e International Journal of

Int J Psychoanal (2009) 90:12551276 doi: 10.1111/j.1745-8315.2009.00212.x

Child versus adult psychoanalysis: Two processes or one?

Alan Sugarman
4180 La Jolla Village Drive, Suite 550B, La Jolla, CA 92037, USA mumford2@cox.net
(Final version accepted 14 May 2009)

Child analysis continues to be seen as a different technique from adult analysis because children are still involved in a developmental process and because the primary objects continue to play active roles in their lives. This paper argues that this is a false dichotomy. An extended vignette of the analysis of a latency-aged girl is used to demonstrate that the psychoanalytic process that develops in child analysis is structurally the same as that in adult analysis. Both revolve around the analysis of resistance and transference and use both to promote knowledge of the patients mind at work. And both techniques formulate interventions based on the analysts appraisal of the patients mental organization. It is hoped that stressing the essential commonality of both techniques will promote the development of an overarching theory of psychoanalytic technique.
Keywords: child analysis, defense, development, enactment, interpretation, resistance, transference

Child analysts no longer find ourselves having to defend our technique as genuine analysis. Indeed, we are often pleased to find that our application of psychoanalytic principles to the treatment of children and adolescents is regarded as valuable both in the development of a psychoanalytic identity, and for providing important information that expands the theory of adult psychoanalytic technique (e.g. Dowling, 1990). Nonetheless, a general tendency to consider child analysis as valuable but different from adult analysis continues to pervade our training programs, our professional standards and our literature. Only Ferro and Basile (2006) have noted the basic similarity in the two techniques so long as the theory of mutative action prioritizes the here-and-now interaction between patient and analyst. Thus psychoanalytic training programs continue to separate child analytic training from adult training. Different committees oversee the separate programs, different curricula are used, and debates continue to occur about the degree to which child control cases should count toward adult training. When institutes try to implement the recommendations of the American Psychoanalytic Associations Committee on Child and Adolescent Analysis to integrate the child curriculum into the adult one, it is not uncommon to hear some candidates complain that motherinfant observation courses or child continuing case conferences are irrelevant to adult analysis and training. Likewise, the American Psychoanalytic Association has only recently allowed analysts to be certified in child analysis before being certified in adult analysis; the two certifications continue to be separated so that child cases cannot be counted
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toward adult or vice versa. Finally, the child analytic literature is replete with emphases on child analysis being a more complicated treatment because the child is engaged in a developmental process at the same time (e.g. Abrams, 1988; Abrams and Solnit, 1998; Ritvo, 1978; Sandler, Kennedy and Tyson, 1980, etc.). This latter point is certainly true. It is my impression, however, that this unassailable truth that children undergoing analysis are also in the midst of a developmental process has interfered with the recognition that the child and adolescent psychoanalytic process has far more similarities than differences with the adult psychoanalytic process. To be sure, there are certain differences in technique between child and adult analysis (the role of the parents, use of the couch, emphasis on free association, etc.). But overemphasis on these differences between the two techniques may have shortchanged the field of child analysis, at times. For example, some argue that transference is less intense, less organized, or less pervasive with children than adults because the child is still so involved with the primary objects (Tyson, 1978).
Analysts have repeatedly emphasized that the child has less of a tendency or a need to make transferences to the analyst because he still has his primary love objects in his daily life for instinctual drive gratification or for symptom formation, which lessens the involvement of the analyst in the transference or the transference neurosis. (Ritvo, 1978, p. 299)

Yet Chused (1988) has questioned this perspective and suggested that such limitations in transference development are usually caused by the child analyst being too gratifying. She has found that a more interpretive and less gratifying approach with children leads to deep, intense, and pervasive transference manifestations, particularly negative ones. Furthermore, those who question the degree of transference possible in children rely implicitly on a narrow definition of transference as the displacement or projection of past object ties. To the degree that transference of defense (Gray, 1994) or of other aspects of mental structure (Sugarman, 2006) occurs, the primary objects become less central to the occurrence of transference. Many analysts today see transference as ubiquitous and involving more than displaced or projected object ties (Joseph, 1985; Schlesinger, 2003). Young children have been said to be incapable of insight (Kennedy, 1979), another truism that can be questioned if one redefines insight as a function called insightfulness that needs to be promoted by the analyst (Sugarman, 2003a). From this perspective, the young child does not gain access so much to repudiated content as to a key psychological process that has been derailed by internal conflict (p. 331). That is, we help child (but also adult) analysands to reflect on their inner worlds and to realize the importance of self-reflection for self-regulation. Busch (2007) has emphasized how the facilitation of this process with adult patients promotes a profound change in the analysands relationship to his own thoughts and feelings (p. 426). Shifting ones focus from promoting insight into repudiated mental content to facilitating the emergence of this function reduces the degree to which the attainment of insight differentiates child from adult analysis.
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Still other child analysts emphasize that the common need to be a developmental object when analyzing less organized children makes for a very different technique called psychodynamic developmental therapy (Fonagy and Target, 1996). This assumption, too, has been studied and thought to be possibly overstated if one considers more carefully what we mean by the concept of developmental object (Sugarman, 2003b). The process of insightfulness seems to occur on a developmental continuum ranging from action modes of experiencing and communicating to verbal, abstract, symbolic ones (Sugarman, 2006, 2009, in press). Actions of the analyst usually subsumed under the rubric of developmental help can be recast as action interpretations, occurring at the same level at which the child is communicating (Sugarman, 2003b, 2009, in press). Ferro (1999) emphasizes the importance of meeting the patient at the level being used to communicate to the analyst; such action interventions occur in many analyses, child and adult (Chused, 1996; Ferro, 1999; Pine, 2007), not just in other treatment modalities. Hence, one can question the extent to which the activities we traditionally call being a developmental object actually differentiate the child from the adult psychoanalytic process. This paper stresses the ways in which the structure of the child and adolescent analytic process is the same as that seen in adult analyses, despite certain technical differences. Examining the commonalities in these processes has the potential to clarify an overarching theory of the psychoanalytic process and to eliminate the artificial division of child and adult psychoanalysts into separate communities. There may be just one treatment that we call analysis, so long as our work with patients always takes into account the organization of their minds, as regards their diagnostic status, or as regards their developmental capacities and limitations. The concept of psychoanalytic process can be particularly helpful in clarifying the essential sameness of the two so-called separate treatments. This paper will not address the myriad of complexities we run into when trying to define the concept of psychoanalytic process. Others have already done so (Abend, 1990; Abrams, 1990; Arlow and Brenner, 1990; Boesky, 1990; Compton, 1990; Dewald, 1990; Erle, 1990; Weinshel, 1990a, 1990b) and concluded that it is a helpful though complex concept. Instead, the analysis of a latency-aged child will be presented that seems to demonstrate virtually the same analytic process as one sees with adult patients if one views the analytic process through the lens of modern-day conflict theory. To be sure, the patients developmental limitations affected how she presented material and how I phrased my interventions. And her parents remained an active force in her life and the analysis. Nonetheless, the structure of the psychoanalytic process we developed was essentially no different than the one that occurs with most of my adult patients despite the absence of free association and use of the couch and despite my regularly meeting with her parents. This view complements Ritvo (1978) who finds that, the process in children not only must be adapted to the development of the child, but is in many instances limited by his developmental status as well (p. 300, my italics). To be sure, the patient was a particularly verbal, insightful child who could participate in this sort of analytic
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process. But I find that even younger and or less organized children can be helped to engage in a similar process so long as one takes into account the nature of their mental organization (Sugarman, 2008a). This process and modifications necessary with younger children will be conceptualized in the discussion section of this paper.

