Psychoanalytic child play (Hug-Hellmuth, A. Freud)

1. Introduction

Version followed: Hermine Hug-Hellmuth's technique as set out in her paper "On the technique of child analysis", given at the Sixth International Psychoanalytic Congress in The Hague in 1920 [source: Walleghem 2013 abstract; Women in World History] and published in 1921 in German ("Zur Technik der Kinderanalyse") and English [uncertain: English journal volume and pages]; it is republished as chapter 2 ("Child analysis") of Routledge's Influential Papers from the 1920s (2020) [source: Routledge chapter abstract]. Her technique is read through Niwa's (2014) detailed analysis of that paper and Vallejo Orellana's (2004) historical study. Anna Freud's approach follows Niwa (2014), Britannica, the Freud Museum London and the Harvard University Press description of Sandler, Kennedy & Tyson (1980) The Technique of Child Psychoanalysis: Discussions with Anna Freud. Sourced on encyclopedia, publisher, library-catalogue, institute and regulator pages are Hug-Hellmuth's 1909 doctorate and 1913 admission to the Vienna Society; the 1920 Hague paper and its 2020 republication; the bibliographic details of Anna Freud's 1927 lectures (English 1928) and of Normality and Pathology in Childhood (1965); the Anna Freud Centre's renaming (1984); and the ACP's Professional Standards Authority accredited register. [uncertain: the full texts of Hug-Hellmuth (1921), Anna Freud (1927/1928) and Anna Freud (1965) are available only by subscription or in print; the procedural claims below rest on the secondary sources cited]

This is a training tradition and a historical lineage, not a manualised therapy. Hug-Hellmuth (Vienna, 1871–1924) was the first person to practise psychoanalysis systematically with children and used play in diagnosis and treatment from the late 1910s; Anna Freud (Vienna 1895 – London 1982) built child analysis into an institution, first in Vienna and then at the Hampstead War Nurseries and the Hampstead Child Therapy Course and Clinic (now the Anna Freud Centre). What remains in practice today is psychoanalytic child and adolescent psychotherapy, taught in the UK by the schools accredited by the Association of Child Psychotherapists (ACP), including the Anna Freud Centre/UCL/British Psychotherapy Foundation doctorate. [source: Niwa 2014; Vallejo Orellana 2004; Austria-Forum/German Wikipedia; Britannica; Freud Museum; ACP; Anna Freud Centre]

Core idea of change: both pioneers held that adult analytic method cannot be transplanted unchanged to children, because children depend on their parents and their inner controls are still forming. Treatment therefore combines analytic understanding with an educational aim. For Hug-Hellmuth, change came less from the child's verbal insight than from the analyst's understanding conveyed through her responses, showing up as changed behaviour; she called child analysis above all an analysis of character with an educational commitment. Anna Freud framed the educational role through the child's weaker superego and dependence on parents, introduced a preparatory phase to build a working alliance before analysis proper, worked closely with parents, analysed the ego's defences, and saw transference symptoms as the "royal road to the unconscious". [source: Niwa 2014; Vallejo Orellana 2004; Britannica; Freud Museum]

Historical figures: what reliable sources report

Hermine Hug-Hellmuth [source: Vallejo Orellana 2004; Austria-Forum copy of German Wikipedia, citing Graf-Nold 1988, Mühlleitner 1992, press reports of 1924]

