. 161)

Challenges to the ‘classical’ view of analysis: The role

of transference

Anna Freud’s views about the aims and technique of psychoanalysis were
intended as merely a restatement of a ‘classical’ position, but from the
beginning they were also controversial. Her view of psychoanalysis, as set
out in the opening chapters of The Ego and the Mechanisms of Defence in
1936, was challenged most forcefully at two points in her career: fi rst in
the early 1940s, when Anna Freud moved to London and quickly became
embroiled in a debate about the nature of psychoanalysis with Melanie
Klein and her colleagues (the so-called Controversial Discussions); and
then again in the 1960s and 1970s, when new trends in psychoanalytic
thinking and practice led her to review her own position on the treatment
of adult patients.

The psychoanalytic treatment of adults 107

 The debates that occurred in the early 1940s were part of a series of meetings
of the British Psychoanalytical Society (BPS) which were intended to try to
deal with the tensions that were created after many European analysts emigrated
to London in the late 1930s. Some of the conceptual and clinical differences
between these ‘classical’ analysts and those that adhered to the work of Melanie
Klein, who had moved to London in 1926, now took on greater urgency. The
aim of the ‘Controversial Discussions’ (King and Steiner, 1991) was to try to
clarify the difference between the various analytic traditions, and to establish
the evidence for Melanie Klein’s views and judge whether they could be
considered compatible with the psychoanalytic ideas of Sigmund Freud – and
therefore whether they should have a place in the training of the BPS or not.
Among the series of presentations and discussions that took place in London
in 1942–44, possibly the most interesting, from a clinical point of view, were
the ‘Memoranda on Technique’, which were presented for discussion in the
autumn of 1943. These brief statements about the fundamental elements of
psychoanalytic technique from several of the leading figures in British
psychoanalysis at the time came about as a result of a proposal made by James
Strachey, who suggested that it might be possible to side-step some of the
issues about which theories were ‘true’ by focusing on what a valid
psychoanalytic technique might look like and (if agreement could be reached
on this) making that the basis for training in the BPS. Brief memoranda were
presented by both Anna Freud and Melanie Klein, as well as others including
Marjorie Brierley, Ella Sharpe and Sylvia Payne (King and Steiner, 1991). In
the discussions that followed the presentation of each of these memoranda,
issues such as the aims of psychoanalysis, the role of transference, the use of
interpretation and the nature of the training analysis were vigorously debated.
In her own memorandum, presented to the Training Committee on
29 September 1943, Anna Freud emphasised that for her the ‘two main
foundation stones of psychoanalytic technique were the substitution of free
association for hypnosis, and the control and reduction to a minimum of the
real relations between analyst and patient’ (1943: 630). The former led
directly to the discovery of the dynamic importance of resistance; the latter
to the fact of the transference. Anna Freud went on to review the technical
innovations that had been introduced by Ferenczi, Rank, Reich and others,
before stating her concern about ‘the almost exclusive emphasis given by
Mrs Klein to all transference material, compared with material which
emerges in dreams, in verbal associations, in memories and screen-memories’
(p. 631). As a consequence of this exclusive focus on only one aspect of the
psychoanalytic encounter, Anna Freud believed, Klein and her colleagues
had also moved towards a narrow focus on phantasies emerging during the
first year of life (which would be repeated in the transference), to the relative
neglect of later stages of development, including the traditional oedipal phase
(which she placed between the third and fifth years of life). By conceiving
of the transference in terms of the repetition of the earliest stages of

108 Reading Anna Freud

object-relations, Anna Freud believed this would lead to an inappropriate
emphasis on interpretations related to the processes of primitive introjection
and projection. For Klein, she believed, analysis was ultimately about the
transformation of these internalised objects; whereas Anna Freud herself
continued to see the aims of analysis in terms of ‘the widening of consciousness
which brings more psychic matter under the control of the ego’ (p. 631). If
the aims are so different, she suggested, so would be the therapeutic techniques
and focus.
In the memorandum, Anna Freud also set out her belief that transference
is something that emerges gradually, with the early stages of contact with
the analyst ‘governed by normal rational attitudes’, and with deeper layers
of the unconscious only being transferred onto the person of the analyst as
the treatment progressed (the so-called transference neurosis). She suggested
that Melanie Klein saw things differently, by emphasising the strength of the
transference from the very beginning of analysis, with inevitable implications
for analytic technique.
Perhaps not surprisingly, the outcome of the Controversial Discussions
was not an increase in understanding between the different schools of
psychoanalysis, but, rather, a hardening of attitudes and an increasing emphasis
on differences. In 1944, the Training Committee proposed that those most
involved in the debates should not play a central role in training, but that all
trainees should have an opportunity to learn about the full range of models
of psychoanalysis held within the BPS, ‘including the most extreme’. When
Anna Freud discovered that her own views were among those considered
‘extreme’, she was so angry that she considered resigning from the BPS.
Although this did not happen, she kept away from meetings at the BPS for
almost two years.

The ‘Freudian Group’ and the creation of the Hampstead Clinic

In the end, the new President of the BPS, Sylvia Payne, hammered out what
became known as the ‘Gentleman’s Agreement’ (somewhat misnamed, as it
was primarily an agreement between three women – herself, Melanie Klein
and Anna Freud). The Agreement, signed in 1946, led to the establishment
of different training tracks within the single organisation, so that candidates
could choose which track they wished to follow. Over the years this led to
the establishment of three training options, one more closely based on the
work of Klein and her colleagues; a second based on the teachings of Anna
Freud and the ‘contemporary Freudians’; and a third, so-called non-aligned,
who later came to be known as the Group of Independents.
Although she did not resign her membership of the BPS, Anna Freud no
longer considered it the centre of her professional life, and she always kept a
certain distance from the organisation. As Young-Bruehl put it, ‘she placed

The psychoanalytic treatment of adults 109

her hopes for the future of psychoanalysis elsewhere’ (1988/2008: 271), and
for the rest of her life she had more contact with psychoanalytic institutes in
the US (where many of her colleagues from Vienna had emigrated) than
with the institute on her own doorstep. At a personal level, these experiences
led Anna Freud into what Young-Bruehl has called a ‘dark night of the soul’
– three years during which she suffered from a serious pneumonia that almost
killed her and during which she finally had to ‘work through’ the grief for
the loss of both her homeland and her father in 1939. On a personal level, one
outcome of this experience was a profound period of self-analysis, which
resulted in one of the most intimate papers that Anna Freud was ever to
write, ‘About Losing and Being Lost’ (1967[1953]) – written in 1953 but only
published 14 years later. In this paper, she revisits Freud’s views on the
meaning of losing objects or getting lost and links this to the experience of
mourning. In its tone and its moving simplicity, the paper deserves comparison
with her father’s equally profound work, ‘Mourning and Melancholia’
(1917[1915]).
A second outcome of her ‘dark night of the soul’ was a decision that was
to have monumental implications for her own career and for the future of
child psychoanalysis. With support from her colleague Kate Friedlander (who
tragically died in 1949, at the age of only 47), Anna Freud decided to try to
transform the Hampstead War Nurseries, which were now starting to wind
down, into a training programme for child psychoanalysis (or ‘child experts’,
as she preferred to think of them), which began in 1948. The decision to link
the training to a clinic offering analytic treatment to children was soon made,
and funding was sought from sympathetic organisations based in the US. In
1951, a house in Maresfield Gardens, London, was bought with funds from
the Field Foundation, and the Hampstead Child Therapy Clinic and Course
was born. The Hampstead Clinic (as it was usually known, until being
renamed ‘the Anna Freud Centre’ following her death) became the centre of
Anna Freud’s professional life, and almost all of the work she did in the post-
war years was intimately connected to the activities of the Clinic and its
training programme.

The widening scope of adult analysis

In 1954 Anna Freud took part in two symposia in the US, both of which
focused on questions related to the widening scope of psychoanalysis and the
implications for technique. In her presentations, Anna Freud acknowledged
that the ‘classical’ psychoanalytic technique that she had always promoted,
with the specific focus on transference and resistance, was only valid for
neurotic disorders (i.e. ones based on unconscious confl icts between the
internal agencies of the mind), but that ‘variations in analytic technique
become necessary whenever the aspect of a case leads us to expect

110 Reading Anna Freud

manifestations of transference or resistance which exceed in force or in
malignancy the amounts with which we are able to cope’ (1954a: 387). She
gives, as examples, the treatment of schizophrenic patients, ‘delinquents and
near-criminals’, ‘atypical character disturbances’, and patients suffering from
addictions (p. 385). In each case, she argues, there may be justifiable reason
for adaptations of psychoanalytic technique; at best, this may lead to new
understanding, which will in turn invigorate psychoanalytic theory and lead
to further developments in treatment and technique.
By the late 1960s, however, when Anna Freud revisited some of the
questions about the widening scope of psychoanalysis, she was more cautious
about the changes that were taking place. Her 1969 paper on ‘Difficulties in
the Path of Psychoanalysis’ deliberately evoked the title of a paper written by
her father in 1917, at another challenging time for the psychoanalytic
movement (S. Freud, 1917). In her own paper, presented at the New York
Psychoanalytic Institute, Anna Freud began by acknowledging the degree to
which some key psychoanalytic concepts were more widely accepted than
ever before. Ideas about the unconscious motivation for behaviour, about the
centrality of sexuality and aggression to human nature, or the fundamental
importance of dream-life were now broadly accepted by many people, but
this raised new challenges. Among the challenges that she enumerated were:

• The competition from a range of other therapies, both psychotropic and

psychological, which led many to see psychoanalytic treatment as ‘too
slow, too laborious, too time-consuming and expensive’ (1969b: 130).
• The altered status of psychoanalysis in the scientific community, which for
many years had been either shunned or ignored. While the new-found
recognition meant that there was opportunity for interdisciplinary
influence, it also led to the risk that psychoanalysis would lose its distinctive
approach in search of ‘recognition’. The balance, she suggested, was to find
a mid-point between ‘an overstrict isolationism’ and an ‘overeager
collaboration’ (p. 133).
• The risk to psychoanalysis now that training had become ‘institutionalised’.
Whereas those who were originally drawn to psychoanalysis were ‘the
unconventional ones, the doubters, those who were dissatisfied with
the limitations imposed on knowledge’, now trainings were more likely to
accept ‘the sober, well-prepared ones, who are hardworking enough
to wish to better their professional efficiency’ (p. 133). As a result of this,
psychoanalysis, she believed, was increasingly losing its attraction to
the younger generation, who saw it as a conservative profession that did
not speak to their deeper needs.

The final change that Anna Freud discussed in her New York paper, and
again in a lecture at the IPA Congress in London in 1975, was the ‘widening
scope of psychoanalysis’ to include the treatment of a range of patients for

The psychoanalytic treatment of adults 111

whom the psychoanalytic method was not originally designed. Among
such patients, Anna Freud spoke about the borderline patients and those
suffering from psychoses, who ‘fail to fulfi l the preconditions for the
employment of the classical analytical technique by eliminating insight,
ego cooperation, or even secondary process thinking and verbal
communication’ (1976[1975]a: 183). Although Anna Freud felt that
psychoanalysis still had a great deal to contribute to the understanding of these
types of pathology, she was less optimistic about the therapeutic potential of
psychoanalysis to cure such patients. She was concerned that psychoanalysis
would lose its credibility as a therapeutic technique by claiming to be able to
treat patients who were clearly more helped by other treatments, including in
some cases drug treatments. Also, she was equally concerned about the
changes in technique that she felt analysts were introducing to try to treat
such patients, at the risk of losing some of the most valuable aspects of the
psychoanalytic method.
Among the clinical and conceptual changes that Anna Freud believed
were being made by ‘modern’ analysts trying to find methods to treat these
new types of pathology, she was especially concerned that analysts were
losing interest in the type of psychic material that had always been so central
to psychoanalysis – that is, the disharmonies between the various agencies
within the mind (Couch, 1995). Instead, she believed, analysts were becoming
more and more concerned with ‘the events which lead from the chaotic,
undifferentiated state toward the initial building up of a psychic structure’
(A. Freud, 1969b: 146) – that is, the first year of life. While this early period
of development is of great interest and importance, Anna Freud was concerned
that it would lead to therapeutic expectations about undoing the very
rudiments of personality development, although the chances of being able to
undo such early damage were uncertain. She confessed to ‘feeling doubtful
about trying to advance into the area of primary repression, i.e., to deal with
processes which, by nature, are totally different from the results of the ego’s
defensive manoeuvres with which we feel familiar’ (1969b: 147), and she
worried about the damage to the reputation of psychoanalysis if it made
therapeutic claims in an area where there was little indication of success. She
accepted that failures in this early relationship could create a ‘basic fault’ in
the personality (Balint, 1968), but she disagreed with the conclusion that she
felt some psychoanalysts drew from this – that is, that all pathology should be
attributed to problems in the early mother–infant relationship (A. Freud,
1955[1954], 1982).
Such a change of focus in respect of therapeutic aim (i.e. to ‘curing’ the
faults from the earliest stages of development) also implied changes in analytic
technique, especially when faced by patients with more borderline or
psychotic functioning. Anna Freud felt that her contemporaries, such as
André Green or Donald Winnicott, were indicating that the analyst–patient
relationship should be modelled on the basis of the mother–infant relationship

112 Reading Anna Freud

and were suggesting that deep regressions by the patient back to the earliest
stages of dependency could have great therapeutic value. In responding to a
1975 paper by André Green in which he put forward such a proposal, Anna
Freud described how he and his colleagues ‘pin their therapeutic hopes on
the reestablishment of this earliest relationship in the psychoanalytic situation’,
but she stressed that there are in fact ‘far-reaching dissimilarities between the
two’ (A. Freud, 1976[1975]a: 183): rather than trying to meet these needs
through the analytic relationship, Anna Freud felt that these demands for
care should be considered material to be analysed. Although conceiving of the
therapist as an ‘analyst-mother’ may help to clarify some of the functions of
the therapist for borderline patients (such as the capacity to act as a repository
for the infant’s primitive feeling states), it may also lead analysts into the kind
of ‘wild analysis’ that Anna Freud believed had been damaging to
psychoanalysis in the early period of its development. ‘Where the phase of
dependence has never been overcome,’ wrote Anna Freud, responding to a
1960 presentation by Winnicott, ‘it is impossible to cure in analysis the state
of dependency’ (1962[1961]: 193).
Anna Freud was also concerned that the focus on non-verbal modes of
communication and the analyst’s intuitive understanding of the patient’s signs
and signals could lead to an overemphasis on repetition and re-enactment,
rather than remembering and verbal communication (1969b: 147). This, in
turn, appeared to Anna Freud to have led to an over-emphasis on
communication in the transference, ‘where transference interpretations are
considered the only therapeutically effective ones and where the transference
phenomena are perforce given preference over memory, free association, and
dreams, as the only real road to the unconscious’ (p. 147). Anna Freud
doubted whether it was actually the case that the very earliest experiences of
infancy were repeated in the transference, or that whatever has been
established in the very earliest period of life is reversible on the basis of a
therapeutic encounter. She also cautioned against any development in
psychoanalysis which put undue emphasis on only one aspect of the
psychoanalytic encounter (i.e. the transference–countertransference matrix)
rather than on a range of techniques.
In concluding her review of ‘modern’ developments within psychoanalysis,
Anna Freud recognised that ‘the desire to unearth ever earlier and deeper
antecedents, not only of the ego but of human emotions, anxieties and
struggles in general, has taken hold of the analyst’s imagination’ and that ‘for
the moment it outstrips most other interests’ (1969b: 156). As part of a talk
given at the IPA Congress in London in 1975, she contrasted this with the
position set out by Leo Rangell, to which she implicitly ascribed, where
the future of psychoanalysis would depend more on ‘modesty of aim and
intensification of insight’ (1976[1975]a: 185), with its therapeutic reputation
intact by means of a ‘process of shrinkage and precision, of fitting the method
to its applicable field’ (Rangell, quoted by Anna Freud, 1976[1975]a: 185). In

The psychoanalytic treatment of adults 113

a private letter to Harold Blum, following the Congress, Anna Freud was
more blunt in her conclusions:

I think that instead of further developing psychoanalytic thought there is

a definite tendency to destroy the gains and advances which have been
made already, and to substitute for them something less valuable. The
difficulty which you as well as I meet in discussion is of course that all
these so-called advances are made under the flag of progress, and that
therefore anyone who does not welcome them is looked at as ‘orthodox’
and ‘conservative’, which I believe neither you nor I are.
(quoted by Young-Bruehl, 1988/2008: 426)

The psychoanalytic understanding of borderline

and psychotic states

Although Anna Freud was pessimistic about the therapeutic possibilities of

treating more psychotic or borderline patients using psychoanalysis, this
did not prevent her from maintaining a deep interest in these areas of
pathology and from using psychoanalytic ideas – especially those derived
from child analysis – to try to understand these types of disturbance better.
As a lay analyst (i.e. one without medical training), she had little opportunity
to treat psychotic patients, but she was also clear that her own clinical
experience ‘extends beyond the run of the common neuroses to character
problems of all kinds’ (1954b: 357). As part of her analytic training in the
early 1920s, she regularly attended the ward rounds at the University of
Vienna’s psychiatric clinic, run by Wagner-Jauregg with his assistants, Paul
Schilder and Heinz Hartmann (both of whom were members of the Vienna
Psychoanalytic Society), and on this basis she developed a thorough knowledge
and understanding of psychiatric illness and diagnosis (Freeman, 1983). In
her later life, she worked alongside many talented adult psychiatrists
examining issues related to borderline and psychotic functioning. She helped
to establish a study group at the Hampstead Clinic in the 1960s (whose
members included Tom Freeman, Humberto Nagera, Jack Novick, Clifford
Yorke and Stanley Wiseberg, among others) to explore schizophrenia and
psychosis in adults from a psychoanalytic perspective. The group explored
the similarities and differences between adult and adolescent psychosis and
borderline states; examined the role of confl ict and the mechanisms of defence
in psychotic functioning; and investigated at length the question of whether
it was possible to identify a ‘predisposition to psychosis’ in childhood
(Freeman, 1995).
Building on Sigmund Freud’s writings, in which he focused on the
‘internal catastrophe’ that underlay psychotic breakdowns, Anna Freud
emphasised the ‘loss of continuity between childhood and adult mental life’

114 Reading Anna Freud

that appeared to characterise psychotic functioning, due to a failure in
maintaining an object relationship. She was interested to see how an
understanding of psychotic phenomena could challenge the limits of
psychoanalytic understanding, and in the last years of her life she was
especially concerned with the question of what kind of ‘fracture’ in the
personality made some people vulnerable to psychotic breakdown, and
whether her ideas about ‘developmental lines’ could help explain this
(Freeman, 1983).
Although Anna Freud was cautious about the therapeutic effectiveness of
psychoanalysis as a method of treatment for psychotic and schizophrenic
patients, she did believe that psychoanalytic investigations had implications
for our understanding of recovery. In her preface to Chronic Schizophrenia
(Freeman, Cameron and McGhie, 1958), she noted that the role of ‘stable,
need-satisfying, reliable figures in the outside world’ was as significant for
schizophrenic patients as it was for young infants (A. Freud, 1958b: 495).
Yorke (1983a), elaborating on this idea, observes that ‘many chronic
schizophrenic patients improve in matters concerning eating, bladder and
bowel control, and bodily care, in the context of a close relationship with a
member of the nursing staff ’ (1983a: 396), and he discusses how the common
phenomenon among schizophrenic patients of bodily self-neglect can be
understood from a developmental perspective, with particular links to the
nature of the patient’s object relations. Yorke calls for a greater dialogue
between those who work with children and those who work with adults, in
order to make full sense of the developmental processes that can lead to
borderline, narcissistic or psychotic functioning in adulthood; we can see in
his own work, as well as in that of other colleagues of Anna Freud’s (e.g.
Freeman, 1976; Yorke and Wiseberg, 1976), examples of what such an
integration could look like.

Conclusion

In her approach to the psychoanalytic treatment of adults, we can perhaps see

most clearly why Anna Freud has a reputation as a ‘traditionalist’, who
rejected many developments in contemporary psychoanalysis. Although she
was excited by the possibilities of opening up new areas of discovery and
understanding, especially in relation to the more serious types of adult
psychopathology, she was also cautious about whether psychoanalytic
treatment could really be effective for such patients. She was also worried
that the changes in technique that analysts made in order to try to become
more efficacious put at risk some of the more valuable parts of the
psychoanalytic method. At times, she expressed concern that the time and
energy put into working with this more disturbed population could have
been better spent perfecting the technique of psychoanalysis with more

The psychoanalytic treatment of adults 115

‘neurotic’ patients, and she worried that some of the key aspects of
psychoanalytic technique – such as dream-interpretation, or working to
develop reconstructions of early infantile experience – would be forsaken.
As Arthur Couch’s (1995) memories of being in analysis with her attest,
Anna Freud tried to maintain a tradition of psychoanalysis as a joint endeavour
between analyst and patient, both working together to try to make sense of
who we are as human beings, and how we came to be this way. By achieving
such self-understanding, she believed, we develop a degree of freedom and
control over our lives, rather than being driven by powerful – and often
destructive – unconscious impulses.

FURTHER READING

Other than papers by Yorke (1983a) and Couch (1995), little attention
has been paid to Anna Freud’s work as a psychoanalyst of adults, although
references to her work with adults can be found throughout her writings and
in the secondary literature about her. Compared to the paper by Couch (1995),
a more critical account of one analysand’s experience of being in analysis
with Anna Freud can be found in Menaker (1989, 1991). Esther Menaker was
in treatment with Anna Freud in Vienna in the early 1930s. Although she says
that she ‘idealised’ her at the time, looking back Menaker paints a more
mixed picture of her analytic experience. While recognising that Anna Freud
was ‘much less rigid in the application of psychoanalytic technique than
most of her colleagues and was certainly more humanistically oriented’
(Menaker, 1989: 609), she also comments somewhat negatively on her ‘very
Freudian interpretations’ and her sense that she could be quite critical and
judgemental. Menaker goes on to speculate that the ‘narrowness and
limitations of her own life’ were responsible for Anna Freud’s limitations as an
analyst (p. 610).
A clear statement of Anna Freud’s own ideas about the fundamental aspects
of psychoanalytic theory and treatment can be found in ‘A Study Guide to
Freud’s Writings’, published in 1978. Although ostensibly about her father’s
work, it is also a very clear statement of her own psychoanalytic thinking and
its relation to the treatment of adult patients. Anna Freud also gave several
presentations where she developed her own ideas about the analytic treatment
of (male) homosexual patients (see A. Freud, 1952[1949–51]), and she had a
specific interest in the complexities of the ‘training analysis’ – that is, the
situation in which analytic treatment is a requirement of clinical training (see
A. Freud, 1950[1938], 1976a).
For Anna Freud’s debates with Klein, there is probably no better place to
start than King and Steiner’s The Freud–Klein Controversies s (1991), which
is based on the detailed notes made at the time of the Controversial
Discussions. The legacy of bitterness and outright hostility that was one

116 Reading Anna Freud

consequence of these discussions can be felt in many papers written from the
1950s onwards, if not by Anna Freud herself (who tended to maintain a
diplomatic silence, at least in her published works) then by many of her
colleagues, for whom Melanie Klein’s ideas were anathema, as well as in the
writings of Klein’s colleagues and followers, who consistently neglected or
criticised ideas that emerged in the Anna Freudian tradition, continuing to see
her ideas as not ‘truly analytic’.
Later debates between Anna Freud and those advocating a more ‘modern’
version of psychoanalysis tended to be less toxic, if no less significant.
Bergmann (1999) has written an interesting account of the 1975 debate at the
IPA Congress in London between André Green and Leo Rangell, and Anna
Freud’s role in it. Bergmann sees this debate as a landmark in the history of
psychoanalysis, with the Freud/Rangell position being brought up against a
way of thinking about psychoanalysis that opened up whole new ways of
thinking about the nature of the analytic setting. He argues that in ‘the debate
itself, Rangell and Anna Freud carried the day . . . [but] the era they represented
had already passed’ (Bergmann, 1999: 198–199).
Many others have written about the debates within contemporary
psychoanalysis and the tension between more ‘orthodox’ and more ‘modern’
views of psychoanalytic treatment. Some of the history of these debates is
captured in Robert Wallerstein’s paper, ‘One Psychoanalysis or Many?’
(1988).

The psychoanalytic treatment of adults 117

8 THE ASSESSMENT AND
DIAGNOSIS OF CHILDHOOD
DISTURBANCES

KEY WRITINGS

1965 Normality and Pathology in Childhood

1970 ‘The Symptomatology of Childhood’
1972 ‘The Widening Scope of Psychoanalytic Child Psychology, Normal
and Abnormal’
1974 ‘Diagnosis and Assessment of Childhood Disturbances’
1974 ‘Beyond the Infantile Neurosis’
1976 ‘Psychopathology Seen against the Background of Normal
Development’
1979 ‘Child Analysis as the Study of Mental Growth, Normal and Abnormal’

Introduction

With the establishment of the Hampstead Clinic in the aftermath of the

Second World War, Anna Freud was confronted with the particular challenges
of providing analytic treatment to a large number of children, of varied ages,
presenting to the Clinic with a wide range of disturbances and presenting
problems. Among the difficulties this raised, one that soon became pressing
for Anna Freud was the question of assessment and meaningful diagnosis.
Many children were being referred whose disturbance appeared to be much
greater than the ‘neurotic’ children for whom child analytic technique was
originally developed, and it was not clear what type of intervention would
be most appropriate for their needs. Often there was uncertainty about the
degree to which organic problems underlay the child’s difficulties, or what
role trauma or parental neglect may have played in the development of
their problems. In addition, a child of three years may have been referred
with similar obsessive symptoms to a young man of 15, yet it seemed
unlikely that diagnosing them both as suffering from ‘obsessional neurosis’
would be clinically meaningful when the underlying meaning of
the symptoms in the context of their development stages would probably be
so different.
Anna Freud quickly realised that the existing diagnostic systems available
were of very little help, whether for making the type of assessments that

118 Reading Anna Freud

would inform decisions about treatment; or for helping to make a prognosis
about the development of adult disturbance; or for learning more about the
developmental processes themselves and how they might go wrong (1965a:
148). ‘In this constantly shifting internal scene of the developing individual,’
she wrote, ‘the current diagnostic categories are of little help and increase
rather than decrease the confusing aspects of the clinical picture’ (pp. 109–110).
This was not just a conceptual problem; it had very real implications for the
day-to-day working of the Clinic. ‘Even with increasing experience of
assessing their psychopathology,’ Anna Freud wrote, discussing the children
who were referred for treatment,

. . . we always remain in doubt how far their symptoms remain influenceable

by external management or how far they are open to spontaneous cure via
developmental alterations, i.e., how far they are transitory. Thus, we are
faced by the dilemma whether, by suggesting treatment, we are perhaps
involving child and parents in much discomfort, trouble, time, and expense
which might be unnecessary; or whether, by refusing it, we are perhaps
condemning the child to a life-time of suffering and failure.
(1974[1973]: 59)

For all these reasons, it seemed to Anna Freud that the development of an
appropriate system for assessment and diagnosis of a range of childhood
disturbances was crucial to the further development of child analysis, and this
became an ongoing project for the next 30 years of her working life, alongside
many colleagues at the Hampstead Clinic and beyond.

The limitations of existing diagnostic approaches

In reviewing the approach to assessment and diagnosis that had existed when
she was training to be a psychoanalyst, Anna Freud recalled with humour her
earliest experience of psychiatric diagnosis:

I still remember the time when I, at the very beginning of my work, was
a guest student at the psychiatric clinic in Vienna where I used to listen to
the young interns as they quickly went through the case sheets of patients
who had arrived the evening before. They read only a few sentences in
each; for instance, a patient complained that the neighbours were talking
about her – paranoia, obviously. Or a patient complained that she was
really not the least good to her family – well, a melancholia. I thought that
was simply marvellous, and I looked forward to a time when I, though not
a psychiatrist myself, would acquire sufficient knowledge to do that in my
work with children.
(1974[1954]: 37).

The assessment and diagnosis of childhood disturbances 119

 This psychiatric approach (which is still the basis for modern systems such
as DSM-V and ICD-10, discussed later in this chapter) relies on the assumption
that certain symptoms can reliably be expected to be part of a specific
syndrome and that a certain pattern of symptoms will indicate an underlying
pathological disturbance. However, as soon as Anna Freud began to
work with children, she realised that such an assumption was dangerously
limiting.
The first problem was that a purely descriptive approach to diagnosis,
based on the phenomenology of manifest symptoms, runs counter to ‘the
essence of psychoanalytic thinking’ (1965a: 110), in which behaviour is
always understood as simply a manifestation of underlying pathogenic factors.
This had not prevented psychoanalysts, it should be added, from using such
descriptive diagnostic terms – indeed, classical psychoanalytic diagnostic
categories such as ‘obsessional neurosis’ or ‘anxiety hysteria’ all assume that a
key symptom (obsessional behaviour, or anxiety states) is central to the
diagnosis. ‘Symptoms give us our bearings when we make a diagnosis,’ Freud
himself had said (1916–17: 271). Yet reliance on such bearings, his daughter
argued, ‘inevitably led into confusion in assessment and subsequently to
erroneous therapeutic inferences’ (1965a: 111), especially when extended to
work with children.
Even more than with adults, Anna Freud pointed out that symptoms
in childhood are often transitory and may mean very different things at
different ages. The same symptom in one child may be the result of a
developmental disturbance, while for another it may be an indication of an
internal confl ict; conversely, two quite different symptoms in different
children (one who steals and the other who suffers from enuresis) may well
be a reflection of remarkably similar underlying pathological dynamics.
Even trying to assess the severity of a child’s disturbance in childhood is
by no means straightforward, for the kinds of indicators that one might
consider using – degree of suffering, impairment of functioning, the nature
of the symptoms – may all prove, suggests Anna Freud, to be misleading
(p. 118).

The difficulty of making diagnoses based on symptomatology

To illustrate how difficult it can be to make a diagnosis based only on manifest

symptoms, Anna Freud gives a number of examples of situations where a
particular symptom could hold very different meanings for different children.
A child who is referred because of compulsive lying, for example, may simply
be behaving in that way because he has not yet reached a sufficient stage of
ego development where it is possible to distinguish clearly between reality
and fantasy; alternatively, it may indicate a delay in acquiring such an
important ego function (1970c: 162). However, another child presenting

120 Reading Anna Freud

with the same behaviour may, on closer inspection, be found to be lying
because of the ‘level and quality of the child’s object relations’ and the lying
may ‘express his fear of punishment and loss of love’ (p. 162). For a third
child, persistent lying may be a reflection, not so much of a failure in reality-
testing, but, rather, of a disturbance in superego functioning.
Likewise, when a child is brought to a clinic with concerns about the
withholding of faeces, such behaviour ‘may have its roots in a very early
vulnerability of the digestive system (i.e., psychosomatic); or it may be
symbolic of the child’s imitation of and identification with a pregnant mother
(hysteric); or it may signify his revolt against inappropriate forms of toilet
training (behavioural); or it may express phallic sexual needs and fantasies on
a regressed anal level (obsessional)’ (p. 162). The same could be true of other
symptoms, such as enuresis, sleep disturbance, separation anxiety or school
phobia (see Hayman, 1978, for an example of three cases of school phobia
which each had very different underlying causes). Clearly treating each child
as if his or her symptom had the same meaning, and therefore required the
same kind of intervention, would be highly inappropriate.
The fact that assessment and diagnosis are complex, however, is not a
reason to abandon this activity altogether and to embrace what Anna Freud
refers to as ‘diagnostic nihilism’; nor is it a reason to simply regard all
disturbances ‘as mere variations of the many vagaries and complexities of
human behaviour’ (1970c: 159). Indeed, it is not even necessary to turn away
from symptoms altogether, for after all, Anna Freud suggests, ‘if the clinician
is alerted to see opening up behind these [symptoms] the whole range of
possible derivations, causations, and developmental affi liations, the field
becomes fascinating, and scrutinizing a child’s symptomatology becomes a
truly analytic task’ (p. 184). From this perspective, symptoms can be
considered the psychological equivalent to what in bodily illness we might
think of as a fever: although it is possible, when a child is unwell, to treat the
fever itself, in itself the illness will not be cured unless there is some
investigation of what underlies the high temperature and treatment focuses on
that deeper cause. Whether the fever is likely to be a transitory problem, dealt
with most profitably by a day in bed and regular paracetamol, or whether it
is the indication of a more serious illness that requires immediate treatment,
is a vital diagnostic question with important therapeutic implications. In the
field of mental health, suggests Anna Freud, making such a differential
diagnosis is equally important:

Ideally the solution for the analytic clinician in the children’s field is a
classification of symptoms which, on the one hand, embodies consideration
of the various metapsychological aspects while, on the other hand,
maintains links with and pointers to the descriptive diagnostic categories
as they are in common use.
(p. 163)

The assessment and diagnosis of childhood disturbances 121

Anna Freud’s own attempt to develop such a system was to lead, in the
mid-1960s, to the development of a new approach to diagnosis based on a
developmental perspective.