Danielle
Danielle was 9 years old when her parents (the Ws) consulted me about her rigid conscience and pervasive inhibitions. Danielle was perfectionistic and compulsive about rules. Homework caused her inordinate tension; but she only cried and balked when her parents suggested she take school less seriously. Danielle was so rule-bound that she would criticize her mother for parking in a time-restricted parking space. She was self-conscious and worried excessively about hurting others feelings. Danielles unusually intense sibling rivalry with her younger brother and sister suggested these concerns were rooted in conflicts over competition. She also criticized her mothers expensive shopping, seemingly an identification with her fathers rants about her mothers spendthrift ways. Peer relations were also inhibited. Danielle avoided close friendships despite being well liked. She preferred one best friend at a time, becoming jealous and possessive if that friend had other friends. Her parents and teachers described her as a follower, not a leader. Both parents dated Danielles emotional inhibition to the past two years. Hypochondriacal worries occurred over the slightest scrape or cold. Danielle was also excessively cautious in activities requiring gross motor skills.

History
Danielles history contradicted her mothers guilty belief that her three year-long depression had damaged Danielle. There was clear evidence that Danielles problems antedated her mothers depression and accompanying marital strife. Danielle was unplanned; the pregnancy led Mr. W reluctantly to marry her mother. Mrs. W was over-protective and refused to leave the baby for more than a few hours until Danielle was 4 years old. Danielle lacked age-appropriate aggression during her anal-rapprochement years, suggesting early inhibition of anger and autonomy and or passive submission to an intrusive and overwhelming mother. She was also more timid on slides and play-structures in the park than other children between ages 2 and 5. Noises and animated characters at theme parks and restaurants frightened her at age 3; her fears soon expanded to include snakes, spiders, and dead animals from which Danielle feared she might catch disease during her oedipal years. At age 4 she insisted on falling asleep in her parents bed and being carried asleep into her own bed for about one year. All these pre-existing difficulties would have made her mothers depressive withdrawal difficult, but not causative of her problems. Psychoanalysis was recommended and I saw Danielle four times a week for three and a half years and met weekly with her parents. It is important to emphasize that the following summary of Danielles analytic process makes it seem more coherent than it felt at the time. Writing up cases such as this one retrospectively gives the analyst the
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benefit of emotional and temporal distance, clarifying patterns that seem less evident and more confusing in the actual clinical moment. None of us are as wise during a clinical analysis as we may seem in retrospect.

Opening phase
Danielle began the analysis by mentioning that her mother had fired a housekeeper for supposedly calling her a bitch when the housekeeper had only said her mother was full of bullshit. I pondered the possible meanings of this statement and said that Danielle might worry in her mind that she, too, could make her mother angry. Her nodded agreement allowed me to say that she might also wonder what was okay to say or do with me. Again Danielle nodded. I then explained that she could say whatever she wanted or do anything except intentionally hurt either of us; I also explained confidentiality. She responded by telling me of a family vacation that her mother had boycotted after a fight with Mrs. Ws brother. I commented that she must worry about her mothers anger a lot while thinking to myself how she might fear being rejected by me should she get angry. Her sensitivity to her mother, who was experienced as overwhelmingly powerful, aggressive, and intrusive, foreshadowed a central issue of her analysis and my own countertransference struggle not to over-identify with this view of Mrs. W. Our relationship quickly became the field in which Danielle expressed her conflicts over aggression. Early on, for example, she hesitantly hinted that I buy a game for the office. But she denied my observation that she seemed uncomfortable asking me. Thus, I reminded her that she had told me about her parents frequent arguments over spending money and wondered if she feared I, too, would become angry or say No to spending money. Danielle smiled and mentioned the game she would like me to buy. I did so only to be met by a barrage of requests for new games or toys that she rationalized while refusing to explore. While I tried to analyze these requests to get out of the bind into which I had inadvertently put myself, she called her father cheap. I asked if she was seeing if I was cheap like her father or easily angered like her mother. In this way I emphasized our here-and-now interaction. Danielle denied being angry with me while belittling her fathers cheapness. I wondered if she was telling me that she tried to make her own angry feelings go away by thinking the person toward whom she felt angry was bad; perhaps that helped her feel she was not bad. Using my preferred conflict model, I was trying to address her defenses and superego injunctions against anger before trying to directly discuss her anger. But Danielle simply denied having any angry feelings, making me aware of the danger of premature interpretation. Denial gave way gradually to more open demonstrations of Danielles conflicts over anger, particularly around our relationship. Mildly sadistic teasing about not wanting to attend sessions seemed safer than direct expression of anger at me. For example, she mentioned that attending a previous session had prevented her from riding in a truck. I said she might be angry and resentful at me for saying she needed to come. Danielle emphasized that her parents, not me, made her come. But I seemed to control them. They asked me if she could miss a session and I said: Its not a
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good idea! Danielle then asked me how long her analysis would last; her mother said that she would probably only need two years. I commented that she seemed to hope it would be over as quickly as possible. She agreed but could not explain why she disliked coming. I said: Talking about feelings you try not to think about probably hurts just like the feelings, themselves. Danielle shook her head no, nodded yes, and explained that she was not sure. She was glad she was not her mom because Mrs. W had to attend analysis five sessions weekly. I said she was probably glad not to be like her mother in other ways, reminding her of complaints about her mothers anger. Danielle agreed emphatically that she was glad to be different than her mother in that respect. Thinking about her loyalty conflicts, I added that she might also want to be like her mother but worried that I would disapprove. Danielle replied that she wished she was more talkative like her mother. I inquired into this wish. She explained that she thought it had to do with being shy. Danielle felt puzzled because she did not feel shy, but she acted as though she did. She then realized that she had not always been so quiet; she had been talkative until she was 3. My question of what had happened at age 3 led Danielle to say that her sister had been born. Her sister had been a pest, imitating everything Danielle said and did. I then wondered whether she might have stopped talking so much to prevent her sister from repeating her words. Danielle exclaimed: I just had that same thought! I added that her quietness seemed to be a way to control and express her anger at the same time, while I wondered to myself if she was just complying with my interpretation to please me. But to date, I had not noticed tendencies to comply in the analysis. She became more comfortable with her aggression, playing tricks on me, bringing in peppered candy, packs of gum that would snap my fingers, fake piles of feces or vomit, etc. She laughed gleefully when I fell for them. I struggled to find ways to use such behavior to promote self-reflectiveness. Thus, I suggested she was trying to show me about the tricks she felt were played on her, like the trick of expecting to be picked up by her mother only to be disappointed. Danielle angrily enumerated the times her mother had forgotten to pick up her car-pool, take her to school, etc. Her need to balance anger at one parent with anger at the other led her then to complain that her father was also always late except for work. She said she feared complaining to her mother because of her mothers anger. I labeled her inhibited affect a freezing of her feelings because she was also afraid of how big and destructive her own anger was. Over the first year of analysis I showed Danielle how she moved her feelings from her parents to other people as well, and that her freezing of her feelings also contributed to her shyness. In this way I tried to help her to observe and learn about how her mind functioned more than interpreting repressed mental content.

