‘The Thinking Heart’

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.

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