Towards an alternative approach to assessment and diagnosis

In turning away from the traditional approaches to the assessment and

diagnosis of childhood disturbances, Anna Freud had set herself a challenge,
as she realised quite early on: ‘If . . . we decide to abandon the usual diagnostic
distinctions, we are left in a void which we need to fi ll’ (1956c: 304). But this
was also an opportunity:

Once we decide to disregard the diagnostic categories derived from

descriptive psychiatry for adult psychopathology and to play down the
importance of symptomatology as such, we can hope to be alerted more
vigorously to these other aspects of the patient’s personality. Where
children are concerned, these will be mostly developmental ones.
(p. 307)

This idea of putting the capacity to develop per se at the centre of the
diagnostic process was the key feature of Anna Freud’s new approach. If her
father had named the capacity to love and to work (S. Freud, 1916–17: 457)
as the crucial determinants of an adult’s mental health, then Anna Freud
argued that ‘the child’s capacity to move forward in progressive steps until
maturation [and] development in all areas of the personality . . . have been
completed’ was the equivalent for the child (1965a: 123). This meant that the
diagnostician had to avoid certain dangers that psychoanalysts had often
fallen into previously.
The first of these dangers was that of trying to understand all aspects
of development by means of studying the pathological. Anna Freud’s
approach to diagnosis had to begin by understanding a great deal
about normal development and having the language and the conceptual
framework to be able to describe what it means for things to ‘go well’. As
she wrote in 1974:

We have broken with the tradition [begun in her father’s work and
continued in much post-Freudian psychoanalysis] according to which
every mental difficulty is seen and explained by comparison with severe
pathological patterns and, instead, try to see it against the background of
the norm, expectable for the particular child’s age, and to measure its
distance from it. We have thus redirected the main bulk of our inquiries
from interest in pathology towards a study of the norm.
(1974[1973]: 60–61)

122 Reading Anna Freud

 The second danger that Anna Freud wished to avoid was an exclusive
focus on one aspect of development to the neglect of others. All too often,
she believed, new insights had emerged within the field of psychoanalysis at
the expense of older truths, rather than being seen as one of many factors in
a ‘complementary series’ of causal factors. Writing of analysts who had gone
before her, starting with Freud himself, she warned:

They did not guard sufficiently against their most recent work at any
period being given undue emphasis in application. In their own activity of
fact finding, one element of the human mind after the other moved into
the centre of attention and naturally received prominence in publications:
infantile sexuality and the sequence of libidinal stages; repression and the
unconscious mind; the division of the personality into various agencies
and the confl icts between them; the Oedipus and castration complexes;
the role of anxiety; aggression as an independent drive; the relationship
between mother and infant and the consequences of early interruptions of
the mother–child relationship. Yet, no single one of these factors was ever
meant to be considered the only or even the foremost pathogenic agent, as
happens all too frequently in clinical evaluations and publications.
(1962a: 361)

It was Anna Freud’s ambition to ‘replace this piecemeal and frustrating

application of psychoanalytic data by an assessment of children which includes
all the areas of the child’s mind’, organised systematically in order to ‘prevent
us from seeing the child one-sidedly’ (pp. 361–362). Such a scheme should
not only focus on what is wrong with the child, but also pay attention to
which aspects of development are progressing well (Yorke, 1995). The name
that Anna Freud and her colleagues came to give to this scheme was the
‘Diagnostic Profi le’ (1965a).

The assessment process and the Diagnostic Profile

In a paper on assessment and diagnosis of childhood disturbances, Anna

Freud comments on the high reputation that analysts often have among the
lay public regarding their diagnostic skills: ‘Some people even believe that an
analyst need only look at a complete stranger to know everything about him’
(1974[1954]: 41). Unfortunately (or fortunately) this is not the case, so Anna
Freud insisted that any diagnostic assessment relied on as wide a range of data
as possible: not only the observations made by the child analyst as part of the
diagnostic interviews (unstructured play sessions for younger children), but
also information from structured assessments (such as cognitive assessments
or projective testing), reports from school, interviews with parents and any
other relevant information.

The assessment and diagnosis of childhood disturbances 123

 The individual sessions with the child are an essential aspect of the
assessment process, because it is through them that one tries to develop
a sense of the subjective world of the child him/herself. Despite the
obvious advantages of more structured interviews for diagnostic purposes
(such as are widely used today), these more open, play-based sessions,
as Model (1995) has argued, are essential for both contacting and exploring
the child’s inner experience. Putting what is known from the outside to
one side temporarily, Green (1995) suggests that the assessing clinician
can see how the child ‘relates and plays out or narrates his internal
preoccupations’:

How has he made sense of his experiences? What are his wishes, pleasures
and hopes, his fears and sadness? What sort of internal figures inhabit his
world and what feelings have clustered around these figures? What too are
his feelings about himself?
(p. 173)

Bringing together this view of the child from the ‘inside’ with information
from the ‘outside’, it is the job of the diagnostician to synthesise this
information, alongside his or her own knowledge and understanding of
normal child development, without giving undue privilege to any one type
of data over another, as part of the diagnostic process. The ultimate aim is
to link the presenting problems with possible underlying causes, in order to
make both predictions about development and recommendations about any
potential treatment.
As was traditionally done at the Hampstead Clinic, a diagnostic conference
was held in relation to each assessment, during which the Diagnostic Profile
was presented and ‘discussion, criticisms and amendments . . . are contributed
freely by all participants and the principal investigator’ (A. Freud, 1962–66:
28). In this Diagnostic Profi le, information from the wide range of sources
was synthesised in three main sections:

• The first section, resembling a traditional case history, includes the reason
for referral, a description of the child, family history and background and
potentially significant environmental influences.
• The second section then moves towards an assessment of the internal
picture and the child’s overall development, taking into account the overall
structure of the child’s personality as well as ‘the child’s position on the
scales of drive (sexual and aggressive) development, of ego development,
and of the interactions between the two which manifest themselves in the
various steps towards social adaptation’ (1962a: 363). In this section the
Profi le looks at social and moral development and offers both a genetic
assessment (considering, for example, the degree to which development
has been arrested in certain areas, or whether there have been regressions

124 Reading Anna Freud

 due to particular stresses) and a dynamic and structural assessment,
considering the central confl icts governing the child’s behaviour, and
whether these confl icts are internal to the child or whether they are
confl icts with the child’s environment. This section ends by exploring
certain general characteristics of the child which may have a bearing on
the child’s capacity for health, such as the child’s capacity to bear anxiety
or his or her levels of frustration tolerance.

On the basis of all this, the diagnostician’s task is to ‘reassemble the items
mentioned above and to combine them in a clinically meaningful assessment’
(1965a: 147), in which the child’s capacity to develop is the central feature.
Anna Freud provisionally proposed six categories of diagnosis:

• Children whose personality development is essentially healthy, in spite of

current manifest behaviour disturbances;
• Children whose symptoms can be understood as a transitory reaction to a
specific developmental strain;
• Children with a classical ‘infantile neurosis’, where personality development
has proceeded normally, but internal confl icts have led to specific symptom
formation;
• Children with developmental disturbances, leading to borderline or
atypical presentation based primarily on disturbances in the early stages of
development;
• Children with primary deficiencies of an organic nature which have
distorted development;
• Children who have ‘destructive processes at work’, whether of an organic
or psychic origin, which have led to a profound disruption of mental
growth (p. 147).

An example of a diagnostic assessment

Kaplan-Solms and McLean (1995) give an example of the value of a diagnostic

profi le in the assessment of delays in language development, a relatively
common disorder of childhood. They discuss the case of a five-and-a-half-
year-old boy, A, who was referred to the Hampstead Clinic because of his
immature speech and poor motor skills. On assessment, it soon became
apparent that he also had a range of fears and phobias and his interaction with
his peers was poor. During the course of the detailed social history, it became
clear that A’s parents were a happy, successful couple who were well able to
attend to their child’s needs, but who nevertheless appeared highly anxious
about his development. At 19 months, A had a serious ear infection and
seems likely to have suffered some degree of hearing impairment, which was
only corrected just before his third birthday by a minor ear operation. It was

The assessment and diagnosis of childhood disturbances 125

only when he was almost four, and attending a full-time nursery, that
concerns were raised about A’s development, including his poor motor skills,
his fear of crowds and his dramatic temper tantrums.
The primary question for the diagnostician was whether A’s difficulties
should be considered as a neuropsychological abnormality, a disturbance
in reality-testing or a genetic or chromosomal syndrome; also, what
relation there was between the specific language delay and the wider
behavioural problems. Given the particular concerns, the usual play-based
assessment sessions were complemented by a neuropsychological assessment,
in which A’s speech and language symptomatology was considered in
relation to the organisation of these functions in the brain. Despite the very
different approach taken in these two types of assessment, the authors
point out that in both cases ‘the diagnostician wishes to understand the
presenting complaint rather than to measure it’ (p. 188). For both the child
analyst and the neuropsychologist, the important point was also the
interaction between speech and language difficulties and other aspects of
development.
The diagnostic profi le constructed on the basis of this assessment was
wide-ranging, covering every aspect of the child’s development. In relation
to the speech delay (the referring problem), the diagnostician suggested that
A’s speech problems showed all the characteristics of a syndrome that was
typical of children who suffered hearing impairments during critical
periods of language development. In particular, A had not made the
shift from ‘egocentric’ to ‘internal speech’, with significant implications for
other aspects of his development. ‘For example, he was unable to use
inner speech in the service of intellectual activity, reality testing and self-
regulation. . . . His frustration tolerance was poor because he could not
hold on to verbal explanations of things. . . . The resultant clinical
picture was complicated by the fact that the period of hearing loss
apparently left A with hypersensitivity to unfamiliar or sudden noise,
which became a focus for the development of many of his fears and phobias’
(p. 194).
On the basis of this assessment, the diagnostician was therefore able to
suggest that most of the behavioural and emotional difficulties were secondary
to his speech and language problems – which were in themselves best
understood in relation to his experience of hearing loss at a crucial
developmental phase. On the basis of this diagnosis, the Clinic recommended
specific remedial work to address the speech difficulties, but also recommended
psychoanalytic support ‘in order to secure his internalized verbal and self-
reflective function [and to] address directly the emotional sequelae of the
delay’ (p. 194). The assessment suggested that A’s speech delay had a simple
explanation, but that his experience had affected all aspects of his development,
and any intervention would be most effective if it attended to all aspects of
this difficulty.

126 Reading Anna Freud

Some uses and implications of the Diagnostic Profile

Anna Freud had ambitious plans for the Diagnostic Profi le, and she outlined
a series of research projects in the 1960s that would build on the work that
had been done at the Hampstead Clinic during this period. She hoped that
the Profi le could be conducted as both an initial assessment tool and at the
end of treatment (as well as two or three years after treatment), in order
to assess the impact that treatment had on children’s capacity to develop
(1962–66: 27). Although this was never carried through as systematically as
she had hoped, such ‘before and after’ assessments of the child based on the
Diagnostic Profi le were used in one study looking at the effectiveness of
psychoanalytic treatment for children with learning difficulties (Heinicke,
1965), and adapted versions of it were developed for use with infants (W. E.
Freud, 1967), toddlers (Furman, 1992), adolescents (Laufer, 1965) and adults
(A. Freud, Nagera and Freud, 1965), as well as for blind and deaf children
(Burlingham, 1975; Brinich, 1981). Anna Freud also hoped that the Profi le
could be used to try to identify developmental disturbances before they
reached the status of pathology and in order to allow preventative measures
to take place (1962–66: 37); to be able to investigate specific areas of
disturbance, such as borderline pathology or disturbances of narcissism, more
accurately (p. 45); and to assess the impact of childhood disturbances on the
mental disorders of adult life (1965a: 54).

The legacy of Anna Freud’s approach to the assessment and

diagnosis of childhood disorders

Anna Freud believed that detailed assessment and accurate diagnosis was a
cornerstone of good treatment in child mental health, just as it is in the field
of physical health. But in certain respects it has to be acknowledged that her
innovations in respect to the assessment and diagnosis of childhood disorders
have not had the impact that she hoped they would. Even as she was developing
the Diagnostic Profi le, Anna Freud realised that ‘to the majority of clinic
workers [it may] seem unduly complex’ (1962a: 367), and that there was a
risk that the process she was outlining might be too detailed or time-
consuming for it to be taken up beyond the rather unique setting of a specialist
setting such as the Hampstead Clinic.
Despite the attempts to avoid theoretical reductionism, the Diagnostic
Profi le also suffered from being heavily reliant on a conception of the human
mind (drive theory and the structural model) that gradually fell out of favour
in the years after Anna Freud’s death. Even among psychoanalytically trained
clinicians, the language and conceptual framework within which the
Diagnostic Profi le was couched became increasingly alien, as object relations
theory and other theoretical perspectives became more popular. After Anna

The assessment and diagnosis of childhood disturbances 127

Freud’s death, attempts were made to update the Diagnostic Profi le to
incorporate more contemporary psychoanalytic ways of thinking (Davids
et al., 2001), drawing on the insights from fields such as attachment theory
and the work of developmental researchers like Daniel Stern (1985) on the
development of the self; however, this revised version has not been widely
used.
In broader terms, Anna Freud’s argument against basing diagnosis
(especially for children) on overt symptomatology also appears to have been
a losing battle. Both of the major diagnostic systems in use today – the
Diagnostic and Statistical Manual of Mental Disorders (DSM, published by the
American Psychological Association) and the International Classification of
Diseases (ICD, published by the World Health Organization) – use diagnostic
categories based almost exclusively on symptomatology and make very little
distinction between diagnostic criteria for mental disturbance in childhood
or in adulthood. Clearly there are great advantages to a symptom-based
approach to diagnosis, which is both relatively simple to carry out (as Anna
Freud had learned all those years ago on the psychiatric ward rounds in
Vienna) and relatively reliable and consistent. Especially for researchers,
having a shared diagnostic framework that allows researchers in one setting
to reliably compare their findings with those of researchers working elsewhere
was an important step forward in the development of a cumulative field of
knowledge about key aspects of child and adult mental health.
But in recent years, there have also been signs that some of Anna Freud’s
key points about assessment and diagnosis in child mental health are
beginning to find favour again. Descriptive and atheoretical approaches to
classification, such as that used by the DSM, are increasingly seen as of limited
value, with authors such as Luyten et al. (2006), for example, referring to a
‘growing consensus [which] indicates that it is extremely unlikely that a
classification system of depression based on an assessment of manifest
symptoms alone is feasible’ (p. 987). Without referring to the work of Anna
Freud itself, these authors go on to refer to ‘findings from a wide variety of
fields, including psychiatric genetics, neurobiology, developmental
psychopathology, cognitive, psychodynamic, social and personality
psychology [which] converge to suggest that depression can be best understood
in the context of an etiologically based, dynamic interactionism model’
(p. 991).
These authors – working at the cutting edge of mental health research – offer
a way of thinking about assessment and diagnosis in which endowment
(including genetic factors) and early environmental factors are seen to
reciprocally interact, creating personality dimensions that in turn interact with
life stresses. It is just such a perspective that Anna Freud always argued for,
resisting any form of reductionism, and making it possible that assessment and
diagnosis, even in a field as complex as child mental health, could form the basis
for a much more nuanced and targeted approach to mental health treatment.

128 Reading Anna Freud

FURTHER READING

Anna Freud’s own writing about assessment and diagnosis can be found in
almost every volume of her collected works, but is probably most widely
available in her 1965 work, Normality and Pathology in Childhood.
Childhood d. It is in
that book that she outlines her ideas about the Diagnostic Profile, although the
book does not contain any actual examples of what a Profile might look like.
To find actual examples, it is best to look in the Bulletin of the Hampstead
Clinic – for example, Hodges (1986), Kaplan (1994) or Model (1995). Key
papers, along with examples of the various adaptations of the Diagnostic
Profile, for use with babies, adolescents and adults, have been collected
together in a volume edited by Eissler et al. (1977), which serves as an
important sourcebook for writings about the Diagnostic Profile. More
contemporary appreciations of Anna Freud’s approach to diagnosis can be
found in Midgley (2011) and Hartnup (2012).
Debates about the appropriate form of assessment and diagnosis in child
mental health continue to fill the professional literature, especially when it
comes to the value of the DSM and ICD systems of classification. In recent
years, a group of psychoanalysts attempted to develop a mixed approach, in
which the DSM-style emphasis on symptomatology was linked with more
psychodynamic ideas about etiology and underlying types of disturbance. The
resulting work – which includes a separate section on childhood disorders –
was published as the Psychodynamic Diagnostic Manuall (PDM) by the
Alliance of Psychoanalytic Organizations in 2006. In Europe, a similar project
resulted in the Operationalized Psychodynamic Diagnostics s (OPD) system,
which has been used as the basis for a number of research projects. Neither
system, however, has been adopted outside the field of psychodynamic
research, and it is unlikely that such alternative systems would ever replace
the influence of systems such as the DSM and ICD. Attempts to influence
these systems from within, through the process of revision which both systems
periodically undergo, may be a more effective approach in the long run. Such
ongoing critiques of existing models of psychiatric diagnosis (e.g. Shedler and
Westen, 2004) will be vital if Anna Freud’s vision of a broad, developmentally
based approach to assessment and diagnosis is ever to gain a wider influence.

The assessment and diagnosis of childhood disturbances 129

9 DEVELOPMENTAL
PSYCHOPATHOLOGY

KEY WRITINGS

1965 Normality and Pathology in Childhood

1972 ‘The Widening Scope of Psychoanalytic Child Psychology, Normal
and Abnormal’
1974 ‘Beyond the Infantile Neurosis’
1974 ‘A Psychoanalytic View of Developmental Psychopathology’
1976 ‘Psychopathology Seen against the Background of Normal
Development’
1978 ‘The Principal Task of Child Analysis’
1979 ‘Mental Health and Illness in Terms of Internal Harmony and Disharmony’
1979 ‘Child Analysis as the Study of Mental Growth, Normal and Abnormal’

Introduction

If Anna Freud’s work on the Diagnostic Profi le (Chapter 8 ) had been an

attempt to revise the way in which childhood disturbances were assessed, it
led her on to an even more ambitious aim: to reconceptualise our view of the
developmental process itself and, with it, the idea of childhood difficulties as
‘disorders of development’. If her book The Ego and the Mechanisms of Defence
was her main theoretical contribution during the early part of her career,
then the work that was published as Normality and Pathology in Childhood in
1965, and subsequently elaborated in a number of other papers, was certainly
the main theoretical contribution that she made in the later part of her career
as a psychoanalyst. Although possibly less widely read than the earlier book,
it is arguable that the latter has come to be of greater significance to modern
developments in the study of childhood disorders, even if the work itself is
not always given acknowledgment.

Why study normal development?

Although psychoanalysis had begun as the study of specific aspects of

psychopathology, from its earliest times there had been an implicit interest in

130 Reading Anna Freud

developing models of normal development. The work of Freud (1905) and of
Abraham (1924), for example, had led to a better understanding of the
development of drives and libido, while later analysts had undertaken detailed
investigations of particular periods of development. Anna Freud was especially
impressed, for example, by Spitz’s work (1965) on the first year of the infant’s
life and the development of object relations, and by Mahler’s work on the
toddler years and the process of separation–individuation (1975), both of
which incorporated empirical studies of particular stages of development
with psychoanalytic ideas. But Anna Freud was cautious about the emphasis
each of them gave to one particular stage of development (whether infancy
or toddlerhood) as central to the development of health or mental illness. She
also drew inspiration from the more theoretical work of Heinz Hartmann
(1939), who had introduced the idea that psychoanalysis could contribute to
an understanding of both normal and deviant development by focusing on
the process of adaptation, although she once again rejected the specific focus
he gave to one aspect of development – adaptation – rather than to the wide
range of developmental processes.
But more than anything else, Anna Freud’s emerging ideas about a
‘psychoanalytic developmental psychology’ drew on her own experience and
observations, especially the work that she and her colleagues had carried
out at the Hampstead War Nurseries. Already in The Ego and the Mechanisms
of Defence (1936) Anna Freud had tried to set out how the mechanisms of
defence were used differently across the lifespan, with some defences (such as
splitting or denial in fantasy) associated specifically with very early stages of
development, and some (such as sublimation) more characteristic of
later stages. But her day-to-day involvement with the care of children,
alongside her ongoing child analytic experience, led her to appreciate
the complexity of human development. Her attention moved beyond the
mechanisms of defence – or even the development of the ego – to what she
called, in one of her very last lectures, ‘the steps of the humanizing process
which mark the child’s path from immaturity to maturity’ (1982: 260). She
became increasingly aware that what psychoanalysis had discovered
about human development was mostly in the form of ‘isolated facts’, stumbled
upon ‘as by-products of therapeutic analyses’ (1974[1973]: 62). While each of
these may have value, there was a real danger that the part was mistaken
for the whole:

Some authors fasten onto the birth process itself, hold its accumulation of
distress responsible for creating an imbalance within the pleasure–pain
series and for reducing the child’s later frustration tolerance. Others choose
as the vital era the first year of life with the transition from primary
narcissism to object-directed libidinal interests, the whole process
monitored by a successful or stunted by a deficient mother–infant
relationship. Following Margaret Mahler’s lead, still others select the

Developmental psychopathology 131

 fascinating period of separation–individuation in the second year of life as
the crucial one for deciding about the individual’s further healthy
independence and intact sense of identity.
(1979a: 122)

But such details about one particular period or aspect of development,

however valuable in themselves, ‘do not really satisfy our need for a detailed,
orderly picture of the growth of the child’s integrated personality’ (1974[1973]:
62). In order to try to build such a picture, Anna Freud proposed a wide-
ranging approach to describing the various components of the humanising
process, one that could form the basis for an understanding of both normal
and pathological development.

The concept of developmental lines

Anna Freud’s metaphor of ‘developmental lines’ marked her attempt to create

a set of useful markers of a child’s progress across the whole spectrum of
development. She described each of the lines as ‘ladders leading up to every
one of the expected achievements of the child’s personality, each step on
them being the result of the interaction between id, ego and environment
(1974[1973]: 63). Far from being abstractions, she hoped that these lines of
development could be seen as ‘historical realities which, when assembled,
convey a convincing picture of an individual child’s personal achievements
or, on the other hand, of his failures in personality development’ (1965a: 64).
Whereas Anna Freud’s model of the diagnostic profi le offered a means by
which highly specialist child analysts could make metapsychological
formulations concerning the underlying processes contributing to a child’s
disturbance, with the concept of ‘developmental lines’ she aimed to offer
something far more practical and useable in a range of settings where people
are concerned with the welfare of young children. Mayes and Cohen (1996)
refer to the developmental lines as a ‘semi-scaled method for assessing
children’s relative normality or deviancy from expected patterns of
psychological development’ – a kind of ‘analytic metric’ of mental maturity
and integration (p. 125). Such a metric would aim to help those working
with, and caring for, children answer very simple questions, such as ‘is my
child ready for nursery school yet?’ or ‘how should I make sense of the fact
that my child has begun to lie to me?’ But if this sounds dangerously simplistic,
those authors point out:

. . . to view lines of development as simply descriptive maps of developmental

normalcy or deviation is to be lulled by the deceptive simplicity in Anna
Freud’s presentation. Contained in the notion of progression along different
lines of development is a radical rethinking of the basic questions of

132 Reading Anna Freud

 developmental psychology: what moves development along, and how does
maturation occur? The notion of developmental lines contains within it
a heuristic framework for understanding (and investigating) mechanisms
of development.
(p. 125)

An example of a developmental line

Anna Freud provides a number of examples of developmental lines in

Normality and Pathology in Childhood (1965a). These include various lines
describing aspects of the steps towards bodily independence (e.g. ‘from
wetting and soiling to bladder and bowel control’) and ones describing
aspects of social relationships (e.g. ‘from egocentricity to companionship’,
and ‘from the body to the toy and from play to work’). In her later writings,
she adds other examples, such as the line ‘from physical to mental pathways
of discharge’, or ‘from irresponsibility to guilt’ (1974[1973]).
But throughout her writing Anna Freud comes back to one particular
example of a developmental line that she suggests is a ‘prototype’ from which
all others can be drawn – the line ‘from dependency to emotional self-reliance
and adult object relationships’. It appears that Anna Freud selects this as a
prototypical line because this aspect of development is one that has been of
central importance to psychoanalysis since its origins, and it is one that best
illustrates how progress depends on complex interactions between innate
maturational processes, endowment and experience. It is also a developmental
line that could be sketched out in 1965 on the basis of a great deal of prior
research, including the findings from child and adult analyses and a whole
series of observational studies. It is, to use a term introduced by Glaser and
Strauss (1967), a ‘grounded theory’, although one that would perhaps look
somewhat different if findings from the subsequent 50 years of research were
taken into account.
As a psychoanalyst best known as an ‘ego psychologist’, it may perhaps be
surprising that Anna Freud chose the development of object relations as the
prototypical developmental line. But Anna Freud always gave equal weight
to endowment and to environment, just as she did to the importance of
internal and external reality. The focus of this particular developmental line
reflects the way in which Anna Freud believed that one needed to pay
attention to both ‘internal object relations’ (to use the phrase associated with
the work of Klein and Fairbairn) and actual relations to ‘real’ external objects,
whose relationships to the developing child have a profound impact on their
development.
In Normality and Pathology in Childhood, Anna Freud suggests that there are
eight key steps in this prototypical developmental line, running from the
complete dependency of the newborn infant to the young adult’s emotional

Developmental psychopathology 133

self-reliance and mature object relations. Key stages along the way would
include the establishment of object constancy (Stage 3), in which an ongoing
internal image of the object can be maintained, despite the actual presence or
absence of the primary carer; and ‘the latency period’ (Stage 6), during which
there is an important shift in cathexis from the parental figures to peers,
teachers and ‘aim-inhibited, sublimated interests’. (For a detailed summary
and discussion of this developmental line, see Edgcumbe, 2000: 115–126.)

The interaction between developmental lines

In proposing the concept of developmental lines, Anna Freud was also taking
a major step forward in thinking about what Mahon has described as ‘the
mysterious complexities of normality’ (2001: 77). For many psychoanalysts
before (and even after) Anna Freud, ‘normality’ or ‘mental health’ has been
described simply in the negative, as the absence of mental illness or pathology.
But Anna Freud was suggesting that normal development is a rich and
fascinating process in itself, worthy of psychoanalytic study.
For Anna Freud, ‘normality’ should not be characterised by steady progress
along each of the developmental lines, comparable to the fairly prescribed
paths of physical maturation that the child’s body follows:

Whilst on the physical side, normally, progressive development is the only

innate force in operation, on the mental side we invariably have to count
with a second, additional set of influences which work in the opposite
direction, namely, with fi xations and regressions.
(1965a: 93–94)

She saw in particular that temporary regressions along any one of the lines of
development could well be an important aspect of a child’s overall
development. Such temporary regressions can happen at particular points
during the day (think of the child who, when tired, becomes more clingy,
difficult and demanding, but regains his normal equanimity after a good
night’s sleep) or in response to particular life events. So a young child, when
faced with the birth of a new sibling, may well regress to an earlier stage on
the line of development towards self-reliance, becoming temporarily more
demanding and ‘babyish’ in her behaviour and her demands towards her
parents. Such a temporary regression can be seen as serving an important
function, allowing the child to reassure herself that she hasn’t lost her parents’
care, before she moves forward once again. Indeed, such a temporary
regression may be more developmentally appropriate than its opposite – that
is, a sudden and abrupt advance along one of the developmental lines. With
aggression, for example, Anna Freud describes young children who, almost
overnight, suddenly overcome previously aggressive behaviour and become

134 Reading Anna Freud

shy and restrained. ‘Convenient as such transformations may be for the child’s
environment,’ Anna Freud notes, ‘the diagnostician views them with
suspicion and ascribes them not to the ordinary flow of progressive
development but to traumatic influences and anxieties which unduly hasten
its normal course.’ The most healthy version of psychic growth, she suggests,
is the ‘slow method of trial and error, progression and temporary reversal’
(1965a: 99).

Regressions, fixations and developmental arrests

In Normality and Pathology in Childhood, Anna Freud makes the distinction

between temporary regression, fi xation and developmental arrest. Whereas a
temporary regression is most likely to be in the service of overall development,
fi xations and arrests may have a more detrimental impact on a child’s overall
development.
Green (1995) gives the example of Thomas K, an 11-year-old boy who was
referred to the Anna Freud Centre because of his many anxieties linked to
separation. In exploring the background to the referral, it became clear that
there was an intergenerational pattern of traumatic losses, which had led
Thomas’s mother to find her son’s clingy behaviour as a toddler extremely
difficult to bear. When he had expressed the (developmentally appropriate)
need to stay close to her, she had often responded with impatient annoyance,
which had only exacerbated his clingy behaviour and his anxiety about
separation. With help from the therapist, Thomas’s parents were able to change
the way they handled his behaviour, but his anxiety about separation continued.
In an individual assessment, it became clear that Thomas suffered from
powerful fears that he himself knew to be irrational, such as the belief that
every time his parents went out of the house they might sneak away and never
return home. These fears had not just developed in reaction to recent events,
but had been long-standing – indeed, there had never really been a point at
which he had not had such concerns. One might say that there had been a
developmental arrest, and that Thomas had never been fully able to move
forward on the developmental line from dependency to emotional self-reliance.
In another case, Kevin (aged ten) also expressed separation anxieties in
relation to his parents, but the social history made clear that this boy had
been able to overcome some of his earlier anxieties about separation and
manage the transition to primary school and a life away from home quite
well. However, when he was ten, his mother had been diagnosed with a
cancer, and although treatment had been successful, Kevin had developed
extreme anxieties when his mother was out of his sight. Like Thomas, he
knew that to some degree these anxieties were ‘irrational’, but that did not
stop them from having a powerful effect, and the anxieties did not disappear
naturally, even after his mother had been physically well for a number of

Developmental psychopathology 135

months. Unlike Thomas, who had never really progressed along this
particular developmental line (i.e. his development had been arrested at an
earlier stage), Kevin had been able to move forward, despite some early
difficulties in the separation–individuation phase, but when faced by a
stressful situation later in childhood, his ‘fi xation’ at the early developmental
stage led to a regression. Unlike the temporary regressions that are part of all
normal development, this regression was in danger of becoming permanent,
and the assessing clinician recommended that analytic help was needed in
order to restore him to a path of normal development.