Born Hermine Hug Edle von Hugenstein, Vienna, 31 August 1871; trained and worked as a teacher; passed her Matura in 1897 and took a doctorate at the University of Vienna in 1909, with a dissertation on the physical and chemical properties of radioactive substances [source: Women in World History via Encyclopedia.com; Vallejo Orellana 2004 also gives 1909; the 1908 date in the Wikipedia-derived source is not supported]. Isidor Sadger introduced her to psychoanalysis (Women in World History) and analysed her (dated 1906 in one source; Vallejo Orellana gives about three years without dates [uncertain]). She was admitted to the Vienna Psychoanalytic Society in 1913 [source: Women in World History; Vallejo Orellana], the third woman admitted per Vallejo Orellana; the Routledge (2020) chapter abstract calls her the Society's first non-Jewish member.
From 1919 she worked in the remedial-education department of the Vienna children's clinic and in 1923 led the child-guidance service of the Vienna psychoanalytic Ambulatorium (Wikipedia-derived source). Vallejo Orellana reports that Freud regarded her as the official representative of child psychoanalysis.
The diary controversy. Tagebuch eines halbwüchsigen Mädchens (1919), presented as the authentic diary of a girl aged about 11 to 14, appeared anonymously with Hug-Hellmuth as editor; Freud praised it in a letter as a "little jewel", and Women in World History reports that his 1915 letter was used as the preface. Its authenticity was doubted at the time: Adler's circle suspected a fake, and Cyril Burt and Charlotte Bühler judged its emotions out of keeping with the supposed author's developmental stage; Bühler pressed her to admit authorship, which she never did. Later scholars (Huber, Graf-Nold and Le Rider per Vallejo Orellana; Soubrenie, Le Rider and Tourné per Women in World History) concluded that she wrote it herself, Vallejo Orellana describing it as a reconstruction of her own pre-adolescence; it was withdrawn from sale in 1927 at Freud's initiative (Vallejo Orellana; Wikipedia-derived source). [source: Women in World History; Vallejo Orellana 2004; Austria-Forum] [uncertain: the later research is cited as these secondary sources report it] Do not treat the diary as authentic clinical or developmental material.
Case material from her nephew. After her half-sister's death in 1915 she took in her young nephew; Sadger became his guardian because women could not then hold guardianship. The Wikipedia-derived source, citing the Andreas-Salomé/Anna Freud correspondence, states that much of her pioneering child-analytic material rested on observations of this nephew, whom she analysed "prophylactically" although she was his close relative and carer, and judges this mixing of parenting and therapy unacceptable today [uncertain: secondary, unverified]. Niwa links her written warning that parents must not analyse their own children to this experience. [uncertain: which published cases derive from the nephew is not established]
Her death. Three secondary sources (Vallejo Orellana; the Wikipedia-derived source; Women in World History) report that on the night of 8–9 September 1924 she was killed at her home in Lustkandlgasse, Vienna, by her nephew, then about 18, during a break-in for money; Vallejo Orellana describes strangling and gagging, and the Wikipedia-derived source cites contemporary press reports of a handkerchief in the mouth. The same secondary sources report that he was sentenced to twelve years (of solitary confinement, per Women in World History, which adds that Sadger testified against him at the trial), that at trial he said she had analysed him in childhood and interpreted his behaviour sexually, and that after release he sought compensation from the Vienna Psychoanalytic Society as a "victim of psychoanalysis" (Wikipedia-derived source). They also report that opponents of lay analysis used the case against her and against child analysis, and that her work was then largely forgotten. Vallejo Orellana reports that her will forbade publication about her life and work; the Wikipedia-derived source does not mention a will [uncertain]. All details here are as these secondary sources give them [uncertain: secondary].

Anna Freud [source: Britannica; Freud Museum; Patel 2015; Vallejo Orellana 2004]

Born Vienna, 3 December 1895; qualified and worked as a teacher (qualification given as 1920 in Patel 2015) before training in psychoanalysis; chaired the Vienna Psycho-Analytic Society 1925–28 and published her approach to child analysis in 1927 (Einführung in die Technik der Kinderanalyse, 1927; English: Introduction to the Technic of Child Analysis, authorised translation supervised by L. Pierce Clark, Nervous and Mental Disease Publishing Co., New York, 1928, Nervous and Mental Disease Monograph Series no. 48, reprinted by Arno Press in 1975 [source: Deakin University Library catalogue record]).
Das Ich und die Abwehrmechanismen (1936; English 1937) gave new impetus to ego psychology.
Emigrated to London with her father in 1938; with Dorothy Burlingham ran the Hampstead War Nurseries to 1945 and published Young Children in Wartime (1942), Infants Without Families and War and Children (1943).
With Kate Friedlander she founded the Hampstead Child Therapy Course in 1947 [source: Freud Museum; Wellcome Collection also dates the course and clinic to 1947]. The Anna Freud Centre's own history dates the clinic's opening at 12 Maresfield Gardens to 1951 and lists the Hampstead Child Therapy Clinic and Course under 1952; Wellcome states that she directed it from 1952 until her death in 1982. The Centre's history page dates the renaming from Hampstead Child Therapy Centre to the Anna Freud Centre to 1984, and Wellcome says it came two years after her death; the dates of 1982 (Freud Museum page) and 1983 (Patel) are not supported [source: Anna Freud Centre, Our history; Wellcome Collection]. Normality and Pathology in Childhood: Assessments of Development was published in 1965 by International Universities Press, New York, as volume 6 of The Writings of Anna Freud (273 pp.) [source: CiNii catalogue record; PEP-Web citation of Kestenberg's 1967 review in Psychoanalytic Quarterly]; Britannica's 1968 date is not supported. Her disputes with Melanie Klein culminated in the British Society's Controversial Discussions, 1941–45. She died in London on 9 October 1982.
Vallejo Orellana notes that Anna Freud dated the start of child analysis to 1926, although Hug-Hellmuth had treated children since about 1915.

2. Framework

The cited sources give no fixed number of phases or sessions; the stages below are organised from what Hug-Hellmuth and Anna Freud are reported to have done. Criteria for moving between stages are not given in the sources and are marked [synthesis].

