In March 2021, Hannah Wallerstein and Jordan Osserman facilitated a live dialogue over Zoom on the subject of transgender young people, with four psychoanalytic clinicians and thinkers. The conversation draws on short essays submitted in this section of The Psychoanalytic Study of the Child as a springboard for discussion. It has been transcribed and edited for length and clarity, and is reproduced here. Questions explored include the differences surrounding gender identity in childhood versus adulthood, the use of medical interventions for children experiencing gender dysphoria, the tension between psychoanalytic neutrality and affirmation, and the ethical stakes of working in this field.

This paper introduces the topic and unique format of the section that follows, on psychoanalytic work with transgender children. We first review the apparent impasse that characterizes our field regarding clinical work with gender diverse kids, as well as the reasons we pursued a live dialog to push thinking forward. Then, we outline the structure of the entire section, in which four contributors offer short essays, followed by a transcribed and edited version of the dialog we facilitated, which uses these essays as a starting point. We conclude with reflections on some of the themes that arise in the dialog, and implications for all of us who work in the arena of gender and young people.

In this paper the lasting effect of the work of Berta Bornstein is described, particularly the technique of interpreting defenses against unpleasant emotions when beginning an analysis with a young child. This technique is illustrated in the analysis of the patient she called "Frankie" (1949). Although her work is rarely cited (perhaps because she did not publish widely as a result of the dominance of the oral tradition at the New York Psychoanalytic Society and Institute), her work remains centralfor child psychoanalysis and psychodynamic psychotherapy, with the evolution of the experience-near technique of interpreting defenses against unpleasant emotions. The applicability of Bornstein's ideas to contemporary ideas about affect regulation and the treatment of disruptive children is discussed.

My comments focus on a consideration of three issues central to child psychoanalysis stimulated by rereading the classic paper by Berta Bornstein, "The Analysis of a Phobic Child: Some Problems of Theory and Technique in Child Analysis": (1) the importance of "co-creativity" and its use in analysis to repair disruptions in the mother-child relationship; (2) working analytically with the "inner world of the child "; and (3) the fundamental importance of multiple simultaneous meaning-making processes. I begin with a discussion of current thinking about the importance of interactive processes in developmental and therapeutic change and then lead to the concepts of "co-creativity" and interactive repair, elements that are missing in the "Frankie" paper. The co-creative process that I outline includes multiple contributions that Frankie and his caregivers brought to their relationships--his mother, his father, his nurse, and even his analyst. I then address the question of how child analysts can maintain a central focus on the inner world of the child while still taking into account the complex nature of co-creativity in the change process. Finally, I discuss insights into the multiple simultaneous meaning-making processes in the analytic relationship to effect therapeutic change, including what I call the "sandwich model," an attempt to organize this complexity so that is more accessible to the practicing clinician. In terms of the specific case of Frankie, my reading of the case suggests that failure to repair disruptions in the mother-child relationship from infancy through the time of the analytic treatment was central to Frankie's problems. My hypothesis is that, rather than the content of his analyst's interpretations, what was helpful to Frankie in the analysis was the series of attempts at interactive repair in the analytic process. Unfortunately, the case report does not offer data to test this hypothesis. Indeed, one concluding observation from my reading of this classic case is how useful it would be for the contemporary analyst to pay attention to the multifaceted co-creative process in order to explain and foster the therapeutic change that can occur in analysis.

There are no clinical techniques not always already embedded within a psychoanalyst's way-of-being-in-the-world. This claim, grounded in the author's reading of Steven Ablon's "What Child Analysis Can Teach Us about Psychoanalytic Technique" (in this volume), takes us to Ablon's exemplary psychoanalytic comportment, with a particular focus on poetics, playfulness, practicality, and pluralism. These complex, intertwined features of child psychoanalysis have had a broad and deep impact on contemporary adult psychoanalysis, influencing praxis, conceptions of therapeutic action, ethics, and workaday worldview.

I wish to showcase the importance of plasticity of narrative in fantasy formations, as exemplified in Achilles' psychological trajectory in The Iliad. Applying conceptual formulations concerning the psychoanalytic developmental process to Achilles' growth piques my reflections about the sibling experience and its unique position in the mental life of children and adolescents. With developmental advance and the capacity for measured fluidity of self and other structures, the original sibling experience--whether it be tilted toward aggressiveness or toward loving concern or a place in between--may acquire new meanings. By locating it within this contextual framework, Achilles' story line can be seen as a metaphorical description of the continuous and discontinuous patterns in growth. This poses intriguing questions: What contexts are useful in pondering Achilles' psychological shifts? Might the domain of disposition prove useful? Is birth order another? Is his gradual empathic concern for the enemy a demonstration of an elasticity of imaginative capacity that reassembles murderous potential? Child and adult analysts alike may find a rich trove in Homer's masterpiece for contemplating potential sources within their patients that spur forward movement.