Midphase
Danielles transition to midphase was characterized by much greater accessibility to affect, both at home, and in the analysis, as we worked through her emotional freezing. Our work on her defenses against anger led initially to
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tantrums at home over having to dress up to accompany her parents to cultural events, and other control issues, most notably about the analysis. She protested directly to Mrs. W and me that attending analysis was ruining her life by messing up other activities. Danielle challenged me repeatedly with questions about the duration of analysis and why her siblings were not in it. I was encouraged by the affective immediacy with which her anger was entering our relationship. Other more modulated expressions of anger accompanied her increasing awareness of and comfort with this emotion. Giggling, competitive banter and teasing also occurred as her frozen demeanor gave way to an affective range more typical of a child her age. Physical games with Nerf equipment replaced board-games and drawing, and Danielle became interested in baseball, insisting on playing it in our sessions, regularly cheating in order to beat me. I chose not to prematurely interpret her identification with my own interest in baseball while I watched her motoric inhibitions gradually disappear during our sessions. Danielles complaints about seeing me were increasingly belied by her obvious pleasure at playing and discussing baseball during our sessions. Danielle told me that I knew more about baseball than any other grownup in response to my questions about her preoccupation with the subject motivated by my concern that it was being used primarily as a resistance. Her response made me think that her protests about attending defended a growing idealization that might seem dangerous to a child already struggling with loyalty conflicts toward two battling parents. Hence, I focused on her defensive need to minimize her positive feelings toward me. During one session she chatted about some activity which our session had interrupted while we tossed a Nerf ball back and forth. I told Danielle that I thought another reason she disliked sessions might have to do with her reluctance to talk and feel close to me for fear I would learn about her big feelings. She probably questioned whether I would help her to feel safe with them. Danielle responded with a seeming non sequitur, complaining that her mother picked at everything her father did. She then ranted about her mothers spendthrift habits, reciting her fathers litany of feelings. Then she lamented her father saying they would have less money to spend on their Caribbean vacation because Mrs. W spent so much. Puzzling over her response I realized that Danielle was confirming my transference interpretation by expanding on her anger toward her mother. Danielle went on to associate to her phobic fear of stingrays in Jamaica which I then understood as involving guilt and displaced anxiety over her loyalty conflicts and competitive strivings toward her mother. Interpreting such unconscious content risked seeming unempathic and adding to Danielles fear that I could not help her to feel safe with her feelings, particularly her powerful anger. Instead, I watched and listened to Danielles somatic complaints and anger at her mother as the trip grew closer. Worries over scabs, concerns that a cold would cause her ears to hurt while snorkeling, etc., occurred. I considered whether Danielles anxiety about time away from me might also be contributing, but she only discussed her parents bickering over the details and cost of the vacation. Thus I tried to address her fear of her own affects,
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saying that it seemed difficult to talk about her fears of how big her own anger toward her mother felt; it seemed easier for her if her parents were the ones who were angry. Danielle acknowledged that her emotions felt in between being scared of her anger and excited about the trip. Only upon Danielles return did her separation anxiety become clear. In her first session back she expressed surprise her luggage had made it back, detailing the familys almost missing their return flight. Mrs. Ws phone message about Danielle worrying excessively about missing the return flight led me to think she might have feared being separated from me permanently. Atypical concerns about missing or rescheduling sessions around another imminent long weekend away suggested how important I was to her and how frightening separation from me was. So did her requests that I not leave the office for the day until her mother arrived or that I leave the door between the waiting room and my office open so that she might see me. The transference was reaching the intensity and extent usually associated with a transference neurosis. We spent the next six months working on her separation concerns and their connection to her anger that she feared was so powerful it could destroy those whom she loved. These separation anxieties, often expressed in the transference, became intermixed with oedipal ones as Danielle talked about feeling mistreated by her mother who scolded: You learned that from your father! Danielle admitted that sometimes she thought her mothers complaints of You love your father more might be correct. I interpreted: That probably makes you feel guilty since you also love your mom. Danielle agreed but complained: I cant win with her. She doesnt like to play with me. My dad plays and she stands around talking to her friends. I said she might fear her mother did not like or play with her because she loved her father. Danielles eyes teared up as she listed all she felt she had in common with her father, and how little she shared with her mother. I considered the transferential implications but her emotion was more outside the transference at the moment. In this context, transference wishes that I protect Danielle and her mother from each others anger occurred, via displacement, as she criticized the snack her nanny had brought her which she threw out in my waste-basket. She asked me to tell the nanny that she had eaten it all if I was asked. I interpreted her wish that I protect her from her nannys disapproval and Danielle agreed. Her association that her nanny had driven because Mrs. W was ill suggested a displacement of her wish to be protected from her mothers anger. But she seemed not ready to know this about herself. I waited until Danielles complaints about her mother mounted to point out her provocations of her mothers anger, focusing on the defensive function of her provocations. For example, she complained about her mother always threatening to call Dr. Sugarman about parental arguments. I first said that this must make her feel I was on her moms side against her dad. Danielle responded: And youre not on anybodys side but mine, repeating an earlier clarification to her. I agreed, adding that it must still be difficult for her dad because he probably believed I was on her moms side. Danielle agreed and said that her mother probably felt I was on her dads
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side. I lamented feeling caught in the middle like her, worrying that each parent thought she was on the others side. Danielle insisted that her dad was the one in the right 99% of the time. I underlined her idealization of her father, her angry devaluation of her mother, and her feeling united with him against Mrs. W. I then interpreted that that she provoked her mother to blame her or feel the helpless victim of two warring enemies to avoid feeling guilty. Oedipal struggles with her mother peaked in the middle of her second year of analysis; complaints about her mother and vociferous arguments between them occurred frequently in the waiting room whenever Mrs. W refused to bring Danielle her preferred sort of food. In this way Danielle brought her internal conflicts directly into our relationship. Danielle remained reluctant to acknowledge how her provocative demands and rigidity about acceptable food contributed to these arguments. Wishes to leave sessions early began to emerge along with an idealizing paternal transference, even accidentally calling me Dad one session. Unconscious guilt over her longings for her father in the transference seemed the most likely contributor to these wishes to leave early that left me initially confused. Eventually I realized that her paradoxical tendency to then stall when I said it was time to stop revealed the degree of conflict Danielle felt about her longings for me. Interpreting these conflicts over several months eliminated her fear of sleeping in her own bed (a symptom that had reoccurred during the opening phase); now she feared riding the elevator in my building. Her oedipal guilt seemed solidly in the transference at this point, replacing the separation concerns we had analyzed and worked through. Danielle linked her fear with a dream she remembered from a year earlier in which she and her dad were riding an elevator during an earthquake. It turned upside down, leaving her and her dad standing on their heads. At that point her mom came to the rescue, pulling the elevator doors apart with superhuman strength from outside. Danielle associated that an elevator could not flip over unless the entire building did something there was only one chance in a quadrillion of happening. I wondered about things she thought more likely. She reported fearing that my elevator would fall when it shook while she and her brother rode it without a grown-up. Then she complained about her mother not getting her ice-cream before our session prompting me to think that her anxiety involved her longings for me as father and competitive anger at her mother which she defended by having her mother buy her food. Interpreting this conflict over a series of sessions, I explained that Danielle hoped her mother agreed to her requests to avoid feeling angry. Danielle reiterated her need to eat during sessions; I said this need might also help avoid uncomfortable feelings about me. She associated to hating her music teacher, suggesting anger at me that I interpreted. The dynamic meaning of her anger remained unclear although I suspected it defended positive, oedipal longings for me. Indeed, Danielle became more curious about my personal life while more openly acknowledging anger with me. Mrs. W reported that Danielle told her she listened to me in a phone conversation through the closed door of
