Canadian Association of Psychoanalytic Child Therapists

How does Psychoanalytic Psychotherapy work?

Playing is an experience, always a creative experience. Children’s play has everything in it. (Winnicott, 1971)

While adults and adolescents use words to communicate their thoughts and feelings, children primarily use play as their natural way to express themselves. In child psychodynamic psychotherapy, play gives us a window into the child’s internal world of thoughts, feelings, wishes, fantasies, struggles, anxieties and conflicts, as well as the child’s strengths. Through play, children are expressing and processing their moment to moment affective states and will often reveal the nature of any problems they are experiencing.

The therapist serves as a sensitive translator who carefully observes the symbolic play and helps the child decode and make meaning of their world. The trusting bond that develops between the therapist and the child helps the child to feel comfortable in expressing their inner world. It is through this combination of talk and play that the child has an opportunity to understand and safely manage their conflicts and feelings, which leads to changes in their behaviour. The therapist also works with the child’s family in order to support the positive changes taking place in the individual treatment, and to help the parents understand their child’s behaviour, resolve problems, and modify aspects of how family members relate and work together.

The consistency of sessions (and often regular parent meetings) promotes a deepening of the therapeutic relationship and the child’s willingness to share vulnerabilities, worries and unwanted feelings. In this way a child/adolescent can work through difficulties toward more adaptive behaviour. Goals for therapy may be specific such as changes in behaviour, improved relations with friends or family; or more general such as less anxiety and better self-esteem. Throughout the treatment process, based on consistency, reliability and safety, the child is helped to work through the challenges that brought them into treatment.

Psychodynamic Play and the use of Transference and Countertransference

In the safe therapeutic setting the child’s/adolescent’s disavowed affects and unwanted roles are assigned to the therapist, who animates and elaborates them through her participation in the play so that both child and therapist are fully immersed in their imaginary activities, but the therapist attempts to maintain a reflective stance as well, thinking about the play in the context of what is known about child’s history and current situation.

The therapist also listens for the ways in which these patterns occur between client and therapist. The displacement of patterns of feelings, thoughts, and behavior, originally experienced in relation to significant figures during infancy and childhood, onto the therapist is called transference. In psychodynamic therapy, our process of observing, or asking questions, our empathy, and even our sitting quietly all influence the client. As we observe, we influence what we are observing. The therapist’s own subjectivity is influencing the transference and thus it is co-created and mutually contributed to.

The process involved is largely unconscious and it involves a range of affect reflected in positive and negative transference – it is different from the therapeutic alliance, which is a conscious aspect of the relationship between therapist and client. A strong therapeutic alliance is often essential to the continuation of analytic therapy during periods of strong negative transference.

In contrast, countertransference reflects the analytic therapist’s own unconscious reaction to the client. The phenomenon is analogous to transference. The therapist’s scrutiny of countertransference feelings can provide clues to the meaning of the client’s behavior, feelings and thoughts, thus further facilitating understanding of the child/adolescent.