Professional frame. In the UK, psychoanalytic child and adolescent psychotherapy is a distinct profession whose registering body is the Association of Child Psychotherapists (ACP). The ACP accredits five training schools: Birmingham Trust for Psychoanalytic Psychotherapy; Human Development Scotland (Glasgow); Northern School of Child and Adolescent Psychotherapy (Leeds); and in London the Independent training (a UCL doctorate run by IPCAPA at the British Psychotherapy Foundation with the Anna Freud Centre) and the Tavistock and Portman NHS Foundation Trust. The Anna Freud Centre lists the bpf/UCL route as a four-year, full-time professional doctorate leading to the DPsych and ACP membership, delivered with NHS placement providers, and the Tavistock route as a four-year full-time doctorate validated by the University of Essex. The ACP was founded in 1949, and its leaflet describes it as recognised by the Department of Health as an NHS core profession and training. Its register is accredited under the Professional Standards Authority's Accredited Registers programme; the PSA's register page (updated June 2025) lists a September 2024 renewal report and states that no conditions of accreditation were needed. ACP training lasts four years, is based in NHS CAMHS teams and includes a two-year infant/child observation training. [source: PSA register page; ACP leaflet] Neither page mentions the HCPC: this is an accredited voluntary register, not statutory regulation [synthesis from the programme's nature] [uncertain]. [source: ACP Clinical Training Schools; Anna Freud Centre training page] Intensive child analytic treatment, interpretation of transference and defence, and parent work in this tradition must not be practised without such training (or a national equivalent through a psychoanalytic society). An adult psychotherapist without child training can use the developmental and parent-work ideas below for consultation and referral, not to run a child analysis. Child-centred play therapy is a separate profession with its own bodies (e.g. BAPT, PTUK, APT in the US) [synthesis] [uncertain: secondary, unverified].

Stage 0. Referral, parent intake and assessment. Goal: understand the child's history and family and decide whether analytic treatment is indicated. Hug-Hellmuth held the first interview with the parents and asked them in writing about early development, family and upbringing; Anna Freud likewise took the developmental history from parents. At Hampstead the Diagnostic Profile was used to sort what in a case conformed to or deviated from normal development, and Developmental Lines charted expected growth "from dependency to emotional self-reliance". [source: Niwa 2014; Vallejo Orellana 2004; Freud Museum] Move on when parents can commit to the frame and safeguarding checks are complete [synthesis].

Stage 1. Opening and preparatory phase. Goal: rapport and a working alliance. Hug-Hellmuth treated the first session as decisive for rapport and direction; Anna Freud introduced a preparatory phase to win the child's trust and cooperation before analysis proper. [source: Niwa 2014] Move on when the child attends willingly, has some sense of why they come, and can tolerate the analyst commenting on what happens [synthesis].

Stage 2. Analytic work. Goal: understanding transference, resistance, defences, fantasies and dreams, combined with educational help. Hug-Hellmuth preferred 3–4 sessions a week (fewer than the 5–6 Freud suggested) of about an hour, fitted around school, with strict time boundaries; she dropped the couch for children, used play below about 7–8, and treated formal analysis as possible only from about 7–8, with adolescents of about 14–18 approached more like adults but still within an educational frame. Sandler, Kennedy & Tyson cover the structure of treatment, including scheduling and handling interruptions, alliance, transference and resistance, verbal and nonverbal expression and interpretation [uncertain: from the publisher's description]. [source: Niwa 2014; Vallejo Orellana 2004; Harvard University Press]

Stage 3 (parallel throughout). Parent work. Goal: keep the treatment alive and the home supportive (see 4.13). [source: Niwa 2014; Britannica]

Stage 4. Ending and follow-up. Sandler, Kennedy & Tyson cover the course of treatment through termination and follow-up [uncertain: from the publisher's description]. Hug-Hellmuth warned that parents may end treatment prematurely, especially when symptoms worsen or the child protests, and that ending needs special care. [source: Niwa 2014; Harvard University Press] Criteria: symptoms no longer interfering with development, the child back on track on the developmental lines that were off course, and a planned ending agreed with parents and child [synthesis].

Length. The cited sources give no session count. Intensive child analysis in this tradition typically ran for long periods at several sessions a week [uncertain: secondary, unverified]. Contemporary NHS child psychotherapy also offers less intensive formats [synthesis].

3. Guiding principles

[source for each: Niwa 2014 unless stated; [synthesis] where marked]

Adapt the method to the child, not the child to the method. No fixed technique; choose from play, talk, dreams and guidance by age and capacity. Practically: plan each case from the developmental assessment.
Analysis plus education. Treatment has therapeutic and educational aims (Hug-Hellmuth; Anna Freud per Britannica). Practically: you may inform, guide and set age-appropriate tasks, but say clearly which you are doing.
Developmental yardstick. Judge symptoms against expected development (Anna Freud's developmental lines and profile; Freud Museum). Practically: ask "where is this child stuck relative to age?" before "what does this mean?".
Trust before interpretation. The opening and preparatory phase come first. Practically: no deep interpretation until the child wants to come back.
The analyst's attitude: sympathy, patience, intuition, occasional humour, close attention to what matters to the child, and consistency with what the child has said. Practically: remember names, pets and stories, and refer back to them accurately.
Change shows in behaviour, not in confessions. Practically: track school, sleep, play and relationships rather than waiting for verbal insight.
Explain in simple language. Even young children need transference and resistance explained, simply. Practically: one short sentence, linked to something that just happened.
Firm frame. Fixed time and length, held strictly, including refusing requests to extend sessions. Practically: end on time even when the child protests, and name the feeling.
Parents are partners and a source of resistance. Prepare them for slow progress, temporary worsening and jealousy. Practically: schedule regular parent meetings from the start.
Never analyse your own child or relative. Hug-Hellmuth wrote this; her own history and Klein's analysis of her own children show the danger. Practically: no therapy with family members, friends' children or anyone in your care.
Play has its own status. Hug-Hellmuth treated play as a main vehicle for younger children; Anna Freud regarded play as the child's adaptation to reality, not necessarily a direct revelation of unconscious conflict (Britannica), and was more cautious than Klein about reading play symbolically. Practically: observe play as communication and coping before treating it as symbol.
Safeguarding overrides confidentiality [source: NSPCC]. Practically: tell child and parents at the start what you must share.
Assent from the child, consent from those with authority [synthesis, informed by NSPCC on Gillick competence]. Practically: seek the child's agreement in age-appropriate words even when parents consent.
Play, drawings and stories are not evidence of abuse [synthesis]. Practically: act on disclosures and observable concerns via safeguarding procedures, never on symbolic interpretation alone.