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the consulting room. Primal scene fantasies seemed implicit in her report that she had heard my wifes name, and planned to find out more about me. Danielle told me she had seen a Porsche with a personalized license plate saying TALK2ME in the parking lot and concluded it was mine. She became hypersensitive to change in the analytic situation, complaining one session that a chair in my office had been moved. I said she disliked changes; perhaps she wanted to be sure I did not change. Danielle rationalized away such feelings as normal while openly idealizing my ability to anticipate her moves at board-games, which I took as both a defense against competition with me as mother and an expression of an oedipal paternal transference. Exploring these issues led first to the paternal transference with complaints about her mothers chronic lateness. Danielle then asked me to help her with her math homework, explaining that her father, not her mother, helped her with that subject. I noted that she assumed only her dad and I could help her. She explained this was because her dad and I had attended college. My reminder that her mother had also graduated from college led Danielle to say that her mom had forgotten all her math. Working through her devaluation of her mother over some months finally allowed me to link it to her self-reported dislike of menstruation and her selfproclaimed wishes to be a tomboy, telling her I thought she disliked being a girl, and did not want to be a woman, because she wanted to be like her father and myself. Later, I added that being like us helped her avoid competition with her mother for us and guilt. This conflict was worked through for some months and Danielle began to enjoy stereotypically feminine activities. Danielle gradually admitted her tendency to defend her father to her mother because he and she had more in common, such as playing sports. But soon she regressed back to blaming her mothers temper, leading me to remind her that she pushed your mothers buttons so that her mom, not she, lost control of her anger. We tied her fear of losing control to her old fears as well as the inhibitions that had precipitated analysis. Weeks later, Danielle reported going to a ball game with only her father, fearing her mothers temper would embarrass her. She caught herself ruefully: There I go again, putting my mom down! Danielle added that she now preferred doing homework with her mother over her fathers long-winded explanations. Working through her loyalty conflicts led to increasing affection and admiration for Mrs. W. As her competitive strivings resolved Danielle wistfully wished she enjoyed being with her mother more. In this context, she mentioned termination for the first time, saying that she wanted to feel more loving toward her mother and to fear throwing up less before ending. Shortly thereafter, she noticed continuing conflicts over having much in common with her mother, saying in a school assignment that she liked Jeeps more than Mercedes. Danielle laughingly told me this saying: Boy, I keep doing it even when I dont want to! I wondered if this insight might reflect anxiety about terminating and a wish to hold onto me through maintaining her conflicts. But I did not feel sufficiently confident of this formulation to make an interpretation.
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Termination phase
Instead her ability to reflect on herself and to understand her mental functioning continued to improve as did her comfort with emotion, her presenting inhibitions, and her relationship with her mother. I realized that Danielle seemed ready to begin a termination phase and was open to exploring it when Danielle broached it more seriously toward the end of her third year of analysis. She reviewed her analytic gains, acknowledging desires to feel even more comfortable with her mother, and to fully eliminate her occasional somatic anxiety. Danielle believed she could work on these issues during a termination phase. After teasing she would terminate the next day, Danielle suggested terminating in six months, about three and a half years after beginning analysis. Exploring this plan for several sessions reassured me that she seemed sufficiently established on a positive developmental path to make it realistic. Danielle responded to setting a date by briefly regressing back to a mode wherein she would not express feelings. I worried that I had been premature in agreeing with her wishes to terminate. But I thought that we had carefully explored her various feelings about it. Therefore, I just pointed out her emotional reticence, suggesting she might not want to talk about her feelings about terminating. She reported feeling glad about terminating but wished it was sooner. I wondered to myself if she had set the original date to please me. But her immediate association that she had just thought of another fear rattlesnakes led me to think that her wish to terminate earlier was more likely a reaction formation against fears about it. With less than three months left, Danielle calculated the remaining number of sessions on my calendar. She expressed surprise, thinking more sessions remained, and then wished fewer sessions remained. I asked about this. Danielle suggested we meet for two solid days instead. I wondered out loud if this fantasy was a wish to be with me around the clock which she wanted to deny. Soon she began holding in angry feelings toward me again. It seemed that old issues were resurfacing to be worked through one more time similar to the termination phase in adult analyses (Sugarman, 1991). Danielle admitted her anger when I interpreted but refused to discuss it directly. Thus I focused on her resistance to direct expressions of anger and interpreted, once again, her fear of losing control. This work led her to ventilate anger about still attending sessions, comparing the 45 minute sessions to school classes. But analysis is worse because I can still talk to my friends when Im bored in school! I suggested that holding in her feelings as she was doing, and had done earlier in the analysis, might make her bored. Danielle responded with a joke that made the listener become angry by being repetitious. She said she never told it for 45 minutes, fearing anger toward her. I asked if she thought she was testing whether I would tolerate her angry feelings or become angry at her; then I added that she might worry who would tolerate it when we stopped seeing each other. Danielle denied worrying about terminating. But her complaints about sportswriters forgetting the local baseball team, the Padres, during the off season allowed me to ask if she thought I would remember her once she terminated. She asked if I would while refusing to
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share her fantasy. Danielle was surprised when I said I would remember her and asked why I would. I said she seemed to feel we had no real relationship just like the sportswriters and baseball players. She said only a few players and writers were genuine friends. I asked what she thought the players felt about being forgotten. Danielle thought that they probably did not care. Some players did not like sportswriters. Tony Gwynn, the local star, said he would never bat .400 because of them. I said this was because he felt so pressured by them, and added that Danielle seemed to feel pressured by me when I tried to talk about feelings, just as she used to feel pressured by her mother. She agreed, saying that she had not realized how much pressure affected Tony Gwynn or herself. Soon she lamented the trade of her favorite catcher, suggesting that the Padres sign another catcher who had a phobia of throwing the ball to the pitcher. He could see a psychoanalyst. I commented that maybe she thought he could see me; I added that he might fear his feelings and had moved his fear over to throwing the baseball just as Danielle used to move her fear of her feelings over to elevators, germs, and vomit. She agreed and mentioned there were only three and a half weeks of analysis left. Over the last few sessions, we discussed her fears about terminating and Danielle reviewed the progress she had made. Our last weeks together were spent talking about her feelings without her previous veiled hostility.