The developmental lines and psychological well-being

While each of the lines focuses on one important aspect of development,

Anna Freud believed that a child’s psychological well-being ultimately
depended on the interaction or correspondence between the lines. Without
implying a hierarchy as such, she suggested that various developmental lines
had a ‘different value for the final personality picture’ (1979a: 130). The lines
towards, for example, secondary-process functioning, reality sense, objectivity
and insight were more essential, with others, such as the lines towards impulse
control, peer relationships or even sex being to some degree secondary,
considering that ‘numerous individuals achieve no more than partial results’
in terms of their development in these areas, without it necessarily affecting
their overall developmental progress.
But more than weighing up the relative importance of each particular
developmental line, Anna Freud saw ‘average normality’ as being based
primarily on a harmony, or close correspondence, between growth on each
of the lines. Her definition of a ‘harmonious personality’ was one whose
progress in one particular area (e.g. the achievement of object constancy in
the line of emotional maturity) would be synchronous with progress in others
(such as the shift from egocentricity to companionship). With her typical
realism, however, Anna Freud adds: ‘We maintain this expectation of a
norm, even though reality presents us with many examples to the contrary’
(1965a: 85).
Indeed, it is this acceptance of the complexity of normal development that
is a cornerstone of Anna Freud’s thinking. Although she described a process
of ‘synchronization’ and ‘integration’ that is an inherent part of psychic
growth, she also recognised that every step on a developmental line is also ‘a
compromise between confl icting forces’ and that the process of integration
brings together all those contradictory features that are responsible for ‘the
numerous variations, deviations, quirks, and eccentricities displayed in the
final personalities’ (1979a: 129). Although the model of lines or ‘steps’ implies
some achievement of an ideal norm, in which an individual would reach an
age-appropriate level in every aspect of development on the way towards a

136 Reading Anna Freud

‘completely harmonious, well-balanced personality’, in reality Anna Freud
understood all too well that ‘such states of ideal normality do not exist except
in our imagination’:

In fact, progress on any line is subject to influence from three sides: the
variation in innate givens, which provide the raw material out of which id
and ego are differentiated; the environmental conditions and influences,
which only too often differ widely from what is appropriate and favourable
for normal growth; the interactions between internal and external forces,
which constitute the individual experience of each child. . . . [W]hatever
happens in the individual picture, we are left with the impression that it is
this variety of progress on the lines, i.e. developmental failures and
successes, which can be held responsible for the innumerable variations in
human characters and personalities.
(1974[1973]: 69)

The uses of the developmental lines

One of Anna Freud’s earliest publications, Four Lectures on Psycho-Analysis for

Teachers and Parents (1930), had been an attempt to translate psychoanalytic
ideas into a language that would be accessible and useful for a range of adults
who were dealing with children – whether parents, teachers, social workers
or residential care workers. Yet such an act of translation was not always easy.
In 1960 Anna Freud recalled a lecture that she had once given to the Nursery
School Association of Great Britain in the early 1940s, and the sense of a
failure of communication that she had experienced:

When I talked about the hidden motivation of behaviour, they would have
preferred me to deal with its manifest and visible aspects; when I laid stress
on the emotional life of the child with all the ensuing complications, this
appeared to them rather as neglect of the child’s skills, intellectual needs,
and interests; my emphasis on the past events and their impact on the
building up of personalities appeared to distract attention from the
conditions actually present.
(1960a: 316)

With the publication of Normality and Pathology in Childhood, however, and

especially with the concept of ‘developmental lines’, Anna Freud hoped that
she had found a language that would allow psychoanalysts to enter into a
better dialogue with those outside psychoanalysis about issues of very practical
importance – questions as apparently mundane and everyday as: ‘at which
level of development can we expect children simply to go to bed when they
are tired or to eat when their body demands nourishment?’ (1982: 264) or

Developmental psychopathology 137

‘when does falsification of truth begin to deserve the name of lying?’ (1965a:
114). Anna Freud believed that using the developmental lines could help
parents and childcare workers to assess whether a particular child was ready
to face a certain challenge – and, if not, what areas of development would
need to be supported before that child would be ready. Many of her
publications from the last 15 years of her life are based on presentations to a
range of childcare workers, in which she tried to help them to think with
greater complexity about the needs of the children with whom they were
working and to support them to best address those needs. Their more
specialist use, as part of a diagnostic assessment of children with developmental
disturbances, was in some ways of secondary importance, compared to the
way in which they were designed to help think about the rich tapestry of
‘normal’ development.

An example of the use of developmental lines: When is a child

ready for nursery school?

One of the examples that Anna Freud often gave of the potential value of her
thinking concerning developmental lines was the issue of assessing when a
child is ready to start formal education. This is a question that is still widely
debated today, with considerable variation across different cultures. Like the
over-reliance on symptoms as a basis for diagnosis, Anna Freud believed that
chronological age was an overly crude marker of a child’s readiness for school
and that an assessment of a child’s readiness for school needed to be made in a
more nuanced way. Even assessments that were more tailored to the individual
child, but focused only on one aspect of development (e.g. cognitive ability),
were of limited value, she believed, because a child’s readiness depends
crucially on the correspondence between a range of lines of development.
Thinking in such a way would allow a more careful assessment of a child’s
capacity, for example, to separate from their primary caregiver, to behave in
an adequate manner in the classroom and to tolerate (and enjoy) group life –
all essential aspects of the nursery school experience (1960a: 320).
In looking at the particular example of a child’s readiness for nursery
school, Anna Freud described the still common assumption (at least in Britain
in the 1960s, when she first wrote about this subject) that once a child was
three-and-a-half years of age he should be ‘able to separate from his mother
on the first day of entry at the outer door of the nursery school building and
should adapt to the new physical surroundings, the new teacher, and the new
playmates all in one morning’ (1965a: 89). If a child showed distress, or
continued to cry, or failed to participate in the activities with other children,
this was seen as simply part of what the child had to manage. In some cases,
after a period of fairly intense unhappiness, the child might then settle down
into the routine of the nursery; in others, after an initial period of apparent

138 Reading Anna Freud

enjoyment, the child might suddenly break down after several weeks and
show great anger and distress. Either way, such behaviour was considered an
inevitable part of a child’s adaptation to nursery life, and little distinction was
made between how different children responded to this experience. (The
fact that this is no longer the case in the huge majority of nursery schools is
partly a tribute to the work of Anna Freud and others like her, who helped
nursery workers to think differently about children’s developmental needs.)
Anna Freud then proposed a different way of thinking about a child’s
readiness, based on the developmental lines. In speaking to a conference of
the Nursery School Association of Great Britain (the very audience that she
had struggled to communicate with in the late 1940s), she argued that asking
teachers, whether as part of their training or of their ongoing professional
life, to have a detailed understanding of developmental psychopathology was
perhaps too much to expect; however, learning something about the lines of
development could help teachers make better judgements about ‘which
complexities in the external life experiences and the inner mental processes
of the child determine success or failure in living up to the demands of the
nursery school’ (1960a: 320), and so assist them to do their jobs better.
For a child to be able to manage a separation from the primary caregiver,
Anna Freud then suggested that he or she probably needs to be at least at
Stage 3 (object constancy) on the line ‘from dependency to emotional self-
reliance’. After all, if the child is not able to maintain an ongoing and relatively
stable representation of the caregiver, even in his or her absence, then it is
unlikely that the child will be able to either tolerate the separation or reach
out to new people and engage in new ventures. Likewise, in order to cope
with some of the expectations of the nursery setting (at least as those
expectations were set in the 1960s), the child probably needed to have reached
at least Stage 3 in the line towards bowel and bladder control (i.e. through
identification, the child has been able to accept and take over the environment’s
attitudes to cleanliness) and Stage 4 on the line ‘from suckling to rational
eating’ (i.e. able to feed him/herself, and no longer directly equating food
with mother at a psychological level). Anna Freud also considered what level
the child would need to have attained in the lines ‘from egocentricity to
companionship’ and ‘from play to work’ for the child to be able to make use
of the opportunities that nursery school provides, rather than to experience
them as demands beyond his or her current capacity.
We do not know what response Anna Freud received from her audience in
1960, but what she notes is that ‘the knowledge that there are difficult
children has become acceptable and respectable’ among nursery school
workers (1960a: 317) and that their associations were now actively involved
in seeking better ways to support teachers to work with such children.
Without wanting to try to train them to become psychoanalysts, or even
mental health workers, Anna Freud argued that ‘teachers of young children
should be taught to understand the variations which exist within normal

Developmental psychopathology 139

childhood development’ (p. 333) and that such knowledge would help them
to meet the needs of the children they were working with that much better.

The legacy of Anna Freud’s approach to the study

of development

When she first published Normality and Pathology in Childhood, Anna Freud
was partly responding to a problem that had long been recognised in
psychoanalysis (her father had written about it, for example, in his case study
of female homosexuality, 1920b) but had yet to be sufficiently addressed: that
although analysts were expert at reconstructing their patients’ histories, and
tracing back their symptoms to the very earliest years of infancy, they were
far less successful at the task of prediction – that is, identifying potentially
pathogenic agents before they had done their work, or being able to predict
development in a way that would allow for the possibility of preventative
interventions. ‘Whilst the recognised training for psychoanalytic therapy
will prepare the candidate for the former tasks,’ she wrote, ‘no official
curriculum has been devised so far to equip him for the latter’ (1965a: 54).
Anna Freud’s attempt to sketch out what one could call a ‘psychoanalytic
developmental psychology’ was her response to this problem, and her work
on the developmental lines can be thought of as a template for a potential
training curriculum. Her belief was that by taking ‘the totality of
developmental lines as described to date and as to be constructed in the
future, we arrive at a new view of child development’ (1974[1973]: 68), one
that could radically reorientate the way people think and work:

We have broken with the tradition according to which every mental

difficulty is seen and explained by comparison with severe pathological
patterns, and, instead, try to see it against the background of the norm,
expectable for the particular child’s age, and to measure its distance from it.
(1974[1973]: 63)

Such an approach would have implications for research and treatment with
both children and adults, for the lack of any clear model of the pre-stages for
the characteristics of adult personality ‘not only leaves a gap in developmental
theory; it also creates the false impression that such achievements are come
by easily’ (quoted by Meurs, Vliegen and Cluckers, 2005: 192). A lifespan
approach to development, drawing on the rich insights gained by
psychoanalysis, could make a significant contribution to the understanding
and treatment of both child and adult psychopathology.
Mayes and Cohen (1996), in an incredibly rich reading of Anna Freud’s
model of a psychoanalytic developmental psychology, suggest that there are
three principles that became increasingly central to Anna Freud’s thinking:

140 Reading Anna Freud

• The first is the idea that development proceeds not in a predominantly
stage-based manner but more continuously, with progressions and
regressions, with the personality being transformed and organised in
progressively more complex and hierarchical ways;
• Secondly, that development involves subtle interactions among various
lines or functions, and that progression can be either harmonious or
imbalanced;
• Thirdly, that an understanding of the complexities of normal development
is a means of understanding the presence or absence of psychopathology
(p. 124).

Mayes and Cohen (1996) point out that developmental lines should not just
be thought of as ‘descriptive evidence that maturation was occurring but as
metapsychological structures involved in the actual regulation of development’
(p. 127). They use the metaphor of ‘regulatory genes’ to suggest the way in
which Anna Freud’s model of development offers a sophisticated picture of
what might now be thought of as a ‘gene × environment’ interaction, in
which the activation of a certain aspect of development is set off by a genetic
code, but whether that potential is only fully or partially expressed may
depend on timing and environmental conditions. In this metaphor, Anna
Freud’s view of the importance of harmonies and disharmonies between
different lines of development (as opposed to the more traditional views of
intrapsychic confl ict, fi xation and regression) suggests to Mayes and Cohen
how development depends fundamentally on the interplay of biological and
psychological processes. They conclude that Anna Freud

. . . created a general psychology of development built not on discontinuous

phases but on seamless continuity. It allows for innate endowment and for
complex interactions among areas of development and between biology
and experience. Despite her relative isolation from the formal academy,
Anna Freud created a remarkably current model of development that
implicitly draws upon principles of neurobiology, genetics, pediatrics,
and social psychology.
(p. 134)

But Mayes and Cohen also describe Anna Freud’s project as an ‘unfinished
work’, one that failed to clarify how a sense of self, for example, emerged
from developmental lines as the regulators of development, and they
attribute this shortcoming to her reluctance to entirely give up a model
that centred on the concept of drives. They suggest that for a general
psychoanalytic developmental psychology to become more fully realised
would require a greater level of dialogue with other disciplines, including the
more empirical disciplines of neuroscience, child psychiatry and developmental
psychology.

Developmental psychopathology 141

 Alongside the emphasis on the study of normal development, Anna Freud
also introduced the term ‘developmental psychopathology’, to refer to the
study of child (and ultimately adult) disturbance as a deviation from the path
of normal development. Meurs, Vliegen and Cluckers (2005) point out that
Anna Freud first used this term in 1974, in the same year as Achenbach (an
experimental clinical child psychologist, and the developer of the widely
used ‘Child Behaviour Checklist’), and that this field of study can best be
thought of as a coming together of psychoanalytic and mainstream empirical
work. It is an approach that explores disordered behaviour in terms of its
departure from normal development and proposes that there are complex
interactions at work between biological, genetic and environmental factors.
The work of the modern developmental psychopathologists (including
researchers such as Alan Sroufe, Michael Rutter, Robert Emde and Dante
Cicchetti) also draws on findings from a range of disciplines to demonstrate
how the mind (and brain) deals with stress and trauma and how individuals
may shift between normal and abnormal functioning in response to such
experiences. In a review of the history of the discipline, Cicchetti and Toth
(2009) define it as ‘an evolving interdisciplinary scientific field that seeks to
elucidate the interplay among the biological, psychological and socio-
contextual aspects of normal and abnormal development across the life force’,
with a critical emphasis on adopting a ‘developmental perspective in order to
understand the processes underlying individual pathways to adaptive and
maladaptive outcomes’ (p. 16). They go on to say that the defining
characteristics of this discipline include an attempt to reduce the division
between empirical research and clinical studies, as well as those between the
behavioural and biological sciences and between basic and applied research.
The basic theme that runs through all work in the field, the authors claim, is:

. . . that because all psychopathology can be conceived as a distortion,

disturbance or degeneration of normal functioning, it follows that, if one
wishes to comprehend psychopathology more fully, then one must
understand the normal functioning with which psychopathology is
compared.
(p. 17)

If all of this sounds familiar from the work of Anna Freud in the 1960s and
1970s, that is not a coincidence. Yet by the 1990s, when developmental
psychopathology had become a major field in its own right, the link to
psychoanalysis was mostly forgotten or mentioned only in passing. Cicchetti
and Toth’s review paper, for example, mentions psychoanalysis as one of the
disciplines that contributed to the emerging field of developmental
psychopathology, but it makes no reference to the work of Anna Freud. Only
in the work of analysts such as Fonagy and Target, who published their book
on Psychoanalytic Theories: Perspectives from Developmental Psychopathology in

142 Reading Anna Freud

2003, has the link with the work of Anna Freud and others been preserved
and the tradition of integration of psychoanalysis with these emerging
disciplines been promoted. As Mayes and Cohen (1996) point out, in
reviewing the links between Anna Freud and these modern areas of research,
the ‘central tenets of a developmental psychopathology approach sound
remarkably similar to Anna Freud’s emphasis on a general developmental
psychology for children’ (p. 130).
Yet writing in 1974, almost ten years after the publication of her major
work on developmental psychology and the developmental lines, Anna Freud
lamented that the list she had created of the developmental lines was by no
means complete, and that others had not completed the work she had begun.
Although some of her colleagues did sketch out some other lines of
development, such as the line ‘from diffuse somatic excitation to signal
anxiety’ (Yorke, Wiseberg and Freeman, 1989) or the developmental line for
language acquisition (Edgcumbe, 1981) or for gender identity (Tyson and
Tyson, 1990), Anna Freud herself was left with the sense that her challenge
to her colleagues to build a psychoanalytic developmental psychology had ‘so
far not been taken up’ (1974[1973]: 64). In one of her last publications, on
‘The Principal Task of Child Analysis’ (1978b), she reminded her audience of
the opportunity available to them. Whereas classical psychoanalysis had built
up an understanding of the mind based on the dissection of psychic material
and reconstruction of past events, child analysts were in a unique position to
follow things ‘in the opposite direction, i.e. may make the vicissitudes of
forward development . . . its specific aim’. She concluded with a challenge
that, in the light of the most recent work on developmental psychopathology,
may well prove to have been prophetic:

To engage in all this may be a preferable way for child analysis to emulate
classical psychoanalysis. As the latter had produced metapsychological
theory as its crowning achievement, the former can add to this a new,
developmentally oriented psychoanalytic theory of child psychology.
(1978b: 99–100)

FURTHER READING

One of the best commentaries on Anna Freud’s developmental perspective

can be found in the book by Rose Edgcumbe (2000), a long-time colleague
and collaborator of Anna Freud’s at the Hampstead Clinic/Anna Freud Centre.
Other useful overviews of Anna Freud’s developmental way of thinking are
provided by Holder (1995), Neubauer (1984, 1996) and Yorke (1996).
Flashman (1996) offers an interesting perspective on the concept of
‘developmental lines’, and their value in understanding the phenomenon of

Developmental psychopathology 143

 adolescent suicide is illustrated by King and Apter (1996). Sophie Freud
(1988), Anna Freud’s niece and a Professor of Social Work in Boston, offers a
sympathetic but critical analysis of Anna Freud’s concept of ‘developmental
lines’. On the one hand, she recognises the value of seeing ‘the child as a
whole’ and the importance of looking at the interactionn between developmental
lines as a way of assessing normality and psychopathology. But on the other,
she also argues that the lines ‘have no basic common organizational or
transformational theme’ and ‘seem to be chosen haphazardly and from very
different conceptual levels’ (p. 308). Most importantly, she argues that they are
too cumbersome to be used in everyday practice and that their practical utility
is therefore minimal.
The literature on developmental psychopathology is now vast, but a good
introduction to it can be found in the paper by Cicchetti and Toth (2009),
referred to in this chapter. For the particular contribution that psychoanalysis
has made to the field of developmental psychopathology, see Fonagy and
Target (2003). Mayes and Cohen (1996) make a strong case for the value of
Anna Freud’s work as a precursor of this field, while the collection of papers
edited by Mayes, Fonagy and Target (2007) demonstrates what a contemporary
integration of psychoanalysis and developmental science can look like. Such
an integration has also become a characteristic of training courses at the Anna
Freud Centre/UCL today, where an MSc in Psychoanalytic Developmental
Psychology and another in Psychoanalysis and Developmental Neuroscience
reflect the ongoing attempt to integrate psychoanalytic thinking with the latest
findings from developmental research.

144 Reading Anna Freud

10 CHILD ANALYSIS AND
DEVELOPMENTAL THERAPY

KEY WRITINGS

1965 Normality and Pathology in Childhood

1968 ‘Indications and Contraindications for Child Analysis’
1972 ‘The Widening Scope of Psychoanalytic Child Psychology, Normal
and Abnormal’
1974 ‘Beyond the Infantile Neurosis’
1974 ‘A Psychoanalytic View of Developmental Psychopathology’
1976 ‘Psychopathology Seen against the Background of Normal
Development’
1978 ‘The Principal Task of Child Analysis’
1980 ‘Foreword to Analysis of a Phobia in a Five-Year-Old Boy (1909) ’

Introduction

Anna Freud’s first major publication in 1927 was on the topic of the technique
of child analysis, and for many she remains best known as one of the pioneers
of the psychoanalytic treatment of children. Yet except for an important
paper on ‘Indications for Child Analysis’ written in 1945, she published
almost nothing about the technique of child analysis for almost 40 years,
until she revisited the topic in the mid-1960s. Such a long silence has led
many people to assume that what Anna Freud wrote in her earliest publication
represented her view of treatment throughout her life. But a study of the
later (and less well-known) writings demonstrates that important shifts had
taken place, rooted firmly in her new ideas about diagnosis and the
developmental lines.

The relation of child analysis to adult analysis

In the second chapter of Normality and Pathology in Childhood (1965a), Anna

Freud revisits the question of the relationship that child analysis has to adult
analysis, and she reiterates her early belief that the fundamental principles of

Child analysis and developmental therapy 145

both forms of treatment are the same. Following the work of Bibring (1954),
she considers these to be:

• Not to make use of authority and to eliminate thereby as far as possible

suggestion as an element of treatment;
• To discard abreaction as a therapeutic tool;
• To keep manipulation (management) of the patient to a minimum, i.e.
to interfere with the child’s life situation only where demonstrably
harmful or potentially traumatic (seductive) influences were at work;
• To consider the analysis of resistance and transference, and interpretation
of unconscious material as the legitimate tools of therapy.
(1965a: 26)

But if these principles – and therefore the fundamental aims of treatment –

are shared by both child and adult analysts, Anna Freud reiterates her view,
first set out in her work in the 1920s, that the technique of child analysis must
in certain respects be quite different from that for adults, owing to the
fundamental fact of the child’s relative immaturity. The history of child
analysis, she suggests, is the history of the efforts made by generations of
therapists to overcome the difficulties that follow from this fundamental
difference: that children ‘have no insight into their abnormalities; that
accordingly they do not develop the same wish to get well and the same type
of treatment alliance; that, habitually, their ego sides with their resistances;
that they do not decide on their own to begin, to continue, or to complete
treatment; that their relationship to the analyst is not exclusive, but includes
the parents who have to substitute for or supplement the child’s ego and
superego in several respects’ (1965a: 28–29). Anna Freud then goes on to list
some of the consequences of these differences and how they influence the
way in which the child analyst can work.
If all of this sounds as if Anna Freud’s views had barely changed since her
time in Vienna (see Chapter 2 ), there are specific areas where she makes clear
that her ideas about technique have modified over time. In the 1946 preface
to the first English publication of her 1927 lectures on child analysis, for
example, she says that her controversial idea about the need for a ‘preparatory
phase’ in child analysis had now altered. While still emphasising the
importance of building a relationship with the child (what we might now
call the ‘therapeutic alliance’), she recognised that the child analyst, by means
of an analysis of defences, can ‘uncover and penetrate the first resistances in
the analysis of children, whereby the introductory phase of the treatment is
shortened and, in some instances, rendered unnecessary’ (1946c: xi–xii).
In a later discussion of this topic, however, Anna Freud emphasises that the
‘preparatory phase’ was never really about trying to deliberately arouse a
positive transference or ‘seduce’ the child into wanting treatment; rather, it
was about helping a child, for whom his or her symptoms may not have been

146 Reading Anna Freud

seen as problematic, to develop an ‘inner split’ and internal confl ict, which
would be the basis for the analytic work that was to follow. That this
misunderstanding of her work continued for many years is attested to by a
rumour that circulated in the 1970s that child analysts working at the
Hampstead Clinic used to give their patients sweets to encourage them to
attend. When Anna Freud heard this rumour, she is reported to have said:
‘You can tell them that the Hampstead children bring their own sweets’
(Sandler and Freud, 1985: 52).

A revised view of transference?

In the early chapters of Normality and Pathology in Childhood, Anna Freud

acknowledges that she had ‘modified [her] former opinion that transference
in childhood is restricted to single “transference reactions” and does not
develop to the complete status of “transference neurosis” ’ (1965a: 36). If this
sounds like a significant change of view, however, she was quick to add that
she still believed that the concept of transference was used too broadly by
many child analysts and that too often analysts, following Strachey’s (1934)
lead, over-emphasised the interpretation of the transference as the sole means
of therapeutic action within analytic treatment.
As an alternative, Anna Freud offered what she saw as a more discriminating
view of different types of transference in work with children, distinguishing
habitual modes of relating (patterns that the child repeats in a range of
situations, regardless of the specific setting) from the transference of current
or past relationships or the externalisation of internal impulses (Sandler,
Kennedy and Tyson, 1980: Chapter 10). To show the difference between
habitual modes of relating and transference proper, Anna Freud gives the
example of a child who leaves something in the consulting room at the end
of a session:

Most analysts would say, ‘Of course, you wanted to stay with me and so left
your cap (or your penknife or pencil)’. Then the analyst hears that the child
leaves his cap and pencil everywhere – in school, on the bus, at home – and
it can be seen that it simply isn’t true that the child wants to stay in all these
places. The whole thing has a completely different meaning and only
comes into analysis as a fi xed symptom. . . . This particular patient
demonstrated by losing inanimate possessions how ‘lost’ he felt in regard to
his parents.
(Sandler, Kennedy and Tyson, 1980: 80)

Clearly, these very different ways of understanding the meaning of the child’s
behaviour would have implications for how the analyst responds in the session.
Even if one were to take up the behaviour in the transference, its meaning

Child analysis and developmental therapy 147

would be very different if one understands the behaviour as a habitual mode
of relating rather than as a transference specific to the analytic setting.
Despite these slight modifications of her earlier views, a reading of this
early chapter from Normality and Pathology in Childhood would not lead one to
greatly revise one’s view of how Anna Freud thought about child analysis
compared to the views set out in her 1927 work. But a more fundamental
shift in her thinking emerges in the final chapter of the book (and in a
number of papers published in the following years) based on her new ideas
about differential diagnosis and the ‘developmental lines’. This work led
Anna Freud to make a new distinction in her understanding of childhood
pathology, which was to have major implications for therapeutic technique.

Child analysis and the infantile neurosis

As is often the case with Anna Freud’s writing, her new ideas were first
contextualised within the history of psychoanalytic thinking, so that it could
be seen how the ideas she developed emerged out of an ongoing inquiry into
certain core questions. In examining the way that psychoanalysis understood
childhood disturbance, Anna Freud recognised that analytic technique first
developed as a means of treating neurotic disorders, and that this context
inevitably influenced the emerging theory:

Since neurotic manifestations emanate from the depth, psychoanalysis

embarked on the study of the unconscious. Since they are due to confl ict
between internal forces, it became a dynamic psychology. Since confl icts
are solved according to the relative strength of these forces, the economic
viewpoint was developed. Since the roots of every neurosis reach back to
the early years of the individual’s life, the genetic aspects of the theory
played a paramount part.
(1976[1975]b: 83)

But the structure of the neuroses did not only influence the evolving theory
of psychoanalysis; it also influenced the evolving therapeutic approach. If
symptoms could be understood as compromise formations based on
intrapsychic confl ict, which had been dealt with by means of repression, then
the aims of treatment were to lift repression and to ‘make the unconscious
conscious’. The primary means of doing that were interpretation and
reconstruction – at first, with a significant focus on dream interpretation,
and later on, by means of the interpretation (and working through) of the
transference:

As analysts, we are proud to possess a therapeutic technique by means of

which psychic processes can be undone, and even apparently stable psychic

148 Reading Anna Freud

 structures can be dissolved into their elements. . . . What analysis tries to
reverse here, and usually succeeds in reversing, are the immature ego’s
misguided decisions which were made under the pressure of danger and
anxiety. These are remade under the new conditions and in the safer
atmosphere of the analytic setting.
(1972: 32)

Given that all adult neuroses were understood by Freud to originate in an

‘infantile neurosis’ that developed in the fi rst few years of childhood, it was
perhaps no surprise to Anna Freud and her colleagues, when they fi rst began
working with child patients in the 1920s, that they discovered almost exactly
the same features in their child patients as Freud had discovered in adults. Just
like adults, children in the early years of their lives were faced by internal
contradictions that they struggled to manage, and they dealt with them in
very similar ways:

Both then, adult and child, find themselves in the same situation. They are
confronted by urges and fantasies which had been age-adequate at the oral
and anal-sadistic level of development, but which, re-cathected at this later
stage, are rejected by the personality as unacceptable and therefore arouse
deep-seated anxieties. These latter have to be defended against and their
content compromised with. To bring about the compromise formations
which are symptomatic for the neuroses at all ages, adults and children
employ defence mechanisms which . . . are more or less identical.
(1972: 11)

Given that the structure of the adult neuroses and the child neuroses were
seen to be so similar, it is perhaps not surprising that the fundamental ideas
about treatment were also similar. For the early child analysts working with
Anna Freud, the treatment of the infantile neurosis in a child would depend
on assisting the ego to widen its sphere of influence, and this could best be
achieved by means of the interpretation of the unconscious elements outside
its reach. By making the unconscious conscious, and bringing its content
under the conscious control of the ego, more adaptive means could be found
to deal with these previously unconscious elements (A. Freud, 1970b). Despite
the technical challenges of carrying out the analysis of a child, the fundamental
principles of resistance and interpretation remained the same, whether the
patient was a fully grown adult or a six-year-old child.

An example of the infantile neurosis: The case of Little Hans

In describing the nature and treatment of childhood disturbance in her

writings, Anna Freud frequently refers back to Freud’s case of ‘Little Hans’

Child analysis and developmental therapy 149

(1909), which she considers to be a paradigm of the infantile neurosis and its
treatment.
At the time of his therapy, Little Hans was a four-and-a-half-year-old
boy who was progressing well in many respects, but he had developed a
crippling anxiety about horses, which prevented him from being able to go
outside his house and walk safely in the streets. (In Vienna in the early
1900s, a phobia about horses would be as crippling as one about cars might
be in a modern city.) Through a series of ‘analytic conversations’ and
interpretations of his dreams, carried out by Little Hans’s father and reported
to Freud, the latter was able to interpret how the fear of horses could be
understood as a displacement of Little Hans’s fear of his father, against
whom he had developed death-wishes owing to his oedipal rivalry for
his mother’s love. This confl ict between love and hate, and between the
‘pleasure in his sexual organ [and] the fear for its safety’, had led the little boy
to repress his forbidden wishes, and his psychic functioning to regress to an
earlier stage of development. Fear of retribution from his father was now
displaced onto the horse, a fear that was itself coloured by primitive oral-
aggressive fantasies.
The phobia that Hans formed interrupted his development and caused
great distress both to himself and to his parents; but in itself it was not the
sign of serious disturbance, and the matter was fairly quickly cleared up. As
Anna Freud recounts it:

. . . during the treatment he received, this crippling state gradually

gave way to the unravelling of its confl icting elements. Repression, as
an automatic and excessive process, was replaced by conscious
understanding and ‘condemnation’ by the higher agencies of the mind.
Regression was undone and finally and almost triumphantly the boy
reclaimed his lost masculine aspirations via the fantasy of the plumber who
restored his sexual organ. This signified the victory of manhood over
feminine trends, of activity over passivity, and of progressive over regressive
tendencies.
(1972: 14)

As other analysts before and since have done (see Midgley, 2006), Anna
Freud took great inspiration from this treatment, which she used as a model
for her own early attempts at child analysis – although in her case, treatment
was to be carried out by an outside figure rather than the child’s parent. But
in the post-war years, she also came to see that the type of disturbance
described by Freud – and the model of treatment it implied – was very
different from that of the majority of children who were referred for treatment
at child guidance clinics, and thus child analysts needed to adapt to the very
different needs of these children.

150 Reading Anna Freud

Beyond the infantile neurosis

In her writings in the 1960s and 1970s, Anna Freud continues to promote the
model of treatment for the infantile neuroses that she had fi rst developed
while working in Vienna; however, with her increasingly developmental
perspective, she looked on the infantile neuroses somewhat differently. In
keeping with her more developmental perspective, she now emphasised, not
so much the neurotic symptoms themselves, but, rather, ‘the bearing of these
manifestations on the maturation processes within the child’:

Emphasis is shifted thereby from the purely clinical aspects of a case to the
developmental aspects.
(1945: 37)

Anna Freud now emphasised that the capacity to have the kind of infantile
neurosis described in her father’s work is actually positive evidence of
personality growth, and that the confl icts underlying the infantile neurosis
are no more than the normal ones of early childhood. For a child to be able
to develop this type of confl ict-based neurosis, after all, implies healthy
development in a range of areas: a significant capacity for object relationships;
a considerable degree of ‘inner structuralisation’, based on positive
identifications and internalisations; and an ego sufficiently strong as to be
able to defend against the demands of the drives (1972: 31).
But, as became increasingly clear to her, ‘there is a world of difference
between those investigations of the infantile neurosis as a “type and model”
for adult neuroses and our present explorations of normal and abnormal child
development which aim at the enumeration, description and exploration of
any interference with optimal mental growth’ (1972: 16). Indeed, as Anna
Freud and her colleagues at the Hampstead Clinic reflected on their
observations of children with extremely traumatic early histories, and began
to work with a large number of children referred to the Clinic with histories
of severe deprivation, none of the ‘achievements’ of the classically neurotic
child could be taken for granted. In particular, many of the children referred
to the Clinic had suffered from maltreatment and abuse or showed major
delays in their development which could not be understood, or treated, using
the traditional analytic methods. Writing in 1968, Anna Freud spelt out the
dilemma:

The appeal for help, which is implicit in their precarious circumstances, is

too strong to be dismissed lightly and often brings them into treatment.
But this does not by any means imply that child analysis is indicated for
them as the treatment of choice and that its technical tools are found to be
potent enough to counteract the ongoing upsetting influences.
(1968b: 123)

Child analysis and developmental therapy 151

 Anna Freud’s way of thinking about this, based primarily on her study of
the developmental lines and her work on the Diagnostic Profi le, was to
declare a need to go ‘beyond the infantile neurosis’, deliberately echoing
Sigmund Freud’s famous paper in which he spoke of the need to go ‘beyond
the pleasure principle’ (1920a). As Murray (1994) points out, what lay beyond
the pleasure principle for Freud was the death instinct and the compulsion to
repeat; but what lay beyond the infantile neurosis for his daughter was the
concept of developmental disturbance.

