Health: Children on the couch: Is three the perfect age to meet your sh rink?
Small children, some as young as three and four, are now being given daily sessions of psychoanalysis. Over the top? Certainly not, say the analysts. Wendy Wallace reports on children who talk quite naturally about all sorts of things that they wouldn't mention a few years later.
Tuesday 16 September 1997
Hampstead is the therapy capital of Britain but here in Maresfield Gardens, a few doors away from the Freud Museum, it is not adults who come to talk over their worries and examine their inner selves, but small children. The Anna Freud Centre was started by Sigmund Freud's daughter during the Second World War to care for children traumatised by the Blitz. Now it offers psychological services to children and their families, and has some 50 children having long-term treatment of up to two years, half of them coming four or five times a week for psychoanalysis. The youngest patients are three years old.
The lay response to this tends to be that whether or not there's anything wrong with these children, the parents must be mad. Who in their right mind would impose the tyranny of a daily therapy session on a pre-schooler? But the centre's director, Julia Fabricius, says that tiny children make ideal candidates for full-time psychoanalysis. "I would like to see more of the under-fives," she says. "They end up coming at eight or nine. But a year when you're four is better than three years when you're nine. All sorts of things that we don't talk about later in life - sex, death, babies - a small child talks about just like that."
Julia Fabricius, herself a Freudian analyst, is attuned to the inner world of small children. In the consulting room, she has been Sellotaped to her chair (by a little girl who had "suffered a lot of losses" and didn't want her to go on holiday), regularly gets down on all fours to play complicated games of murder and marriage, and has communicated by letters and drawings with children who wouldn't speak. `You're trying to give the child a space which is safe in every way," she says. "Where all sorts of things can be expressed, and gradually be understood."
Upstairs, in the centre's consulting rooms, there are small couches. But children tend not to lie on them. They bounce on them, or pull off the cushions to construct castles or caves. There are also sinks, and lino-covered floors. Childish therapy is done in childish ways - through the media of paint and Plasticine and water. Children are allowed to make a mess in their 50-minute sessions. It's important for them to see, says a senior child therapist, Rose Edgcumbe, that mess is all right, that it can exist, then be cleared up. It sends them a message.
And their play informs the therapist. "You get clues from every little bit of behaviour that tell you what sort of child this is," says Rose Edgcumbe. "You get a sense of what worries the child and what he does about it. Up to the age of five or six, the child may instantly start playing out stories. Then the curtains start coming down."
Full psychoanalysis for children is at the pinnacle of a range of services the centre offers families who are struggling with their relationships. So far this year, 99 people have approached the support service where parents can talk over their worries with a trained child therapist, and 15 children displaying various degrees of distress are enrolled in the centre's nursery. Only a small minority of the troubled children assessed are advised to embark on full therapy.
Colin, now aged six, was one of them. He has recently finished two years of psychoanalysis, which began when he was enrolled in the centre's nursery at the age of four, and continued through his first year of primary school. His grandmother Nancy Osborn, who looks after him, believes he has benefited. "I think it helped him to believe in himself and get some self-worth," she says.
Colin's mother, Nancy's daughter, is mentally ill. His father is an alcoholic. The two struggled to care for him until he was three, then couldn't cope any more. Colin's mother had spent long periods in hospital; his father has bobbed in and out of his life.
"Colin has had a very ... His early life was very ..." his grandmother says. The words never quite materialise. She has looked after him for the past three years.
But the little boy was slow to speak, and cautious with other children. He was very, very good - except when he had violent temper tantrums. Despite being bright, he couldn't colour in a picture or write his name. "It all pointed to a lack of confidence and a bit of insecurity," says Nancy Osborn. "They consulted me and his mother, and felt maybe he could do with a bit of help."
How did she explain it to the child?
"They call her a special friend. They don't say you're going to have psychoanalysis, just that you're going each day to talk and play." Sometimes Colin didn't want to go but they stuck with it, going four days a week for two years. His grandmother is sure it was worth it. "He seems such a well-balanced, well-adjusted child, and such a nice companion," she says. "But I think if we hadn't had that help, he would have been more anxious and insecure. Quite definitely I can say that therapy has helped him." Colin is now doing well in a mainstream school.
The process of psychoanalysis with children - as with adults - involves the analyst reflecting the patient's view of the world back to them, but with more light let in. Children, like adults, can be helped to understand themselves, says Julia Fabricius. "A lot of people do not know what they're feeling. Just to be able to know it and name it is a great gain. If you can go farther and understand why you are feeling it, so much the better."
In Colin's case, the main causes of his disturbance seem fairly clear. But it is not always the case. "People tend to think that small children are happy," says Rose Edgcumbe. "They can understand that abused or neglected children may have difficulties, but they don't expect it of ordinary children in ordinary families."
There was no obvious reason why Chloe Goodman (not her real name) by the age of three didn't sleep, wouldn't feed herself and was reluctant to socialise with other children at nursery school. The nursery suggested an educational psychologist but her mother took Chloe for assessment at the Anna Freud Centre, where staff recommended full psychoanalysis. "I panicked," says Deborah Goodman. "I think because it was five days a week, I was shocked. But that's how they work with children, to build a relationship and give continuity."
Mrs Goodman didn't discuss her daughter's intensive therapy with friends. "I found that the response is that people are very scared to see that they may have a part to play in their children's development. They would rather the child was diagnosed with an illness than with an emotional difficulty."
But she took Chloe every weekday for more than a year, for sessions which she did not sit in on. "I know she did a lot of playing and drawing, and played a lot with little figures. I had a sense that she was coming out feeling very happy and relaxed."
Chloe gradually stopped coming into her parents' bed every two hours, and her eating became less erratic. By the time she started primary school, the sessions were cut down to four per week, and Chloe had made a lot of progress.
The Anna Freud Centre is one of only a handful of places in Britain where children can receive full psychoanalysis. Payment is on a sliding scale according to means; not all the parents are the rich and introverted stuff of Hampstead stereotype. Around one-third of children are from low-income families and contribute only pounds 2.50 a week. A few pay the going market rate for full-time therapy - about pounds 8,000-pounds 9,000 per year. A few children are paid for by their local health authority. Parents are usually seen once a week by a separate therapist to discuss their child's progress and their role in it.
But full-time therapy is not for any child, says Julia Fabricius. "There is a cost to the child's life," she says. "So he or she needs to be in some trouble - bullying or being bullied, with no friends, unable to separate from mother, underperforming at school. And the school has tried, the parents have tried and failed to make any difference. In a child of three, four or five, when development is galloping along, there is room for things to go rapidly wrong but also to go right. There is huge potential to do good."
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