Anne Alvarez is interested in how thoughts are in dynamic relation and link together. Thoughts are highly active as people are. In health thinking is not static: it is always moving on; ideas can wait in line and do not disappear. Sometimes, however, our thoughts escape us and we feel frustrated if we can’t catch them. Other times we feel crowded by them. You cannot link thoughts together if the thoughts are not given weight. What gives weight to a baby’s thought is for it to be listened to and appreciated first by the primary objects and then by the baby herself. The curious baby has a thought, implements it, and takes pleasure in the resulting sense of agency. He also becomes aware of his thought having an effect on someone else’s mind. When there is too much disturbance thoughts cannot be thought, much less connected. When there is too much greed and impatience, the child in therapy does not take time to have his thoughts. Then the analyst needs to provide a container in which thoughts are held and can wait their turn to be thought.

Anne Alvarez looked back over her clinical work of years ago and found her technique at that time insufficient for reaching the terror and despair of tormented, vulnerable children. The interpretation of projections into the therapist as defenses against wishes or of transference as resistance might be useful for those who can hold in mind two thoughts and feelings and two people at once but for these children it is better to speak not of wish but of rightful need so that the children know you understand their need for rectification of deficit. For instance, the child who seems indifferent to the analyst might wrongly be thought of as omnipotently defending against need but Anne Alvarez points not to defense against need but to lack of interest because of having had no interesting or interested object to look up to. Once that child knows the therapist is interested in him, he can become interested and eventually find himself interesting.

Anne Alvarez acknowledges aggression ( how could she not when the child has just put her neck out of alignment) but she cautions against interpretive emphasis on the death wish. When a child becomes angry or horrendously anxious about a weekend separation, rather than say to the child “You are showing me that you want me to die” or “You are afraid that I will die” she suggests saying, “It’s hard to believe I will still be here on Monday”. I enjoyed her emphasis on looking for the good, reliable, interested, surviving object. The child can identify with that good object because the analyst relates positively to the child and to the stability of the therapeutic contact, and she welcomes the child’s identification.

Anne Alvarez is presenting today at IPI at the conference called The Thinking Heart (the same name as the title of her excellent book). Anne described three levels of therapeutic response — 1) explanatory, 2) descriptive, and 3) intensifying and vitalizing — depending on the state of mind of the patient. At the explanatory level the analyst makes an interpretation about what the patient is projecting into the analyst and why he needs to. At the descriptive level she describes what the patient feels and does not address why. Both these approaches involve addressing the patient directly as “you” but in some states of mind the patient experiences a “you” comment as persecutory. At the intensifying and vitalizing level, she simply says to the patient “it” is upsetting, acknowledging and sharing the experience without intrusion and without insisting on “you” and “I”.