The new focus on developmental disorders

Anna Freud’s growing interest in assessment and the use of a developmental

perspective helped her to appreciate that many of the children who were
being referred for treatment had disturbances that were not based on
internal confl icts between fully structured internal agencies. In some
cases, these children might present with symptoms that could easily
be mistaken for neurotic ones (such as anxieties or obsessional features),
or they may have been labelled using terms ranging from ‘slow or
irregular developer to serious backwardness, borderline, autistic, and
psychotic states’ (1974a: 77). What all of these children had in common,
once a full assessment had taken place, was that their difficulties could be
understood as failures of development, with relatively more or less serious
consequences.
In some cases, Anna Freud believed that the disturbances could be
considered transitory, likely to pass in the course of ongoing development.
She gave as examples some difficulties with sleeping that are an appropriate
part of the separation–individuation stage; or the confl icts around eating
that are a predictable aspect of the toddler stage, when ambivalence towards
the primary caregiver is both normal and appropriate – and is often
expressed through feeding difficulties. Assuming that those caring for
the child are able to handle these difficulties appropriately (and parent
guidance could be valuable in this respect), the children would be likely to
grow out of such problems spontaneously, as part of the normal process
of ongoing development. In some cases, however, these disturbances
might form a vulnerability for later neurotic difficulties. Such problems
were distinguished from more serious cases of developmental disorders, in
which the very building blocks of the personality fail to be properly put
in place.
On the basis of these distinctions, Anna Freud suggested that it was possible
to differentiate two types of infantile psychopathology:

The one based on confl ict is responsible for the anxiety states and the
phobic, hysterical, and obsessional manifestations, i.e. the infantile

152 Reading Anna Freud

 neuroses; the one based on developmental defects, for the psychosomatic
symptomatology, the backwardness, the atypical and borderline states.
(1974[1973]: 70)

Anna Freud was careful not to conflate all of these development defects, or
to confuse the various causes for these disturbances. While all of them have
their origins in the child’s early period of growth and maturation, this might
be due to organic or environmental deficits, or indeed to a combination of
both. Referring to the observational research of her colleague Dorothy
Burlingham, for example, she notes that ‘analytic studies of the blind, deaf,
and mentally deficient show that any single defect in the individual’s inborn
equipment suffices to throw the entire developmental course into disarray,
far beyond the sphere where the damage itself is located’ (1976[1975]b: 92).
However, those who have lacked the ‘average expectable environment’ in
their early years are also likely to show disturbances in their development,
although she emphasised that ‘there is no one-to-one, invariable relationship
between the fact of parents being absent, neglecting, indifferent, punitive,
cruel, seductive, overprotective, delinquent, or psychotic and the resultant
distortions in the personality picture of the child’ (p. 93). Cruel treatment,
for example, may lead to a child who is aggressive and violent, or to one who
is timid and passive; sexual abuse (or ‘parental seduction’, as Anna Freud
continued to call it), on the other hand, could result in a child with a ‘complete
inability to control sexual impulses ever after, or in severe inhibition and
abhorrence of any form of sexuality’ (p. 93). It is the complex interaction
between endowment and experience (nowadays we might speak of genetics
× environment) that determines how the disturbance of development will be
expressed. What these disturbances all have in common, however, is that
they impact on the very process of personality development, rather than
being (as is the case with the neuroses) a consequence of confl icts within an
already well-structured personality.

The challenge of making a differential diagnosis

Although Anna Freud never gave her own clinical example of the assessment
of a child with a ‘developmental disorder’, many such assessments have been
published by Anna Freud’s colleagues and students. Cara F, for example, was
referred to the Anna Freud Centre when she was seven years old, at the
recommendation of an educational psychologist (Green, 1995). She was
reported to be very confused and unable to relate to other children, and she
had severe difficulties with writing, which led to an ongoing refusal to
engage with schoolwork. In her diagnostic interview, she moved from one
activity to another without any obvious connection, all the while producing
a confused and confusing monologue on unrelated topics. She did, however,

Child analysis and developmental therapy 153

indicate to the therapist that she wanted help, although she demonstrated
very little sense of feeling that she had an internal world that could be thought
about – by herself or by anyone else.
At the diagnostic meeting where Cara’s assessment was presented and
discussed, there was agreement that Cara was operating like a much younger
child, but it was unclear whether this was due to an overall arrest in her
development, or whether she had regressed to a more immature mode of
functioning due to the confl icts aroused by her current home situation, in
which the parents were going through a very acrimonious period in their
relationship. It was also not clear whether her refusal to engage with
schoolwork was due to a fundamental incapacity or was a symptom of her
confl icts – in short, whether she wouldn’t or whether she couldn’t do the work.
The assessment concluded that Cara was probably a borderline child – that
is, one who ‘can be deemed neither neurotic, nor psychotic, nor autistic, nor
totally arrested in developmental progress, but who nevertheless show[s]
features of any of these, fitting sometimes more one, sometimes more another
of these diagnostic labels . . . [all] welded into a bizarre, atypical whole which
defies definition’ (A. Freud, 1977: 2). Once she began treatment, however, it
became clear that this provisional diagnosis was probably not correct. ‘She was
not a borderline child with a hostile internal object world and fluctuating ego
capacities giving rise to disintegration anxiety,’ writes Green, ‘but a child in
whom early misattunement had resulted in a failure to develop a stable,
coherent, safe internal world, with consequent repercussions for a range of ego
functions’ (Green, 1995: 183). Understanding this distinction led to a different
prognosis for Cara and had implications for the way her treatment was
conducted. The treatment focused more on helping her to organise, regulate
and represent her affects – and with help of this sort, Cara gradually presented
in a more organised way, suggesting that her functioning was not at a borderline
level. By the time she was a young adolescent, for example, Cara was able to
make friends with children at school, in a way that had been impossible for her
as a younger child, when her impulsive behaviour had alienated her from her
peers. As she gradually became more able to learn, she also had to contend
with some of her limitations. The therapist describes one poignant occasion
on which Cara tried very hard to achieve something, but couldn’t manage it.
Crying with frustration, she said: ‘It’s not fair, I am trying so hard and I still
can’t do it’ (p. 184). Although painful, such expression showed Cara’s capacity
to develop in a way that the initial diagnosis would not have predicted.

The developmental disturbances: Indications

and contraindications for child analysis

When Anna Freud published her paper on ‘Indications for Child Analysis’ in
1945, she was quite clear that this treatment should be ‘restricted to the most

154 Reading Anna Freud

severe cases of the infantile neurosis’ and that for children whose difficulties
did not meet this criteria, it was better to use psychoanalytic insights to
inform other types of intervention, whether educational or otherwise.
Revisiting this same topic in 1968, Anna Freud significantly called her paper
‘Indications and Contraindications for Child Analysis’ (my emphasis), as if to
make clear that child analysis is not the treatment of choice for all children in
need of help. Indeed, in that paper she emphasised that our ‘recommendations
for analytic treatment become much more hesitant’ when dealing with
children with developmental disorders compared to those with neurotic
disturbance, and she describes the way that this uncertainty typically gets
expressed in clinical case discussions:

Usually a minority opinion advocates waiting and watching for the ego’s
spontaneous compromises, while the majority verdict recommends
beginning immediate treatment to avoid lasting harm being done to the
child’s further chance of normal growth . . . only analytic help [they
argue], applied without delay, will be effective in avoiding crippling
solutions and thereby serve a truly preventative aim.
(1968b: 115–116)

Anna Freud makes clear that she has a great deal of sympathy with the
‘minority opinion’, for in many cases treatment was taken on, in great
expectation, only to end in disappointment and failure. And, as she adds,
somewhat sardonically, when analysis ‘fails to bring about improvements, the
blame is usually laid not on the psychopathology of the case as such, but on
unfavourable external circumstances such as the therapist’s lack of experience
or skill, the parents’ failure to cooperate, insufficient time being allowed for
the analytic process, interruptions due to bodily illness, upsets in the home,
change of therapist, etc.’ (1965a: 214).
Anna Freud herself was not so sure that the reason for the
treatment’s failure is always so unrelated to the nature of the pathology
itself. After all, if interpretation aims to lift repression and support the ego
to find more adaptive ways to deal with internal confl ict, then it is by no
means clear that a developmental disorder that is not based on confl ict or
repression will necessarily respond to this type of intervention. Anna Freud
makes a distinction between the ‘fact-finding’ aspect of child analysis
and the ‘therapeutic’ aspect: in terms of the former, there is no doubt
that a great deal can be understood about early development and its
disturbance by means of the analytic method – but this does not mean
that the disturbance will necessarily be cured. ‘At the worst’, she says, ‘the
benefit is not on the side of the patient at all but on that of the analyst,
who from the treatment of such cases gains valuable insights into the
conditions of growth’ (1968b: 120). This insight may be of scientific value,
and ultimately of value to those seeking to promote early intervention and

Child analysis and developmental therapy 155

preventative work, but analytic insight per se ‘is unable to undo the damage’
(1978b: 109).
This does not answer the question, however, of how to respond when a
child is referred with serious difficulties and is in urgent need of help. With
typical understatement, Anna Freud explains why this poses ‘considerable
problems’ for the clinician:

Therapeutic help, in answer to the parents’ or the school’s request, can

hardly be refused since the difficulties caused by the child’s abnormality
are of an urgent nature. Nevertheless, once embarked on therapy, the child
analyst feels doubtful of his aim and competence. He is face to face with
the so far unanswered question whether and how far the neglect of
developmental needs can be undone by treatment.
(1968b: 118)

As late as 1976, just a few years before her death, Anna Freud continued to
speak of the ‘humiliating fact’ for child analysts that ‘the developmental
damage which they understand so well and reconstruct so efficiently can be
beyond their power to cure by truly analytic means’ (1976[1975]a: 182).
Indeed, when such children did benefit from analytic treatment, against her
prediction, Anna Freud suggested that such success ‘may be due not to the
truly analytic work but to admixtures to the technique such as new positive
object attachment, new superego identification, suggestive influence, or even
corrective emotional experience, which with the very young can set arrested
developmental lines going again’ (1974[1973]: 72).
Anna Freud speaks here as if such processes are not truly part of analytic
work and are almost unfortunate by-products of the analytic setting. Yet at
other points she appeared to see these more as important adaptations and
innovations in child analytic technique, changes that were to have significant
consequences for the work of child psychotherapists dealing with children
with severely damaged internal worlds.

Innovations in technique for working with children

with developmental disorders

In reviewing the topic of ‘therapeutic possibilities’ in the final chapter of

Normality and Pathology in Childhood (1965a), Anna Freud recognised that
analytic treatment has always been a complex mixture of interventions, and
that whatever the analyst may think he or she is doing, patients will take
from it what they most need. In the case of children whose difficulties can be
understood in terms of neurotic confl ict, they mostly ‘react fully to
interpretations of resistance and transference, defence and content, i.e. to the
truly analytic measures, which for them turn into therapeutic processes’

156 Reading Anna Freud

(1965a: 229). Although various other things may also be going on during
analytic treatment, these do not play a hugely significant role in treatment,
she argues, so long as the therapist does not step out of his or her analytic role.
‘In contrast to this,’ she continues:

. . . the nonneurotic cases single out for benefitting from them sometimes
one, sometimes another, sometimes a mixture of the subsidiary therapeutic
elements, while the main analytic procedure may remain without effect or
bring about undesirable results.
(p. 230)

By ‘subsidiary therapeutic elements’ Anna Freud is referring to things such

as verbalisation and clarification, reassurance and support – all elements that
have long been considered ‘educational’ and therefore outside the analyst’s
remit. She gives the example of a child with a borderline diagnosis, who in
treatment produced huge amounts of fantasy material and for whom
‘distortion of id derivatives is minimal’. In such a case, it is relatively easy for
the analyst to make interpretations; however, the relief and improved ego
control that one would expect from a child with a more well-structured
internal world does not follow:

Instead, the very wording of the analytic interpretations is taken up by the

patient and woven into a continued and increased flow of anxiety-arousing
fantasy. Met by interpretation only, whether within or outside the
transference material, the borderline child uses the opportunity to turn
the relationship with the analyst into a kind of folie à deux, which is
pleasurable for him and in accordance with his pathological needs, but
unprofitable from the point of view of therapy.
(p. 230)

A child such as this, suggests Anna Freud, is far more likely to be helped by
verbalisation and clarification of internal and external dangers, or of
frightening affects, which ‘his weak and helpless ego, left to itself, cannot
integrate and bring under secondary process dominance’ (p. 230). Likewise,
a severely deprived child, who has lacked the kind of early caregiving which
is so essential to the development of a secure sense of self, may well develop
a strong feeling of dependency and yearning for his or her analyst; but again,
Anna Freud warns, ‘interpretation of the transferred repetition has no
therapeutic results’:

Instead, the child may answer to the intimacy of the analyst–patient

relationship, which is favourable for the proliferation of libidinal attachment
because of the frequency and long duration of the contact, the lack of
interruptions, the exclusion of disturbing rivals, etc. On the basis of this

Child analysis and developmental therapy 157

 new and different emotional experience, the child may move forward to
more appropriate levels of libido development, a therapeutic change set in
motion within the outward setting of child analysis but on the basis of
‘corrective emotional experience’.
(p. 231)

Anna Freud’s examples of the way in which deprived children or those

with a borderline diagnosis may ‘mis-use’ analysis can be reframed in a more
positive way, if one looks more closely at what she is describing. When looked
at in this way, Anna Freud is making it clear that one of the primary aims of
treatment for children with developmental disorders is increasing the capacity
for affect (or emotional) regulation, a focus that has become far more central
to both modern clinical psychoanalysis – as in the concepts of ‘holding’
(Winnicott) or ‘containment’ (Bion) – and also in modern developmental
research, where the early build-up of the capacity for emotional regulation
has been seen as a central feature of early development in the work of Schore
(1999), Fonagy et al. (2002) and many others.
In particular, techniques such as the careful use of clarification can be
important ways of helping a child who is utterly confused about internal and
external reality. Whereas a ‘neurotic’ child who is anxious, for example, that
his house may burn down during the night will not benefit from an
explanation of why this will not happen (since the anxiety is based on an
internal fantasy, such as an aggressive wish or a fear of punishment), the case
is different with children whose inner lives are not yet so clearly structured.
In the case of ‘Susan’, for example, a six-year-old girl with an early history of
multiple hospitalisations that her parents had not been able to help her prepare
for or understand (Sandler, Kennedy and Tyson, 1980), helping to sort out
reality from fantasy had more therapeutic value. In this case, the therapist
responded directly when the little girl was fi nally able to ask for the first time
about why she had been in hospital as a child and helped her to talk through
the details of what had happened to her in a careful, age-appropriate way. By
explaining reality to this child, before exploring her fantasies about the
hospital treatment, the child analyst was recognising the importance for this
child of being able to make sense of her experience and put it into words
(p. 159).

The role of verbalisation – a clinical example

Audrey Gavshon, who worked as a child analyst at the Hampstead Clinic for
many years, gives a good example of the role of verbalisation in her treatment
of a seven-year-old-boy called ‘Martin’ (Gavshon, 1988), who suffered from
extensive developmental delay, with a likely organic basis compounded by
physical health problems. His parents treated him like a much more advanced

158 Reading Anna Freud

child, and they struggled to respond appropriately to his developmental
needs, which probably contributed to his difficulties in coping with his
deficits.
When Martin first started treatment, his therapist struggled to understand
his communications, as Martin’s language skills were so poor. Yet the therapist
was also aware that he found it shaming when she had to ask him to repeat
things and that this was making him increasingly uncooperative with the
treatment. Using her creativity, Gavshon came up with the idea of fi nger
games, and she showed him the well-known game where you fold your
hands together to make a church and then open them up to reveal the people
(wiggling fingers) inside. From here, Martin and his therapist began to
communicate and tell stories through various finger-games, which both of
them clearly enjoyed. After a while, the therapist began to shape these stories
around some of the important themes in Martin’s life (a type of ‘finger-
interpretation-in-displacement’, you might say). She acted out a story of a
boy who was upset because he wasn’t able to run fast, like his brother, and, as
he watched this, Martin said (speaking quite clearly this time): ‘Tell him why
he is crying.’ This was the start of a period of the analysis in which Martin
and his therapist were able to work on some of his fears about being
misunderstood and feeling stupid, and his despair that he would never be as
capable as other children, including his brother. Gradually Martin and his
therapist found ways to communicate together, and Gavshon was able to
make increasing uses of verbal interpretations – although at times Martin
would tell her: ‘Now say that again, but don’t say so much.’
This improved capacity for verbalisation, which was one of the outcomes
of Martin’s therapy, has been increasingly recognised as an important aspect
of ‘developmental therapy’. The capacity to use language is increasingly
recognised as a crucial element of affect regulation and the development
of the self. As Anna Freud put it, verbalisation ‘facilitates the maturing of
the ego and the acquisition of the capacity for self-observation’ (quoted
in Sandler, Kennedy and Tyson, 1980: 68), both of which are crucial
for a developing capacity for affect regulation and a more mature sense
of self.
In emphasising the importance of promoting affect regulation by means of
‘ego supportive’ interventions such as the use of clarifications and the
promotion of the capacity to verbalise, Anna Freud was also implying a major
shift in the way in which one conceptualises therapeutic change itself. She
was always curious about the fact that people who have never had any
experience of analysis are able to undergo profound inner changes, which
suggests that the process of personality transformation cannot be specific to
the analytic setting. Increasingly, she came to believe in the importance of
relationships themselves as a vehicle of psychic transformation, and this led her
to new ways of thinking about the role of transference in clinical work with
children suffering from developmental disorders.

Child analysis and developmental therapy 159

The ‘transference object’ and the ‘developmental object’

As discussed above, Anna Freud came to appreciate that children do develop

all kinds of transference relationships in the course of analytic treatment, and
she saw the interpretation of the transference as a key (but not exclusive)
component of therapeutic change. Such transferences, she believed, were
based on the child’s object relations from all levels of development, both
oedipal and pre-oedipal, and needed to be worked with as such. In her
discussion of clinical cases, as reported in Sandler, Kennedy and Tyson (1980),
there are many examples of how the analyst can interpret the child’s
transference, whether it is the transference of libidinal and aggressive drives
or that of characteristic defences.
But Anna Freud also thought that the child analyst – especially (but not
exclusively) when working with children with more developmental disorders –
is ‘used by the patient in a variety of ways’, and that children themselves ‘have a
hunger for new experience which is as strong as the urge to repeat’ (1965a: 38;
italics in original). This ‘double relationship’ which the child forms to the analyst
– as both a transference object and a new (developmental) object – is not easy for
the child analyst to handle:

If he accepts the status of the new object, different from the parents, he
undoubtedly interferes with the transference reactions. If he ignores or
rejects this side of the relationship, he disappoints the child patient in his
expectations which the latter feels to be legitimate. . . . To learn how to
sort out the mixture and to move carefully between the two roles which
are thrust upon him are essential elements of every child analyst’s training
in technique.
(1965a: 38–39)

Anna Freud gives an example of how the child analyst can handle this
dual role in her discussion of the case of ‘Frank’, a ten-year-old boy who
was brought up by his father after his mother had left when he was three
years old. In so far as the analyst was used as a ‘new object’, Frank was able to
take a step forward in his ego development and build up a more trusting
and safe sense of his objects, thanks to the reliability of his therapist. But
at the same time, Frank’s rage with his mother for deserting him as a
small child, and his fantasy that he was responsible for her abandonment
because of his own badness, came into the relationship with the therapist
as a ‘transference object’. In this case, the child analyst was able to accept
both roles and to move between them as the child needed. ‘It was the
combination of this “corrective” emotional experience of finding a better
mother with the analysis of the relationship to the deserting mother,’ said
Anna Freud, ‘which did the trick’ (quoted by Sandler, Kennedy and Tyson,
1980: 110).

160 Reading Anna Freud

 In fact, as Edgcumbe (1995) points out, this view of the double use that the
child makes of the analyst was not entirely new in Anna Freud’s work. As
early as her 1927 lectures on the technique of child analysis, she had written
about the role the analyst plays as an ego-ideal for a child whose superego is
not yet fully structured, and who therefore needs to make use of the analyst,
at certain points, as an ‘auxiliary ego’ support. But her later focus on the
therapy of children with developmental disorders helped her to focus more
explicitly on this aspect of the child analyst’s role. Even interpretation, she
came to see, was not only about providing insight into unconscious content
or patterns of relating; it was also an aspect of the analyst acting as a ‘new
object’, in so far as it gives the child a new experience of being recognised
and thought about. In a clinical discussion of work with children with
developmental disorders, she explained:

There are many moments . . . where one . . . shows the child that one is
different from the parents, merely by understanding, by reacting differently
to something the child says or does. That’s an element which is very often
neglected, which we call the analyst as a new object.
(quoted by Hurry, 1998: 48)

The child analyst as a new object is very different from the orthodox view
of an analyst, in which her function is to offer herself as a ‘blank screen’ and
provide interpretations of the unconscious transference material. Anna Freud
strongly opposed the stereotype of the analyst as someone who simply delivers
a series of clever interpretations. In a transcript from a seminar she gave at the
Hampstead Clinic towards the end of her life, she is quoted as saying to her
students:

It is a great danger to get a child accustomed to a constant flow of

interpretation, which to him becomes a sort of nagging. . . . Interpretations
thrown at the child indiscriminately are a great mistake [and are] usually
meaningless to the child . . . I think what one should interpret are
experiences, inner experiences . . . and not words, not images, not single
items.
(1983: 119)

As Bonaminio (2007) points out, in quoting these words, what is striking in

this seminar is Anna Freud’s emphasis on the importance of the analyst
making contact with the child, and on staying close to the child’s experience.
Bonaminio considers this attitude to be almost Winnicottian – and certainly
a far cry from the view of Anna Freud as a ‘conservative’ analyst. One of
Anna Freud’s former trainees, Carla Elliott-Neely, captures the same spirit of
adventure and creativity when she describes how Anna Freud ‘was never
content to rely on a “rule” in an unthinking way’. Rather, she ‘thought about

Child analysis and developmental therapy 161

each case from the child to the theory, so that the theory came alive in the
context of a human being. This meant that her suggestions for technique
were creative and directly related to the therapeutic task’ (Elliott-Neely,
1995: 381).

Is developmental therapy a part of ‘proper’ child analysis?

In discussing the different ways in which children with a range of

developmental disorders may make use of analytic treatment, Anna
Freud often used words such as ‘misuse’, ‘unintended’ and ‘unavoidable’,
as if the elements of treatment that may be of help to these severely
deprived children are not something that one should be proud of – that
they are not part of ‘proper analysis’. As a child analyst at the Hampstead
Clinic, Rose Edgcumbe (1995) describes her own experience of feeling
rather indignant on behalf of her child patients, who she felt Anna
Freud implied were ‘not suitable’ for psychoanalysis: ‘Anna Freud made us
feel that it was not right. Yet she undoubtedly encouraged us to carry on
experimenting’ (p. 22).
This ambivalence is well captured in Anna Freud’s reported comments in
a case discussion of a young patient, ‘Helen’, who was referred at the age of
six because of learning problems (Sandler, Kennedy and Tyson, 1980) and
whose treatment was initially based on the traditional model of interpretation
of repressed impulses and defences. During the course of the first year of
treatment, it became clear that Helen probably suffered from some form of
mild learning disability; she was also living in an extremely chaotic home
environment, in which she had been given very little support or sympathy in
the early years of her life. After listening to a presentation of the case for some
while, Anna Freud commented:

This case was misdiagnosed. Helen was not a suitable case for analysis but
a severely deprived and traumatized child who suffered from a consequent
personality distortion and who needed help, support, encouragement and
sympathy. The analytic method was not right for her, both because of the
nature of her disturbance and because of her external circumstances.
Analysts at the Hampstead Clinic have now had sufficient experience with
children like this to know that the analytic method does not help them. . . .
It must not be forgotten that interpretation always depends on there being
an ego able to make use of it, something which is deficient in these children.
Also, the disturbance is due not so much to internal confl icts as to a
mixture of early neglect and damage, lost opportunities for development,
unavailable permanent objects, and all sorts of adverse environmental
influences.
(p. 255)

162 Reading Anna Freud

In this comment, Anna Freud shows great insight into the nature of this girl’s
difficulties and has clear ideas about what could help her. But in emphasising
that the child ‘was not a suitable case for analysis’, she seemed to be implying
that the developmental psychotherapy that could be so valuable to this child –
and which draws so deeply on psychoanalytic knowledge and understanding –
would nevertheless not be considered ‘proper analysis’.

The legacy of Anna Freud’s developments ‘beyond

the infantile neurosis’

Anna Freud was by no means alone in exploring the widening scope of child
analysis or the therapeutic techniques that would follow from it. As she
acknowledges in Normality and Pathology in Childhood, Melanie Klein and her
followers were unique among the early generation of child analysts in so far
as they included children with severe ego defects and psychoses among their
patients from the very beginning (1965a: 215), and some of the adaptations
of technique that Anna Freud was exploring in the 1960s have clear parallels
with the work of others, especially those working in the ‘Independent’
tradition in Britain and the ‘relational school’ of psychoanalysis in the US
(see Hurry, 1998). The increasing emphasis on the relational component of
treatment has continued to this day, alongside a growing attention to the
importance of ‘attunement’ (Stern), ‘holding’ (Winnicott) and ‘containment’
(Bion) in facilitating the development of severely deprived and disturbed
young children. Much of the developmental research that has taken place
since Anna Freud’s death, especially the work focusing on the early mother–
infant relationship (e.g. Stern, 1985; Tronick et al., 1998), has helped to
increase our understanding of the parent (and by extension, the therapist) as
a ‘developmental object’. In addition, work in the neurosciences has increased
our understanding of how even brain development is use-dependent and
relies to a great degree on the environment – for example, in the build up of
affect regulatory systems (Schore, 1999). These discoveries in developmental
research and neuroscience have been helpfully integrated into a developmental
therapy model by Greenspan (1996), Hurry (1998), Green (2003) and others,
who have also been able to incorporate more of a focus on the processing of
the analyst’s own countertransference – an aspect of the work which is notably
absent in Anna Freud’s writing, but which is central to modern versions of
developmental therapy (e.g. Ralph, 2001).
Fonagy et al. (1993), building on the work of Anna Freud, have argued
that what is most striking in the children whom Anna Freud described is a
fundamental failure in the development of the child’s mental functioning.
They suggest that such children need a more developmentally focused form
of treatment, which focuses on supporting the development of mental
processes themselves, such as mentalisation-based therapy (which has been

Child analysis and developmental therapy 163

described by some, e.g. Verheugt-Pleiter, Schmeets and Zevalkink [2008], as
a modern version of Anna Freud’s developmental therapy). Such a hypothesis
has received some empirical support from outcome research carried out at the
Anna Freud Centre, which demonstrated that children with more severe
levels of disturbance benefitted from a more intensive, developmentally
focused form of intervention (Fonagy and Target, 1996). As Anne Hurry
puts it, in her important book on the subject:

Child analysts have always used . . . techniques such as helping a child to

be able to play, to name feelings, to control wishes and impulses rather
than be driven and enact them, to relate to others, and to think of and see
others as thinking and feeling. They have done such work intuitively,
and at times, lacking a fully developed theoretical framework in which to
view it, they have undervalued and sometimes failed to record it. Anna
Freud, however, believed that this ‘developmental help’ called for further
study. . . . [Now] developmental help has moved to the forefront of
psychoanalytic thinking; it is valued in its own right, it has been made
‘respectable’.
(Hurry, 1998: 37–38)

FURTHER READING

The best account of Anna Freud’s approach to analytic work with children in
the latter part of her career is probably the book, The Technique of Child
Psychoanalysis: Discussions with Anna Freud d, edited by Sandler, Kennedy
and Tyson (1980). The book records a series of discussions that took place
at the Hampstead Clinic within one of the study groups, working on the
topic of psychoanalytic technique. All the discussions, which Anna Freud
participated in, were tape-recorded and transcribed, and the book offers a
view of what the authors call ‘the essential features of the treatment situation
in one particular psychoanalytic milieu, the Hampstead Child-Therapy Clinic in
London’, at one particular moment in time – the late 1970s (p. 1). The book is
unusual, especially among Anna Freud’s later writings, in that it is full of clinical
case material and discusses a wide range of topics that rarely get written
about in the professional literature of child analysis, even if they are essential
to the practice of child analysis. These topics include not only the major
questions, such as the aims of treatment and the role of transference and
interpretation, but also quite specific (but vital) issues, such as whether it is
best for analytic sessions to coincide with school term dates or not; whether
parents should be able to pay ‘half price’ for child analysis (since in other areas
of life children are given a reduced rate); how to deal with the ‘Monday crust’
when a child hasn’t been seen for several days; and what are the best ways to
handle a change of setting – or indeed, a change of therapist – if this becomes

164 Reading Anna Freud

necessary. This book is a fitting final statement of Anna Freud’s approach,
ending, very appropriately, with Anna Freud discussing what things we still
don’t know.
A number of authors have written helpful accounts of clinical work using an
approach based on Anna Freud’s developmental therapy. Kennedy and Yorke
(1980), for example, give a very clear clinical example of the differences
between clinical work with a ‘neurotic’ child and one with a ‘developmental
disturbance’, while Elliott-Neely (1996) shows the implications of a developmental
perspective for the treatment of a young child with a history of prematurity and
early environmental stresses. The Bulletin of the Anna Freud Centre e contains
many clinical papers demonstrating the use of ‘developmental therapy’ with
children with a range of difficulties, and Edgcumbe (1985) gives a good overview
of how this fits within Anna Freud’s overall approach to child analysis.
For an overview of how the theory and practice of ‘developmental therapy’
has proceeded at the Hampstead Clinic since Anna Freud’s death, there are
two excellent collections of papers that balance conceptual and clinical issues
brilliantly: Anne Hurry’s book, Psychoanalysis and Developmental Therapy
(1998) and Viviane Green’s Emotional Development in Psychoanalysis,
Attachment Theory and Neuroscience: Creating Connections s (2003).
More recently, Malberg and Raphael-Leff’s The Anna Freud Tradition n (2012)
offers a series of case studies of children of different ages, showing how
graduates of the Hampstead Clinic training have adopted and adapted a
developmental approach to therapy.
For an account of parallel clinical developments within the post-Kleinian
child psychotherapy field, the work of Anne Alvarez (e.g. 1992, 1996) is an
excellent example, while the work of Greenspan (1996) shows parallel
developments within American psychoanalysis. Verheugt-Pleiter, Schmeets
and Zevalkink’s book on Mentalizing in Child Therapy y (2008) is an interesting
account of some more recent adaptations of developmental child
psychotherapy, linking it up with ideas about ways in which therapy can
promote the capacity for ‘reflective functioning’.

Child analysis and developmental therapy 165

11 PSYCHOANALYSIS AND
PAEDIATRICS
The care of children in hospital

KEY WRITINGS

1952 ‘The Role of Bodily Illness in the Mental Life of Children’

1952 ‘Visiting Children – The Child’
1953 ‘James Robertson’s A Two-Year-Old Goes to Hospitall film review’
1956 ‘Comments on Joyce Robertson’s A Mother’s Observation of the
Tonsillectomy of Her Four-Year-Old Daughter’
Daughterr ’
1961 ‘Answering Pediatricians’ Questions’
1965 Children in the Hospitall (with Thesi Bergmann)
1970 ‘Foreword to A Psychoanalytic Contribution to Pediatrics ’
1975 ‘On the Interaction between Pediatrics and Child Psychology’
1976 ‘Foreword to The Hospitalized Adolescent ’

Introduction

Ever since her early experience in Vienna, working with impoverished and
orphaned children in the wake of the First World War, Anna Freud had been
attentive to the physical needs of children alongside their psychological needs.
When she established the Jackson Nursery in Vienna in 1937, Josefi ne Stross
was employed alongside the teachers to act as a paediatrician for the children,
most of whom came from the poorest families in Vienna. Elisabeth Young-
Bruehl records in her biography of Anna Freud the precautions that she and
her staff took to try to prevent the spread of infectious diseases, including
daily baths and medical examinations each morning by Dr Stross, who kept
careful records of the children’s physical health and reported any concerns to
the children’s parents (1988/2008: 220). Many years later, Anna Freud
proudly remembered that the parents of the toddler-age children who
attended the Jackson Nursery were ‘delighted with their good care’ and that
the children in turn ‘thrived and, on their part, recompensed us by providing
knowledge about a child’s first steps out of the biological unity between
infant and mother’ (quoted by Young-Bruehl, 1988/2008: 219). When the
Nursery was closed and the Freud family escaped to London, Anna Freud
worked alongside Josefine Stross once again in the Hampstead War Nurseries
and in the post-war years established a ‘Well-Baby Clinic’ at the Hampstead

166 Reading Anna Freud

Clinic, which was intended to provide sound advice on both the physical and
the psychological needs of children in the early years of life.
Anna Freud had her own experiences of ill-health and knew what a
devastating effect it could have. In her early twenties, she had suffered from
tuberculosis, which continued to affect her on and off for about five years;
then, in the immediate aftermath of the Second World War, she fell ill with
an influenza so serious that she came close to death and was left with a
permanent vulnerability to bronchial infections. In addition, Anna Freud
had seen her own sister, Sophie, die in the influenza epidemic of 1919/20 and
had watched for over 15 years as her father went through one treatment after
another for his cancer of the jaw. All of these experiences had brought home
to her the profound impact that bodily illness could have on the mind and
the particular impact of treatment and hospitalisation on the developing
personality of the child.
This concern with the interaction of body and mind – and in particular for
those children suffering from physical illness – took on a particular significance
in the post-war years, when the issue of how best to care for children in
hospital came to the fore both in Britain and across the world (e.g. Spitz,
1945).

