Educational Toolkits, Readings, and Webinars

This annotated bibliography is an attempt by the Psychotherapy Committee to do two things: the first is to provide a list of papers and books that would help a psychiatric trainee understand and do psychotherapy with children and adolescents; the second is to provide a list that would be of use to psychiatrists in practice who wanted to further their studies in psychotherapy. The plan is for this bibliography to grow and develop over time. We hope this list can not only be helpful because of the citations themselves but also because of the subsequent discussion brought to life from the comments posted by readers of the citations (to be forthcoming). Please view these citations and if you would like to read a brief commentary made by a member of the Psychotherapy Committee, just click on the link. If you would like to post  comments on any of the citations you can do so by requesting access to the psychotherapy online community ( for AACAP members only), this can be done by simply sending a message to psychbiblio@aacap.org.

Psychodynamic Readings for Later in the Career

Psychotherapy with Children:
Terr LC, Deeney JM, Drell M, et al. Playful "moments" in psychotherapy. J Am Acad Child Adoles Psychiatry. 2006;45(5):604-613. (top)

As a first year child fellow, it was very inspiring to read this article. It is unfortunate that in training play therapy in not reinforced enough. Reading this article helped to remember how important it is to play with our young patients "the natural language of the young" if we want to discover their inner world. Lenore Terr put together 10 vignettes of different psychiatrists that shared with us moments in psychotherapy that dramatically change their patients. The author reaffirms the importance of the patient doctor relationship to implement change and gave us four main principles of treatment that came up from the vignettes: using play to communicate, good timing, creativity and the use of imaginative code. Being during an evaluation, after the first session or three months later, the use of play described in each vignette allowed the child or the teenager to free themselves of some psychological burden that was taken away by the therapist playfully. Please post any constructive comments you have about this article. -C. Matip.

Willock B. From acting out to interactive play. Int J Psychoanal. 1990;71:321-334. (top)

This paper addresses working with aggressive, acting-out and notoriously hard to treat children and adolescents. The author writes from a perspective that includes both outpatient clinics and residential settings. He argues that using developmental lines to understand aggression can be helpful in understanding how the developmental sequence of aggression can be interrupted, lead to emotional behavioral problems and in turn be treated through therapy. Using the peek-a-boo game as a model of mastering separation individuation, he shows how arrested development of aggression can lead to a 'prolonged game of peek-a-boo' (my paraphrase) that can manifest as running away. He argues with descriptive examples that if the running away can be contained and safely tolerated eventually the child can begin to use words instead of action and eventually think about his feelings before acting. Please post any constructive thoughts you have about this article.-L. Moix.

Frankel JB. The Play's the Thing: how the essential processes of therapy are seen most clearly in child psychotherapy. Psychoanalytic Dialogues. 1998;8:149-182. (top)

In this paper Dr. Frankel argues that as opposed to assertions by some analysts child therapy is not an adaptation of adult analysis and that verbal interpretation does not have a central role in how therapy is mutative. He argues that play therapy not only exhibits all of the central processes of what is mutative in therapy but that these mutative central processes are more clearly observed in play therapy than in adult analysis. He goes on to describe and exemplify these central mutative processes as twofold, first there is play and its vicissitudes, integration of self states, symbolization, and recognition by the other, and secondly there is renegotiation of the self-other relationship through action. Please post any constructive thoughts you have about this article.-L. Moix.

Bellinson, J. (2000). "Shut Up and Move: The Uses of Board Games in Child Psychotherapy." Journal of Infant, Child, and Adolescent Psychotherapy 1(2): 23-41. (top)
Bellinson, J. (2002). Children's Use of Board Games in Psychotherapy. Northvale, New Jersey, Jason Aronson Inc.

Many child and adolescent psychiatrists find the use of traditional board games in play therapy problematic. Because playing games with rules is an appropriate developmental achievement of middle childhood it is important for therapists to engage with patients in these activities. Bellinson shows how to recognize the themes and unconscious dynamics that are revealed by a child playing a game that ostensibly has rules. She goes on to demonstrate how the therapist can respond in a fashion that addresses these issues without becoming too judgmental or parental. -R. Ritvo.

Psychotherapy with Adolescents:
Shapiro T, Esman A. Psychoanalysis and child and adolescent psychiatry. J Am Acad Child Adolesc Psychiatry. 1992;31(1):6-13. (top)

For a practicing psychoanalyst and especially a psychiatrist in training it can be difficult to bridge older psychoanalytic writing with those of the last 25 years influenced by infant observation along with the writing of newer theoretical schools of thought especially around matters of affect development, regulation and interpersonal relations. He speaks to the importance of incorporating affects as motivators and modulators of interaction in the transference. This article I think helps with integration of many of the different theories without doing any disservice to the differences between theories. Please post any constructive thoughts you have about this article.-L. Moix.