Follow-up
Mrs. W maintained contact for the next decade, providing news of Danielles progress. During high school, she participated in various sports and dramatic activities that put her in the limelight without anxiety. Peer relations were excellent; she was popular, shared friends, was a class leader, dated, and even had a boyfriend. Her mother remained highly anxious about her, however, calling frequently with concerns about the inevitable fluctuations in Danielles behavior. The occasional B in a class, peer difficulty, etc., threw Mrs. W into a tizzy. Generally, brief reassurance calmed her down. Danielle excelled at college and, at present, is attending graduate school. She went through a period of seemingly masochistic relationships with weak, passive men, inciting her mothers criticism. Mrs. Ws reaction to this seeming imperfection in her daughter needed my reassurance that new developmental tasks would always lead to ebbs and flows in Danielles functioning just as with anyone else. Most of my follow-up information was provided by Mrs. W who was both thankful and reluctant to lose me as a source of advice when she was worried about Danielle. But Danielle, herself, sent me a note at the time of her high-school graduation expressing gratitude for our work together. I did wonder if she sent the letter to please her mother or me but the wording felt heartfelt. The fact that it was the only time she ever contacted me after terminating also made it seem more likely to be genuine.

Discussion
I believe that the structure of Danielles analytic process is virtually the same as the sort of analytic process that one finds in adult analyses. As
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mentioned above, notwithstanding the complexities of defining a psychoanalytic process, such a process does emerge in most clinical analyses that is recognizable to most psychoanalysts, regardless of theoretical persuasion. This position is analogous to the oft-heard political wisdom about defining pornography: I may not be able to define it but I know it when I see it. Many of us in national or international study groups have noticed that colleagues operating from theoretical models very different from our own, nonetheless, present material that undeniably demonstrates a psychoanalytic process that we recognize. The psychoanalytic process apparently has a structure or organization that is relatively consistent regardless of the mental content emphasized by a particular school of psychoanalysis. Whether one focuses on narcissistic vulnerability, drivedefense configurations, primitive object relational paradigms, etc., most analyses, child or adult, demonstrate certain phenomena characteristic of a psychoanalytic process. These phenomena comprise its structure. Toward this end, one can agree with Boesky (1990) who says: My own opinion is that transference and resistance remain the core of any definition of the analytic process (p. 572). These are two structural elements of the psychoanalytic process that tend to occur regardless of the analysts school of thought. The analysis of resistance as a key element in an analytic process has been emphasized by analysts who operate from some variant of the structural model (e.g. Abrams, 1987, 1990; Davison, Pray and Bristol, 1990; Feigelson, 1977; Ritvo, 1978; Weinshel, 1984, 1990a, 1990b), the Kleinian model (Joseph, 1985; Steiner, 1993), the British object relations model (Casement, 1982; Guntrip, 1969; Stewart, 1992) and the self-psychological one (Malin, 1993). Weinshel (1984, 1990a, 1990b) clearly articulated the centrality of negotiating and analyzing resistance in the analytic process, anchoring his view in structural theory and the ubiquitousness of conflict and compromise formation. But Smith (2003, 2005) notes that even analysts who do not anchor their thinking in terms of intrapsychic conflict do, in reality, analyze clinical phenomena that can be understood in terms of such conflict; hence Weinshels perspective should apply to other persuasions. To the degree that most, if not all, mental phenomena involve intrapsychic conflict and compromise formation, it is simply inevitable that resistance analysis will occupy a significant part of an analytic process. After all, the internal world is constantly being externalized into the analytic frame and the relationship with the analyst (White, 1996). Hence, all key facets of the patients key conflicts and compromise formations will appear for analysis as they appear in the analytic interaction. Resistance is simply the interpersonalization of the defensive facets of the compromise formations that shape the patients mind and the symptoms and character traits it creates. It requires analysis so that self-reflection and self-knowledge can deepen. Resistance analysis involves understanding the motives or fantasies that cause the need to defend, not just removing the defense to get to that which is defended (Busch, 1995, 1999; Gray, 1994). After all, defenses exist because they feel necessary to the patient, not just to complicate the analysts job. This clinical principle should hold just as true for the analysis of resistance. That is, the self-knowledge gained from the analytic process will ideally
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include knowing why one prevents oneself from knowing all aspects of ones mind and the ways one does so. Children, in particular, avoid certain internal phenomena; affects, for example, are so frightening that they try to avoid facing them (Bornstein, 1945, 1949; Hoffman, 2007). But, as Ritvo (1978) makes clear, the child analyst will hopefully analyze resistance and defense to initiate, guide, and intensify the analytic process. Doing so promotes the childs self-reflection. To this end, Danielles analytic process demonstrates my attempt to consistently understand her resistances and the reasons for them. For example, early on I pursued her reluctance to ask me directly to buy her a new game for the office, interpreting the anxiety I thought caused her to inhibit the direct knowledge and expression of her wish. Analyzing this resistance furthered the analytic process, leading Danielle to express her wishes more directly. Those wishes were then analyzed, both their defensive function and the impulses expressed. Just as with the analytic process with adult patients, the analytic process with children is facilitated by interpreting in the neighborhood (Busch, 1993, p. 151). In this way, analyzing resistance and defense expands child analysands knowledge of the workings of their minds. Indeed, Danielles ability to reflect on and understand the workings of her mind impulses, defenses, and moral injunctions and ideals as well as the ways in which she tried to balance these elements of conflict deepened and expanded. Labeling her resistance to knowing and expressing emotions as freezing her feelings increased Danielles awareness and expression of anger, other emotions, and associated fantasies. It also interested her in her minds workings, motivating her to understand even more. To be sure, my interest in understanding her resistance also promoted her interest in self-reflectiveness. After all, the relationship with the analyst is thought to be another way by which the analyst promotes insightfulness (Sugarman, 2003a). But this holds true for the adult psychoanalytic process as well (Sugarman, 2006). One could say that her analytic process was characterized by the emergence and analysis of one resistance after another as her ability to examine, know, and integrate her minds intricacies expanded. Resistance to aggressive derivatives was replaced by resistance to positive feelings toward me which gave way to resistance to dependent longings and separation anxiety that were followed by resistance to oedipal competition and so on. Analyzing and working through each resistance both expanded her awareness of a particular conflict and allowed another to emerge. Weinshel and Renik (1992) believe that analyzing resistance inevitably modifies symptoms and character traits:
Whatever an analysts particular theoretical orientation or emphasis, he is likely to understand analytic work as some sort of ongoing process in which an analysands capacity for self-observation is enlarged and refined. Therefore, in clinical psychoanalysis as it is generally understood (the diversity of individual approaches notwithstanding) when analytic work proceeds, insight and symptom relief merge into a single goal. The analysands resistances clarify themselves as the most immediately relevant symptoms to be studied, and no distinction can or need be made between investigation of the analysands self-observational difficulties and investigation of his psychopathology. (p. 97, original italics)
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Danielle demonstrated this clinical truism repeatedly for example, her resistance to knowing and expressing emotion in the sessions and her presenting symptom of affective inhibition. It is important to note, however, that such self-reflectiveness or insightfulness occurs through a number of interventions, not just verbal interpretations. Younger and or more anxious children may need such self-reflectiveness to be promoted in the displacement of the play, for example, before they can use it more directly (Sugarman, 2003b, 2008a). But it is often necessary to work in the displacement with adult patients too, particularly by using their function of fantasizing (Sugarman, 2008b). Likewise, analysands (child and adult) may also learn to self-reflect in order to identify with the analysts interest in their minds. Danielles analytic process also supports Fraibergs (1967) contention that a transference neurosis emerges when analyzing children if one conducts their analysis similarly to adult analyses, conceding only the use of play, free movement, and the substitution of another therapeutic contract for the analytic rule (p. 101). Implicit in this statement seems to be agreement with the thesis of this paper; the structure of the child analytic process is quite similar to that of the adult, notwithstanding certain technical differences. Fraiberg (1967) appears prescient in saying that:
increased appreciation of transference by child analysts may lead to changes in technique toward minimizing supportive measures and encouraging autonomy. The very change in technique may create an atmosphere which facilitates the development of transference manifestations. The result will be a decrease in the tendency to manipulate the transference and an opportunity to encourage the full development of the transference. (p. 102)