4. Intervention inventory

All example language is illustrative wording written for this guide, not the founders' words. The primary technique papers (Hug-Hellmuth 1921, republished by Routledge in 2020; Anna Freud 1927, English 1928) are available only by subscription or in print, so the steps are reconstructed from the secondary sources cited, with gaps filled as marked [synthesis].

4.1 Parent intake and written developmental history

Purpose / when: Before meeting the child. Gives the developmental history, family picture and parents' expectations, and starts the alliance with the parents. [source: Niwa 2014; Vallejo Orellana 2004 (first interview with parents)]
Steps: (1) Meet the parents (or carers with parental responsibility) without the child. (2) Ask for a written account of pregnancy, early development, feeding, sleep, toileting, illnesses, separations, family composition and upbringing, as Hug-Hellmuth requested in writing. (3) Go through it with them and add the current complaint, school reports and who holds parental responsibility [synthesis for the last two]. (4) Ask what they expect and how quickly; Hug-Hellmuth found parents expected quick cures and broke off early. (5) Explain frequency, length, fees, the parents' own meetings, confidentiality and its limits (see 4.3).
Example language (illustrative): "It helps me a lot to have the story of your child's early years in your own words. Could you write down what you remember, and we'll go through it together next time?"
Watch for: Parents who want a report on the child's secrets, who expect results in weeks, or who disagree with each other about treatment. Working: parents return the history, attend, and can describe the child as a developing person rather than only a problem.

4.2 Developmental assessment: Diagnostic Profile and Developmental Lines

Purpose / when: Anna Freud's Hampstead method for deciding whether and how to treat. The Profile separates what in a case conforms to normal development from what deviates; the Developmental Lines chart expected growth "from dependency to emotional self-reliance" and in other areas. [source: Freud Museum; the method is set out in Anna Freud (1965) Normality and Pathology in Childhood, International Universities Press, New York (date from CiNii)]
Steps: (1) Gather history (4.1), observation in sessions and school information. (2) Organise the material under the headings of Anna Freud's published Profile; use the published version, do not improvise one [uncertain: the headings are not reproduced here]. (3) For each developmental line, place the child relative to age and note lags, regressions and unevenness between lines [synthesis on procedure]. (4) Formulate whether the difficulty is a passing developmental strain, a fixed internal conflict suited to analysis, or something needing other help (developmental support, parental guidance, medical or educational assessment) [synthesis]. (5) Feed back to parents in plain language.
Example language (illustrative, to parents): "In some areas she's right where we'd expect for seven; in managing separations she's more like a much younger child. That unevenness is what I'd want to work on."
Watch for: The Profile is a clinical formulation framework, not a standardised test; the cited sources report no reliability or validity data [uncertain]. Never present Profile findings, play or drawings as diagnostic evidence of abuse or of a psychiatric disorder [synthesis]. Refer for paediatric, speech-language, neurodevelopmental or educational assessment where indicated [synthesis].

4.3 Consent, assent, confidentiality and the safeguarding contract

Purpose / when: At intake and again with the child in the first session; revisit when the child's capacity changes. [source: NSPCC child competency guidance; otherwise synthesis]
Steps: (1) Identify who holds parental responsibility and obtain their informed consent to assessment and treatment; record it [synthesis]. (2) Seek the child's assent at every age in words they can grasp: who you are, what happens in the room, how often, that they can say no to particular activities [synthesis]. (3) For older children who may consent for themselves, assess competence as the NSPCC describes Gillick competence: age, maturity and mental capacity; understanding of risks, benefits and long-term effects; grasp of alternatives; ability to explain their reasoning; freedom from pressure. Competence is decision-specific and can be reduced by stress or mental-health difficulties; if in doubt, seek parental consent and a colleague's view. Encourage the young person to involve parents and explore any refusal. [source: NSPCC] (4) Explain confidentiality and its limit: the NSPCC states "You must always share child protection concerns with the relevant agencies", even against the child's wishes. (5) Agree with parents what they will and will not hear (themes and progress, not the child's words) [synthesis]. (6) Know your local duty: in England and the rest of the UK, follow the statutory multi-agency safeguarding guidance and your employer's policy and refer to children's social care or police; sexual activity involving a child under 13 always warrants a child protection referral [source: NSPCC]. Whether a statutory mandatory-reporting duty is in force in your UK nation at the time you read this should be checked locally [uncertain]. In US states, Canada, Australia and many other countries, mental-health professionals are mandated reporters by statute; know the threshold, timeframe and agency [synthesis; verify locally]. The ACP publishes a Code of Professional Conduct and Ethics and a Safeguarding Policy [source: ACP site navigation].
Example language (illustrative, to a 7-year-old): "What you say and play in here stays between us. The only time I'd tell someone is if I was worried you or another child might get hurt. If that happened, I'd tell you first what I was going to do."
Watch for: A child who stops playing after hearing the limits (go slowly; repeat that most things stay private); parents pressing for disclosure of content; disclosures made in play (see 5).