The following (quite personal and idiosyncratic) review of The PSOC's first volume, published in 1945, highlights some aspects of then-current psychoanalytic thinking that have passed--or failed--the test of time. Two abstractions rise from the particulars of the volume's twenty-five chapters. First, those authors who respected the position of the founding editors--that is, that child psychoanalysis was both independent from related fields and, at the same time, dependent upon them--tend to have fared better than those who allowed their psychoanalytic theories(and sometimes personal rancor) to cloud their views of the facts on the ground. Second, many of the contributions in this first volume integrated an intrapsychic perspective with an environmental or social one. This gave the work of these authors a kind of vitality that is lost when psychoanalytic theory is used to promote adaptation and social conformity. Perhaps it is worth recalling Freud's (1900) opening to The Interpretation of Dreams: "Flectere si nequeo Superos, Acheronta movebo" (If I cannot move the heavens, I shall shake the nether regions). Freud and The PSOC's founding editors knew very well how disturbing psychoanalysis could be to the Superos, the established order. The revolutionary potential of Freud's analysis of the human condition attracted some remarkable people to the field, most of whom believed that intrapsychic and social changes are intimately related to each other. We would do well to emulate their example; only such an integration will keep psychoanalysis alive in the twenty-first century.

It has long been recognized that many of the original psychoanalytic views of women were derived from misguided theories. Regrettably, residues of the foundational postulates that informed those theories still persist, assuring a pervasive gender bias even in contemporary psychoanalytic investigations. This contribution describes where those postulates reside, while proposing alternates that could prove far more useful for the theory and practice of our profession.

This paper addresses factors other than symbolic capacity that can influence the use of language by children on the autism spectrum. Chief among the issues considered are the influence of bodily experience on the articulation of words and the influence of fantasies concerning bodily relationships on the construction of words and sentences. It is suggested that such considerations may shed light on the behavior of those children on the autism spectrum whose symbolic capacity is greater than might be assumed from their use of language, and also on that of some children with selective mutism.

In this collection of papers, psychoanalytic principles come to life in a variety of settings: in a therapeutic nursery, in two schools serving children with special needs, in mainstream schools, and in a psychiatric practice. From dyadic work with a two-year-old's tantrums, to play therapy using deep-sea symbolism with a five-year-old; from the interchange with parents and school administrators in a middle school regarding "sexting, " to the in-depth assessment of children upon entry to a special school, these papers illustrate enriching exchanges between psychoanalysts, educators, children, and their communities.

In this paper we describe an intake evaluation process of elementary schoolchildren who have exhibited difficulties in a more traditional school environment. We show how a dynamic understanding of the child's emotional life and the child's emotions affects his or her behavior, cognitive development, and academic performance. We illustrate how to utilize this understanding in planning an approach in the classroom.

This paper represents and attempts to describe psychoanalytically informed work applied in a school setting with children with special needs. While many therapists at the Parkside School are trained in analytic techniques and principles, these ideas have not traditionally been applied to children with language-based learning difficulties. Over the years, we have found that analytic ideas such as transference, countertransference, projective identification, containment, and attachment are especially salient to our understanding of these very complex children. Despite being in a school--a nontraditional setting for psychoanalysis--children are seen in individual and group therapy, often more than once a week. We believe that therapeutic relationships and play (sometimes bringing a child to a place of being able to play) are especially mutative with children with language-based learning challenges. Play and relationship provide a holding environment that, over time, allows for the reorganization of a child's often immature developmental capacities into a sense of agency that captures more clearly a child's innate potential. This article includes case studies of children with complex language-based learning difficulties, including autism spectrum disorders.

The self begins as a social self and is dependent on the other and the self-other relationship. Furthermore, shortly after birth, the intersubjective self is nurtured and sustained by the reciprocal interactions with the significant other. Recent research suggests that the significant other's reciprocity depends on his or her capacity for mentalization, and this reflective functioning capacity influences not only the child's developing sense of I, other, and we, but also his or her developing attachment pattern. Several studies have demonstrated that parental reflective functioning can be improved with intervention, and enhancing parental reflective functioning can lead to a more secure attachment pattern and better outcomes for the child and parent. Therefore, intervention with toddlers and their families requires us to consider this dynamic two-person psychology. In this paper, we describe an academic parent-child nursery program aimed at enhancing parental reflective functioning. A clinical example from the collaborative treatment of a mother and her two-year-old will demonstrate how reflective functioning can be enhanced in the parent-child dyad and lead to a more secure parent-child relationship. We will also discuss the value of reflective functioning to the interdisciplinary team and how we dealt with countertransference issues that arose during the treatment.