Shapiro T. The unconscious still occupies us. Psychoanal St Ch. 1983;28:547-567. (top)

This paper by Dr.Shapiro uses the single visit of a 6 year old girl to communicate the importance of the unconscious in psychodynamic work with patients. This might seem obvious but he explicates what he means by valuing the unconscious and this includes having a healthy, caring respect for it. In the clinical example he was very, very careful with his approach to the child's unconscious which allowed him I think to achieve beautiful results and to be clear on his goals for this child and her family as opposed to mining the unconscious merely because there was more to interpret, as there always is. Please post any constructive thoughts you have about this article.-L. Moix.

Shapiro T. (1985) Adolescent Language: Its use for diagnosis, group identity and treatment. Adolesc Psychiatry. 1985;12:297-311. (top)

This paper by Dr. Shapiro is very helpful in thinking about an idiosyncratic part of adolescent psychotherapy and that is the difference between the language spoken by the therapist and the patient despite the fact that they speak the same core language. This is a critical aspect of working with adolescents that doesn't get as much attention as other aspect of adolescent psychotherapy. Please post any constructive thoughts you have about this article.-L. Moix.

Infant Mental Health:
Fraiberg S, Adelson E, Shapiro V. Ghosts in the nursery: a psychoanalytic approach to the problems of impaired infant-mother relationships. J Am Acad Child Adolesc Psychiatry. 1975;14(3):387-421. (top)

In this paper Dr. Fraiberg uses two compelling and convincing examples of families she and her Infant and Parent program helped avoid repetitions of parental traumas by helping the mothers experience the painful emotions associated with the traumas they experienced when they were very young. Her central assertion is that as adults, caregivers might remember the concrete details of their traumas but have repressed the unbearable emotions. The experience of being a new parents can bring to the fore these repressed emotions compelling the parent to use action to get away from such emotions. These actions can be very dangerous to the new child as they often take the form of identification with the aggressor and turning passive into active. Helping these parents experience the emotions with a supportive, containing, and caring therapist can be crucial in breaking the pattern of abuse. Please post any constructive thoughts you have about this article.-L. Moix.

Fraiberg S. The clinical dimension of baby games. J Am Acad Child Adolesc Psychiatry. 1974;13(2):202-220. (top)

In this paper Dr. Fraiberg describes games she and her colleagues in her Infant Parent Program observed infant-caregiver dyads playing. She beautifully and in plain terms describes not just some games that might display healthy sublimation but also games that seemed to be clear markers of inadequately defended against emotions such as aggression, envy, hostility among others that posed a significant threat to the safety and development of the child. She describes how the therapist helped the children and their caregivers who displayed such problematic interactions. Please post any constructive thoughts you have about this article.-L. Moix.

Fraiberg S. Pathological defenses in infancy. Psychoanal Q. 1982;51(4):612-635. (top)

In this paper Dr. Fraiberg starts with an important distinction between defenses and defense mechanisms and goes on to describe infants with what she argues convincingly in my opinion exhibiting defenses that are potentially the beginnings of pathological defense mechanisms. She focuses on what she termed "avoidance," "freezing," and "fighting" which she links with an innate tendency to "flight or fight" in the face of threat. She also describes how she worked with the infants and their caregivers. Please post any constructive thoughts you have about this article.-L. Moix.

Lieberman A, Padron E, Van Horn P, Harris WW. Angels in the nursery: the intergenerational transmission of benevolent parental influences. Infant Ment Health J. 2005;26(6):504-520. (top)

This paper is a nice complement to the Freiberg's paper "Ghost in the nursery" which describes how abused parents might transmit maltreatment to their children and how to correct it. This paper reminds us that it is just as important to have a patient recall the positive experience he or she had from his or her caregivers as the bad ones. Their theory is that: knowing that some abused parents do not repeat the abuse to their children, the protective factors might be the benevolent experiences that they had in their childhood . This paper explains some techniques to make this positive memories resurrect to enable maltreated parents to find empathy with their children and to prevent or decrease child abuse from one generation to the next.