This approach assumes that transference is a basic aspect of interpersonal relating. Most modern-day analysts (child or adult) believe it unnecessary to make special efforts to promote the formation or emergence of transference. It occurs naturally so long as nothing interferes. Anna Freuds early efforts to ensure a positive transference were unnecessary and probably prevented full expression of child patients transferences from this perspective. The work with Danielle seems to support Chuseds (1988) contention that the most effective conflict resolution and symptom relief can be found through the analysis of the childs transference; the same can be said for the analyses of adults. But children, in particular, because of their often less mature cognitive abilities, are more concrete. Hence it is easier and even more important to draw their attention to their internal workings as they manifest in the relationship with the analyst. This point brings up the definition of transference neurosis. More traditional definitions of it as the development within the analytic situation of a new neurosis, complete with a new set of symptoms (Chused, 1988, p. 51) reduce the likelihood of finding it in a childs analytic process, although Danielle did develop a new symptom (elevator phobia) with a range of oedipal fantasies in the transference. Nonetheless, this is an outdated definition based on other theoretically vague concepts such as the infantile neurosis (Tyson, 1996). Chuseds (1988) more modern definition of a transference neurosis as the intensification of
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pathological character traits and modes of relating within the analytic setting, with the gradual emergence of regressive, incestuous fantasies, conflicts, and impulses experienced in relation to and centered on the analyst (p. 52) more accurately describes the transference neurosis that characterizes both child and adult analytic processes and is the one shown by Danielle. As mentioned earlier, too often we forget that transference includes more than the displacement and projection of past object ties onto the analyst. Transference of defense (A. Freud, 1936; Gill, 1982; Gray, 1994) can be expanded to the transference of intrapsychic structure more generally (Sugarman, 2003a, 2003b, 2006) so that transference can be more comprehensively understood as the interpersonalization of psychic structure (Silk, 2004). Joseph (1985) seems to have a similar idea in mind with her emphasis on the total situation of transference as does Schlesinger (2003) with his view of transference as a process. Thus, a transference neurosis has occurred when the childs (or adults) internal structure including impulses, defenses, prohibitions, ideals, etc. become centered on the person of the analyst and or in the analytic interaction much of the time and with significant emotional intensity. Danielles analysis shows the interpersonalization of the structure of her mind to a degree and intensity that fits this definition. From the beginning of her analysis, her key conflicts were expressed and analyzed in the transference. As noted by Chused (1988) to characterize childrens transference neuroses, these often involved vicissitudes of aggression as I adopted the neutral position that many (Feigelson, 1977; Fraiberg (1967; Weiss, 1976) suggest allows the child the greatest freedom to externalize her inner world into the analytic interaction. Not excessively gratifying Danielles wishes allowed her to feel, express, and understood her aggression toward me. This work began with her inhibition about asking me to buy a game, moving into complaints about attending analysis, playing tricks on me, worries about being separated from me, and, ultimately, oedipal longings for me leading to fears of riding in the elevator in my building. In these ways she enacted every important conflict contributing to her presenting symptoms in the transference; and we used these enactments to expand her knowledge of her minds working. The guiding principle in this work was conflict resolution. Learning to consciously represent and articulate aspects of her inner world that were previously unconscious and, hence, latent allowed Danielle to know herself in new ways. Structural change followed as this new knowledge was integrated into her self and object representations, and reorganized her mental workings (Abrams, 1990). Affect tolerance improved, peer relations expanded and deepened, and her superego became less punitive. Using her ever-deepening transference as one would with an adult promoted conflict resolution. Never did I see myself as functioning primarily as a developmental object to compensate for her parents obvious deficiencies, even in the face of Danielles complaints about them. To be sure, Danielle often cast me in the role of one parent or the other, often with the aim of idealizing me (as someone who would protect her from her mother, who knew more about baseball than anyone else, and who would accept her feelings without
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retaliating, etc.). But these perceptions were analyzed and used to further her self-knowledge our relationship was not seen as curative in its own right, despite its importance in moving the analytic process along, deepening it, and encouraging self-reflection through a secure attachment. One could argue that my equanimity in the face of her anger, my regularity and punctuality in our meetings, etc. offered a new experience that contrasted with her parents. This is certainly true just as it is in adult analyses. But I believe that the ability to reflect on and express her feelings about me was the main factor in the stability of her change. Furthermore, our analytic work followed the suggestion of several prominent child analysts (Chused, 1988; Ferro and Basile, 2006; Yanof, 2005) to minimize reconstructions. I rarely found it necessary or helpful to tie the understanding of any particular conflict unearthed in our work to its presumed past origin. I would regularly link the conflicts manifested to their current-day expressions in Danielles life, particularly her current-day relationship with her parents. But this sort of understanding usually seemed sufficient. This way of working should not be taken as a sign of a different kind of analytic process from that which develops with adult analysands. Many (Ferro and Basile, 2006; Fonagy, 2001) argue that reconstructions of the past are rarely necessary in adult analysis either. Memory is never veridical and present-day conflicts serve dynamic functions in the current equilibrium of mental functioning. Knowledge of these present-day meanings of conflict is often more mutative than understanding their historical origins. This approach facilitates greater emergence and ability to work in the transference because it reduces the likelihood of defensive displacement to the past in order to avoid affects in the room. Finally, I believe that Danielles analytic process demonstrates the series of changes that usually define an adult analytic process (Boesky, 1990; Weinshel, 1990a, 1990b). These include: Gradual and progressive revealing of current and historical material relevant to presenting symptoms Unfolding in the analytic relationship of all aspects of key conflicts explaining presenting symptoms Cooperative interest in understanding the meaning of everything emerging in sessions Improvement in symptoms and functioning in and out of analysis Emergence of dynamically new material and thematic shifts in content Alternation between progressive and regressive phenomena, e.g. regular defensive regressions as new conflicts emerge and are analyzed Fluctuations in representations of self, key others, and the analyst Improved affect tolerance and modulation Reduced need for self-punishment These characteristics of an analytic process were as evident in the work with Danielle as with any of my adult patients; they were brought about by a similar kind of interaction. As with adult patients, I tried to create a frame in which she externalized the workings of her mind, reflected on those workings, understood them, and used that self-knowledge to modify her
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symptoms, behaviors, or character traits. This is consistent with Feigelsons (1977) sine qua non of both child and adult analysis:
That is, the existence of a discernible process that leads from defense and character analysis to repressed wishes, impulses, memories, and fantasies with the goal of bringing about a higher level of psychic organization by increasing self-awareness and problem-solving. (p. 357)

