A Research Study into the Process of Change in Under Fives' Psychoanalytic Psychotherapy

The present study was designed to evaluate the effectiveness of brief
psychoanalytic psychotherapy with children under five and their families. This
method originated at the Tavistock Clinic in the nineteen-eighties.
The aim of the intervention is to resolve symptoms and deep anxieties in the
child, which impede developmental progress, through paying close attention to
the emotional dynamic within the family and to trans-generational issues.
This research study has taken place in a National Health Child and Adolescent
Mental Health Service in England.
The families were offered treatment as usual, which included a preliminary
telephone consultation to establish the urgency of the difficulty. During this
consultation the criteria for inclusion in the study were established.
The hypothesis underlying this research is that there is a link between the
parents' state of mind and their child's behaviour and symptoms as indicated in
the referral letter. In particular, if parents feel understood and have the
experience of being emotionally contained by the therapist in treatment, their
state of mind is likely to move along a continuum from being predominantly
reactive to being more reflective.
In psychoanalytic parlance, they move from a paranoid-schizoid position to one
that is more depressive (PS^D).
A methodology has been devised which includes both a qualitative and a
quantitative approach and videotaping of sessions.
The quantitative findings suggest that the parents' state of mind in relation to
their child did indeed alter from being predominantly reactive to being more
reflective, but this was specific to one of the three dimensions measured. By
the end of treatment, parents were found to be less blaming and more
reparatory in their general state of mind, having started at baseline, by being
rather blaming in their general attitude.
However the findings were less conclusive in terms of the parents changing on
the other two dimensions i.e. of enmeshment - separateness and criticism -
identification with the child. The qualitative findings based on the parents' reports on the children's
progress and the therapist's observation and countertransference showed that
the children's symptoms and behaviour changed and improved. However, this
part of the research was based on a qualitative and not a statistical analysis of
the data. The qualitative material supported the hypothesis and the predictions
generally as well as the quantitative findings. However, it could have been
argued that it was the statistical findings that lent some partial credibility to the
qualitative findings.

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