Visiting sick children in hospital: The work of

James and Joyce Robertson

James and Joyce Robertson (1989), working alongside John Bowlby in the
post-war years to study the effects of separation on children, decided to focus
on the impact of hospitalisation in order to illustrate their ideas about the
importance of attachment relationships. In doing so, they raised serious
concerns about the impact that separation from parents had on children
hospitalised for even quite minor operations. Likewise, the work of Isabel
Menzies Lyth (1959), using psychoanalytic ideas to examine the organisational
defences at work in hospital settings, raised real concerns about how staff in
hospitals manage the unbearable anxiety of working in a setting where pain,
loss and death are such unavoidable realities. Anna Freud followed this work
with interest, although her own interests led her to focus her attention
somewhat differently.
Anna Freud’s interest in the work of these colleagues was not just academic.
James and Joyce Robertson both worked with Anna Freud in the Hampstead
War Nurseries, where they came to appreciate the powerful impact that
separation could have on young children. In 1948 James Robertson joined
John Bowlby’s team at the Tavistock Clinic studying ‘The Effects on
Personality Development of Separation from the Mother in Early Childhood’.
As part of this study, Robertson was asked to undertake a series of observations
at the Central Middlesex Hospital, where he was shocked by the impact of

Psychoanalysis and paediatrics 167

the severely restricted hospital visiting hours on the children’s emotional
well-being, especially on children below the age of three years.
Together with John Bowlby, Robertson used his hospital observations to
develop a theory of how young children react to experiences of separation.
He argued that they go through three key stages: protest, despair and fi nally
detachment (Robertson and Robertson, 1989). In the protest stage, the
young child will cry, have tantrums and desperately try to fi nd his mother; if
the separation continues, the child will enter a state of despair, in which
he or she will become quiet, withdrawn and appear to lose interest in the
outside world; in the third stage, that of detachment, the child may appear
to have recovered and even start to engage once again with the world, but
the engagement will be shallow and superficial, as if hope in loving
attachments has been surrendered.
In order to challenge the seeming indifference that these initial findings
met, Robertson made a documentary fi lm, A Two-Year-Old Goes to Hospital
(1953), which followed the progress of a two-year-old girl, Laura, entering
hospital for a minor operation. Robertson’s fi lm had a great impact on the
many people who saw it, and it led to a lively debate in the Nursing Times
about the best policy on parental visits for sick children in hospital, ultimately
influencing the recommendations of the Platt Report (MoH, 1959), which
made the case for parents to be admitted alongside very young children.
Anna Freud and her colleagues strongly supported this campaign, and they
wrote a series of letters to the Nursing Times arguing that hospitals
should revise their policies in order to protect the emotional well-being of
young children. As with her experience in the War Nurseries, Anna Freud
realised that the increased ‘difficulty’ that came from allowing young
children to maintain emotional attachments in the face of separation
experiences was a price worth paying for the long-term emotional well-
being of those children.
In a review of Robertson’s fi lm in the International Journal of Psychoanalysis,
Anna Freud was full of praise for the work and the insight it gave into the
effect of hospitalisation on the young child, but she was critical of the
fact that the fi lm and the subsequent writings by Robertson and Bowlby
focused solely on the impact of separation and neglected ‘the importance
of internal reality’ (1953: 285). She pointed out, for example, that Robertson
deliberately chose a child going into hospital for a minor operation, in
order to emphasise that the little girl’s behaviour was a result of the
separation from her mother and not of any other factor, such as the operation
itself. For Anna Freud, this approach comes ‘dangerously near to those
arguments and prejudices of the medical profession which the fi lm sets out
to combat’:

To classify the operation as minor, harmless, practically painless, and of

short duration is a reality assessment not excluding the possibility that to

168 Reading Anna Freud

 Laura herself the same occurrence may be a major traumatic, terrifying
one.
(p. 285)

Anna Freud went on in her review to offer a sensitive re-reading of key

moments in the fi lm, drawing out other aspects of the experience of physical
illness and hospital treatment which Robertson appeared to de-emphasise. In
doing this, she was making the case for a wider view of the impact of bodily
illness on psychological well-being, a perspective that she was concerned
could easily be lost. As she was to write many years later, looking back on the
work of the Robertsons, Bowlby and others:

It was the emphatic description of the separation anxiety of hospitalized

infants which succeeded finally to convince a number of doctors and
nurses that, to be therapeutically effective, the care for a child’s ill body
needs to be complemented by concern for and attention to his psychological
needs. In fact, the general public’s readiness to acknowledge the importance
of separation anxiety threatened for a while to overshadow the equally
important impact of the illnesses themselves.
(1970a: 270)

This ‘equally important’ aspect of the situation was to be a major focus of

Anna Freud’s attention over the following 25 years.

‘The Role of Bodily Illness in the Mental Life of Children’ (1952)

In a paper first published in the Psychoanalytic Study of the Child in 1952, Anna
Freud pointed out that in trying to evaluate the role of bodily illness in the
mental life of children ‘we find ourselves hampered by the lack of integration
at our disposal’ (1952b: 260), with the different perspectives of parents,
nursery workers, child analysts and paediatricians rarely brought together.
While acknowledging the important work of Robertson and his colleagues,
she found that in this work hospitalisation was ‘merely serving as the prototype
of a first, short-term separation from home . . . [without producing] additional
knowledge concerning reactions to illness and pain in infantile life’ (p. 261).
That such knowledge is of importance is suggested by the fact that parents
often date the development of neurotic disorders in children back to the
onset of some form of bodily illness, regardless of whether the child was
hospitalised at the time or not.
In her writings, Anna Freud shows great empathy with the situation of the
child suffering from physical illness. She describes the way in which the child
often has to ‘submit uncomprehendingly, helplessly and passively’ both to
that which comes from inside the body, in the form of disease, and to that

Psychoanalysis and paediatrics 169

which comes from outside, in the form of being cared for and treated by
parents and medical staff. Matters are made more complicated for many
children who are unwell because of ‘a firmly fi xed belief that illnesses are
self-induced, the well-deserved punishment for all sorts of badness,
disobedience, disregard of rules, neglect of prohibitions, bodily abuse’
(Bergmann and Freud, 1965: 80). In the book that Anna Freud wrote with
Thesi Bergmann, Children in the Hospital, they give the example of a nine-
year-old girl called ‘Ruth’, with a rheumatic heart disease, who was admitted
to the Rainbow Hospital in Cleveland, Ohio, where Bergmann worked. At
her first meeting with Bergmann, she told her that she was the ‘goodest’ of
the four children in her family because ‘Mother and the Lord are always
aware of children’s sins’ (p. 82). She went on to tell the hospital therapist that
she thought it was unfair she was sick, as she was not as ‘bad’ as her brothers
had been. But she was worried by the memory that she had masturbated,
which had made her heart begin to pound. In talking with Bergmann, it
became clear that the little girl felt that this was the reason why she now
suffered from a heart condition, and that her illness was in some sense a
punishment for her ‘bad’ behaviour.
Anna Freud was constantly fascinated by the very different ways in which
children (and people more generally) could react to physical illness. Whereas
some children, when they become unwell, appear to withdraw into their
own world, lying in bed ‘without moving, their faces turned to the wall,
refusing toys, food as well as any affectionate advances made to them’, others
‘become demanding, exacting, clinging far beyond their years’ (pp. 275–276).
Anna Freud suggests that in the former case the ‘cathexis is withdrawn from
the object world and concentrated on the body and its needs’, whereas in the
latter the child is returning to the earliest stages of life, ‘when the mother’s
libidinal cathexis of the infant’s body is the main influence in protecting it
from harm, destruction and self-injury’ (pp. 275–276). Both of these reactions,
she emphasised, are normal and appropriate in themselves, as long as the
change in ‘distribution of libido’ is only temporary and the child is able to
return to his or her normal personality once the illness is over. Why some
children tend to behave one way more than the other, however, remained a
question that Anna Freud left open.
One aspect of physical illness that Anna Freud shows particular interest in
is the way in which different children tolerate pain. In her 1952 paper, she
notes that parents and health professionals are often struck by the very
different way in which children respond to bodily pain – ‘what is agonizing
to one child may be negligible to another’ (1952b: 272). Going back to
early infancy, she explores the ‘relative proportion of physiological and
psychological elements in the experience of pain’, suggesting that at the
earliest stages of life no real distinction is made by the infant between an
experience of need or frustration and an experience of pain – both ‘assume
the dignity of traumatic events’ and, as such, are met with in the same way.

170 Reading Anna Freud

By the age of two or three years, however, bodily pain takes on specific
psychological significance for children. She suggests that analytic study has
shown that these differences are based on ‘the degree to which the pain is
charged with psychic meaning’, and that it is where pain is augmented by
anxiety that one is likely to find the most extreme reactions. She gives as an
example the scene in Robertson’s fi lm about Laura where the surgical stitches
are removed by a nurse, who handles the process quickly and skilfully. This
event, however:

. . . may well mean to Laura a terrifying experience, with grim, ghostlike

figures advancing on her without warning, making a deliberate attack on
her body to do her injury. Such events confirm children in their belief that
their fantasies of being attacked, mutilated, annihilated, are capable of
coming true. According to the child’s fi xation to one particular set of
unconscious imaginings, the happening is understood by him as retaliation
for his own aggressive wishes (in Melanie Klein’s sense), as punishment for
misdeeds, for death wishes, as castration.
(1953: 286)

The experience of pain: A clinical example

As with her writings about diagnosis and assessment, Anna Freud did not
give her own clinical account of working with children in a hospital setting,
but left it to her colleagues and students to provide such illustrations of her
thinking. ‘Kieran’, for example, was seven years old when he was referred to
a hospital-based child psychotherapist because of his needle phobia (Neil,
2003). Having suffered from a brain tumour in early childhood, Kieran now
reacted strongly to any type of hospital intervention, screaming and struggling
against the staff, who sometimes had to hold him down to administer an
injection. A clinical psychologist assessed him as suffering from a severe
trauma reaction to his hospital treatment, which had left him constantly
hyper-aroused, so that even minor hospital interventions, such as an injection,
evoked huge anxiety. The psychologist recommended a desensitisation
programme to help Kieran manage his anxiety about needles but was unable
to proceed with the programme after Kieran covered his ears and began to
scream at the very mention of his illness or his treatment. Kieran was referred
on for individual psychotherapy.
The full course of Kieran’s therapy is described in a wonderful paper by
Marta Neil (2003), in which she describes how she made use of psychoanalytic
developmental therapy to help Kieran with his overall psychic development.
During the course of this treatment, Kieran and his therapist came to
understand a great deal about the psychic significance of his early experiences
of medical treatment, and how this affected his way of managing any new

Psychoanalysis and paediatrics 171

experiences of pain. Neil writes of Kieran at the age of three, when he first
underwent surgery and radiotherapy for his tumour:

Lacking the cognitive maturity to distinguish between the pain and

suffering caused by the disease within the body and the pain and
suffering imposed on him from the outside, both the illness and the
treatment must have been experienced as inescapable terrors to which
he had to submit passively and helplessly. Also, that the illness and
treatment coincided with wishes, fears and feelings that one might
expect to emerge in line with his developing emotional life, meant that
his internal world of fantasies was dramatically brought to life at a time
when Kieran would have lacked the cognitive maturity to distinguish
fantasy from reality.
(p. 157)

In response to these situations, Kieran had developed a whole series of

fantasies that both helped him to symbolically represent his early experiences,
but also became sources of anxiety in themselves, thereby exacerbating the
impact of the trauma. He described fantasies, for example, of a ‘little boy
snake’ who had been attacked by dangerous animals until his whole body
was damaged, while his mother watched passively, unable (or unwilling) to
help him (p. 150). Kieran’s anxiety lessened not when he was given more
‘realistic’ explanations of hospital procedures, but only when he was able to
fully explore fantasies like this one, which he was able to connect to his anger
towards his own mother for allowing the doctors to put him through such
painful experiences, such as a catheterisation at the age of four which had left
him bloody and in pain and scared that he had been ‘turned into a girl on the
inside’ (p. 151). By coming to verbalise the feelings associated with fantasies
such as this, Kieran was gradually able to reduce the anxiety associated with
his frightening internal world.

‘Children in the Hospital’ (1965)

Based on her observations about the impact of bodily illness on the mind of
the developing child, Anna Freud grew increasingly interested in the question
of how psychoanalysis could engage in a dialogue with paediatrics, in order
to find ways in which a psychoanalytic-developmental perspective could
influence the work of doctors and nurses in hospitals.
An important component of this bridge that Anna Freud wished to
create was the establishment of a monthly meeting that took place in her
home with a group of paediatricians, among whom the most influential
was perhaps Ronald MacKeith, a paediatrician at Guy’s Hospital in
London who was so interested in seeing the world from the child’s

172 Reading Anna Freud

perspective that he would often insist that his staff knelt down at the end of
children’s beds, so that the children ‘are looking down on us, instead of us
looking down on them’ (quoted by Lindsay, 2008). MacKeith had
supported Joyce Robertson in her decision to accompany her child into
hospital for a tonsillectomy and to keep detailed observations of this visit,
which were published in 1956. The paper described how her mother’s
presence had helped the little girl, Jean, to cope with the terrors that were
brought to the surface by this experience, but its publication caused a
furore at the time. Anna Freud wrote a very positive review of Joyce
Robertson’s paper (A. Freud, 1956b) and through this met with MacKeith.
The two of them immediately recognised their common interest in bringing
together paediatrics and child psychiatry, and so on a Thursday evening in
1956 a first meeting took place between Anna Freud and a group of senior
paediatricians (Cooper, 1983b). These meetings continued on a regular
basis for over 25 years, and they were an opportunity for the paediatricians
to consult with Anna Freud about patients whose emotional well-being was
causing them concern; in turn, Anna Freud had the opportunity to learn
a great deal about the challenges of working with physically ill children in a
hospital setting.
Christine Cooper was one of the people who took part in those meetings,
and she described her memories of the evenings in a talk given soon after
Anna Freud’s death:

The evening began with the welcome from Paula the Viennese maid,
followed by the charm and graciousness of Miss Freud as she ushered us
into the dining room overlooking the lovely garden. We were offered a
delicious light meal and coffee before our work together [creating] the
relaxed atmosphere for mutual exchange and enlightenment. . . . We
would then move into the library adjoining Freud’s study . . . and each
week 2 or 3 of us took turns to bring up difficult cases or problems in
paediatrics. The atmosphere was friendly and informal, but critical
comment occurred freely and sometimes there was gentle rebuke from
Miss Freud. . . . Our discussions ranged widely over paediatrics covering
acute and chronic illness, cancer, deformity, children with ambiguous
sex, accidents, child abuse, stillbirth, the stresses of bereavement, and
many other topics. . . . The whole gamut of behavioural disorders
were discussed time and again, and the illumination of key paediatric
issues through the insights of psychoanalysis made a deep impression
on us.
(Cooper, 1983b: 472)

Although no records of specific discussions remain, we can get some sense

of how these consultations may have gone thanks to a meeting that took
place between Anna Freud and a group of paediatricians at the Royal College

Psychoanalysis and paediatrics 173

of Physicians in 1959, which was later published as a paper called ‘Answering
Pediatricians’ Questions’ (1961). In the paper, Anna Freud makes the case for
a ‘double orientation’, directed simultaneously towards the body and the
mind, based on a hope ‘that all people who practice medicine will also
receive a double training: that they will learn approximately the same
about the body and the mind’ (p. 380). Following a brief introduction, Anna
Freud went on to address a series of questions, ranging from the use of
suppositories to crying infants, sleep disturbances and food refusal among
small children. In all of her answers, Anna Freud emphasised the importance
of taking a developmental perspective and of considering the specific
meaning of any behaviour depending on the particular context and history
of each child. For example, in responding to a specific query about a mother
who fails to pick up on her child’s readiness for toilet training because she has
read somewhere about the dangers of ‘coercive’ toilet training, Anna Freud
replies:

I often feel that the mothers of young children are the most maltreated
individuals in our community, because they are made responsible for
whatever happens to the child, whatever is found in the child, without
being given the possibility to do something positive about it or even to
defend themselves . . . [Many] mothers look to Dr. Spock [the author of a
well-known child care manual ] for guidance. He, quite intentionally, accepts
this role. He tries to set himself up as a benevolent, and at the same time
firm, authoritarian figure, in order to return to mothers the self-confidence
which they have lost. I had a discussion with Dr. Spock about it once in
which I took another point of view. I said I think all this advice to mothers
is not really what is needed; the spreading of knowledge is what is necessary.
(1961: 401–402)

One of the best examples of how Anna Freud tried to spread knowledge
of the experience of children in hospitals was through her collaborations
with colleagues where she encouraged them to gather systematic observations,
as she had done in the Hampstead War Nurseries, which would highlight the
emotional needs of physically sick children. She wrote forewords for works
such as The Hospitalized Adolescent (1976c) and A Psychoanalytic Contribution to
Paediatrics (1970a), written by her colleague, Bianca Gordon, and she
collaborated with her old friend from Vienna, Thesi Bergmann, to put
together observations from Bergmann’s work at the Rainbow Hospital into
a book about Children in the Hospital (Bergmann and Freud, 1965). In this
book and in a series of related papers, Anna Freud explored a range of issues,
including the child’s relationship to medical staff; visiting rules and the
impact of separation from parents; preparations for surgery; the use of defences
against anxiety when faced by medical illness; and the impact on personality
development of bodily illness and hospital treatment.

174 Reading Anna Freud

The experience of being cared for in hospital

Anna Freud’s comments about the experience of being cared for when sick
are typical of her approach, in which she places the specific experience in the
wider context of the child’s development and asks what the meaning of an
experience will be for a particular child. She notes, for example, that adult
patients often describe the indignity and humiliation of being nursed through
a severe illness as being ‘treated like a baby’. This might suggest that such care
was less upsetting for the child than for an adult, who is already familiar with
the experience of being cared for by adults. But drawing on her knowledge
of the developmental lines, Anna Freud suggests that in certain cases the
opposite may be the case. For example, if a child has only just achieved
mastery of various bodily functions, such as bladder control, independent
eating or the capacity to wash and dress by himself, then the possible loss of
such functions can be devastating, as it may be experienced as a loss in ego
control and a pull ‘towards the earlier and more passive levels of infantile
development’ from which the child has only just moved on: ‘Newly acquired
and, for that reason, precariously anchored ego achievements are most
frequently lost under these conditions’ (1952b: 265).
What Anna Freud is describing here is the ‘normal regression’ that can
occur on any of the child’s developmental lines in response to external
experiences, especially ones that are stressful or anxiety-provoking. How the
child reacts to such an experience may depend on what kind of defences he
or she has developed against these regressive tendencies. Some may fi nd such
enforced regression intolerable and become difficult, intractable patients;
others, with less severe defences against the more passive-dependent feelings,
may slip back very comfortably into a more infantile role, giving up the
advances that they fought so hard to achieve. Whether such a reaction is an
indication of longer-term difficulties may depend, Anna Freud suggested, on
the degree to which the regression is a temporary one or a permanent state,
continuing even when the external circumstances alter for the better.

Children’s illnesses, treatment and surgery

The way children react to operations and surgery was a topic of great interest
to Anna Freud, who as a child herself had undergone an appendectomy
operation without being told by her parents that this was to happen. As with
many children of her generation, this was done deliberately in order to avoid
her ‘worrying’, but it left the young Anna with a sense of ongoing distrust
and anger directed towards her mother, which remained an important part of
her childhood and adolescence experience (Young-Bruehl, 1988/2008).
Medical treatment had been a topic of interest to psychoanalysts for
some time before Anna Freud wrote about it. The earliest generation of

Psychoanalysis and paediatrics 175

psychoanalysts had been interested in how children responded to surgery,
seeing this is an opportunity to observe the workings of ‘castration anxiety’
in a symbolic form. Although Anna Freud recognised that ‘any surgical
interference with the child’s body may serve as a focal point for the activation,
reactivation, grouping and rationalisation of ideas of being attacked,
overwhelmed, castrated’ (1952b: 269), she widened the perspective, describing
how a child’s reaction to surgery will depend far more on his level of
development and his characteristic use of defence mechanisms than on the
‘seriousness’ of the operation itself:

What the experience means in his life, therefore, does not depend on the
type or seriousness of the operation that has actually been performed, but
on the type and depth of the fantasies aroused by it. If, for example, the
child’s fantasies are concerned with his aggression against the mother
projected onto her person, the operation is experienced as a retaliatory
attack made by the mother on the inside of the child’s body (Melanie
Klein); or the operation may be used to represent the child’s sadistic
conception of what takes place between the parents in intercourse, with
the child in the role of the passive sexual partner; or the operation is
experienced as mutilation, i.e. as punishment for exhibitionistic desires, for
aggressive penis envy, above all for masturbatory practices and oedipal
jealousies.
(1952b: 269–270)

On a number of occasions, Anna Freud returned to the topic of

tonsillectomies, which were a common form of medical intervention for
children in the post-war years. A symposium on the topic was held in 1949,
involving a group of psychoanalysts, paediatricians and psychologists, which
recognised the potentially traumatic impact of various aspects of the
tonsillectomy ‘journey’, including the experience of undergoing anaesthesia;
of entering hospital; and of the operation itself (A. Freud, 1952b: 271). A
series of papers by Anna Freud and her psychoanalytic colleagues explored
issues such as the optimal timing for the operation, methods of preparation
and means of facilitating the child’s expression of feelings; Joyce Robertson
presented an observation of her own daughter’s experience of entering
hospital for a tonsillectomy, which emphasised how a child can be protected
against the harmful effects of this experience by the presence of the mother.
Anna Freud praised the approach taken by Joyce Robertson, but she noted
that it did not prevent the four-year-old girl from experiencing the anaesthetic
as an ‘oral attack’ or the surgery itself as a type of punishment against which
she developed phobic defences (A. Freud, 1956b). She also noted how the
experience of surgery continued to affect the little girl after her return
home – for example, in her increased ambivalence towards her mother and
her increased separation anxiety, which manifested itself in a fear of going to

176 Reading Anna Freud

sleep. That this little girl was soon able to overcome these fears was understood
by Anna Freud as being in large part due to the careful management of the
experience by her mother. In clarifying how this mother helped her child,
Anna Freud also made a helpful distinction between the ‘therapeutic’ role of
parents and that of child analysts:

Mrs Robertson helped her child precisely in this way: to meet the operation
on the level of reality; to keep the external danger in consciousness, to be
dealt with by the reasonable ego, instead of allowing it to slip to those
depths in which the rational powers of the ego become ineffective. . . .
[Mothers] limit themselves to assisting the child’s ego in its task of mastery,
lend it their strength, and help guard it against irruptions from the id.
Analysts work in the opposite direction. Under carefully controlled
conditions, they induce the child to lower his defences and to accept the id
derivatives in consciousness. The contact with the id impulses which is
thereby obtained is then used to effect a gradual transformation of these
strivings to which all neurotic anxieties and symptoms owe their origin.
(1956b: 300–301)

Conclusion: The child therapist’s role in the hospital setting

Al Solnit and Lottie Newman, who both worked alongside Anna Freud,
commented after her death that ‘she was always puzzled by why it was so
difficult to convince pediatricians and nurses that physical illness, medical
procedures, hospitalizations and surgery had a profound effect on the child’s
emotional development’ (Solnit and Newman, 1984: 59). In the lecture to
the Royal College of Physicians published as ‘Answering Pediatricians’
Questions’ (1961), Anna Freud praises her audience for their growing interest
in the psychosomatic disorders, and their understanding of how the body
may influence the mind, but went on:

I always wonder why you are not equally interested in the other side of the
picture, namely, what repercussions the truly organic disturbances which
you treat have on the mind of the child. I often regret that paediatricians
care more for the psychosomatic side and are less interested in the
psychological after effects of physical illness.
(1961: 405)

Anna Freud’s own work in the post-war years showed a concerted effort
to correct this deficiency. Solnit and Newman (1984) note that the papers
addressed to medical audiences that were included in the eight volumes of
The Writings of Anna Freud were only a small fraction of the talks she gave,
and that ‘for more than three decades [from 1950 onwards] she used and

Psychoanalysis and paediatrics 177

sought every opportunity to speak to medical students, residents, nurses, and
physicians, each time bringing essentially the same message’ (1984: 59). As
she put it herself in 1965:

The medical and nursing personnel must inevitably be guided in their

actions by the needs which arise during the various physical crises or the
exigencies of pre- and post-operative situations. This, nevertheless, does
not alter the fact that every single happening during illness, as well as
every single action performed during its course and for its sake, beneficial
as it may be in the physical sense, also has its potential adverse repercussions
in the child’s mind.
(Bergmann and Freud, 1965: 142)

In order to encourage a greater awareness of this fact, Anna Freud supported

the idea of psychoanalytic child psychotherapists working in hospitals as part
of paediatric liaison teams – ‘hospital therapists’, as she called them, offering
what she and Thesi Bergmann described as ‘mental fi rst aid’ (p. 145). For
Anna Freud, this situation was in some ways an unfortunate compromise:

Perhaps, in the distant future, new training programs in paediatrics and

nursing will equip all hospital staff with sufficient knowledge of emotional
factors to ensure enlightened management of child patients. But, until the
time when this happens, paediatricians will have to rely on consultation
with a psychoanalytically trained advisor; ward sisters and nurses will need
instruction and guidance of some kind; medical social workers and hospital
teachers will learn from such help to use their professional skills to the best
advantage.
(1970a: 270)

Anna Freud saw the hospital therapist’s task as being ‘to introduce the staff
to the intricacies of the child’s mental and emotional functioning [just] as it
is her task to guide the children toward a clearer grasp of the physical and
medical necessities’ (Bergmann and Freud, 1965: 145). As such, the role of
the hospital therapist requires flexibility and the capacity to adapt models of
working derived from other fields according to the need of the moment – but
Anna Freud believed that the hospital therapist could greatly benefit by
having some knowledge of a psychoanalytic model of child development.
How the hospital therapist would use this knowledge required tact and
flexibility. In some cases, it may be a case of giving comfort, as where a
child’s own parent is too distressed to be able to support a child through a
difficult procedure; for others, it may be taking the role of an ‘auxiliary ego’,
trying to support the child’s capacity to cope with a situation that might
otherwise be overwhelming; whereas in yet other cases, the approach most
needed may be based on play therapy, helping the child to express his or her

178 Reading Anna Freud

inner feelings in displacement using dolls or other figures (pp. 148–149). In
certain select situations, the hospital therapist may also need to promote
communication between children and adults – both parents and in many
cases staff – or to offer analytic interpretations: for example, of a child
suffering from nightmares related to mourning and anxiety (p. 150). Despite
the wide range of roles that the hospital therapist will need to play, what runs
like a thread through all of them is the need ‘to be flexible’:

Since therapy is carried out within the hospital setting, it has to involve not
only the parents of the patient, as in child guidance work, but equally the
nursing and medical staffs. Since the approach ranges from the human to
the scientific and covers every aspect of the child’s life, such as physical
health, illness, normal and abnormal mental life, an orientation in these
various fields will be essential for the worker; so will observational skill
and a thorough grounding in the essentials of a developmental child
psychology.
(p. 151)

Although Anna Freud herself was pessimistic about the degree to which
such thinking was able to influence paediatric practice, Young-Bruehl speaks
of the way in which Anna Freud’s work ‘contributed to a psychoanalytic
revolution in both English and American treatment protocols for children
requiring long-term hospital care’ (1988/2008: 410), with profound changes
taking place in the way in which hospitals think about parental visitations;
how they help children to prepare for operations; and how they help them to
make sense of the profound emotional impact of their physical illnesses
(Malberg, 2012).
Of course, the work of many (non-psychoanalytic) nurses, psychologists,
psychiatrists and paediatricians has contributed to these changes in hospital
practice, but psychoanalytic child psychotherapists continue to make a specific
contribution to this field, whether it is working with children with life-
threatening diseases, such as leukaemia (e.g. Emanuel et al., 1990; Judd,
1989); or parents and babies in a neo-natal unit (e.g. Cohen, 2003; Midgley,
2008b); or those with long-term chronic health conditions (e.g. Malberg,
Fonagy and Mayes, 2008; Winkley, 1990). To take but one example, a Study
Group on Diabetic Children was established at the Hampstead Clinic in
1976, chaired by Marion Berger and Elisabeth Model, with the aim of
investigating the emotional problems of children with diabetes and examining
the effect of illness on the diabetic child’s personality (Moran and Berger,
1980). The Study Group ran in collaboration with the Middlesex Hospital,
and it led to (among other things) the publication of an important series of
studies by Fonagy and Moran, which explored how poorly controlled diabetes
in children could be understood as reflecting ‘conscious or unconscious acts
of transgression of the treatment regimen’, based on underlying

Psychoanalysis and paediatrics 179

psychopathological aspects of the personality. In particular, these studies
identified failures in ‘theory of mind’ in this group of children, which in turn
led to a poor sense of self-cohesion and diabetic mismanagement as
a maladaptive means of trying to manage poor internal representations of self
and other by means of the body itself. A special adaptation of psychoanalytic
treatment was found to be effective in improving the management of this
group of children (Fonagy and Moran, 1990), leading it to be recommended
as an ‘evidence-based treatment’ in clinical guidelines in the UK on
psychological support for children with physical health problems (NICE,
2004).
Pleased as she would no doubt have been by this evidence for the
effectiveness of psychoanalytic treatment, Anna Freud’s work not only
focused on the individual therapy of children in hospital, but also on support
to staff, parents and even the siblings of children in hospital. It also called for
a revolutionary rethink of the way that children’s emotional needs were
considered in a hospital setting. Whether directly influenced by the pioneering
work of Anna Freud or not, the considerable changes that have taken place
in paediatric wards over the last 30 years would have felt to her like a
vindication of her belief that ‘applied’ psychoanalysis could make a significant
contribution not only to the small number of children who received treatment,
but also to the well-being of children in hospitals in general.

FURTHER READING

The book written by Thesi Bergmann and Anna Freud, Children in the
Hospitall (1965), probably gives the best feel for how Anna Freud’s approach
could inform the way one thinks about, and works with, chronically ill children,
while the papers by Cooper (1983a, 1983b) and Lindsay (2008) give a clear
sense of how Anna Freud’s thinking influenced the work of paediatricians in
the UK in the post-war years.
There are not many reviews of Anna Freud’s influence on hospital work, but
Malberg (2012) is an extremely valuable contribution, linking Anna Freud’s
contribution to more recent developments; Solnit (1983) is also very helpful, as
he reviews the application of Anna Freud’s psychoanalytic thinking to a whole
range of fields, not just paediatrics.
Many contemporary psychoanalytic child psychotherapists have
written about the use of applied psychoanalytic thinking in various
hospital settings. Ramsden (1999) provides an excellent overview of this work,
while Kraemer (2010) gives a helpful overview of liaison work between
paediatrics and mental health more generally. An interesting update on
the 1959 Platt Report, which examined hospital policy in regard to visits
for children, can be found in Brandon et al. (2009). A summary of the

180 Reading Anna Freud

contribution of psychoanalytic child psychotherapists to hospital work in
the UK today can be found in a briefing paper from the Association of
Child Psychotherapists (2011). A good example of hospital work in the
Anna Freudian tradition can be found in Malberg (2012), who also discusses
Anna Freud’s contribution to paediatric psychology more generally.