From this perspective, insight remains as important to the childs analytic process as it is to the adults. Most children, even very young ones, are capable of insight if we redefine it as a process (insightfulness) whereby they learn to mentalize and develop an ability to reflect on their own minds and understand that the workings of their minds affects their behaviors, fears, fantasies, etc. Developing this process of insightfulness or insighting (Abrams, 1996; Boesky, 1990) often has a greater mutative impact than gaining insight into repressed mental content. This holds true for adult analysands just as much as for child patients (Sugarman, 2006, 2008b): what is central is the minds ability to elaborate experience in a more or less symbolic key, no matter how old the subject (Ferro and Basile, 2006, p. 497). To be sure, child analysts must take into account the childs mental structure, particularly their affect tolerance and ability to differentiate reality from fantasy. But this holds true for adult analyses, too, as many adult analysands present with minds that are less than neurotically organized (Sugarman, 2007): hence, the recommendation to promote insightfulness by working in the displacement in the play. Helping a young or less integrated child to learn about the intricacies of his mind by articulating characters thoughts and feelings in the play allows him eventually to discuss these mental phenomena directly. Older and more integrated children, such as Danielle, may not need this first step. Her affect tolerance and ability to distinguish her inner world from the external allowed an immediate focus on her mind. And her material progressively deepened with corresponding shifts in her symptoms and problematic ways of relating as she gained insightfulness. In my model, evolutionary changes correspond to differing abilities to elaborate and transform experience (Ferro and Basile, 2006, p. 497). As with any successful analysis, her appreciation for the importance of understanding her minds intricacies increased as it affected her own behavior and emotions. Thus, even with regard to the important dimension of insight, it appears unnecessary to distinguish between an adult and a child analytic process. To be sure, parents do occupy a role in child analysis different from that in adult analysis, most notably with regard to deciding to start or continue the treatment, and by communicating with the analyst. But my experience is that they rarely affect the childs analytic process. Danielles work exemplifies how these aspects become just more grist for the mill so long as the analyst makes promoting self-reflection a key focus of the process. One can analyze the meaning to the child of the parents contact with the analyst or their insistence that the child be in analysis. This is similar to the ways we analyze adult analysands interpersonal interactions. They are handled as
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just one more type of mental content that is entering the analysis at any particular moment for a number of reasons that can be reflected upon and understood. One of the most common reasons parents come into childrens associations is as a displacement from the transference, something that can be analyzed as it was with Danielle.

