This book will provide the novice or experienced child and adolescent psychiatrist or psychotherapist an objective view of how the advances in attachment theory, systems theory, developmental psychology, and neuroscience have contributed to the contemporary practice of psychotherapy in children and adolescents. Consequently, with these advances, child and adolescent psychodynamic psychotherapy has transitioned from a traditional one-person model to a contemporary two-person relational psychotherapy model to an understanding of the psychological development of children and adolescents.

We define traditional one-person psychology as that which is based on traditional psychoanalytic concepts and the form of technique that emphasizes the role of the psychotherapist as an objective observer (one-person) of the patient’s ego defenses (the symptoms) and the discoverer of the truth regarding the patient’s intrapsychic conflicts and object relations (the patient’s inner life). Further, a goal of the traditional one-person model is to make the repressed and unconscious conflicts conscious through the use of interpretations by the psychotherapist.

We define two-person relational psychology as a model based on the integration of innate genetic, biological, psychosocial, and cultural factors. The psychotherapeutic intervention occurs at an implicit level, with the goal of a new emotional experience to create more adaptive patterns of interaction with others. To this, the psychotherapist and patient are mutually engaged in each other’s subjectivities (two-person) and states of mind. The two-person relational psychotherapist facilitates the psychotherapeutic process through enactments and self-disclosures that frequently occur unknowingly by the psychotherapist, although, at times, can be carefully timed, to move along the psychotherapeutic relationship. As Wachtel (2010) states, “two-person psychology takes the relationships seriously.” The choice of the term two-person relational psychology is designed to convey to the reader that in any here-and-now interaction, there are two present and active people mutually influencing each other’s subjectivities in the intersubjective field.

Although the interaction may be of two people (e.g., patient and psychotherapist), it is important to note that, in vivo, these processes are actively influenced and directed by previous relational experiences. In contrast to a traditional one-person model, the in vivo experiences in a two-person relational model require that the psychotherapist be “real” and genuine to allow the patient to implicitly know about his or her state of mind. That is, each person brings to the interaction a multitude of relational experiences stored in nondeclarative memory systems that influence the encounter, which are not limited to the relationship to their parents or primary caregivers. Nondeclarative memory refers to a dynamic nonconflicted unconscious also referred to by the Boston Change Process Study Group as “nonconscious” (Chap.​ 5). The nonconscious processes begin during infancy and help the infant implicitly learn how to perform certain tasks without the use of conscious thought. Everyday examples include: walking, talking, smiling, laughing, playing, and riding a bike. The nondeclarative memory is also known as implicit or procedural memory. Infantile memories from early childhood are not accessible to verbal or symbolic recall, but rather are encoded within the nondeclarative memory system machinery that is unique to each child and is driven by their innate cognitive abilities (or limitations). A person’s representational models are fine-tuned in perpetuity as they make sense of the meaning, affect, and intentions of others within the intersubjective field. Nondeclarative memory system is distinct from Freud’s “conflicted unconscious.” Freud’s conflicted unconscious is a central tenet to all one-person psychologies (i.e., drive, ego, object relations, and self) and is a concept that adheres to an innate psychic determinism, where nothing occurs at random; all mental events are caused by the interplay of the unconscious forces between the id, ego, and superego that preceded the event (see Chaps.​ 2 and 6) and are consciously retrievable through free associations and dreams.

In this book, we will review the work of major psychodynamic psychoanalysts and psychotherapists over the last century (Table 1.1); our goal is to both applaud and critique their unique contributions. In addition, we will demonstrate the seductive nature of the pursuit of understanding human behavior by each theoretical school.

For some, the transformation of the scientific advances in early childhood development into clinical applications has been viewed with a great deal of skepticism. It is reminiscent of the manner in which the works of John Bowlby, Donald Winnicott, and Donald Fairbairn were initially viewed, with skepticism, as they gave importance to the actual loving relationship between the infant and the mother while distancing themselves from Freud’s drive theory and Klein’s object relations theory.

To date, the schism between the schools of traditional one-person psychology and two-person relational psychology remains, and we view this as problematic for the young clinician. Under the broad umbrella of psychodynamic psychotherapy for children and adolescents, there are those that hold to the importance of the Oedipus complex and the internal life of the child in the form of object relations when helping the child. In essence, the traditional one-person psychology model can be viewed as a long journey with the psychotherapist leading the patient to the excavation site considered by the psychotherapist to hold the valuable artifacts. Over time, using specialized tools, a careful reconstruction of the original site is accomplished by removing the suspected calamity, thereby ultimately resulting in a return to happiness. For many of us who are physicians or academics, this approach is not only personally appealing but consistent with our years of training. Yet, we would offer that such an approach to psychodynamic psychotherapy is somewhat lonely and distant for the patient, as the psychotherapist is an objective observer and thus considered a “one-person” model.

Under the same umbrella of psychodynamic psychotherapy for children and adolescents, are those— authors included—that have incorporated the advances in developmental scientific research in the form of meaning-making processes, emotional availability, social reciprocity, relational schemas, implicit working memory, and right brain regulatory functions into their theoretical understanding. These functions underscore the complexities in understanding that what may appear as a developmental or behavioral disturbance in the present may ultimately represent patterns imbedded in disturbances of the original caregiver–infant relationships (Sameroff and Emde 1989). We posit that the difference from a “one-person” model is that in the “two-person” model, the original caregiver–infant relationships are stored in a dynamic nonconscious at an implicit preverbal level and are not retrievable through autobiographic recall. As the title of this book suggests, the authors are very much immersed in a contemporary two-person relational model of psychodynamic psychotherapy for children and adolescents that integrates concepts of intersubjectivity —“the capacity to share, know, understand, empathize with, feel, participate in, resonate with, enter into the lived subjective experience from another” (Stern 2005)—and neuroscience (see Chap.​ 5). Emde (2009) further states, “Much that is important to us as human beings is shared implicitly. We now have a neurobiology of intersubjectivity that is rapidly accumulating new knowledge; it involves basic nonconscious functioning and it has major implications for psychoanalytic work.” Additionally, Rustin and Sekaer (2004) state, “Although some psychoanalysts still dismiss the impact of neuroscience on psychoanalysis as ‘Darwinian,’ the general view is changing.”

The two-person relational concepts reviewed in this book are written to help the reader expand, synthesize, and contextualize their applicability to a contemporary two-person relational psychodynamic psychotherapy, as it relates to children and adolescents. We seek to integrate the contributions from developmental research, neuroscience, and intersubjectivity. We emphasize that our book is strongly influenced by the works of Emde, Stern, Beebe, Lackman, Wachtel, Altman, Lyons-Ruth, and the Boston Change Process Study Group.