4.4 Choosing and preparing the setting; play materials safety

Purpose / when: Before treatment starts. Hug-Hellmuth preferred the child's home to a clinic, because children brought to clinics arrived late or missed sessions and parents then stopped treatment; she distrusted institutions where children were teased and could not keep secrets. [source: Niwa 2014; Vallejo Orellana 2004 (first session at home)]
Steps: (1) Today, use a consistent, private clinic or school room unless there is a strong reason for home visits; if home visits are used, follow lone-working and safeguarding policy, keep a door-open or chaperone arrangement agreed with your service, and keep the space and time as fixed as possible [synthesis]. (2) Keep the same room, time and toy set each session [synthesis, consistent with the firm frame in Niwa]. (3) Many child psychotherapists give each child a personal box of toys kept between sessions [synthesis; not confirmed for these founders]. (4) Materials safety [synthesis]: age-graded toys only, no small parts or magnets for under-threes or children who mouth objects; non-toxic, washable paints, felt-tips, modelling clay and play-dough labelled for children; round-ended scissors and supervised use of any sharp tool; no latex balloons for young children; check for allergies (latex, wheat in play-dough, food colouring); water and sand play with clean water, mopped floors and a plan for wet clothes; clean or wipe shared toys between children and discard broken items; secure furniture, radiators and windows; no cords or ties long enough to wrap round a neck; keep a first-aid kit and know your incident-reporting route. (5) Avoid anatomically detailed dolls unless you are trained in their forensic use; they are not an analytic play material [synthesis].
Watch for: The room becoming unsafe during aggressive play (see 5); a child taking toys home (a meaning to explore, and a practical rule to set).

4.5 The first session

Purpose / when: Hug-Hellmuth treated the first session as especially important for rapport and for setting the direction of treatment; the first symbolic play often showed the core conflict. [source: Niwa 2014; Vallejo Orellana 2004]
Steps: (1) Meet child and parent together briefly, then the child alone if they can separate; if not, let the parent stay and plan gradual separation [synthesis]. (2) Say who you are and why the child is here in simple, honest words agreed with parents beforehand [synthesis]. (3) Show the materials and let the child choose. (4) Follow the child's lead with sympathy, patience and interest in what matters to them; Hug-Hellmuth also recommended occasional humour. (5) Note the first play theme carefully but do not interpret it yet [synthesis on timing]. (6) End on time and say when you will meet again.
Example language (illustrative): "Your mum told me that going to sleep has been really hard. Lots of children come here and play and talk about things like that. You choose what we do."
Watch for: Over-compliance (Hug-Hellmuth noted children may agree with everything while holding deep resistance); total refusal (see 5). Working: the child shows curiosity about the room or about you and is willing to return.

4.6 The preparatory (introductory) phase: building the working alliance

Purpose / when: Anna Freud's addition: a phase before analysis proper in which the analyst wins the child's trust and cooperation, because children rarely seek treatment themselves. [source: Niwa 2014] [uncertain: the detailed procedures of her 1927 lectures are not described in the cited sources; Sandler, Kennedy & Tyson's discussion of the alliance is known from the publisher's description only]
Steps: (1) Show yourself useful and interesting to the child: take their interests seriously, be reliable, remember what they told you (Hug-Hellmuth's consistency principle). (2) Help the child see that they have a difficulty that bothers them, not only one that bothers adults [synthesis]. (3) Explain what the work is for in words fitted to their age. (4) Avoid early interpretation of negative transference, which Anna Freud reportedly postponed [source: Niwa 2014]. (5) Move on when the child comes willingly and accepts that you will sometimes say what you notice [synthesis].
Example language (illustrative): "You told me last week your football team lost. Did they win this time?" / "Coming here might help with the bad dreams. We can find out together."
Watch for: Becoming a playmate or tutor only, or competing with parents for the child's affection (Hug-Hellmuth noted maternal jealousy). Working: the child brings worries spontaneously.

