566 Book Reviews

A HANDBOOK OF CHILD PSYCHOANALYSIS. Edited by Gerald H . J . Pearson. New York: Basic Books, 1968,384 pp., $12.50.

Reviewed by Aaron H . Esman, M.D.

That the technique of psychoanalysis resides as much within the realm of art as in that of science is in no way better demonstrated than by the outpouring of volumes on the subject that has ap- peared in recent times. As they harvest the fruits of years of ex- perience, many senior analysts feel the call to transmit to their juniors the skills and insights they have gleaned from the practice of their profession, and to answer, where possible, some of the de- mands of their students for a codification of the rules of the game.

Now Pearson, one of the pioneer figures in child analysis in America, has responded to this call and, with a group of younger colleagues from the Philadelphia Association for Psychoanalysis, has formulated A Handbook of Child Psychoanalysis. One must say, at the outset, that it goes far toward achieving the aims that are generic to such works.

Pearson and his colleagues begin from the basic premise that a fair number of those psychoanalytic students who will undertake child analytic studies have not had prior training in child psy- chiatry. Thus their introductory chapters deal in great detail with the opening phases of clinical contact with parents around their children’s difficulties. Much of this will no doubt be unnecessary for the trained child psychiatrist who is accustomed to the require- ment for initial evaluative contacts with parents and through assess- ment of developmental data prior to direct interviews with chil- dren, but it is of the essence for those trained only in adult work.

The discussion of indications for child analysis rests heavily on the foundation provided by Anna Freud, to whom there is frequent and respectful reference. Considerable attention is given to the group of conditions referred to by the authors as “pervoid” reac- tions, by which they mean to describe those disturbances character- ized by more or less direct discharge of preoedipal drive modali- ties. I do not regard this as a felicitous term; as a neologism it is an unattractive one, and it is founded on an analogy to perversions that, however hallowed in the literature, is somewhat questionable

Dr. Esman is Director of Psychiatric Training at the Jewish Board of Guardians, New York, and a Lecturer in Psychiatry at Columbia University. He is a member of the New York Psychoanalytic Society and the American Psychoanalytic Association.

Book Reviews 567

in the light of recent advances in theory. I t seems to me unfortu- nate that the authors did not attempt to correlate their diagnostic thinking with that of the GAP Committee on Child Psychiatry, which labored so long and so well to bring forth a diagnostic classi- fication based on psychodynamic principles on which all could agree and which all could use.

I t is with the chapters on the actual clinical process of child analysis that the Handbook hits its stride and makes its unique contribution. The body of the text is devoted to the detailed pre- sentation of the analytic treatment of two boys-one a latency child and one an adolescent. In these case descriptions, and in the subsequent chapters on technical problems, termination, and trans- ference and countertransference problems, the authors formulate with closely reasoned argument the classical approach to the analy- sis of children. Throughout, they emphasize the necessity for pa- tient, nonintrusive observation of the child’s play and other forms of communication, and for careful meticulous analysis of defenses as a precursor to interpretation of instinctual conflicts.

One must particularly commend the authors for their thought- ful discussion of variations in technique appropriate to the develop- mental phase of the child and of the necessity for the analyst to play a role consonant with the child’s actual needs and capacities. They thus emphasize the “parameters” required in the analysis of the preoedipal child, where the technique approximates in many ways that which would be considered psychotherapeutic in a latency child, but which follows upon a psychoanalytic understanding of the immaturity of the preschooler and his realistic need for an active role on the analyst’s part.

One must confess, however, to certain reservations about the Handbook. As noted above, the experienced child psychiatrist will find the early chapters somewhat redundant. The authors have a tendency to make statements ex cathedra-statements such as “the infantile neurosis [is] found in every adult neurotic” or, “We do not think that anyone would disagree that a case of conversion hysteria. . . or anxiety hysteria, or of obsessional neurosis. . . should be treated by any form of therapy than psychoanalysis.” In fact, both of these statements would be questioned by many-the first even by some analysts, the second by innumerable people, lay and professional, who do not accept the very existence of child analy- sis as a legitimate form of therapy. Similarly, the observation that “All children in the latency period show marked but transitory subservience to rituals” is certainly an overstatement of the case, and the proposition that “the use of energy in growth depletes the amount available for intellectual work” is based on an obsolete closed-system model and is, besides, not supportable by observational

568 Book Reviews

data. Finally, the notion that “unsupervised play has a therapeutic effect in itself” would be seriously questioned by many observers.

But perhaps the greatest weakness of the book lies in precisely the area of its greatest strength. The clinical reports of two well- conducted analyses are revealing, informative, and highly useful uuides for the student. At every point, however, they invite ques- 9 tions about technique and interpretation-questions that can be answered only infrequently by the authors and that could be ade- quately dealt with only in a live case seminar. There is no help for this; the authors have sought diligently to anticipate questions and to justify the technical procedures involved, but at best an exhaustive case report of the kind offered here cannot avoid the some- what lifeless quality that these, unfortunately, have.

Notwithstanding, the Hundbook is a valuable addition to the literature. For the student of child analysis, particularly for those with no extensive prior experience in work with children, it will serve as an invaluable chart through the innumerable practical problems that beset such work. For the experienced child analyst, it affords an opportunity to check his own approach and concepts against those of a group of highly skilled and experienced peers. And for those with an armchair interest, it is a lucid and theoreti- cally sound text that will afford a clear view of the field. I t is not the fault of the authors that, as Freud put it in his famous chess analogy, “only the openings and end-games admit of an exhaustive systematic presentation and . . . the infinite variety of moves which develop after the opening defy any such description.” They have made a valiant effort, and one that is, in the main, a successful one.

THE PSYCHIATRIC DILEMMA OF ADOLESCENCE. By James F. Mm- tenon, Jr. Boston: Little, Brown & Co., 1967, 217 pp., $9.00.

Reviewed by Robert E . Nixon, M.D.

In his preface, Masterson says, “The psychiatric dilemma of adoles- cence is created by the clinical difficulty in determining whether

Dr. Nixon is College Psychiatrist at Vassar College, the author of “The Art of Growing: A Guide to Psychological Growth” {Random House) and a number of papers concerned with the psychology of adolescence.