In the world of education the emotional life of the child has come in and out of focus. Psychoanalytic ideas and principles, including an emphasis on the individual, unconscious motivations, attachments, transferences, disavowed intentions, and feelings defended against, are in full operation within school settings. More recent developments in social-emotional skill promotion in schools and the emphasis on instilling skills such as perseverance and self-control have aims similar to psychoanalytic ideas of healthy ego functioning but use a more direct, didactic approach. We propose that the psychoanalytic school consultant can help bridge the gap between our wish to instill values and skills and some of the obstacles the individual student and school community might face. Through two case examples, one of a latency-age boy who struggled with aggressive impulses, and the other an adolescent caught in a "sexting" scandal, we delineate how the consultant using a psychoanalytic lens can intervene with the students, parents, faculty, and administration to facilitate the type of growth and education desired.

For children with moderate to severe emotional or behavioral problems, the current approach in child psychiatry is to make an assessment for the use of both psychotherapy and medication. This paper describes integration of antidepressants and stimulants with psychoanalytically oriented techniques.

Psychoanalysis has both waged "hot" war on women overtly and "cold" war covertly over the years by colluding with cultural stereotypes offered as "theory," starting with Freud and his Viennese circle. True freedom of thinking, however, broke through in Freud's originality even then, and from time to time subsequently in the history of the movement only to keep retreating. Fritz Wittels's thesis on the "Child Woman" will exemplify Horneys (1924, 1926, 1933) and Jones's (1927) grounds for engaging in the "hot war" in the 1920s and challenging the unselfconscious inbuilt denigration of women. This skirmish had little impact, however, in the New World up till the 1970s. In the aftermath of the second wave of feminism, there were (and are) bursts of new thought about sex and gender that remain fragmented and unintegrated into general acceptance. The contemporary situation has been more like a "cold" war waged by ennui in the field. A sexed and agendered theories of mind as a "no man's land" absorb an intense focus away from the sexual and gender specificities that were alive, contentious, and unresolved in Freud's libido theory. The third sociocultural wave of feminism, since the 1990s, has refocused vitality on individuality, race, and varieties of sexual identity. I identify the latter as the psychoanalytic space for a potential renewed interest in theorizing the female body within heterosexual, homosexual, queer, or transgendered individuals. The "wars" have shown how fruitless for peace and new discovery is the compulsive (but still common) close comparison between males and females developmentally. Female development is as fresh and unsettled a theoretical question as it once was with Freud.

"The war against women" is a systemic process of discrimination that seeks to subjugate women. In this essay, I will critically examine a contemporary paper, published in a well-known psychoanalytic journal, that views the patient through the lens of Bion's "reverie-ing mother" concept. I argue that leaning upon any particular theory to explain an individual's complex psychological disturbance adheres to a reductionistic line of reasoning that falls prey to the genetic fallacy; interpreting psychological phenomena in this way becomes a myopically focused perch that narrows the clinician's range of vision in scanning the field for other features that influenced the patient's symptomatology and suffering. It defies what we know about the reorganizational potential of the developmental trajectory wherein early features undergo significant change over the course of growth. Within the context of the war against women, such a constrained perspective places the onus of responsibility upon the mother, making her the "whipping boy" for her child's difficulties. Within a blink of an eye, she turns into the embodiment of the trope of the "bad mother." The consequence of misusing a way of thinking about the early mother-child relationship has the unfortunate effect of promoting the war in our current zeitgeist.

Observations of videotaped sessions of the analytic treatment of a four-year-old autistic boy offer insights into the meanings and the mechanisms of transference. These observations illustrate the well-known fact that the relationship of transference to symbolization is ambiguous. They also demonstrate that multiple simultaneous meanings exist in a transference field, and many of these meanings emerge from partially or nonsymbolized domains of experience, including and perhaps most important, bodily experience. Whereas many clinicians would agree with these proposals, finding supportive data for them is difficult. One way to explore nonsymbolized phenomena is by analyzing the observable data in videotapes of an autistic child with limited symbolic capacity. Then these data can be put together with the emerging symbolic communications of the child as well as the countertransference reactions of the analyst and some of the biological processes contributing to these meanings. In this study, complex interactions between and among transference reactions of varying degrees of symbolization and in different domains of meaning may provide clues to transference in patients of all ages.