4.7 Playing with the child

Purpose / when: Hug-Hellmuth introduced play for children under about 7–8, for those who did not understand treatment, and for those who could not yet reflect; the analyst played with the child, and play built rapport and revealed symptoms. In her case of a 7-year-old boy, feelings such as identification with his father came out in play. Anna Freud treated play as the child's adaptation to reality and was more cautious than Klein in reading it as direct symbolic expression. [source: Niwa 2014; Vallejo Orellana 2004; Britannica]
Steps: (1) Offer simple, open materials (figures, animals, houses, cars, blocks, drawing materials, clay) [synthesis on materials]. (2) Join the play when invited, in the role the child gives you, without directing the story [synthesis]. (3) Describe what is happening before commenting on meaning ("the tiger keeps knocking the house down") [synthesis]. (4) Note recurrent themes, interruptions and moments when play stops (often where anxiety rises) [synthesis]. (5) Link play to the child's life or to the relationship with you only when the alliance can bear it, and in one simple sentence (see 4.9). (6) With Anna Freud's caution in mind, consider whether a play sequence is coping with a real event (adaptation to reality) before reading it as unconscious symbol.
Example language (illustrative): "The little boy figure wants to be as big and strong as the daddy figure." / "Every time the baby cries, the game stops."
Watch for: Play that becomes repetitive and distressing rather than relieving (see 5, overwhelm); physical contact in play (keep to the child's invitation, never sexual or genital, stop if unsure, follow your service's touch policy) [synthesis]. Working: play becomes richer, more varied and more linked to words.

4.8 Indirect communication: stories about another child and pretend events

Purpose / when: Hug-Hellmuth used indirect messages, such as a story about another child, and pretended events to draw out a child's responses without confronting them directly. [source: Niwa 2014]
Steps: (1) Pick a theme the child is avoiding but has signalled. (2) Tell a brief invented story about a child of similar age facing something similar, clearly fictional and not about a real client [synthesis safeguard]. (3) Pause and let the child correct, add to or reject the story. (4) Do not push the child to admit the story is about them [synthesis].
Example language (illustrative): "I once heard about a boy who was scared to tell anyone he'd broken something. What do you think he did?"
Watch for: The child feeling tricked; use sparingly and openly. Never invent stories that suggest a particular event (such as abuse) happened, because suggestive questioning can contaminate any later forensic account [synthesis]. Working: the child adds their own details or switches to talking about themselves.

4.9 Simple explanation of transference and resistance

Purpose / when: Hug-Hellmuth held that formal interpretation is not always possible with children, but that transference and resistance must still be explained, simply, even to young children. She expected the analyst to stand in for a parent, linked resistance to rebellion, shame or fear of revealing family matters, and also reported interpreting defences and transference in ways closer to Klein. She found negative transference (rebellion, distrust) easier to address than positive transference, which she handled cautiously. Vallejo Orellana reports she spoke of "explanations" rather than interpretations. Anna Freud, by contrast, reportedly avoided analysing negative transference early in treatment. [source: Niwa 2014; Vallejo Orellana 2004] Version note: where the two differ, follow Anna Freud's sequence (alliance first, negative transference later) in the opening months, and Hug-Hellmuth's directness once the alliance holds [synthesis].
Steps: (1) Wait for a live, observable moment (lateness, refusal, a sudden angry game, treating you like a parent). (2) Describe it in one short sentence. (3) Offer a possible reason linked to how the child feels about you or about coming, as a guess. (4) Let the child disagree. (5) Return to it later if it recurs [synthesis on steps 2–5].
Example language (illustrative): "You're cross with me today. Maybe because I'm the one who says when it's time to go, like your dad does." / "It's hard to talk about home here. Perhaps you worry it would get your family into trouble."
Watch for: Long or adult-style interpretations; interpreting positive feelings in a way that embarrasses the child. Working: the child pauses, argues, or changes the game in a way that shows the comment landed; Hug-Hellmuth looked for change in behaviour rather than verbal agreement.

4.10 Analysis of defences (Anna Freud)

Purpose / when: Anna Freud's The Ego and the Mechanisms of Defence (1936) described how the ego protects itself: repression as the principal defence, plus projection, turning aggression against the self, identification with an overpowering aggressor and the separation of ideas from feelings. [source: Britannica] Use when the child's way of avoiding a feeling, rather than the feeling itself, is the obstacle. [uncertain: how she sequenced defence interpretation with children is not described in the cited sources]
Steps: (1) Notice the defence in action (blaming a toy for what the child did; becoming the scary monster after a frightening event; reporting something awful without feeling). (2) Name the protective function first, before the feeling being avoided [synthesis, consistent with ego-psychological practice]. (3) Only later link to the feared feeling or impulse. (4) Expect the defence to return; repeat gently.
Example language (illustrative): "When something scary happens, you become the scariest one of all. Then nobody can scare you." / "You told me about the accident like it was the weather. Maybe feeling it is too much right now."
Watch for: Stripping a defence the child still needs (sudden anxiety, regression, sleep problems); slow down. Working: the child can play or talk about the feared theme with some feeling and without collapse.