Psychoanalysis and paediatrics 181

12 CHILDREN AND FAMILY LAW

KEY WRITINGS

1965 ‘Three Contributions to a Seminar on Family Law’

1966 ‘Psychoanalysis and Family Law’
1968 ‘Address at the Commencement Services of the Yale Law School’
1968 ‘Painter v Bannister: Postscript by a Psychoanalyst’
1973 Beyond the Best Interests of the Child
d (with J. Goldstein and A. Solnit)
1975 ‘Children Possessed: Anna Freud Looks at a Central Concern of the
Children’s Bill: The Psychological Needs of Adopted Children’
1979 Before the Best Interests of the Child
d (with J. Goldstein and A. Solnit)
1986 In the Best Interests of the Childd (with J. Goldstein, A. Solnit and
S. Goldstein)

Introduction

Towards the end of 1961, when Anna Freud was already in her mid-sixties,
she was visited at her home in Hampstead by the Dean of the Yale Law
School, Eugene Rostow, with an invitation to join the law faculty as a Senior
Fellow and Visiting Lecturer (Goldstein, 1984; Young-Bruehl, 1988/2008).
The faculty was fortunate to already have two professors, Jay Katz and Joseph
Goldstein, who were interested in the application of psychoanalytic ideas to
the law, and they were soon to publish an influential book on Psychoanalysis,
Psychiatry and the Law (Katz, Goldstein and Dershowitz, 1967). Katz and
Goldstein met with Anna Freud and agreed that she would visit for a month
every other year and join the regular seminar discussion groups that took
place between staff and students, on topics such as ‘Family Law’, ‘Psychoanalysis
and Jurisprudence’ and ‘Criminal Law’. Remembering these visits, which
were the start of a collaboration that continued until only months before
Anna Freud died, Goldstein writes:

Anna Freud loved this way of working. The students never got enough, no
class ever ended on time. They insisted on posing new questions and
hearing what she had to say. She not only willingly stayed on – caught in
the excitement of the exchange – she never tired of responding to their

182 Reading Anna Freud

 challenges. Indeed, year after year she insisted on a schedule which had us
teaching more than twice our normal load. . . . We always looked forward
to her visits, and we were delighted when she left – her pace was more
than we could manage for long.
(Goldstein, 1984: 5)

The visits to the Yale Law School also allowed Anna Freud to maintain
her links with the Yale Child Study Center, and in particular with Al Solnit,
who soon joined the collaboration, becoming the third party in a three-way
discussion between the law (Goldstein), paediatrics (Solnit) and psychoanalysis
(Anna Freud). As Solnit was later to observe, this new collaboration, which
Anna Freud entered into with great energy and enthusiasm, could also be
understood as a continuation of ‘her lifelong interest in the interactions of
children and their parents and in the psychoanalytic theory of object relations’
(Solnit, 1983: 387) – starting in Vienna with her work with the toddlers of
the poorest members of the working class, through to the children in war-torn
London and onto the work with neglected and abused children at the
Hampstead Clinic in the post-war years. For Solnit, Anna Freud’s growing
interest in legal questions was the ‘logical extension of her long-term interests
in the applications of psychoanalysis’ (p. 387).
Yet in other respects, the attempt to build links between the disciplines of
law and psychoanalysis was an unusual one. As Anna Freud herself noted, in
an address to the students of the Yale Law School in 1968:

As you well know, our two disciplines, the law and psychoanalysis, have
approached each other very cautiously and diffidently, with the links
between them few and far between. To begin with, they were wholly
divided and seemed destined to remain that way for good reasons. Legal
concepts are time-honoured, clear-cut, concise, well defined, and based
on indisputable facts; contrasted with them, psychoanalytic tenets are
vague, diffuse, complex, and rooted in the revolutionary assumption of a
dynamic unconscious mind. No wonder that there was – and still is – the
widespread conviction that to include in legal teaching some thinking
about the psychology of the human beings to whom the laws are applied is
at best unprofitable and at worst leads to confusion.
(1968a: 257)

In her address, Anna Freud went on to talk about the many obstacles in the
way of a mutual understanding between these two fields, but she argued that
both have much to learn from a more active dialogue. She picks out for
special mention two areas where the law and psychology have no choice but
to interact: first, in the field of criminal law, where the ‘insanity defence’ has
inevitably brought a psychiatric perspective to legal debates; and second, in
the field of family law, where legal discussions concerning ‘the best interests

Children and family law 183

of the child’ cannot choose but to engage with questions that belong to the
realm of developmental psychology.
As Young-Bruehl notes in her biography, Anna Freud’s initial excitement
about developing a dialogue with the Yale Law Faculty focused more on the
field of criminal law, and the possibilities of using psychoanalytic insights to
help develop a new system of crime prevention, based on an understanding
of the ‘internal constellation’ that led to the criminal act (1988/2008: 414).
But as her visits continued, her attention was led more and more to the field
of family law and to a growing conviction that the insights gained by
psychoanalytic developmental psychology could make a significant
contribution to a revision of legal practice for children and families entering
the court system. In a short paper in 1966, she set out a range of topics that
fell within the scope of family law which she felt overlapped with the work
she was already doing at the Hampstead Clinic – topics such as the impact of
separation and family disorganisation on personality development; the effect
of divided loyalties for children with separated parents; the links between
multiple placements in early childhood and later delinquent development;
and the specific problems faced by adopted children in relation to both their
birth parents and their adoptive parents (1966[1964]: 77).
As her visits to Yale continued, Anna Freud and her colleagues began to
think how they could best share some of the ideas that they were developing
together. Starting in 1969, she began to meet on a regular basis with Goldstein
and Solnit to try to produce a series of essays that would help the legal profession
to gain from the insights of psychoanalytic understanding. This collaboration
ultimately produced three jointly authored books: Beyond the Best Interests of the
Child (Goldstein, Freud and Solnit, 1973), Before the Best Interests of the Child
(Goldstein, Freud and Solnit, 1979) and (posthumously, with Sonya Goldstein
joining as a fourth author) In the Best Interests of the Child (Goldstein, Freud,
Solnit and Goldstein, 1986). Each work addressed itself to a specific question:

• Volume One – Beyond the Best Interests of the Child: The issue of contested
child placements – what are the appropriate guidelines that should be used by
courts to guide their decisions about child placement?
• Volume Two – Before the Best Interests of the Child: The issue of state
intervention in the life of the family – when and why should a child’s relationship
to his parents become a matter of state concern? What are the justifications
for authorising the state to modify parent–child relationships?
• Volume Three – In the Best Interests of the Child: The issue of respecting the
boundaries of professional knowledge – when and how do professionals working
in family law assume roles or undertake tasks that are outside their province
or beyond their expertise?

The trilogy of books produced by this collaboration were, as one reviewer

described them, ‘a penetrating, relentlessly lucid examination of the ways in

184 Reading Anna Freud

which society managed – and mismanaged – the lives of children’ (Esman,
1981: 275). Another American reviewer, quoted by Young-Bruehl, described
the first work in the trilogy (which was probably the most influential of the
three, at least in the US) as ‘the most discussed book on law and family ever
published’ (1988/2008: 416). Each volume systematically addresses a range of
questions and illustrates the issues with examples of legal cases that highlight
the dilemmas being addressed. Each book also ends with a set of specific
proposals (or guidelines) that are aimed at improving the working of the
family law system. The books are informed by a set of guiding principles, and
so, rather than summarise each of these books in turn, this chapter will
present some of the key ideas introduced in the trilogy in relation to these
guiding principles.

Putting the child’s needs at the centre of decision-making

If there is one guiding principle that runs like a thread throughout each of
these books, it is the idea that the child’s needs – rather than the parents’
rights – should be the decisive factor guiding every stage of the legal process
in family law. Anna Freud and her colleagues argue that decision-makers in
law have long recognised the necessity of protecting a child’s physical well-
being, but that they have been ‘slow to understand and to acknowledge the
necessity of safeguarding a child’s psychological well-being’ (Goldstein,
Freud and Solnit, 1973: 4). Psychoanalysis, they argue, provides a valuable
body of generally applicable knowledge that could be easily ‘translated’ into
guidelines to facilitate good decision-making; but psychoanalysis is also
important because it reminds us to see things from the point of view of the
child’s own developmental needs. As Goldstein put it, in looking back on this
collaborative work:

Anna Freud taught us to put childish things before, not behind us. She
taught us to place ourselves in a child’s skin to try and think a child’s
thoughts and feel a child’s feelings about being ‘removed from a known
environment into an unknown one’, about his residence being divided
evenly between two warring parties or about having to visit an absent
parent on ‘prescribed days and hours’. She helped us understand that a
child, like an adult, is a ‘person in his own right’; but that unlike adults,
children ‘change constantly: from one state of growth to another’,
measuring the passage of time not by clock and calendar but by their own
built-in sense of time.
(Goldstein, 1984: 6)

Using non-technical language, they emphasise the child’s need for affection,
stimulation and unbroken continuity of care and explore what the implications

Children and family law 185

are of these needs for family law. Their understanding leads them to emphasise
the importance of the psychological parent and the psychological parent–child
relationship. While recognising that the fact of being a biological parent has
great significance, they argue that from the child’s perspective ‘the physical
realities of his conception and birth are not the direct cause of his emotional
attachment’ (Goldstein, Freud and Solnit, 1973: 17). They argue, instead,
that it is the caregiver who meets the various needs of the child (for care,
nourishment, comfort, affection and stimulation) who will become the
psychological parent, and that it is this relationship that the law needs to
protect in order to safeguard the child’s emotional well-being. They defi ne
the role as follows:

A psychological parent is one who, on a continuing, day-to-day basis,

through interaction, companionship, interplay, and mutuality, fulfi ls the
child’s psychological need for a parent, as well as the child’s physical needs.
The psychological parent may be a biological, adoptive, foster, or common-
law parent, or any other person. There is no presumption in favour of any
of these after the initial assignment at birth.
(p. 98)

The complex problem of how to assess who should be considered a child’s

psychological parent, when a child has had multiple caregivers, is addressed
in Chapter 4 of the second book of the trilogy, Before the Best Interests of the
Child. But once such a relationship has been established, then it is only on the
basis of a relationship with such a psychological parent, the authors argue,
that children are able to experience themselves as a wanted child and so can
form the ‘internal mental images of the parents which remain available even
if the parents are absent’ (p. 19). To neglect this relationship in favour of the
rights of parents is, they argue, a dangerous step to take.
The implications of this point of view for decision-makers working in the
field of contested child placements is immediate. In Beyond the Best Interests of
the Child, the authors argue that placement decisions should aim to safeguard
the child’s need for continuity of relationships. They set out the differential
impact of discontinuities of care for children at different stages in their
development (pp. 32–34), and they argue for a shortening of the usual waiting
period with an adoptive family before a final order of adoption is granted
(which at the time in the US was one year). They also suggest that the
adoption decree should be made final as soon as the child is placed with the
family and that custody decrees for children of divorced or separated parents
should not be subject to modification (unless there are further grounds for
state intervention). They also argue that the child’s different sense of time
means that decision-makers should act with ‘all deliberate speed’ in order to
‘maximize each child’s opportunity either to restore stability in an existing
relationship or to facilitate the establishment of new relationships’ (p. 42),

186 Reading Anna Freud

with every child-placement case effectively dealt with as an emergency, in
the same way that decisions about a child’s physical well-being are treated as
emergencies requiring speedy determination (p. 43). Most controversially of
all, at the time the book was published, Anna Freud and her colleagues
suggested that it should be the custodial parent, not the court, who decides
what visiting rights should be allowed to the non-custodial parent (p. 38) – a
viewpoint that led to heated debates at the time in the American press.

The primacy of the relationship to the psychological parent

In arguing that a child’s placement ‘should rest entirely on consideration for

the child’s own inner situation and developmental needs’, Anna Freud and
her colleagues recognise that this ‘simple’ rule is by no means easy when one
looks at its implications for placement decisions in the family courts. They
note in particular that decisions are made by judges who, like all human
beings, are swayed by different sympathies and may have ‘deeply engrained
irrational reservations about the primacy of children’s needs’ (Goldstein,
Freud and Solnit, 1973: 106). Where a parent has deliberately abandoned or
mistreated a child, so that the child has been placed in care and formed an
attachment to another adult, the judge may more easily be convinced of the
priority of a child’s needs to maintain continuity of care with the psychological
parent. But when the abandonment by the biological parent is entirely
involuntary, the judge’s decision will inevitably be affected by very different
emotions.
Anna Freud and her colleagues give as an extreme example the 2,500
Jewish parents from Holland who returned from concentration camps at the
end of the Second World War. Many of these parents had entrusted their
children to non-Jewish friends and neighbours, who had cared for them for
the duration of the war. When the war ended, those parents who had survived
the camps returned to Holland and wished to reclaim their children. But
in the intervening years, many of those children had become estranged from
their biological parents and had effectively developed a relationship in which
their foster carers were now their psychological parents. ‘The choice in such
tragic circumstances,’ Anna Freud and her colleagues write, ‘is between
causing intolerable hardship to the child who is torn away from his
psychological parents, or causing further intolerable hardship to already
victimized adults who, after losing freedom, livelihood, and worldly
possessions may now also lose possession of their child’ (p. 107).
The Dutch parliament made the decision that these children should all
be returned to the care of their biological parents, rather than allowing the
courts to make a judgement about each child on a case-by-case basis. While
recognising the almost unbearable difficulty of this decision, Anna Freud and
her colleagues argue that the placement decision should have been based on

Children and family law 187

the principle of maintaining the child’s relationship to the psychological
parent, whoever that was deemed to be. Such a decision, they argue, is based
on our knowledge of the detrimental effects of broken attachments:

To favour the biological parents [on principle] would impose an intolerable

hardship on both the child and the psychological parents. . . . Only in the
implementation of this policy does there lie a real opportunity for beginning
to break the cycle of sickness and hardship bequeathed from one generation
to the next.
(pp. 110–111)

The ‘least detrimental alternative’

As the example above makes clear, to speak about acting ‘in the best interests
of the child’ can sound dangerously glib in the context of difficult decisions
in which no side is entirely right or wrong. Moreover, as the authors
acknowledge throughout the trilogy, there are serious limitations to the
predictive value of the knowledge on which many judgements are based,
and no one can ‘predict in detail how the unfolding development of a child
and his family will be reflected in the long run in the child’s personality and
character formation’ (Goldstein, Freud and Solnit, 1973: 51). The awareness
of this limitation was one that struck Anna Freud forcefully in her work on
the Diagnostic Profi le, despite the knowledge gained by psychoanalysis and
developmental psychology about the averagely expectable ‘lines of
development’ and the way in which they can be derailed by adverse
experiences.
Anna Freud and her colleagues therefore proposed that guidelines for
family law decision-makers should be based not on the idea of what is ‘in the
best interests of the child’, but, rather, on the concept of the ‘least detrimental
available alternative for safeguarding the child’s growth and development’
(p. 53). They define this alternative as the one that maximises ‘the child’s
opportunity for being wanted, and for maintaining on a continuous,
unconditional, and permanent basis a relationship with at least one adult who
is or will become the child’s psychological parent’ (p. 99). Framing decisions
in terms of the least detrimental alternative makes explicit the fact that family
courts, often dealing with children and families in almost unbearably difficult
situations, are not so much able to do good, but, rather, to minimise harm. As
a standard, they see it as ‘less awesome and grandiose, more realistic, and thus
more amenable to relevant data-gathering than “best interest” ’ (p. 63):

To use ‘[least] detrimental’ rather than ‘best interest’ should enable

legislatures, courts, and child care agencies to acknowledge and respond to
the inherent detriments in any procedure for child placement as well as to

188 Reading Anna Freud

 remind decisionmakers that their task is to salvage as much as possible out
of an unsatisfactory situation.
(pp. 62–63)

Implications of choosing the ‘least detrimental alternative’

In Before the Best Interests of the Child, Anna Freud and her colleagues give an
example of a ruling that, they suggest, did not lead to the least detrimental
alternative, as it was not based primarily on the needs of the child.
The Appleton Case (the case is real, but the name fictitious) related to a
five-year-old boy, Tom, who had lived for four years of his life with his foster
carers, the Appletons. Tom had been removed from his biological parents’
care when he was a year old because of his mother’s violent behaviour towards
his elder brother, coupled with his father’s alcoholism. When he was five,
however, Tom’s biological parents requested that he be returned to their care,
on the recommendation of the Child Care Services who now deemed that
they were capable of parenting Tom. The Appletons opposed this request,
arguing that Tom had formed an attachment to them and that it would not
be in his interest to be returned to the care of his biological parents. The
judge ruled, however, that the Appletons had taken Tom into their care with
knowledge of the terms of the agreement as foster carers and had received
money compensation for their services. Part of the original agreement
had been that the Appletons would not apply to adopt Tom, and that the
biological parents had natural rights and obligations that entitled them to
care for their son.
About a year after Tom returned to the care of his biological parents, his
father was charged with abusing him; Tom then entered an orphanage, where
he remained for five months before the court ruled that he should be returned
to the care of the Appletons. At the time of his return, he was showing
symptoms of anxiety, nightmares and sleeping difficulties and appeared
confused and upset.
In retrospect, it is perhaps easy to see that returning Tom to the care of his
natural parents had a detrimental effect on his emotional development. But
following the principles set out by Anna Freud and her colleagues, the court
would not have decided to return Tom to his biological parents’ care, even if
there had been little risk of him suffering further abuse:

Instead of protecting the development and emotional well-being of the

child, the Appleton court chose to safeguard child care agency policy, to
enforce a contract, and to respect a legal, not an actual, relationship. Even
if a contract theory deserves recognition, there is no reason why the child
must be sacrificed to the injured party.
(Goldstein, Freud and Solnit, 1979: 54)

Children and family law 189

The principle of ‘minimum state intervention’

The examples given above may seem to imply that Anna Freud and her
colleagues were not ‘on the side’ of biological parents and were strong
supporters of state intervention. But on the contrary, the guidelines that the
authors produce are based on the belief that ‘a child’s need for continuity of
care by autonomous parents requires acknowledging that parents should
generally be entitled to raise their children as they think best, free of state
interference’ (Goldstein, Freud and Solnit, 1979: 4). Since a child’s paramount
need is for continuity of caregiving relationships, the state’s primary interest
should lie in the preservation of the family, whenever possible. Children’s
development, they argue, has the best chance of proceeding in the context of
a family (whether biological or not) which is granted the right to privacy, so
long as the child’s well-being is not threatened:

When family integrity is broken or weakened by state intrusion, [the

child’s] needs are thwarted and his belief that his parents are omniscient
and all-powerful is shaken prematurely. The effect on the child’s
developmental progress is invariably detrimental.
(p. 9)

Anna Freud had come to recognise, especially during her work in the
Hampstead War Nurseries during the Second World War, the great degree to
which children’s progress in terms of emotional and social development
depended on the establishment and continuation of emotional ties to an adult
caregiver. Once a child is taken into care, ‘the state is too crude an instrument
to become an adequate substitute for flesh and blood parents’ (p. 12), and in
many cases, as we know from the terrible statistics about outcomes for looked-
after children in terms of mental health and well-being, the fact that a child
has been protected from harm by removal from a dangerous situation by no
means guarantees that a better outcome will follow. As the authors drily
note, by its intrusion the state may make a bad situation worse; indeed, it
‘may turn a tolerable one or even a good situation into a bad one’ (p. 13).
In Before the Best Interests of the Child, the question of what justifies the
state’s intervention in the life of families is posed. Anna Freud and her
colleagues therefore put forward a series of questions that those involved in
family law should ask at each stage of the process – from the initial point of
investigation (‘invocation’) through to the stages of ‘adjudication’ and
‘disposition’. They ask (and give practical guidelines to help answer) questions
such as: What events provide reasonable bases for authorising an investigation
by a child protection agency? What must an inquiry uncover before parents
can be forced to defend their entitlement to care for and represent their child?
What should constitute sufficient cause for the state to modify or terminate
a parent–child relationship? And if there is sufficient cause for modification

190 Reading Anna Freud

or termination, which of the available placements is the least detrimental?
The authors go through a range of situations, including parent–child
separations, physical and sexual abuse, emotional neglect, and refusal of
medical care, and consider for each one on what grounds an intervention by
state services should or should not take place. In each case, they provide
examples of how their guidelines would influence decision-making in family
courts, and they draw out the principles on which these recommendations
have been made. They recognise that without some clearly defined principles
to guide the work, there is a danger that terms such as ‘neglected’ or ‘abused’
will be used with little agreement about what is actually meant, leading
judges to make decisions on a case-by-case basis on a purely ad hoc basis. By
clarifying the fundamental principles by which decisions should be made, the
authors argue that ‘fair warning’ is thereby given to parents, who can know
the criteria by which their behaviour will be judged, thereby minimising the
arbitrary authority of state officials (pp. 16–17).

Protecting the integrity of the family

As an illustration of their principles in practice, Anna Freud and her colleagues

discuss the legal decision In re Sampson, where a judge in New York declared
15-year-old Kevin Sampson to be a ‘neglected child’, because his parents
decided not to oblige their son to undergo a series of operations that had been
recommended by the Commissioner of Health to correct a serious facial
deformity that the boy suffered as a result of neurofibromatosis. This
disease had left Kevin (in the judge’s words) with ‘a large fold or flap of an
overgrowth of facial tissue which causes the whole cheek, the corner of
his mouth and right ear to drop down, giving him an appearance which can
only be described as grotesque and repulsive’ (Goldstein, Freud and Solnit,
1979: 102).
The judge ruled that this deformity would inevitably affect Kevin’s
personality development, and his opportunities for education and for later
employment, and that any decision to postpone or not go ahead with the
surgery would have a detrimental effect on the boy’s development. The fact
that Kevin himself did not wish to go ahead with the operation – and that his
mother supported this decision – should not be the primary issue, the judge
declared; as such, he considered that Kevin was a ‘neglected child’ and should
be taken into the care of the state, so that his ‘need’ for the operation should
be adequately addressed.
Anna Freud and her colleagues criticised this judgement on the basis that
it interfered with the integrity of the family and went beyond what is required
by the principle of minimum state intervention. They argued that the judge
had placed himself in the position of ‘prophet, psychological expert, and
all-knowing parent’, but that there was no reason why his own view on the

Children and family law 191

likely outcome of a decision not to have an operation would be any more
or less accurate than the view of Kevin’s parents. But given that the judges
would not need ‘to assume day-to-day responsibility for giving their Kevins
the personal care they may require’, the authors argue that the autonomy and
freedom of the family to decide – free from state intervention – should be
protected. A ‘prime function of the law,’ they remind us, ‘is to prevent one
person’s truth . . . from becoming another person’s tyranny’ (p. 93).
Although they do not discuss Kevin’s case specifically, the authors return
to similar situations in the final book in the trilogy, In the Best Interests of the
Child. Here they discuss the danger of crossing professional boundaries,
whether it is a judge acting as an expert in child development, or a child
therapist serving as a consultant to the court on issues of custody. They argue,
instead, that experts from different fields should work together, learning
from each other, but maintaining their own professional role, and making
explicit, as necessary, the knowledge and assumptions that they are drawing
on to make their claims. They conclude by arguing that professionals working
in this field need to be both ‘softhearted’ and ‘hardhearted’, able to act with
kindness and sympathy while at the same time remaining professional and
never confusing their own role with that of the child’s primary carers.

The ‘agonizing dilemma’

Anna Freud and her co-authors of the Best Interests trilogy maintain a stance
throughout that family law decision-making should be informed by research,
by knowledge deriving from a range of different disciplines, and from clear
guidelines that reduce the impact of personal prejudice and make the family
law system as open and transparent as possible. Each volume ends with a
chapter setting out provisions for a Child Placement Code, in which
definitions are clearly stated and the explicit principles on which decisions
should be made are set out. They also make a clear case for how the fi ndings
from psychoanalytic developmental psychology can inform the workings of
family law, and how an understanding of children’s development is central to
deciding, on a case-by-case basis, what the ‘least detrimental alternative’ is
for each particular child.
But throughout the trilogy the authors also emphasise what they describe
as ‘the law’s incapacity to supervise interpersonal relationships and the limits
of knowledge to make long-range decisions’ (Goldstein, Freud and Solnit,
1973: 49). They discuss the dangerous ‘rescue fantasies’ that professionals
working in family law may develop, and they argue that a healthy awareness
of our limitations is vital if this work is to be effective:

In the long run, the child’s chances will be better if the law is less pretentious
and ambitious in its aim, that is, if it confines itself to the avoidance of

192 Reading Anna Freud

 harm and acts in accord with a few, even if modest, generally applicable
short-term predictions.
(p. 52)

Unlike most writing for a legal audience, the authors make explicit their own
assumptions and premises and discuss the implications of these for the policies
they are proposing. They also write movingly about the ‘agonizing dilemma’
for those working in the field of family law, who have to bear the tension
‘between the fear of encouraging the state to violate a family’s integrity
before intervention is justified and the fear of inhibiting the state until it may
be too late to protect the child whose well-being is threatened’ (Goldstein,
Freud and Solnit, 1979: 133). For every case where the state has stepped in
and disrupted family life unnecessarily, there is another where they have
waited too long, and the child has suffered. The second volume of the trilogy
includes a long appendix on ‘children killed by their parents’, reviewing a
series of tragic cases and trying to learn lessons from these for the lives of
other children and their families. The authors make a strong case for children
being given the right to legal representation in their own right (Goldstein,
Freud and Solnit, 1973: 65–70), and Anna Freud also shows how the skills
gained by child therapists can be used to make sure that professionals can
communicate with children in such a way that their true feelings are
understood.

Conclusion: Building bridges between psychoanalysis

and the law

In 1995, Mr Justice Thorpe, then a judge of the Family Division of the High
Court in the UK, gave a talk on ‘the impact of psychoanalytic practice on the
family justice system’ to a special multidisciplinary conference held at
Dartington Hall in Devon, at which family law judges and mental health
professionals came together to discuss the relations between their two fields.
In his talk, Justice Thorpe spoke about the ‘crucial interdependency’ between
the family justice system and child psychiatry, but he added that there
appeared not to be any history of a relationship between psychoanalysis and
family law – noting, for example, that ‘there is not a single dictum upon the
relevance of the psychodynamic approach to assessments and conclusions
affecting outcome in Family Division cases’ (Thorpe, 1997: 3). And while
recognising the profound changes that had taken place in relation to family
law from the mid-1960s to the mid-1990s, he went on to say there was no
‘evidence that psychoanalytic thinking has made any direct contribution to
this evolution in judicial approach’ (p. 3). He explains this lack of influence
as having to do with the often arcane language used by psychoanalysis, as
well as the lack of opportunities for High Court judges to enter into

Children and family law 193

interdisciplinary dialogue with those from other fields. Nevertheless, he
suggests, the lack of mutual influence is striking.
However, there is one exception to this rule, which Mr Justice Thorpe
notes. The work done by Anna Freud and her colleagues at Yale, he says, ‘was
remarkable in that it launched concepts many of which have since become
axiomatic’. He goes on to list some of the key ideas from Goldstein, Freud
and Solnit’s 1973 book – all of which have become core features of modern
family law. Some of the thinking set out in Anna Freud’s collaboration with
the Yale Law School were enshrined in law in the UK in the landmark
Children Act 1989, which put the needs of the developing child at the heart
of family law decision-making. But Thorpe questions to what degree
Anna Freud’s work directly influenced these reforms – noting that no English
lawyers played a part in the collaboration that led to her three books and that
the Supreme Court Library in London ‘does not possess a copy’ of even the
first, most influential of these works (Thorpe, 1997: 4).
Anna Freud would probably have smiled ruefully if she had lived to read
this comment. In a letter to Joseph Goldstein in 1973, she had warned him
that they ‘must not be disappointed if England is less enthusiastic [about the
book] than America, since you probably know that is always the case’ (quoted
by Goldstein, 1984: 7). James Robertson was one of the few psychoanalytic
practitioners in the UK who regularly worked as an expert witness in the
family courts in the 1970s, and he remembered how helpful he had found it
to speak to judges about the ‘psychological parent’, and how supported he had
been by discussions with Anna Freud in which she had been ‘unshakeable in
her confidence in the value of clinical evidence’ (Robertson, 1983: 21).
Despite the relative neglect of the books in the UK, Before the Best Interests
of the Child (and to a lesser degree the two later books) was hugely influential
in the US, with lively debates about its opinions taking place in both the
psychoanalytic and the legal press, as well as in more popular journalism. The
work of Anna Freud and her colleagues was received much more receptively
in a culture where a great majority of the psychiatrists were psychoanalytically
trained (which was not the case in the UK or Europe). The book also appears
to have come at exactly the right time in the US, when debates about the
nature of the family and the role of the state were being widely discussed.
Young-Bruehl (2012: 13), possibly without exaggeration, suggests that in the
US ‘no other psychoanalytic book has had as profound an influence in
the wider world on thinking about children and on policy toward children’
as Before the Best Interests of the Child. The work that Anna Freud and her Yale
colleagues did was unique because they tried to ‘identify principles for
resolving legal disputes that took explicit account of the non-rational and did
not simply impose a rational facade on unruly psychological forces’ (Burt,
2006: 404). This was more than just an academic exercise. On the basis of
such principles, they went on ‘to identify rules that were themselves respectful
of children’s developmentally distinct non-rationalities, rules that could be

194 Reading Anna Freud

applied by legal decision-makers in resolving a wide range of child welfare
disputes’ (p. 404). As such, they offered very clear evidence of how
psychoanalytic thinking could be used to improve the lives of children, even
those who would never meet a psychoanalyst.
Anna Freud was right to predict such a fruitful interaction between these
two disciplines. In recent times, the field of psychoanalytic child psychotherapy
more generally has made a significant contribution to court assessment work
in the UK, as reflected in two important publications based on conferences
at Dartington Hall, which brought together psychoanalytic practitioners and
family law judges and solicitors to discuss points of common interest (Thorpe
and Trowell, 2007; Wall, 1997a). The presentation at the conference by
Stephen Cobb, QC, a family lawyer and member of the Family Justice Panel,
illustrates how many of Anna Freud’s ideas have entered common practice:
the importance of interdisciplinary communication; the value of independent
legal representation for the child; and most significantly, the idea of putting
children ‘at the heart of the process’ (Thorpe and Trowell, 2007: 82). But he
notes that the length of the legal process, and the delays that often occur, is
‘probably singly the most serious failing in the delivery of effective justice to
families’ (p. 82) – a point that Anna Freud and her colleagues had emphatically
made in the early 1970s.
The fact that much remains to be done to improve the process of family
justice is a reason why the dialogue between the legal profession and
psychoanalysis (as well as psychology and psychiatry more generally) continues
to be important. Anna Freud began her address to the students attending the
commencement services at Yale Law School in 1968 by pointing out all
the obstacles that existed to a dialogue between these two disciplines. But she
ended by reminding them that both psychoanalysis and the law shared a focus
on an important area of common ground:

. . . the fact that all of us deal with human failures. . . . Whilst we try to
protect our patients from the harm they do themselves, it is your task to
safeguard society by keeping criminal activity in check. . . . [On this level,]
the disagreements between us disappear and make way for a common
effort to increase understanding.
(1968a: 258–260)

FURTHER READING

Few psychoanalysts or child psychotherapists have discussed Anna Freud’s

writings about the law in any detail, but Elizabeth Young-Bruehl (1988/2008)
gives the background and sketches out the content of the three volumes of

Children and family law 195

 Anna Freud’s collaboration with Goldstein, Solnit and Katz well. She also
suggests that one can get a sense of the impact of the books on the legal
profession in the US through two lengthy review articles, by Davis (1987) and
Crouch (1979).
The legal approach of Jay Katz and Joseph Goldstein at the Yale Law
School is well represented by two books, The Family and the Law w (Goldstein
and Katz, 1965) and Psychoanalysis, Psychiatry and the Law w (Katz,
Goldstein and Dershowitz, 1967). A more recent article by Burt (2006)
discusses the influence of the psychoanalytic approach of both Goldstein and
Katz on legal thinking in the US more generally.
After Anna Freud’s death, the Hampstead Clinic continued to bring together
psychoanalysts and members of the legal profession – for example, in a
symposium in 1986 on the implications of the ‘Inquiry into the Death of Jasmine
Beckford’, which looked at the lessons to be learnt from the death of a
four-and-a-half-year-old child in Britain from multiple injuries inflicted by her
parents (see the Bulletin of the Anna Freud Centre e, Vol. 9, part 4). The
interest in adoption that Anna Freud’s collaboration with Yale had promoted
led to the setting up of an Adoption Research Group at the Hampstead Clinic
in the 1970s, which continued under the leadership of Jill Hodges after
Anna Freud died. Hodges’ work with Miriam and Howard Steele, on the impact
of early abuse and maltreatment on the ‘internal working models’ of adopted
children, has been one of the major research studies to come out of what
is now the Anna Freud Centre (Steele et al., 2010), while the ideas that Anna
Freud promoted have been further developed in the work of the Court
Assessment Service and the Family Assessment Service at the Anna Freud
Centre (Daum and Mayes, 2012). Meanwhile, in Yale, the Family Preservation
and Support Program (Adnopoz, 1996) drew directly on Anna Freud’s
ideas to develop in-home services for the most high-risk families in New
Haven, Connecticut, whose children were vulnerable to out-of-home
placement.
Contemporary psychoanalytic contributions to the field of family law in the
UK are well represented by the work of Judith Trowell, who edited a book (with
M. King) on Children’s Welfare and the Law w (1992) and also contributed to
the two volumes based on the fascinating interdisciplinary dialogues that took
place at the Dartington Hall conferences: Rooted Sorrows s (Wall, 1997b) and
Re-Rooted Lives s (Thorpe and Trowell, 2007).