This paper was really helpful for me as a child fellow in training as I work a lot with female teenagers with emotional problem often secondary to their abusive parents. It made me understand how important it is to work with their mothers to make them understand the pain they are causing their daughters by understanding and validating their own pain. Talking to my teen patients about the nurturing side of their mothers helps them to promote self worth.-C. Matip

Shuttleworth J. Psychoanalytic theory and infant development. In: Miller L, Rustin ME, Rustin MJ, Shuttleworth J, eds. Closely Observed Infants. London, UK: Duckworth; 1989:22-51. (top)

In this chapter, Ms. Shuttleworth outlines a psychoanalytic model of early development that is, "broadly speaking, part of a shared tradition of thought among those teaching on the Tavistock Clinic Psycho-analytic Observation course" and which "derives centrally, though not exclusively, from the work of Klein, Winnicott, Bick, and Bion." The chapter describes this evolving perspective on the infant's developing sense of himself. Additionally, it relates the development of a theory of object relations that has a central interest in "the mind's experience of itself and the world" and a model of the mind "in which experience accumulates and develops within the individual, affecting the present in complicated and indirect ways." Please post any constructive thoughts that you have about this chapter. -A. Haber

Development:
Dalsimer K. Female adolescent development - a study of The Diary of Ann Frank. Psychoanal St Child. 1982;37:487-522. (top)

This article is a jewel to read. You will be enjoying the dynamic study of normal female development from Anne Frank's raconto while living during the stress of war. She walks us through every emotion possible to describe such as love, hate, ambivalence, identification with her parents and psychic changes of puberty. The author describes Anne's female development with clarity and enthusiasm. -H. Hojman.

Psychodynamic Formulation and General Theory:
To be developed. (top)

Psychodynamic Readings for Later in the Career
Psychotherapy with Children:
Mahon E. The painted guinea pig. Psychoanal St Child. 1977;32:283-303. (top)

This paper addresses the complicated issue of mourning in children. There is a longstanding debate around the capacities that children have for mourning. This paper is a study of 30 three year old nursery school children as they responded to the death of their school pet, a guinea pig. I must admit I came to the paper with much skepticism regarding the accuracy any such study might have around the internal experience of children, around the relevance of such a study and also regarding the study's applicability to the loss of a caregiver. I personally really appreciated the paper finding the narratives and subsequent arguments regarding mourning extremely compelling and thought provoking. Please post any constructive thoughts you have about this article.-L. Moix.

Psychotherapy with Adolescents:
To be developed. (top)

Infant Mental Health:
To be developed. (top)

Development:
To be developed. (top)

Psychodynamic Formulation and General Theory:
Winnicott, DW. Hate in the countertransference (1949). In: Collected Papers: Through Paediatrics to Psycho-analysis. London, UK: Tavistock; 1958. (top)

In this paper Winnicott shows us how important is for for the therapist to be aware of negative feelings, particularly hate in the countertransference realm. This awareness is particularly helpful while treating psychotic and antisocial patients enabling the therapist to sort out and study his objective reactions to the patient symptoms. -H. Hojman

Winnicott DW. Transitional objects and transitional phenomena. In: Playing and Reality. New York, NY: Tavistock/Routledge; 1971. (top)

In this article Winnicott describes how the child deals with transitions between the intimate mother-infant relationship and the internalization of the mother as a true object.He describes his interest with the intermediate area between subjective and objective perception.This paper shows us the dynamic understanding of the preciousness of blankets, teddy bears and other objects children adore keeping so as to be comfortable and contained. -H. Hojman

Winnicott DW. The use of an object and relating through identifications. In: Playing and Reality. New York, NY: Tavistock/Routledge; 1971. (top)

Why are we so rushed with the use of interpretations with patients? Winnicott asks us in a way if can wait, be less clever among ourselves and let patients arrive to a creative understanding of conflict in the presence of a containing therapist. This article describes how to understand interpretation as a limit of the therapist own understanding and believing that the patient and solely the patient will give us the answer. In this paper Winnicott tells us how the patient can use the therapist as an object and develop a capacity to use the therapist. This process is part of a maturational process that can grow in a facilitating environment. Winnicott describes how the therapist becomes a valued object after surviving negative feelings from the patient which arises as soon as the patient realizes in his fantasy world that the patient is still alive becoming a source for emotional analysis and containment.-H. Hojman.

Winnicott DW. The place where we live. In: Playing and Reality. New York, NY: Tavistock/Routledge; 1971. (top)

In this paper Winnicott describes that the psychic place depends for its existence on living experiences and not on inherited tendencies. When the baby has a sensitive experience with the mother while separating, the space for creative play becomes richer. Also, when the mother adapts to the baby's needs who is evolving in personality and character, this adaptation gives the mother a sense of reliability which gives rise to a feeling of confidence in the growing child. -H. Hojman.