The phrase "the war against women" refers to the overt an a stealth global prejudice against women that aims to subjugate them. Freud was not immune to this prejudice, as can be seen in those late-nineteenth-century Victorian views about sexuality that helped to shape his conceptualizations of gender. Despite the fact that many of these antediluvian views have been overturned, some continue to live on in the contemporary psychoanalytic scene. This introduction provides an overview of the contributions in this section, which explore how the war quietly or openly insinuates its way into our psychoanalytic culture. The offerings will undoubtedly appeal to the readership, whether one's interest concerning the war leans toward considering a contemporary recontextualization of foundational tenets within the psychoanalytic setting, which directly affect women; how it appears within the domain of the consulting room; third-wave feminism's reach into theory and practice; or forms of institutional and organizational prejudice on the local and national levels, including the field of child analysis.

The current paper provides an overview of an evidence-based treatment, Pivotal Response Treatment (PRT), for autism spectrum disorder (ASD). The paper describes PRT principles and then illustrates the approach using two case reports. The children are preschool-aged children with high-functioning ASD. They were participating in a four-month clinical trial of PRT. At the start of treatment, they presented with significant social communication impairments, including a minimal understanding of reciprocity, limited play skills, and repetitive behaviors and speech. The paper outlines how behavioral treatment goals were identified and then how activities were designed, using principles of PRT, to target skill acquisition. Following the treatment course, both children made substantial and meaningful gains in social communication skill development.

Psychoanalytic literature has often overlooked the child's participation in organized sports, which often can facilitate or impede not only expression of aggression and narcissism, but enhance or skew the growth of the child's superego and ego ideal. Specific outcomes are largely determined by the experience and knowledge of the parents, the coaches, and sports organizations for latency-aged youth. Sports participation facilitates a major step forward in psychic development, that is, an agreed-upon adherence to a set of rules and regulations, monitored by an official embodying the final word regarding rules and their infractions. This paper is an attempt to delineate the role of sports in the life of the latency child, the parents who become involved, the coaches who teach and supervise, and the social and individual milieu within which sports take place. All these contribute to common goals: the engendering of good sportsmanship and the encouragement of psychic growth, particularly regarding how aggression and narcissism contribute to the development of superego and ego ideals. The fate of aggression and narcissism in superego and ego ideal development is influenced to a large degree by the nature, orientation, and motivations of all involved in sports for the latency-aged.

Autism is a prevalent and strongly genetic brain-based disorder. Early focus in the field on the relevance of psychogenic factors led to the blaming of parents for the occurrence of the disorder, and as a result mainstream research on psychotherapeutic approaches has until recently been limited. Although psychoanalytic approaches continue to be considered of limited relevance for these individuals, dynamic theory is both informative and informed by conceptual approaches to the understanding of autism. Theory of mind in particular is a prominent model for understanding the core deficits of autism and bears strong resemblance to the concept of mentalization. Although cognitive-behavioral and social skills interventions may form the cornerstone of psychotherapy for individuals with autism, the formation of a treatment alliance remains crucial and may require a particular willingness for flexibility on the part of the therapist.

This paper delineates a deeper and more flexible approach to the termination of an analysis. When a patient returns following the ending of a treatment, the analyst has the opportunity to observe the effects of the termination on her former analysand. If the ending of an analytic treatment is not handled sensitively, much of what has been accomplished may be undone. Also, the quality of the post-termination contact itself may affect the long-term outcome of the analysis. The analyst's availability after termination is important if the termination has set off feelings of abandonment. Clinical vignettes are used to demonstrate how patients may need to touch base with the analyst or actually return for a period of continued treatment. The process of terminating is crucial in setting the stage for continued self-analysis or for the return to analytic treatment.

Contemporary child and adolescent psychoanalytic technique has evolved and changed a great deal in the last thirty years. This paper will describe the analysis of an adolescent girl from early in the author's career to demonstrate the ways in which technique has changed. The clinical material presented highlights six areas in which contemporary child and adolescent analysts practice and/or understand material and the clinical process differently than they did thirty years ago: (1) the contemporary perspective on mutative action, (2) the contemporary emphasis on mental organization, (3) the developmental lag in integrating the structural model, (4) the child analyst's multiple functions, (5) the child analyst's use of countertransference, and (6) the child analyst's work with parents. The author discusses how he would work differently with the patient now using his contemporary perspective. But he also wonders what might have been lost by not working in a more traditional manner, in particular the opportunity to analyze the patient's hypersensitivity to feeling hurt and mistreated so directly in the transference.