196 Reading Anna Freud

13 CONCLUSION
The legacy of Anna Freud

Anna Freud, psychoanalyst

Anna Freud was, first and foremost, a psychoanalyst – and a psychoanalyst,

moreover, who was committed to promoting and preserving the fundamental
ideas passed down by her father, Sigmund Freud. During his lifetime she
cared for him directly, throughout his long illness, and as he became
increasingly frail she took on the role of his spokesperson in the psychoanalytic
community – reading his papers at meetings when he was too ill to attend
himself, and trying to represent his views in the political debates within the
IPA (Limentani, 1983). After his death, Anna Freud was in many respects
the ‘dutiful daughter’ – described half-mockingly by Jacques Lacan (1988:
63) as the ‘plumb line of psychoanalysis’ – connecting all post-Freudian
developments back to their roots in her father’s work. She played a major role
in editing Freud’s work and supervising the publication of his correspondence,
and she was closely involved with Ernest Jones’s official biography of Sigmund
Freud, published in the 1950s ( Jones, 1953–57). One of her last major works
was a long ‘Study Guide to Freud’s Writing’ (1978a), and in the last years
of her life Anna Freud continued to see herself as ‘the ambassador and
representative’ of her father’s life and work (Grubrich-Simitis, 1983: 43). She
was, as W. Ernest Freud put it at a memorial service for Anna Freud, ‘the
dutiful daughter, following in the spirit of her father, devoted, enthusiastic,
indomitable’ (W. E. Freud, 1983: 8).
This absolute identification with psychoanalysis and the work of her father
gave a strong core to Anna Freud’s own professional and personal life,
especially in the final years of her life when psychoanalysis generally was
coming under increasing attack and new developments within psychoanalysis
were challenging the idea that there was ‘one psychoanalysis’ to which all
analysts could subscribe (Wallerstein, 1988). In such a climate, Anna Freud
stood out in her difference to her colleagues. At an international symposium
in 1976 on ‘The Identity of the Psychoanalyst’, Anna Freud (now over
80 years old) explained her dilemma in addressing the topic:

I really have no justification to speak: I have never gone through a crisis of

identity as an analyst. I can remember that during my analytic life I have
met with several crises, in the external world and in the internal world; but

Conclusion 197
 what I have missed out on evidently is that I felt my own identity shaken
. . . Valenstein has mentioned the dichotomy between, or the need to bring
together, the social identity, the professional identity, and the personal
identity, as an analyst. I think that I was probably helped by the fact that
with me, those three fell together into one.
(1976a: 189–190)

But Anna Freud’s self-anointed role as the guardian of classical psychoanalysis

had another consequence, both during her life and after her death. From
the late 1920s onwards, those who developed new ideas in psychoanalysis,
such as Otto Rank, Melanie Klein, and later Jacques Lacan and John
Bowlby, were treated with suspicion by Anna Freud, who worried that
their innovations would undermine the fundamental ideas of Freudian
psychoanalysis. She was increasingly seen as ‘old fashioned’, ‘conservative’, an
upholder of psychoanalytic ‘orthodoxy’. Her adherence to the structural
model of the mind (id, ego, superego) and drive theory was seen as increasingly
out of date, especially with the growth of object relations theory and
relational models of psychoanalysis more generally (e.g. Greenberg and
Mitchell, 1983). As Rose Edgcumbe (2000: 4) pointed out, in addressing
the question, ‘Why is she not better known?’, it was perhaps ‘her overall
adherence to theories which have come to be considered, rightly or wrongly,
as outmoded’ which has led to her relative neglect among modern
psychoanalytic practitioners. The fact that Anna Freud never challenged the
basic principles of classical psychoanalytic theory is, according to Peters,
‘probably the reason why her independence has not been fully recognised
and honoured’ (1995: 84).
There were institutional reasons, too, why her work became relatively
neglected following her death, especially in her adopted home, the UK. One
outcome of the Controversial Discussions in London in the early 1940s was
a decision by Anna Freud to establish her own clinic and training, independent
of both the BPS but also the newly formed National Health Service (NHS)
in Great Britain. Although this gave Anna Freud and her colleagues
considerable independence and freedom to pursue their own interests, it also
led to a relative lack of communication or cross-fertilisation between Anna
Freud and her contemporaries in London. (Many who trained at the
Hampstead Clinic in the 1960s and 1970s comment on the complete lack of
communication with those working at the Tavistock Clinic, just a few
hundred metres down the road; others – aware of the active hostility between
the two organisations – noted wryly that these two leading centres of child
analysis and psychotherapy were ‘within spitting distance’ of each other.)
Despite her many attempts, Anna Freud’s failure to get the Hampstead
Clinic’s training recognised by the IPA only increased the gap between the
work she and her colleagues were doing in Hampstead and the work that was
being carried out by psychoanalytic practitioners around the world.

198 Reading Anna Freud

 There were other reasons why Anna Freud’s work came to be neglected in
the years following her death, especially in the UK, her adopted home.
Edgcumbe (2000) points out that many of Anna Freud’s major papers and
seminars were given at psychoanalytic conferences in the US and were not
published until some years later, making it difficult for analysts elsewhere to
access her work. Moreover, ‘many of the students at the Hampstead Clinic
came from the US and returned there after training’ (p. 201), often going
back to work alongside old colleagues of Anna Freud’s from her time in
Vienna, many of whom had emigrated to the US and established themselves
in cities such as New Haven, Boston and New York. It was America that
provided most of the funding for the Hampstead Clinic, which did not
integrate itself with the British NHS. As Robert Wallerstein said, with
obvious regret, at Anna Freud’s memorial service:

Anna Freud and the Hampstead Clinic have always stood within a proud
but also a somewhat lonely isolation; a part of, but also – for all kinds of
complicated historical reasons – apart from the main body of organized
psychoanalytic activity in Britain.
(Wallerstein, 1983: 97)

For some time, this independence probably served Anna Freud well, and
it allowed her to develop her ideas and her projects with relative freedom.
But the 1980s and 1990s saw a general cultural shift away from psychoanalysis
in many parts of the world, and there was also the start of what has been
called the ‘Freud Wars’ (Crews, 1990), where the work of Sigmund Freud
came increasingly under attack and was discredited by many as lacking any
scientific basis. Given her close identification with her father’s work, Anna
Freud’s reputation ‘fell under the shadow of the shadow Freud’, his daughter
seen increasingly as a ‘rigid conservator of a harmful psychoanalysis’ (Young-
Bruehl, 1988/2008: 1).
But as Wallerstein (1984) rightly pointed out at the time of Anna Freud’s
death, if she was in one sense a ‘staunch conservative’, she was also a ‘radical
innovator’. Not only was she one of the first analysts to extend treatment to
include children; she was also a leading figure in what came to be called ‘Ego
Psychology’, with her 1936 book on The Ego and the Mechanisms of Defence.
Although this work is now considered a classic, it is worth remembering how
controversial it appeared at the time. Helene Deutsch, Anna Freud’s friend
and colleague at the time the book was written, even went so far as to try to
persuade her not to publish the work, for fear that Anna Freud would be
thrown out of the Vienna Psychoanalytic Society because her ideas were so
provocative (A.-M. Sandler, 1995).
As if this was not sufficient, Anna Freud went beyond an investigation of
the development of the ego and gradually became interested in the
‘humanizing process’ itself (A. Freud, 1982), including the complex

Conclusion 199
interactions between internal givens, individual experience and wider social
factors. She came to realise that Freud’s model of ‘psychosexual development’
(S. Freud, 1905) told only one part of the story about how and why children
develop and that it did not adequately describe the full range of the
developmental process. Nor was it enough to simply describe the development
of the other agencies of the mind (ego and superego) as if they were parallel,
but separate, lines of development. What was needed was a fully integrated
way of viewing things that could allow one to ‘achieve a thorough
understanding of the ebb and flow of development, its progressive and
regressive trends, its inhibitions, failures, partial and total arrests’ (1982: 265),
as a means of understanding the full picture of development – as well as the
ways in which it can go wrong.
With this work, Anna Freud was the first to bring a truly developmental
perspective to psychoanalysis, in anticipation of (and coining the term now
so widely used) the field of ‘developmental psychopathology’. Through her
investigation of the developmental process, Anna Freud helped to change
psychoanalysis ‘from a medical discipline which concerned itself with illnesses
to a discipline which was concerned with the healthy and supportive
environment necessary for the normal development of the child’ (Argelander,
1983: 40). As Anna Freud herself said (although she was never one to
emphasise her own originality), if ‘metapsychological theory’ was the
crowning achievement of classical psychoanalysis, then the findings of child
analysis ‘can add to this a new, developmentally oriented psychoanalytic
theory of child psychology’ (1978b: 100):

As child analysts, we thus acquire a view of average, so-called normal,

development as the background against which infantile psychopathology
can be assessed, while as analysts of adults our glimpses of normality are
always seen through and against the background of psychopathological
manifestations.
(A. Freud, 1975b: x)

Anna Freud’s developmental perspective, and her willingness to try to

integrate psychoanalytic thinking with ideas emerging in other fields
concerned with understanding the complex process by which babies and
infants transform into fi rst children and then adults, is probably what makes
her work most relevant to contemporary psychoanalysis. In her preface to the
second edition of her biography of Anna Freud, Elisabeth Young-Bruehl
identifies this significant change in how Anna Freud’s work can now be
received by the psychoanalytic community. She writes:

[T]he main reason . . . that Anna Freud’s legacy has been revitalized in
recent years is that the emphasis on development at the core of Anna
Freud’s work was just what was needed. . . . As the commitment to

200 Reading Anna Freud

 integrate the findings of neuroscience into psychoanalysis grows at the
Anna Freud Centre (and more generally), her concepts of developmental
lines, developmental disorders, and developmental help will have greater
and wider influence.
(Young-Bruehl, 1988/2008: 13)

Anna Freud, child expert

Anna Freud’s developmental perspective is an important bridge between

her work as a psychoanalyst and her role, more broadly, in bringing the
findings of psychoanalysis to the wider community, through what she
might have called ‘applied work’. Anna Freud was a great champion of
psychoanalysis not simply because she believed that psychoanalytic
treatment could have a profound effect on people’s lives. (She did believe
this, but she was also very aware that psychoanalysis is not helpful to
everyone, and that it could never be available to more than a small proportion
of those in need.) The primary reason why Anna Freud championed
psychoanalysis was because she felt that its way of understanding the mind –
and especially the developing mind of the child – was of huge relevance
to those living and working with children in a whole range of settings:
schools, hospitals, residential care settings, child guidance clinics, law courts,
social services, etc. Psychoanalysis could be useful to people working in
these settings because it could help them to understand more about the
needs of children – physically, emotionally, developmentally. Psychoanalysis,
as she conceived it, not only enabled people to understand what might
go wrong in children’s development, but also offered a way of thinking
about healthy development and what was needed to promote it. Steve Marans,
who took inspiration from Anna Freud in developing a liaison service that
brought together child analysts and members of the police force in New
Haven, wrote:

Anna Freud’s ability to make her findings about the inner world of the
children accessible to non-analysts has helped to shape policies and practices
that affect the lives of children in multiple circumstances and settings. . . .
Without the opportunity to learn from children in the clinical setting we
would have little role to assume in helping others consider what children
need. Without venturing beyond the consulting room, child analysts
might have little opportunity to be heard or to learn more about those
exigent circumstances in children’s lives that so often undermine
developmental potential and immobilize the efforts of adult caregivers to
intervene on their behalf.
(Marans, 1996: 539)

Conclusion 201
 In her own professional life, Anna Freud worked in many settings – with
children who were homeless, or who came from disadvantaged and
underprivileged backgrounds, or who were the victims of war and persecution.
At the Hampstead Clinic, she and her colleagues offered not only child
analysis and therapy, but also a Well Baby Clinic, a Nursery for underprivileged
children (and those with physical disabilities) and other preventative services.
Anna Freud was tireless in her support of the newly emerging Child Guidance
Clinics in the UK, as well as similar services being established in the US and
Europe, and she did all she could to make sure that psychoanalytic thinking
could be used to support this work (e.g. A. Freud, 1960b, 1964). In reviewing
this range of activity, she wrote:

There is a direct line from Kinderheim Baumgarten, founded after the

First World War by Siegfried Bernfeld and Willi Hoffer, by way of the
Jackson Nursery (1937–38) to the Hampstead Nurseries in the Second
World War (1940–45), and from there again to the Nursery Schools of the
James Putnam Clinic in Boston, Mass., of the Child Study Center in Yale,
New Haven, of the Child Development Center in New York, the
therapeutic Nursery School in Cleveland, The Master’s Nursery in New
York, the School for Nursery Years in Los Angeles, the Orthogenic School
in Chicago, the High Wick Hospital for Psychotic Children in
Hertfordshire, England, and the Nursery Schools for Normal and for Blind
Children in the Hampstead Clinic, London. There is also the untiring
work done on the basis of psychoanalysis with well-baby clinics, with
pediatricians and on pediatric wards, in short-stay and in long-stay
hospitals, with residential institutions, foster parents, etc. Many of these
tasks were, and still are, uphill ones since they are carried out in the face
of opposition derived from ingrained traditional attitudes to teaching,
nursing, medical or institutional routines; they are no less rewarding for
this reason, of course.
(A. Freud, 1966a: 55–56)

One of the greatest obstacles to improving the lives of children, Anna Freud
believed, was the fact that training for those working with young people was
(and is) so piecemeal. As early as 1952, she lamented the fact that, ‘with the
present day division between professional teaching, nursing, child guidance
work, child analysis, and paediatrics, there is little or no opportunity for the
trained worker in one of these fields to function, even in the role of observer,
in one of the other services for children’ (1952b: 260–261). When speaking to
those working in hospitals, she called for a ‘double training’, which would
help them to attend to the body and the mind of sick children (Bergmann and
Freud, 1965); to those working in schools, she called for an awareness of
developmental issues, so that they would be able to make informed judgements
about what reasonable expectations they could have of children, and how to

202 Reading Anna Freud

know the difference between a temporary regression and a serious disturbance
in development (A. Freud, 1979a). She called for a training for people in the
children’s workforce that helped develop observational skills and offered a
‘thorough grounding in the essentials of a developmental child psychology’
(1965c: 435). Psychoanalysis, she believed, could contribute significantly to
what she felt was needed: a training for ‘child experts’, whose knowledge cut
across traditional academic and professional disciplines.
As Solnit and Newman (1984) have suggested, Anna Freud herself could
well be thought of as the paradigmatic ‘child expert’, with her range of
experience across a wide variety of settings, but always informed by a
comprehensive psychological theory of development and an understanding of
the child’s mind, in both its conscious and unconscious aspects. This was
coupled with a genuine curiosity about how children see the world and an
openness and interest in ‘learning together’ about the meaning of a child’s
behaviour, whether normal or pathological. The ideas that Anna Freud
developed have, according to Anne-Marie Sandler, had ‘a considerable
influence . . . not only in the field of child analysis, but quite markedly in
fostering new educational, social and legal practices in regard to children and
adolescents’. But she goes on:

However, as these new understandings became accepted and absorbed in

the day-to-day mores, they also became disconnected from their original
source. . . . Anna Freud played a central role in these changes but her initial
input has long been forgotten.
(A.-M. Sandler, 2012: 47)

This is perhaps the final paradox of Anna Freud’s life and work. In a tribute
to the work of August Aichhorn, Anna Freud once remarked that ‘people no
longer remember who led the way in the methods they now use’ (1976[1974]:
344). And in one of her last presentations before she died, reflecting on the
fiftieth anniversary of the publication of her Four Lectures on Psycho-Analysis
for Teachers and Parents (1930), Anna Freud commented about the fate of a
work such as this, which tried to bring new ideas to an existing profession:

Assuming its message to have been successful at all, it becomes superfluous,

obsolete, and loses its readership.
(1982: 259)

Perhaps the ultimate compliment one can pay to Anna Freud’s work is to
acknowledge that her ideas have had such an influence on the way we think
about childhood that they now appear to us as simple ‘common sense’. If this
is the case, then Anna Freud herself would probably have been delighted. But
her contribution as a teacher and a writer (and for her, the two were often
closely entwined) deserves to be remembered, I think, because it still has

Conclusion 203
something to offer today. It is appropriate, perhaps, to end with the words of
her own niece, Sophie Freud, who was a professor of social work in Boston
and cared for Anna Freud in her final months of life. Writing about the
legacy of her aunt’s life, she concluded:

She wanted children to have lives that would not be oppressed and
exploited, restricted, impoverished, or damaged by an uncaring adult
world. It was her fervent hope that by spreading the wisdom of
psychoanalytic insight she could improve children’s lives in their families,
clinics, schools, hospitals, and courts. It was in this role of mother/educator
and advocate of children that she spoke most clearly in her own voice and
that we can celebrate her wholeheartedly.
(Sophie Freud, 1988: 319)

204 Reading Anna Freud

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 INDEX

Abraham, K. 131 ‘altruistic surrender’, defence mechanisms as 3

abuse: physical 191; sexual 153, 191 American Foster Parents’ Plan 70
Achenbach, T. M. 142 American Joint Distribution Committee for
‘action research’ at War Nurseries 88 Jewish War Sufferers (‘the Joint’) 36
active therapy 102 anal fantasies 25
Adler, A. 1 anal sadism, regression to 28
adolescence: defence mechanisms in 62–3; Sturm anal-sadistic impulses 26
und Drang of 63 analysis: adult, vs. child analysis 22; suitability for
adolescents, Diagnostic Profile for 127 162, 163
adopted children 184 analytic neutrality 104
adult analysis: and child analysis, relationship analytic stance and technique 104–5
between 22, 145–7; fundamental principles of Andreas-Salomé, L. 2
145; widening scope of 110–14 Anna Freud Centre 8, 31, 81, 110, 135, 153,
adult neurosis(es) 149, 151; infantile roots of 18, 164, 201
32 anxiety(ies): air-raid 72; annihilation, and relation
adult patients, psychoanalytic treatment of to maternal breast 26; deepest and most
101–16 primitive, interpretation of 26; defences
adult psychopathology 9, 115, 122, 140 against, use of, when faced by medical illness
adults, Diagnostic Profile for 127 174; objective 64; role of 123
affect, associated with threat 64 anxiety attacks 66; phobic 22
affect regulation 159 anxiety hysteria 120
affect regulatory systems, build-up of 163 Appleton Case 189
aggression: centrality to human nature 111; as archaeology, work of psychoanalyst akin to 56
ego instinct 73; frustration theory of 73; as Argelander, H. 11
independent drive 123; inhibition of 80; ‘artificial families’ 80; creation of 77–8
psychoanalytic view of, at Hampstead War artificial laboratory situation as means of
Nurseries 73–4 investigation 86
aggressive impulses and libidinal impulses, fusion asceticism 63
of 74 assessment: diagnostic 123, 125, 138 [example
aggressor, identification with 55, 62; as defence 125–6]; dynamic and structural 125; genetic
mechanism 60–1 124; structural 125
Aichhorn, A. 6, 20, 42–4, 48, 60, 62, 79, 203; assessment process and Diagnostic Profile 123–5
early educational influence on Anna Freud Association of the Jewish Youth of Austria 36
35–7; work with ‘wayward youth’ 38–41 associations, chain of, break in 56
Aichhorn, W. 42 attachment(s): biological and behavioural vs.
air-raid anxiety 72 psychological aspects of 76; broken,
altruism, form of, as defence mechanism 55 detrimental effects of 188 [vs. emotional

222 Index
 barrenness 80]; figure, libidinal relationship to Breuer, J. 1, 29
40; to loved adult 48; needs of child in Brierley, M. 108
residential setting 77, 80; and separation 74–5 Brill, A. A. 13
[Anna Freud and John Bowlby on 75–7] British Psychoanalytical Society (BPS) 7, 31, 108,
attachment relationships, children’s, and 109, 198
hospitalisation 167 Bühler, C. 85
attachment theory (Bowlby) 76, 128 Bulldogs Bank home for child survivors of
attunement (Stern) 163 concentration camps 89–92
atypical character disturbances, psychoanalysis of Burlingham, D. 2, 4, 6, 8, 13, 42, 50, 51, 69–71,
111 73–5, 77, 79, 89, 91, 97, 99, 153
autism 50 Burlingham/Rosenfeld School, Vienna:
auxiliary ego 73, 161, 178; child’s, analyst’s role see ‘Matchbox’ School, Vienna
as 161; parents’ ability to provide 73, 161, 178
caregiver, primary, separation from 139
Balint, A. 30 castration anxiety/complex 18, 123, 176
Balint, M., 112 castration threats 34
‘basic fault’ (Balint) 112 Central Middlesex Hospital 167
Baumgarten Children’s home/‘camp school’ 6, character, development of 57
10, 37, 38, 202; as experiment 37–8 ‘character armour’ (Reich) 30
behaviour: psychoanalytic investigation of, Chicago Institute for Psychoanalysis 51
aspects of 84; unconscious motivation for 111 child(ren) (passim): adopted 184; –analyst
Bellman, D. 105 relationship, confidentiality of 23; blind,
Berger, M. 179 development of 91; blind and deaf, Diagnostic
Bergmann, T. 170, 174, 178 Profile for 127; with congenital blindness 96;
Bernays, M. 2 contact with, importance of making 161;
Bernfeld, S. 6, 38, 41, 62, 79, 85, 202; early deprived 158, 162; development of 9, 80, 87,
educational influence on Anna Freud 35–7 94, 95, 124, 126, 140, 151, 175, 178 [early 85;
Bibring, E. 7, 146 longitudinal study of 91]; from disadvantaged
Bick, E. 85 and underprivileged backgrounds 202; dreams
Bion, W. R., concept of containment 158, 163 and day-dreams of 29; early attachment of to
Blatt, S. 128 caregivers, importance of 70; effects of
blind children 127; development of 91 separation on 167; experience of, staying close
Blos, P. 42, 43 to 161; experience of pain of, clinical example
Blum, H. 114 171–2; and family law 182–5; growth and
bodily illness: impact of, on personality development of, least detrimental available
development 174; role of, in mental life of alternative for safeguarding 188; heroes,
children 169–71 psychology of 96; homeless 202; in hospital,
bodily self-neglect of schizophrenic patients 115 care of 166–80; hospital treatment of 175–7;
Bonaminio, V. 161 identification of, with teachers 46; illnesses of
borderline functioning in adulthood 115 175–7; impact of war on, study of 89; killed
borderline pathology 96, 127, 153, 157, 158; by their parents 193; with learning difficulties,
adult and adolescent, differences between 114; Diagnostic Profile for 127; looked-after,
psychoanalytic understanding of 114–15 outcomes for, in terms of mental health and
borderline patients 112, 113, 114 well-being 190; mass evacuation of, in Second
Bornstein, B. 21, 30 World War 75, 88; mental life of, role of
Bowlby, J. 75, 76, 79, 167, 168, 169, 198 bodily illness in 169–71; needs of, and legal
Brahms, J. 4 decisions 185–7; observation 85, 87, 92; point
Brazelton, T. 92 of view of, seeing things from 11;
breast, maternal, relation to, and annihilation psychopathology of 119; relationship to
anxiety 26 medical staff 174; surgery of 175–7; teacher’s
breast-feeding 50 unconscious identification with 47; tolerance
Brenner, N. 11 of pain of 170; in treatment, importance of

Index 223
 working with parents of 22; unconscious clinical setting as method of research, challenges
fantasy life of 29; victims of war and to using 95–6
persecution 202; young, effect of Cluckers, G. 142
hospitalisation on 168 Cobb, S. 195
child analysis (passim): vs. adult analysis 22, cognitive assessments 123
145–7; Anna Freud’s approach to, legacy of cognitive psychology 128
30–1; attending to affect in 67; and Cohen, M. 87, 132, 140, 141, 143
developmental therapy 145–64; ‘fact-finding’ Coles, R. 13, 14, 44, 52
aspect of, vs. ‘therapeutic’ aspect 155; communication, nonverbal: in analysis, focus on
fundamental principles of 145; indications and 113; in classroom, understanding of 51
contraindications for 154–6; and infantile compulsion and liberation, ‘middle path’
neurosis 148–9; optimum age for 22; origins between 44
of 18–19; preparatory phase in 146; ‘proper’, concentration camps 10, 187; child survivors of,
developmental therapy as part of 162–3; role experiment in group upbringing 89–2
of transference in 23–4; symposium on, consciousness, bringing into, that which is
London (1927) 21, 25–6, 31; technique of 5, unconscious 65, 103, 148, 149
7, 9, 19–20, 25, 27, 54, 64, 145, 146, 161 contact with child, importance of making 161
child analyst(s): analytic and educational stances containment, concept of (Bion) 158, 163
of 28; early, experience of, as teachers 34; as ‘contemporary Freudians’ 109
new object 161; role of, educational or Continental (or Vienna) School of Child Analysis
classical analytic 24–5 30
Child Behaviour Checklist 142 Controversial Discussions between Anna Freud
Child Development Center, New York 202 and Melanie Klein 31, 107, 108, 198; and
child neuroses 149 ‘Gentleman’s Agreement’ 109
child observation 18, 85, 87, 92; development of Cooper, C. 173
85; direct, value of 92; and psychoanalytic Corveleyn, J. 128
research 83–9; role of 87–9; see also infant couch, use of 29, 104
observation Couch, A., memories of analysis with Anna
Child Placement Code 192 Freud 105–7, 116
child placements, contested 184, 186 countertransference, psychoanalytic
child protection agency 190 understanding of 46
child psychiatry 141, 173, 193 cure and research, ‘inseparable bond’ of in
child psychology, psychoanalytic 6, 94 practice of psychoanalysis 95
child study, observational, analytically directed 91
Child Study Center, Yale, New Haven, CT, Dann, G. 89
USA 202 Dann, S. 89, 90
child therapist, role of in hospital setting 177–80 day care in nurseries 10
childhood disorders/disturbances 130; assessment day-dreams 93; use of 24
and diagnosis of 118–28 [legacy of Anna de Saussure, R. 85
Freud’s approach to 127–8]; diagnostic deaf children 127
approaches to, limitations of 119–20 death drive 5, 61
childhood pathology 148 death instinct 9, 73, 152
childhood trauma 92 death wishes 27, 171; towards father 28, 46, 150;
Children Act (1989) 194 towards mother 26, 28
Children’s Rest Centre, London 8, 70 defence analysis 21, 102, 103, 104; Anna Freud’s
Cicchetti, D. 142 contribution 67; case example 66
Cihlarz, J. 2 defence mechanisms 3, 7, 55, 60, 72, 87, 103,
City University of New York 1 149, 176; against affects 63–5; concept of
Clark University, Worcester, MA, lecture (1950) 58–9; and ego 30, 67, 69; against instincts
84 63–5; mechanisms 30, 55, 58, 59, 61, 63, 67,
‘classical’ analytic view of adult analysis 102–4 69, 86, 114, 131; need of mind for 59–60; role
clinical case studies 92–3 of, during puberty and adolescence 55

224 Index
deferred action 92 Diagnostic Profile 94, 128, 130, 152, 188; and
delinquency: as manifestation of arrested assessment process 123–5; uses and
personality development 39; as neurotic implications of 127
disturbance 39 double training, necessity for 174, 202
delinquents 11, 38, 39, 40; psychoanalysis of 111 drawing(s) 29; use of, in child analysis 24, 29
denial as defence 131 dream analysis 22, 24
depression, concept of (Sandler) 97 dream interpretation 104, 116, 148; as treatment
depth psychology 56, 57 tool 105
despair, phase of, in mourning process, on dreams: censorship of, and unconscious drives or
separation from primary caregivers 33, 76, wishes 56; interactions between ego and id in
168 56; psychoanalytic focus on 65; road to the
destruction and violence, children’s reactions to, unconscious 113
Hampstead War Nurseries 72–3 dream-work 56
detachment, phase of, in mourning process, on drive psychology, psychoanalysis as 58
separation from primary caregivers 33, 76, drive theory 127, 198
168 DSM: see Diagnostic and Statistical Manual of
Deutsch, H. 36, 199 Mental Disorders
development: failure of 152; normal, reasons for Dyer, R. 21, 67
study of 130–2; study of, legacy of Anna dynamic and structural assessment 125
Freud’s approach to 140–3 dynamic psychology 83, 148
developmental arrest, temporary 135–6
developmental charts 72 eating disorders 63, 93
developmental disorders/disturbances 40, 67, Edgcumbe, R. M. 101, 161, 162, 163, 198, 199
125, 127, 138, 152–6, 159, 160–2, 201; education: application of, to psychoanalysis
children with, innovations in technique for 32–52; progressive 36, 43; and psychoanalysis
work with 156–8 [early history 33–4; relation between 47–9];
developmental line(s) 9, 52, 60, 94, 115, 141, radical, and Red Vienna 34–5; three cardinal
143, 145, 148, 152, 156, 175, 201; averagely goals of 34
expectable 188; concept of 132–3, 137; ego: analysis of 103; auxiliary, parents’ ability to
example 133–4; interaction between 134–5; provide 73, 161, 178; as both defensive and
and psychological well-being 136–7; uses of adaptive 57; censorship of 29; concept of 55,
137–8 [example 138–40] 57; as constitutional monarch 55; and defence
developmental needs, neglect of 156 mechanisms 54–68 [Anna Freud’s work on,
developmental object 160–2; therapist as 163 legacy of 67–8]; defensive manoeuvres of 66,
developmental perspective, assessment and use of 103, 112; as defensive pole of the personality
152 55; functions of 55; and id [infantile battle
developmental psychology 84, 87, 88, 92, 133, between, ending in truce at puberty 62;
188; psychoanalytic 99, 131, 141, 143, 184, interactions between 55, 56]; and mechanisms
192 [contribution to legal practice for children of defence 30, 67, 69; place of, in
and families 184; principles of 140] psychoanalysis 55; psychoanalytic concept of
developmental psychopathology 9, 128, 130–43, 55; role of 6, 45, 55; synthetic function of 57;
200 unconscious 56
developmental therapy 9; and child analysis ego boundary, concept of (Federn) 57
145–64; as a part of ‘proper’ child analysis ego development 9, 62, 120, 124, 131, 160, 199;
162–3; psychoanalytic, clinical example 171 early stages of 57
‘devil girl’ (clinical example) 24–8 ego functioning 60, 98
diagnosis: based on developmental perspective ego-ideal: for child, analyst’s role as 41, 161;
122–3; categories of 125 structure of 40; teacher as 44
Diagnostic and Statistical Manual of Mental ego instinct, aggression as 73
Disorders (DSM) 120, 128 ego mediation 98
diagnostic assessment 123, 138; example 125–6 ego psychology 30, 199; birth of 57–8; era of, in
diagnostic nihilism 121 USA 54, 58