4.11 Dreams, fantasies and modified free association

Purpose / when: Hug-Hellmuth valued dreams because children often cannot say their thoughts freely, and dreams reveal fantasies they would not otherwise express; Anna Freud also emphasised dream and fantasy analysis. Hug-Hellmuth used free association only when the situation called for it, usually face to face, with the couch sometimes used by older adolescents (16–17); Vallejo Orellana's abstract says she did not use free association, a discrepancy between sources [uncertain]. [source: Niwa 2014; Vallejo Orellana 2004]
Steps: (1) Invite the child to tell or draw any dream they remember. (2) Ask what comes to mind about each part ("what else is like that?") rather than asking for free association in the adult sense [synthesis]. (3) Link to the day's events or to current worries before linking to deeper wishes [synthesis]. (4) With adolescents, offer more open association, seated or (rarely, with older adolescents) on the couch.
Example language (illustrative): "You dreamt the dog ran away. What does that remind you of?"
Watch for: Recurrent nightmares with trauma content (assess for trauma and consider trauma-focused treatment; see 5). Working: the child volunteers dreams and daydreams.

4.12 Educational guidance within the analysis

Purpose / when: Hug-Hellmuth called her approach educational psychoanalysis: alongside analysis she gave guidance, information, tasks suited to the child's level and advice, and avoided direct prohibitions, preferring to discuss the pros and cons of a situation with the child. Her approach was, per Vallejo Orellana, more psychotherapeutic than strictly analytic, and her 1914 work leaned towards education. Anna Freud saw analysis as having an educational influence. [source: Niwa 2014; Vallejo Orellana 2004; Britannica] For younger or developmentally delayed children, educational methods based on analytic knowledge were the main approach from the start.
Steps: (1) Decide whether the moment calls for understanding or for help (a child about to be excluded from school may need practical guidance first) [synthesis]. (2) Offer the information or task explicitly. (3) Instead of forbidding, weigh options aloud with the child. (4) Return to analytic listening afterwards and notice how the child took your help [synthesis].
Example language (illustrative): "If you hit him back, what might happen next? And if you tell the teacher? Let's look at both."
Watch for: Drifting into tutoring or moralising; taking sides with parents or school against the child. Working: the child begins to weigh choices without you.

4.13 Ongoing parent work

Purpose / when: Throughout treatment. Hug-Hellmuth found that parents expected quick cures and ended treatment early if progress was slow; that symptoms could worsen during treatment as old patterns broke down, and parents might blame the analysis; that mothers especially could be jealous of the child's attachment to the analyst; and that children sometimes used the analyst against their parents. She asked parents for patience and restraint, including not pressing for school results, and Vallejo Orellana reports she recommended that parents themselves undergo analysis. Anna Freud worked closely with parents. [source: Niwa 2014; Vallejo Orellana 2004; Britannica] Walleghem (2013) names the parents' position as an ethical question still open today [source: Psychoanalytische Perspectieven abstract].
Steps: (1) Schedule regular parent meetings (frequency not specified in sources; monthly is common practice) [synthesis]. (2) Before treatment, warn that symptoms may worsen temporarily. (3) Share themes and progress, not the child's words; agree this with the child [synthesis]. (4) Name jealousy and competition openly and normalise them. (5) Advise against pressure on schoolwork during treatment. (6) Where a parent's own difficulties drive the child's symptoms, refer the parent for their own therapy rather than treating them yourself [synthesis on the referral]. (7) If the child is in care, involve the social worker and carers with parental responsibility according to the care plan [synthesis].
Example language (illustrative, to parents): "Things may get a bit worse before they get better. That often means the work is reaching something important. Please call me before deciding to stop." / "It's natural to feel left out when your son talks about me at home."
Watch for: Threats to withdraw after a bad week; a parent seeking an ally against the other parent in separation disputes (stay neutral; do not write custody opinions outside your role) [synthesis]. Working: parents tolerate setbacks and report changes at home.

4.14 Talking about sexuality: what was done and how to handle it now

Purpose / when: Hug-Hellmuth discussed sexuality frankly with children, drawing on Freud's drive theory; Niwa notes this could build trust but could also provoke distrust and ambivalence. Her nephew later said in court that she had interpreted his behaviour sexually. [source: Niwa 2014; Vallejo Orellana 2004; Austria-Forum/German Wikipedia]
Steps for current practice [synthesis]: (1) Do not introduce sexual themes or interpretations yourself. (2) Respond to the child's own questions with brief, factual, age-appropriate answers, and tell parents the topic came up (not the child's words). (3) Treat sexualised play, knowledge beyond the child's age or sexual remarks towards you as possible safeguarding indicators to discuss with your safeguarding lead, not as material for interpretation alone. (4) Record carefully what the child said and did, in their words.
Example language (illustrative): "That's a good question about where babies come from. Have you talked about it with mum? Shall I tell her you were wondering?"
Watch for: Any drift toward sexualised interpretations of the child's behaviour, which carry risk to the child and to the therapy, as this history shows.