Child analysis has much to teach us about analytic technique. Children have an innate, developmentally driven sense of analytic process. Children in analysis underscore the importance of an understanding and belief in the therapeutic action of play, the provisional aspects of play, and that not all play will be understood. Each analysis requires learning a new play signature that is constantly reorganized. Child analysis emphasizes the emergence and integration of dissociated states, the negotiation of self-other relationships, the importance of co-creation, and the child's awareness of the analyst's sensibility. Child analysis highlights the robust nature of transference and how working through and repairing is related to the initiation of coordinated patterns of high predictability in the context of deep attachments. I will illustrate these and other ideas in the description of the analysis of a nine-year-old boy.

The authors apply a two-systems approach to demonstrate improved treatment possibilities and outcomes in this group of children and suggest that psychoanalysis can be defined as a multimodal strengths-based learning experience. Using clinical material from the analysis of an aggressive, "out-of-control" child, they discuss how these behaviors and symptoms are better understood as an actively constructed effort at self-regulation than as a deficiency in capacity or primitive, lagging development. They illustrate how a two-systems framework can allow for an expanded repertoire of techniques and reclaim psychoanalytic concepts that have fallen into disuse.

This reading of Berta Bornstein's case of "Frankie" half a century after its publication focuses on the knowing attitude that pervades her description of child analysis and child development, and this attitude is used to explain interventions that appear harsh and anti-analytic to today's reader. Using concepts from nonlinear dynamic systems theory and, particularly, network theory help to both understand what is troubling in the case description and how these problematic features came to be part of the case description. The mistaken view that development is linear leads to attempts to get development "on track" and a view that the goal of analysis is well-defined psychological maturity, as opposed to the ongoing freedom to explore the psychological world in new and creative ways. Bornstein's authoritative style was not only coercive of her young patient but also of the reader who is invited to uncritically agree with her formulations. It is suggested that the appeal of this way of writing is best understood in the broad, historical context within which the work with Frankie was undertaken.

Some older members of the Boston Psychoanalytic Society remarked that in the 1950s and 1960s there was a group of prominent women analytic leaders at BPSI. They were training analysts, writers, and teachers active in the society and in the community. They were succeeded primarily by men. The question arose Was that an expression of "the war on women"? This paper explores and discusses this question. Although there were some expressions of resentment at being "dominated" by women, the answer appears to be more complex. For various reasons there was not a group of younger women available to move into this role at that time. The reasons for this are described--including the need for a medical degree for psychoanalytic training, the cultural postwar pressures in the United States for women not to work, and the institutional structural problems making it difficult for women candidates, such as ambivalence about pregnancy and the delays in changes in theory to enter the curriculum. This made for discrepancies between theory and the experience of candidates. The earlier group of women were mostly trained in Europe and the implications of this are described. In the years when the leadership was primarily male, decisions subtly reflected this.

Bornstein's paper is a true psychoanalytic study of a child, if ever there was one. The fine tracing and discussion of the technical detail, together with the clarity and exposition of the theoretical underpinning make it a truly deep and thorough study and a model for those of us doing this work and trying to understand what indeed we do and why. I should say that although I have read the writings of the (then) Hampstead Clinic's borderline workshop (Kut Rosenfeld and Sprince, 1965), I had not read this outstanding paper by Berta Bornstein, and I wish I had done so long ago. I shall begin with some comments about psychoanalytic theory and then go on to discuss Bornstein's abundant and fascinating analyses of technique. I shall conclude with some observations on the child's psychopathology.

From the very first efforts to analyze children and adolescents to the present day, child and adolescent analysis has been denigrated in the analytic community. It has been viewed as "women's work" and regarded as clinically inferior to the analysis of adults. It has been seen as less important for understanding the psyche and in the training of psychoanalysts. This attitude is rationalized by observations that children and adolescents engage psychological material differently than adults do, so that, it is claimed, child and adolescent analysis is severely limited compared to adult analysis with regard to the material available for analysis. Beliefs that children require socialization lead some child analysts to indoctrinate children and sacrifice a respectful exploratory and uncovering approach. The situation of child analysis reflects larger social phenomenona, namely childism and sexism, the prejudices against children and women, as these prejudices are elaborated in our culture. Like others, child analysts respond to being the objects of prejudice by both isolating ourselves, reacting against the prejudice, and internalizing the prejudice. This paper includes clinical and institutional illustrations of these prejudices in action.