Conclusion
In summary, I believe that Danielles analytic process supports the contention that there is no structurally meaningful difference between the analytic process that defines adult psychoanalysis from that which defines child and adolescent analysis so long as one emphasizes the structural phenomena that define that process. To be sure, ones interventions with children must always take their level of mental organization into account. But this is equally true of adult analysis. There, too, we consider issues such as affect tolerance, fantasyreality boundary, regressive potential, etc. when we decide where and how to intervene. But the same principles of resistance before impulse, process before content, and interpreting from the surface downward operate in all analyses. And the analytic process with children, as with adults, is based on the centrality of analyzing resistance and transference toward the goal of promoting insightfulness into the workings of the patients mind so that structural change occurs. Even the role of the parents with the child can be incorporated into the analytic work that defines the analytic process. Recognizing that these traditionally separated treatment processes (child versus adult analysis) are, pretty much, one and the same should help us to better clarify and define what is unique to the treatment procedure we call psychoanalysis. For most analysts, the significant difference between psychoanalysis and other treatment modalities, including psychoanalytic psychotherapy, is the emergence and centrality of the psychoanalytic process.

Translations of summary
Kinder- und Erwachsenenanalyse: zwei verschiedene Prozesse oder der gleiche? Die Technik der Kinderanalyse wird noch immer als von der Technik der Erwachsenenanalyse verschieden betrachtet, da Kinder sich noch in der Entwicklung befinden und die Primrobjekte weiterhin eine aktive Rolle in ihrem Leben spielen. In dieser Abhandlung wird dahingehend argumentiert, dass es sich hier um einen falschen Gegensatz handelt. Eine ausfhrliche Vignette der Analyse eines Mdchens in der Latenzzeit zeigt auf, dass der psychoanalytische Prozess, der sich in der Kinderanalyse entwickelt, strukturell dem der Erwachsenenanalyse gleicht. Beide drehen sich um die Analyse von Widerstand und bertragung und beide nutzen diese, um die Kenntnis ber die Funktionsweise der Psyche des Patienten zu erweitern. Und beide Techniken entwerfen Interventionen, die auf der Einschtzung des Analytikers der mentalen Organisation des Patienten beruhen. Es wre wnschenswert, dass die Betonung der wesentlichen Gemeinsamkeiten der beiden Techniken die Entwicklung einer bergreifenden Theorie der psychoanalytischen Technik frdert. lisis de nin lisis de adultos: dos procesos o uno? El anlisis de os versus psicoana Psicoana nios sigue considerndose una tcnica diferente que el anlisis de adultos, porque los nios an se encuentran involucrados en un proceso de desarrollo y los objetos primarios continan desempeando un papel activo en sus vidas. Este artculo sostiene que esa es una falsa dicotoma. Mediante una vieta extensa del anlisis de una nia en periodo de latencia se demuestra que el proceso psicoanaltico desplegado en el anlisis de nios es estructuralmente el mismo que el del anlisis de adultos. Ambos giran en torno al anlisis de la resistencia y la transferencia, y son empleados para promover el conocimiento del funcionamiento mental del paciente. Asimismo, ambas tcnicas formulan intervenciones basadas en 2009 Institute of Psychoanalysis Int J Psychoanal (2009) 90

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la evaluacin de la organizacin mental del paciente por parte del analista. Se espera que el nfasis en la comunidad esencial de ambas tcnicas promueva el desarrollo de una teora general de la tcnica psicoanaltica. thodes ou une? La psychanalyse de lenfant Psychanalyse de lenfant vs de ladulte: deux me continue tre perue comme une technique diffrente de celle de ladulte car les enfants sont encore pris dans un processus de dveloppement et car les objets primaires continuent jouer des rles actifs dans leurs vies. Cet article soutient quil sagit l dune fausse dichotomie. Une vignette dtaille de lanalyse dune fillette dans sa phase de latence servira montrer que le processus psychanalytique qui se dveloppe dans lanalyse denfant est structurellement le mme que dans lanalyse dadulte. Toutes deux gravitent autour de lanalyse de la rsistance et du transfert, deux lments quelles utilisent pour favoriser la connaissance du psychisme du patient en travail. Et les deux techniques formulent des interventions bases sur lvaluation par lanalyste de lorganisation mentale du patient. Il est espr que mettre laccent sur la communaut dessences des deux techniques favorisera le dveloppement dune thorie globale de la technique psychanalytique. La psicanalisi del bambino rispetto a quella delladulto: due processi o uno? Lanalisi del bambino continua a essere considerata una tecnica diversa rispetto a quella delladulto perch i bambini sono ancora coinvolti in un processo evolutivo e perch gli oggetti primari continuano a rivestire un ruolo attivo nelle loro vite. Questo saggio sostiene che si tratta di una falsa dicotomia. Viene [qui] unutilizzata unampia vignetta relativa allanalisi di una bambina in fase di latenza per dimostrare che il processo psicanalitico che si sviluppa nellanalisi del bambino strutturalmente uguale a quello dellanalisi delladulto. Entrambi si concentrano sullanalisi della resistenza e del transfert, che vengono usati per migliorare la conoscenza della mente del paziente al lavoro. Entrambe le tecniche formulano interventi basati sulla valutazione, da parte dellanalista, dellorganizzazione mentale del paziente. Si auspica che sottolineando lessenziale comunanza di intenti di entrambe le tecniche si favorisca lo sviluppo di una teoria globale della tecnica psicanalitica.

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