Panel III: Child Case:
Balancing Enriching the Sense of Self and the Intersubjective Realm

This panel, engagingly introduced and moderated by Mark Smaller, featured an extraordinarily lyrical and touching case presentation by Jacqueline Gotthold, with stimulating discussions of the case presentation by Rosalind Chaplin Kindler and Christine Kieffer. According to Ros Kindler, the panel was ground-breaking, in that it was the first plenary panel on child treatment in the conference's history.

Mark Smaller introduced the panel by describing some of the fascinating experiences he has had in the past three years as head of the Neuropsychoanalysis Foundation, including his encounters with a neuropsychologist named Jaak Panksepp, who has been studying the neurobiology and evolutionary significance of play and laughter in humans and animals. Dr. Smaller described some of the many forms and functions of play, including its manifestations in humor, laughter and fantasy.

One of the many dimensions of clinical work beautifully illustrated by Jacqueline Gotthold's case presentation was the evolving but ever-present experience of play in her relationship with her child client Daria, as Daria developed from a latency-age fifth grader to a young adult departing for college. In addition, Dr. Gotthold's case description illustrated the interweaving of play with the multitude of non-verbal interactions, implicit relational knowing, and "unarticulated and almost unarticulatable processes as they form the ongoingness of treatment."

Play formed the initial bridge between Daria and Dr. Gotthold. In their first meeting together, Daria seemed to be stuck and confused in response to Dr. Gotthold's questions and "lapsed into a motionless silence." Undaunted, Dr. Gotthold saw her eyes moving about the room, joined her eye movement and began mentioning the things they could do together. When Daria's eyes landed on the Lego bin, Dr. Gotthold registered Daria's unspoken interest. "With large movements" Dr. Gotthold slid to the floor, retrieved the Lego bin, brought it in front of Daria and began to build. When Daria asked what she was making, she replied, "A wall... for a house." Daria stayed silent a little while longer and then blurted out, "Can I do that?" Dr. Gotthold said, "Sure, here, all yours," handing her the Lego wall. Daria searched her face, smiled a small almost concealed smile and echoed, "All yours." Thus began their relationship, within which developed an "unarticulated sacred vow." Seeing Daria over and over search her face, Dr. Gotthold sensed Daria's "desire and fear to be known," and wanted to carve enough psychic space for Daria so she could grow, learn and develop. For her part, Daria played, searched for words, and searched Dr. Gotthold's face for response. Eventually Daria's searching look became more expectant, as she grew more confident of receiving an interested, accepting, validating response; and Daria became able to be increasingly more open about her experience. A series of wonderful vignettes illustrated both the evolution of the therapeutic relationship and Daria's increasing self-articulation as her development progressed. The role of play in its many manifestations, including adolescent experiments in creativity and life style, was an important feature of both the relationship and Daria's development. Play was again apparent in the last session that Dr. Gotthold reported. In this session, Dr. Gotthold with seriousness raised the question of what they would do when Daria left for college. Daria for a moment looked alarmed and then with a joking, ironic quip, transformed the moment into one of shared play, in which the very important emotions involved were both acknowledged and held lightly between them.

In her discussion, Rosalind Kindler described "the ways the world of adult analysis has become more attentive to the elements of practice familiar to those who work with children," elements including the significance of spontaneity, creativity, improvisation, metaphor, playfulness, music, and art, as well as the importance of non-verbal, non-interpretive modes of communication and the implicitly-known and co-constructed nature of the analytic encounter. While attention to these elements has brought the world of adult analysis closer to the world of working with children, the articulation of these concepts and their importance has provided a language for child analysts to describe what they have intuitively known and practiced. Ms. Kindler also discussed important differences between child and adult treatment. One important difference is the experience the child analyst has of moving through a child's development with him or her and seeing how developmental tasks are negotiated. Another difference is that the child analyst is not dealing with reconstructions of parent-child relationships. The child analyst has direct contact with the child's caregivers and, in fact, must form a relationship of one kind or another with them. Ms. Kindler also focused on the "unarticulated sacred vow" between Dr. Gotthold and Daria to "allow each other to know and be known and to be and become who {they} were individually and together." Ms. Kindler described the way this vow was manifested in the array of vignettes presented, in Daria's search for herself in Dr. Gotthold's face, and in the way her searching gave way to "expectancy," as Daria came to anticipate validation and acknowledgement in their co-created relationship.

Christine Kieffer, in her discussion, focused on the idea that "The Play is the Thing." She cited Jay Frankel's assertion that the development of a capacity for play is basic to all psychotherapy and that child and adolescent analysis give us that basic mechanism of therapeutic action in its purest form. Within play occur the emergence and integration of dissociated self-states, symbolization and recognition. The other essential process is "the renegotiation of self-other relationships through action." Dr. Kieffer described these processes as they unfolded in Dr. Gotthold's work with Daria. She described the safety created for Daria to explore dissociated self states by Dr. Gotthold's empathic understanding of Daria's inhibitions about self expression. Dr. Gotthold's initiation of Lego play in the first session conveyed an interest in understanding; and "her pleasure in playing conveyed a sense of complicity and recognition to Daria." Dr. Kieffer referred to infant research as contributing to our understanding of the way "even wordless play can initiate the development of procedures that become saturated with meaning." Dr. Kieffer described play as a form of recognition that is conveyed as "a spontaneous unconscious-to-unconscious connection and communication" between analyst and child patient. Dr. Kieffer also observed that play in child analysis can foster the establishment of new procedures and their internalization as working models, "thus privileging action over verbally based insight."

Dr. Kieffer concluded by discussing aspects of systems theory, particularly "equifinality," emergence and phase transition, as well as the idea of the Analytic Third, as concepts illuminating the processes of child treatment so vividly illustrated in Dr. Gotthold's case description. As Dr. Kieffer said, "Self-organization cannot be separated from relations with others..." Along with systems concepts, Dr. Kieffer described the emergence in the treatment of Daria of the development of mature selfobject function and discussed its relationship to Jessica Benjamin's idea of mutual recognition.

This panel was indeed a stellar experience for the conference attendees and provided an extraordinary example of the ways child treatment embodies and exemplifies the important non-verbal, symbolic and relational processes currently receiving so much focus in contemporary psychoanalysis.

Carol Mayhew, Ph.D., Psy.D., is a supervising and training analyst and past president of the Institute of Contemporary Psychoanalysis in Los Angeles. She is also a member of the Council of the International Association for Psychoanalytic Self Psychology. Her practice is in the Brentwood area of Los Angeles.