Index 225
ego resistances 29, 56 as child expert 201–4; childhood 1–2;
ego-supportive work with children 67 commitment of, to systematic observation 99;
Eitingon, M. 54 Continental (or Vienna) School of Child
Ekins, R. 14 Analysis 30; Controversial Discussions 31,
Elliott-Neely, C. 161 107–9, 198 [‘Gentleman’s Agreement’ 109];
Emde, R. 142 ‘dark night of the soul’ 110; beyond depth
emotional neglect 191 psychology 56–7; early educational influences
English School 30 35–7; ego and mechanisms of defence 54–68;
enuresis 120; possible reasons for 121 lecture at IPA Congress, London (1975) 111,
environment, ‘average expectable’, lack of 153 113; lecture to Royal College of Physicians
Erikson, E. 10, 42, 43, 105 (1961) 177; life 1–15; memorandum to
‘Erna’, Klein’s case of, response to Anna Freud Training Committee (1943) 108; paper
26–7 presented to New York Psychoanalytic
evacuation, policy of, broken attachments Institute 111; personality of 2–4; as
resulting from 75 psychoanalyst 197–201; ‘schools’ of child
analysis, Vienna 19; as teacher and writer
faeces, withholding of, possible reasons for 121 11–15; ‘The Theory of Child Analysis’
Fairbairn, R. 133 (1928[1927]) 27–8; tuberculosis 167; in
‘falsification’, role of, central to the scientific Vienna 4
method (Popper) 84 Freud, A., works of: ‘About Losing and Being
family, integrity of, protecting 191–2 Lost’ 110; ‘Address at the Commencement
family law: application of psychoanalytic ideas to Services of the Yale Law School’ 182, 195;
11; and children 182–5; professionals working ‘Adolescence’ 62, 63; ‘Adolescence as a
in, rescue fantasies of 192 Developmental Disturbance’ 63; ‘Aggression
family life, disruption of, reactions to 72 in Relation to Emotional Development:
fantasy, concept of (Sandler) 97 Normal and Pathological’ 69; ‘The Analysis of
fascism, rise of, in Europe 7, 51, 67, 69, 70 Defence’, with J. Sandler 54; ‘Answering
father: absent 79, 93, 94 [clinical case study 93; Pediatricians’ Questions’ 166, 174, 177;
role of, clinical case study 93–4]; death wishes ‘Answering Teachers’ Questions’ 32, 47;
towards 28, 46, 150; and development of ‘Appendix’, The Writings of Anna Freud, Vol. 5
identifications 78; and development of object 96; ‘The Assessment of Borderline Cases’ 122;
relations 78; role of 78–9; superego ‘The Assessment of Pathology in Childhood’
development 78 124, 127; ‘August Aichhorn’ 203; ‘Beating
Ferenczi, S. 1, 6, 33, 34, 102, 108 Fantasies and Daydreams’ 2, 14; Before the Best
Field, K. 110 Interests of the Child, with J. Godstein & A.
‘finger-interpretation-indisplacement’ 159 Solnit 182, 184, 189–91, 193, 194; Beyond the
Fischer, H. 78 Best Interests of the Child, with J. Godstein & A.
fixations, temporary 135–6 Solnit 182, 184–8, 192, 193, 194; ‘Beyond the
Fonagy, P. 142, 158, 163, 179 Infantile Neurosis’ 118, 130, 145, 151, 152;
Foster Parents’ Plan for War Children 89 ‘On Certain Difficulties in the Preadolescent’s
free association 22, 29, 104; as ‘golden rule’ of Relation to His Parents’ 62; ‘Certain Types
psychoanalysis 102; interactions between ego and Stages of Social Maladjustment’ 63;
and id in 56; psychoanalytic focus on 65; ‘Changes in Psychoanalytic Practice and
resistance in, and unconscious drives or wishes Experience’ 101, 113, 156; ‘Child Analysis as
56; road to the unconscious 113; substitution the Study of Mental Growth, Normal and
of, for hypnosis 108; as tool of treatment 105 Abnormal’ 118, 130, 132, 136, 203; ‘The
Freeman, R. 14 Child Guidance Clinic as the Center of
Freeman, T. 114 Prophylaxis and Enlightenment’ 49, 50, 202;
Freud, A. (passim): address to students at Yale ‘Child Observation and Prediction of
Law School (1968) 183; approach to study of Development: A Memorial Lecture in Honour
development, legacy of 140–3; Arthur of Ernst Kris’ 83, 92, 94; ‘Children in the
Couch’s memories of an analysis with 105–7; Hospital’, with T. Bergmann 166, 203;

226 Index
‘Children Possessed: Anna Freud Looks at a Hartmann: A Tribute’ 57; In the Best Interests of
Central Concern of the Children’s Bill: The the Child, with J. Goldstein & A. Solnit 182,
Psychological Needs of Adopted Children’ 184; ‘Indications for Child Analysis’ 16, 18,
182; ‘Clinical Problems of Young Children’ 145, 154; ‘Indications and Contraindications
123, 124, 127; ‘Clinical Studies in for Child Analysis’ 145, 151, 155, 156;
Psychoanalysis – Research Project of the Indications for Child Analysis and Other Papers
Hampstead Child-Therapy Clinic’ 95; (The Writings of Anna Freud, Vol. 4) 16; ‘The
‘Comments on Joyce Robertson’s A Mother’s Infantile Neurosis’ 149; Infants without Families:
Observations on the Tonsillectomy of Her Four- The Case for and against Residential Nurseries
Year-Old Daughter’ 166, 173, 176, 177; (The Writings of Anna Freud, Vol. 3), with D.
‘Comments on Psychic Trauma’ 5, 10, 98; Burlingham 16, 69, 72, 73, 77, 79, 80, 81;
‘The Concept of the Rejecting Mother’ 101, Infants without Families: Reports on the
112; ‘The Contribution of Direct Child Hampstead Nurseries, 1939–1945 16;
Observation to Psychoanalysis’ 83, 92; ‘The ‘Instinctual Drives and Their Bearing on
Contribution of Psychoanalysis to Genetic Human Behaviour’ 82; ‘On the Interaction
Psychology’ 83–7, 91; ‘Diagnosis and between Paediatrics and Child Psychology’
Assessment of Childhood Disturbances’ 15, 166; ‘Interactions between Nursery School
118, 119, 123; ‘Difficulties in the Path of and Child Guidance Clinic’ 32; ‘Introduction’,
Psychoanalysis: A Confrontation of Past with The Writings of Anna Freud, Vol. 1 8, 9;
Present Viewpoints’ 87, 101, 104, 111, 112, Introduction to Psychoanalysis: Lectures for Child
113; ‘Discussion of John Bowlby’s Work on Analysts and Teachers (Writings of Anna Freud,
Separation, Grief and Mourning’ 69, 76; Vol. 1) 16; Introduction to the Technique of Child
‘Doctoral Award Address’ 5–7, 19; ‘Dorothy Analysis 12, 18–31, 41, 42, 145, 146, 148, 161;
Burlingham – 1891–1979’ 42; ‘Dynamic ‘James Robertson’s A Two-Year-Old Goes to
Psychology and Education’ 32, 35, 36, 51; The Hospital film review’ 166, 168, 171; ‘Links
Ego and the Mechanisms of Defence (The Writings between Hartmann’s Ego Psychology and the
of Anna Freud, Vol. 2) 3, 7, 14, 16, 29, 54–9, Child Analyst’s Thinking’ 54, 57, 68;
61–3, 65, 67, 68, 87, 101–3, 107, 130, 131, ‘Memorandum on Technique’ 101; ‘Mental
199; ‘The Emotional and Social Development Health and Illness in Terms of Internal
of Young Children’ 32; ‘Entrance into Harmony and Disharmony’ 130;
Nursery School: The Psychological ‘Metapsychological Assessment of the Adult
Pre-requisites’ 32, 137, 138, 139; ‘An Personality: The Adult Profile’, with H.
Experiment in Group Upbringing’, with S. Nagera & W. E. Freud 101, 127; ‘The Mutual
Dann 83, 89, 90; ‘Expert knowledge for the Influences in the Development of the Ego and
average mother’ 49; ‘Foreword’, Analysis of a the Id: Introduction to the Discussion’ 54;
Phobia in a Five-Year-Old Boy 145; ‘Foreword’, Normality and Pathology in Childhood:
Beyond the Infantile Neurosis (Rosenfeld) 154; Assessments of Development (The Writings of
‘Foreword’, The Hosptialised Adolescent Anna Freud, Vol. 6) 9, 14, 16, 20, 94, 118–20,
(Hofmann, Becker, Gabriel) 166, 174; 122, 123, 125, 127, 130, 132–8, 140, 145–8,
‘Foreword’, Maria Montessori (Kramer) 36; 155–7, 160, 163; ‘Notes on Aggression’ 69,
‘Foreword’, Parent Guidance in the Nursery 73; ‘Nursery School Education: Its Uses and
School (Ruben) 50; ‘Foreword’, A Dangers’ 32; ‘The Nursery School from the
Psychoanalytic Contribution to Pediatrics (Gordon) Psychoanalytic Point of View’ 32;
166, 169, 174, 178; ‘Foreword’, Studies in ‘Observations on Child Development’ 69, 83;
Child Psychoanalysis 200; ‘Foreword’, The ‘Painter v Bannister: Postscript by a
Writings of Anna Freud, Vol. 3 89; Four Lectures Psychoanalyst’ 182; ‘The Past Revisited’ 32,
on Child Analysis, see Introduction to the 51, 112, 199, 200; ‘Personal Memories of
Technique of Child Analysis ; Four Lectures on Ernest Jones’ 7, 136; ‘Preface’, Chronic
Psycho-Analysis for Teachers and Parents 12, 18, Schizophrenia (Freeman, Cameron, & McGhie)
32, 41, 45, 137, 203; ‘Freedom from Want in 115; ‘Preface’, The Hampstead Psychoanalytic
Early Education’ 32; ‘The Hampstead Child- Index (Bolland, Sandler, et al.) 97; ‘The
Therapy Course and Clinic’ 95; ‘Heinz Principal Task of Child Analysis’ 130, 143,

Index 227
 145, 156, 200; ‘The Problem of Training Anna Freud 12–16, 72, 177; ‘Young Children
Analysis’ 116; Problems of Psychoanalytic in War-Time’, with D. Burlingham 69, 72
Training, Diagnosis, and the Technique of Therapy ‘Freudian Group’ 109–10
(The Writings of Anna Freud, Vol. 7) 16; Freud, M. 1
‘Problems of Technique in Adult Analysis’ Freud, Sigmund 1, 2, 24, 35, 43, 55, 59, 70, 105,
101, 104, 111; ‘Psychoanalysis and Education’ 108, 197, 199; adult neurosis, infantile roots of
32, 34, 47; ‘Psychoanalysis and Family Law’ 18, 32; application of psychoanalysis, to
182, 184; ‘Psychoanalysis and the Upbringing education 32; ‘beyond pleasure principle’ 152;
of the Young Child’ 32; ‘Psychoanalytic capacity to love and to work, as determinant
Knowledge Applied to the Rearing of of mental health 122; castration complex 18;
Children’ 50; ‘Psychoanalytic Knowledge and concept of ‘defence’ 58; deferred action 92;
Its Application to Children’s Services’ 49, 202; female homosexuality 140; infantile sexuality
Psychoanalytic Psychology of Normal Development 18, 62, 123; lack of experience of working
(The Writings of Anna Freud, Vol. 8) 16; ‘A with children 34; ‘Little Hans’ 18, 85, 149,
Psychoanalytic View of Developmental 150 [phobia about horses 19, 150]; metaphor
Psychopathology’ 119, 122, 130–3, 137, 140, of archaeology to describe work of
143, 145, 153, 156; ‘Psychopathology Seen psychoanalyst 56; model of psychosexual
against the Background of Normal development 200; Oedipus complex 18, 25,
Development’ 118, 130, 145, 148, 153; 27, 45, 46, 86; ‘polymorphous perversity’ 18;
‘Remarks on Problems of Psychoanalytic psychotic breakdowns 114; structural model of
Training’ 116, 198; Reports on the Hampstead mind 5, 102, 127, 198; symptoms and
Nurseries 1939–1945, with D. Burlingham 69, diagnosis 120; theory of neurosis 64; use of
72, 74, 75, 77, 80, 88; Research at the hypnosis 29; ‘where id was, there ego shall be’
Hampstead Child-Therapy Clinic and Other 24
Papers (The Writings of Anna Freud, Vol. 5) 16; Freud, Sophie (A. Freud’s niece) 204
‘Research Projects of the Hampstead Child- Freud, Sophie (A. Freud’s sister) 2, 167
Therapy Clinic, 1957–1960’ 83, 83, 96, 99; Freud, W. E. 12, 14, 197
‘The Role of Bodily Illness in the Mental Life ‘Freud Wars’ 199
of Children’ 166, 168, 169, 170, 175, 176, Friedlander, K. 110
202; ‘A Short History of Child Analysis’ 7, 9, Fries, M. 94
18, 30, 31, 202; ‘The Significance of the ‘fundamental rule’ of psychoanalysis 22, 29
Evolution of Psychoanalytic Child Psychology’
83, 88; ‘Some Thoughts about the Place of Gardener, M. 1
Psychoanalytic Theory in the Training of Gavshon, A. 158, 159
Psychiatrists’ 101; ‘Special Experiences of gender identity, developmental line for 143
Young Children, Particularly in Times of genetic assessment 124
Social Disturbance’ 50, 69, 82; ‘Studies in genetic psychology 87
Passivity’ 116; ‘A Study Guide to Freud’s genetics 128, 141, 153
writings’ 38, 39, 197; ‘The Symptomatology ‘Gentleman’s Agreement’, and Controversial
of Childhood’ 118, 120, 121; ‘The Technique Discussions 109
of Child analysis – Excerpts from Seminars and Gergely, G. 158
Meetings’ 161; ‘The Theory of Child Analysis’ Glaser, B. G. 133
18, 27; ‘The Theory of the Parent–Infant Glöckel, O. 35
Relationship’ 113, 123; ‘Three Contributions Glover, E. 59
to a Seminar on Family Law’ 182; ‘Visiting Goethe, J. W. von 14
Children – The Child’ 166; War and Children, Goldberger, A. 91
with D. Burlingham 69, 72; ‘The Widening Goldstein, J. 11, 182, 183, 184, 185, 194
Scope of Indications for Psychoanalysis’ 101, Gordon, B. 174
102, 114; ‘The Widening Scope of Graf, H. 18
Psychoanalytic Child Psychology, Normal and Green, A. 112, 113
Abnormal’ 118, 130, 145, 149, 150, 151; Green, V. 124, 135, 154, 163
‘Willi Hoffer, MD’ 37, 38; The Writings of Greenspan, S. 163

228 Index
group dynamics, psychoanalytic study of 38 ICD: see International Classification of Diseases
group upbringing, experiment in, child survivors id: and ego [infantile battle between, ending in
of concentration camps 89–2 truce at puberty 62; interactions between 55,
Guy’s Hospital, London 172 56]; as instinctual pole 55
id analysis 104
Halberstadt-Freud, E. 42 id impulses 66
Hampstead Child Therapy Course and Clinic 3, id psychology, psychoanalysis as 58
15, 31, 81, 106–8, 118, 119, 124–7, 147, 184, identification 3, 59; with aggressor, as defence
198, 199; centre of A. Freud’s professional life mechanism 55, 60, 61, 62
110; clinical research at, 84, 91–101, 151; ‘Independent Group’ 109, 163
creation of 8–12, 96, 109–10; Nursery of 11, infant(s): Diagnostic Profile for 127; early
51, 95; Nursery Schools for Normal and for psychological needs of 91; relationship of, to
Blind Children 202; Study Group on Diabetic maternal breast (M. Klein) 26; see also
Children 179; study group on adult child(ren)
schizophrenia and psychosis 114; Well Baby infant observation 18, 85, 94; see also child
Clinic 166, 202; work with neglected and observation
abused children 183; see also Anna Freud infantile amnesia and Oedipus complex 45
Centre infantile development 90, 175
Hampstead Index 96–8; as collective analytic infantile experience, early, reconstructions of
memory 97 116
Hampstead War Nurseries, London 8, 9, 12, 15, infantile instinctual life 45
37, 51, 69–82, 85–9, 92–9, 110, 131, 166–8, infantile neurosis(es) 9, 34, 60, 62, 125, 151–5,
174, 190, 202; and observational research 163; and child analysis 148–9; example of, case
70–2; research and training as aim of 70–2 of Little Hans 149–50
Hartmann, H. 30, 54, 57, 58, 84, 86, 114, 131 infantile psychopathology 200; types of 152
Hayman, A. 121 infantile sexual curiosity, repression of 33
head-banging 77, 80 infantile sexuality 18, 62, 123
Heller, P. 42 influenza epidemic (1919/20), death of Sophie
Hellman, I. 71, 85 Freud in 167
‘here-and-now’ transference interpretations instinctual drives: repressed 30; vicissitudes
106 of 58
Hietzing School, Vienna: see Matchbox School, instinctual life, infantile 45
Vienna institutional care, impact of 79–81
High Wick Hospital for Psychotic Children, intellectualisation 63
Hertfordshire 202 internal censorship 22
Hitler, A. 4, 7, 30 International Classification of Diseases (ICD)
Hoffer, W. 6, 37, 38, 41, 50, 202 120, 128
‘holding’ (Winnicott) 158, 163 International Psychoanalytical Association (IPA)
horses, phobia about 19, 150 1, 7, 101, 197, 198; Congresses [(1920) 13, 19;
‘Hort’ schools, Vienna 10, 44, 46 (1927) 27; (1957) 92; A. Freud’s lecture at
hospital: children in, care of 166–80; setting, (1975) 111, 113]
role of child therapist in 177–80; visiting interpretation(s): dream 116, 148; of dreams, as
rules 174 tool of treatment 105; of manifestations of
hospital treatment, impact on personality transference 104; as research tool 93;
development 174 transference, ‘here-and-now’ 106; of
hospitalism 91 unconscious material, as tool of therapy 146;
hospitalisation: and children’s attachment use of 108 [‘Memoranda on Technique’ 108]
relationships 167; experience of 175 introjection 59; primitive 109
Hug-Hellmuth, H. 19 IPA: see International Psychoanalytical
Hurry, A. 163, 164 Association
hypnosis: as core technique of treatment 102; Isaacs, S. 85
substitution of free association for 108 isolation, as defence 60

Index 229
Jackson, E. 51 looked-after children, outcomes for, in terms of
Jackson Nursery, Vienna 6, 8, 10, 51, 69, 70, 72, mental health and well-being 190
87, 166, 202 loss, traumatic, and separation, experiences of 81
James Putnam Clinic, Boston, MA 202 Luyten, P. 128
Jones, E. 7, 13, 33, 34, 57, 197 lying, compulsive, possible reasons for 120
Jung, C. G. 1, 6
Jurist, E. 158 MacKeith, R. 172, 173
juvenile delinquency 39; see also wayward youth McLean, D. 125
Maenchen, A. 5
Kaplan-Solms, K. 125 Mahler, G. 4
Katz, J. 182 Mahler, M. 30, 91; separation–individuation 131
Kennedy, H. 8, 160, 163 Mahon, E. J. 134
kibbutz movement 36 Marans, S. 201
‘Kinderseminar’ 5 Master’s Nursery, New York 202
Kipling, R. 2 masturbation 23, 61, 77, 80
Klein, M. 21, 57, 59, 74, 171, 176; case of Matchbox School, Vienna 6, 12, 42–4
‘Erna’, in response to Anna Freud 26–7; child maternal rejection 50
and adult analysis, fundamental identity of 26; May, K. 2
child analyst, ‘educational’ role of 25; Mayes, L. 87, 132, 140, 141, 143
Controversial Discussions 31, 107–9, 198; mechanisms of defence, and ego, Anna Freud’s
English School 30; first year of life, emphasis work on, legacy of 67–8
on 28; focus on phantasies 108; Gentleman’s medical care, refusal of 191
Agreement 109; internal object relations 133; melancholia 119
internalised objects, transformation of 109; ‘Memoranda on Technique’ 108
play technique 22, 27, 30; play therapy 26, 29; memory(ies): recovered, integration of, into
psychoanalytic treatment of children 5; personality 30; road to the unconscious 113
‘schools’ of child analysis, London 19; work of mental functioning, child’s, fundamental failure
with children with ego defects and psychoses in development of 163
163 mentalisation-based therapy 163
Kris, E. 30 Menzies Lyth, I. 167
Kris, M. 7, 30, 84, 86, 91 Meurs, P. 142
Middlesex Hospital, London 167, 179
Lacan, J. 197, 198 Midgley, N. 92, 150
language acquisition, developmental line for 143 mind, agencies within, disharmonies between
language development 80, 125, 126 112
Laplanche, J. 55 ‘minimum state intervention’, principle of 190–1
latency period 45, 62, 134 Model, E. 124, 179
learning difficulties, children with, effectiveness Montessori, M. 35, 36, 43, 70
of psychoanalytic treatment for 127 Moran, G. 163, 179
liberation and compulsion, ‘middle path’ Moskovitz, S. 91
between 44 mother: aggression against 176; death-wishes
libidinal and aggressive development, stages of 71 against 26, 28; depressed, infant’s reaction to
libidinal impulses, and aggressive impulses, fusion 94; hostility towards 28
of 40, 74 mother–infant relationship 131; deficient 131;
libidinal stages, sequence of 123 early 112, 163 [consequences of interruptions
life instinct 73 of 123; problems in 112]
lines of development: see developmental line(s) mothering, substitute, responses to 72
Little Hans 18, 85; case of, example of infantile mourning 76, 110, 179
neurosis 149–50; phobia about horses 19, mourning process, separation from primary
150 caregivers, phases of 76
Loewenstein, R. M. 86 Mozart, W. A. 4
London Blitz 70, 72 Murray, J. 9, 14, 152

230 Index
Nagera, H. 8, 114 parent(s): importance of working with 49–50;
narcissism: concept of (Sandler) 97; disturbances psychological 194 [definition 186; primacy of
of 127; primary 76 relationship with 187–8]; separated, effect of
narcissistic functioning, in adulthood 115 on children 184; separation from, impact of
needle phobia 171 174; and teachers, Anna Freud’s introduction
negative transference 23, 26; child’s resistance as to psychoanalysis for 44–6
23 parent–child relationship: early, difficulties in 39;
Neil, M. 171, 172 modification or termination of 190
neurobiology 128, 141 parental abuse 64
neurosciences 141, 163, 201 parental authority, abuse of 34
neurosis(es): adult 149, 151; child 149; infantile parental seduction 153; see also sexual abuse of
9, 34, 60, 62, 125, 148, 149, 150, 151–2, 153, children
155, 163 [roots of 19]; obsessional 19, 24, 28, parental sexuality, primitive anxieties about 94
118, 120; structure of 148; transference 24, pathogenic environment 65
109, 147 pathological behaviour, motives for 64
neurotic disorders/disturbances 110, 148, 169; Payne, S. 108; ‘Gentleman’s Agreement’ 109
causes of 34 ‘pedagogic’ love, for children in care 78
neutrality, analytic 104 pedagogy, psychoanalytically informed 33
Newman, L. 177, 203 penis envy 176
New York Psychoanalytic Institute 111 personality development: impact of bodily illness
Nijinski, K. 42 on 174; impact of separation and family
nonverbal communication, in classroom, disorganisation on 184
understanding of 51 personality psychology 128
Novick, J. 114 Peters, U. 198
Nunberg, H. 57, 59 phobic anxiety attacks 22
nurseries, day care in 10 phobic defences 176
Nursery School Association of Great Britain 137, physical abuse 191
139 Piaget, J. 85
Nursery Schools for Normal and for Blind Platt Report (1959) 168
Children, Hampstead Clinic, London 202 play: importance of, in psychoanalysis of children
25; role of, in child analysis 29–30; way of
Oberhollabrunn institution for ‘delinquent’ boys mastering anxiety 73
(Austria) 20, 38 play technique/therapy 22, 26, 27, 30; in hospital
object relations, early 24 178
object relations theory 127, 183, 198 pleasure principle 9, 40, 44, 152
‘objective anxiety’ 64 Pollock, G. 51
observation: child 85, 87, 92; infant 18, 85, 94; ‘polymorphous perversity’ 18
and reconstruction, ‘double approach’ 94 Popper, K. 84
observational research 70, 71, 92, 93, 153 positive transference 21, 40, 146; value of 23
obsessional neurosis 19, 24, 28, 118, 120 ‘preparatory period’ of treatment in child analysis
obsessional symptoms 19, 24, 26 20–1, 24, 25, 146
oedipal phase 108 primary narcissism 76, 131
Oedipus complex 18, 25, 27, 45, 46, 86, 123; primary repression 112
and infantile amnesia 45; resolution of, time of primitive introjection 109
25 primitive projection 109
orphanages 74: in Romania, infants raised in 88 progressive education 36, 43
Orthogenic School, Chicago, IL 202 projection 3, 59, 64; primitive 109
projective testing 123; development of 85
paediatrics 141; and psychoanalysis 166–80 protest, phase of, in mourning process, on
pain, children’s experience of 170; clinical separation from primary caregivers 33, 76, 168
example 171–2 Provisional Diagnostic Profile 94
paranoia 119 psychiatric genetics 128

Index 231
psychic trauma, as example of psychoanalytic Rank, O. 1, 6, 102, 108, 198
research 98 reaction formation 59; as defence 60; during
psychoanalysis: aims of, ‘Memoranda on latency period 45
Technique’ 108; application of, to education reconstruction, and observation, ‘double
32–52; and education [early history 33–4; approach’ 94
relation between 47–9]; and paediatrics recovered memories, integration of, into
166–80; and science, uneasy relationship personality 30
between 83; scientific status of 84; widening ‘Red Vienna’ 5, 10; and radical education
scope of, and implications for technique 34–5
110–14 regression(s): enforced 175; normal 175;
psychoanalyst, work of, metaphor of archaeology temporary 134–6, 203 [vs. fixation and
to describe 56 developmental arrest 135]; in transference
psychoanalytically informed pedagogy 33 103
psychoanalytic child psychology 6, 94 Reich, W. 30, 57, 59, 102, 108
psychoanalytic developmental psychology 99, ‘relational school’ of psychoanalysis in US 163
131, 141, 143, 192; contribution to legal repetition compulsion 152
practice for children and families 184; repressed, return of 24, 60
principles of 140 repressed wishes, interpretation of 25
psychoanalytic developmental therapy, clinical repression 59; in formation of symptoms, and
example 171 unconscious drives or wishes 56; freedom
Psychoanalytic Press, Vienna 7 from 34; harmful aspects of 33; primary 112;
psychoanalytic research; and child observation and unconscious drives or wishes 58; and
83–9; clinical and conceptual, Anna Freud as unconscious mind 123
promoter and facilitator of 83 rescue fantasies of professionals working in family
Psychoanalytic Research and Development Fund law 192
conference, New York (1964) 98 research, psychoanalytic, clinical and conceptual,
psychoanalytic treatment: of adult patients Anna Freud as promoter and facilitator of 83
101–16 [A. Freud’s approach to 115] resistance(s) 20, 26, 29, 65, 102; analysis of, as
psychodynamic psychology 128 tool of therapy 146; child’s 21; dynamic
psychological parent 194: definition 186; importance of 108; ego 56; focus on 110; in
relationship with, primacy of 187–8 free association, and unconscious drives or
psychological well-being, impact of bodily illness wishes 56; transference as 23
on 169 Ribble, M. 91, 94
psychopathology: of children 119; developmental Rilke, R. M. 14
130–43; infantile 200 [types of 152] Robertson, James 12, 79, 171, 194; sick children
psychoses(is) 112, 163; adult and adolescent, in hospital 167–9
differences between 114; predisposition to 114 Robertson, Joyce 173, 176, 177; sick children in
psychosexual development 72; S. Freud’s model hospital 167–9
of 200 Romania, infants raised in orphanages in 88
psychosomatic symptomatology 153 Rorschach test 85
psychotic breakdown 115 Rosenfeld, E. 42, 43
psychotic functioning: in adulthood 115; failure Rostow, E. 182
in maintaining object relationship in 115; role Royal College of Physicians 173–4; A. Freud’s
of conflict and the mechanisms of defence in lecture to (1961) 177
114 Rutter, M. 88, 142
psychotic patients 114, 115; treatment of 85
psychotic states, psychoanalytic understanding of St Andrä institution for ‘delinquent’ boys
114–15 (Austria) 38
puberty, defence mechanisms in 62–3 Sandler, A.-M. 83, 199, 203
Sandler, J. 8, 95, 97, 160
Rainbow Hospital, Cleveland, OH 170, 174 Schilder, P. 114
Rangell, L. 113 schizophrenia 114

232 Index
schizophrenic patients: bodily self-neglect of 115; superego: child’s 24, 25; concept of (Sandler) 97;
psychoanalysis of 111 development 40, 46, 61, 72, 78 [early, nature
Schliemann, H. 56 of 25]; functioning, disturbance in 121;
School for Nursery Years, Los Angeles, CA 202 harshness of, minimising 50; as system of ideals
school phobia, possible reasons for 121 and inhibitions 55
Schore, A. 158 superego anxiety 59, 64; role of, in formation of
science, and psychoanalysis, uneasy relationship neurosis 60
between 83 surgery, preparations for 174
screen-memories 108 symptomatology: diagnoses based on, problems
Sears, R. 86 of 120–2; psychosomatic 153
secondary-process functioning 136 symptoms, formation of, and repression, and
seduction theory 64 unconscious drives or wishes 56
separation: and attachment 74 [Anna Freud and
John Bowlby on 75–7]; early, impact of 88; Target, M. 142, 158, 163
and family disorganisation, impact of, on Tavistock Clinic 30, 85, 167, 198
personality development 184; from parents, teacher(s): child’s identification with 46; and
case example 75; and traumatic loss, parents, Anna Freud’s introduction to
experiences of 81 psychoanalysis for 44–6; unconscious
separation anxiety(ies) 135, 169, 176; possible identification of, with child 47; use of
reasons for 121 psychoanalysis for 46–7
separation–individuation (Mahler) 30, 91, 131, Tereszin (Theresienstadt) Concentration Camp
132, 136, 152 89
separation–individuation stage 91, 152 Thematic Apperception Test 86
sexual abuse of children 153, 191 therapeutic alliance 21, 67, 106, 146
sexual curiosity, ban on 34 Therapeutic Nursery School, Cleveland, OH
sexual enlightenment 33, 48, 50 202
sexual expression, prohibition of 34 Thorpe, M. 193, 194
sexuality: centrality to human nature 111; diffuse Tiffany, C. 42
infantile 62; early childhood, psychoanalytic toddlers, Diagnostic Profile for 127
investigations of 85; genitally centred adult 62 toilet training 22, 50, 80, 121, 174; effects of 71
Sharpe, E. 108 tonsillectomies, symposium on (1949) 176
signal anxiety 143 Toth, S. 142
sleep disturbance, possible reasons for 121 training analysis, nature of, ‘Memoranda on
social psychology 128, 141 Technique’ 108
Solnit, A. 177, 183, 184, 194, 203 transference: analysis of, as tool of therapy 146;
Sophocles 2 child’s, interpretation of 160; communication
Spitz, R. 85, 91, 94, 131 in, over-emphasis on 113; earliest experiences
splitting, as defence 131 of infancy repeated in 113; fact of 108; focus
Spock, B. 174 on 110; handling of, as tool of treatment 105;
Sroufe, A. 142 importance of, in psychoanalysis of children
Stern, D., attunement 92, 128, 163 25; interactions between ego and id in 56;
Stockbridge Symposium (1950) 92 interpretation of 147, 148, 160; manifestations
Strachey, J. 108, 147 111 [interpretation of 104]; negative 26
Strauss, A. L. 133 [child’s resistance as 23]; positive 21, 40, 146
Stross, J. 166 [value of 23]; psychoanalytic focus on 65;
structural assessment 123, 125 regression in 103; as research tool 93; as
structural model of mind (S. Freud) 5, 102, 127, resistance 23; revised view of 147–8; role of
198 23, 107–9, 159 [‘Memoranda on Technique’
Study Group on Diabetic Children, Hampstead 108]; in work with children, types of 147
Clinic 179 transference–countertransference matrix 113
sublimation 14, 59, 131; of asocial impulses 39; transference interpretations, ‘here-and-now’
during latency period 45 106

Index 233
transference neurosis 24, 109, 147 Viennese Department of Youth 41
transference object 160–2; therapist as 160 Vliegen, N. 142
transference phenomena 22, 107, 113
transference reactions 147, 160 Wagner-Jauregg, J. 114
trauma, childhood 92 Wallerstein, R. S. 54, 57, 98, 199
tripartite (structural) model of mind 55 ‘wayward youth’, Aichhorn’s work with 20,
Tronick, E. 92 38–41; see also juvenile delinquency
twins, identical, study of 96 weaning, effects of 71
Tyson, R. 160 ‘Wednesday meetings’, Vienna 5
Well Baby Clinic, Hampstead Clinic 166,
unconscious, revelation of 65, 102, 103, 148, 149 202
unconscious drives or wishes: and dream well-being, psychological 185; and
censorship 56; and repression (formation of developmental lines 136–7; impact of bodily
symptoms) 56; and resistance (free association) illness on 169
56 ‘where id was, there ego shall be’ (S. Freud) 24
unconscious ego 56 ‘wild analysis’ (Winnicott) 113
unconscious mind, and repression 123 Winnicott, D. W. 75, 112; concept of ‘holding’
unconscious wishes 102, 104 158, 163; ‘wild analysis’ 113
undoing, as defence 60 Wiseberg, S. 114
University of Vienna, psychiatric clinic 114 wishes: repressed, interpretation of 25;
unconscious 102, 104
Valenstein, A. 198
van Houdenhove, B. 128 Yale Child Study Center, New Haven CT 5, 30,
verbalisation: capacity for 159; role of 158 91, 95, 183
[clinical example 158–9] Yale Law School, New Haven, CT 182, 194,
Vienna, City of, Board of Education of 6 195; A. Freud’s address to students (1968) 183;
Vienna Psychoanalytic Society 1, 5, 7, 18, 36, Faculty 184
38, 85, 114, 199 Yorke, C. 114, 115
Vienna Psychoanalytic Training Course 6, 41 Young-Bruehl, E. 1, 9, 99, 101, 109, 110, 166,
Vienna School of Child Analysis 68 179, 184, 194, 200
Vienna Training Institute 12; Course for
Educators 6, 7 Zetzel, E. R. 21

234 Index