4.15 Keeping the frame: time, frequency and interruptions

Purpose / when: Hug-Hellmuth held to sessions of about an hour with strict time boundaries, refusing requests to extend, and preferred 3–4 sessions a week if treatment could be sustained; Sandler, Kennedy & Tyson address scheduling and interruptions. [source: Niwa 2014; Harvard University Press]
Steps: (1) Fix days and times with parents around school. (2) Give a five-minute warning before the end [synthesis]. (3) End on time; name the child's feeling about stopping. (4) Announce breaks well ahead and mark them on a calendar with young children [synthesis]. (5) Treat missed sessions as communications to be explored with parents and child.
Example language (illustrative): "Five more minutes." / "You want to stay longer. It's hard when I say stop. We'll be back here on Thursday."
Watch for: Bargaining at the end of every session; parents arriving late repeatedly. Working: the child anticipates the end and manages it.

4.16 Siblings and family secrets

Purpose / when: Hug-Hellmuth noted siblings could learn the child's secrets or resent the time the child received; she distrusted settings where children could not keep secrets. [source: Niwa 2014]
Steps: (1) Ask parents to keep siblings out of the session space and not to question the child about sessions [synthesis]. (2) Acknowledge sibling jealousy with the child and with parents. (3) Never pass one sibling's material to another [synthesis].
Example language (illustrative, to a parent): "Please don't ask him what we did. If he tells you, that's fine, but let it be his choice."
Watch for: A child who stops talking because a sibling teases them about "going to the doctor".

4.17 Ending and follow-up

Purpose / when: Hug-Hellmuth warned of premature endings driven by parents and saw ending as requiring special care; Sandler, Kennedy & Tyson cover treatment through termination and follow-up. [source: Niwa 2014; Harvard University Press] [uncertain: the cited sources give no published ending criteria]
Steps [synthesis]: (1) Review progress against the developmental assessment (4.2) with parents. (2) Agree an end date well in advance (weeks to months for intensive work). (3) Tell the child, and count down sessions visibly. (4) Expect temporary return of symptoms and work with the child's feelings about loss. (5) Offer a follow-up meeting with parents and, if appropriate, the child.
Example language (illustrative): "We've got eight more times together. Let's put them on the calendar."
Watch for: Abrupt parental withdrawal; offer at least one ending session.

5. Handling problems

Sources address premature parental ending, symptom worsening, jealousy, over-compliance and secrecy; everything else here is [synthesis].

Child refuses to come in or to separate [synthesis]: let the parent stay in the room for the first sessions and agree a stepwise separation; keep sessions shorter rather than skipping them; comment on the fear simply ("it's hard to be with someone new"); never force a child into the room.
Child agrees with everything but nothing moves [source: Niwa 2014 on hidden resistance; responses synthesis]: treat compliance as resistance; notice it gently ("you always say yes to me; maybe saying no feels risky"); return to play rather than talk.
Silence or "boring" play [synthesis]: describe the play itself; join it fully for a while; check outside events (school, family change) with parents; consider whether the material is too close to something painful.
Negative transference early on [source: Niwa 2014 for the Anna Freud/Hug-Hellmuth difference]: in the preparatory phase follow Anna Freud and do not interpret it deeply; acknowledge feelings, restate the frame and keep being reliable. Once the alliance holds, name it simply (4.9).
Aggressive play or attacks on you or the room [synthesis]: say the limit clearly ("I won't let you hurt me or yourself; you can show me how angry you are with the clay"); remove dangerous objects; end the session early only as a last resort, and tell the parent; review room safety (4.4). Record incidents.
Overwhelm, flooding or dissociation in play [synthesis]: stop interpreting; slow down; shift to a calmer activity; orient the child to the room and to you; reduce depth for some sessions; for trauma-driven repetitive play or nightmares, assess for PTSD and consider a trauma-focused treatment or referral in parallel.
Symptoms worsen and parents want to stop [source: Niwa 2014]: you will have warned them at intake (4.13); meet them promptly, review the developmental picture, separate expected turbulence from risk, and agree a review date rather than an immediate end. If they still end, offer a planned ending session for the child.
Parent jealousy or competition with the analyst [source: Niwa 2014; responses synthesis]: name it as natural; reinforce the parent's role ("you're the one who knows him best"); avoid any gifts, outings or contact that could look like you replacing the parent.
Non-attendance and lateness [source: Niwa 2014 for Hug-Hellmuth's reasons for home visits; responses synthesis]: explore practical barriers (transport, school timetable, siblings) with parents; consider a school-based slot; explore with the child what missed sessions mean.
Rupture: the child feels betrayed (after a break, a safeguarding referral or a parent meeting) [synthesis]: acknowledge it directly; explain what happened and why in simple honest words; accept anger; keep the frame steady.
Disclosure of abuse or harm in session, or in play [source: NSPCC for the duty to share; procedure synthesis]: listen; do not ask leading questions or use suggestive stories (4.8); tell the child you need to pass it on to keep them safe; record their words verbatim, with date and time; inform your safeguarding lead and make the referral to children's social care or police the same day according to local procedures; do not inform a parent who may be the alleged abuser before agreeing this with the agency. A theme in play or drawing alone is not a disclosure; discuss uncertain indicators with your safeguarding lead and supervisor.
Self-harm or suicidal talk in a child or adolescent [synthesis]: ask directly about thoughts, intent, plans and past acts; follow your service's risk-assessment and escalation protocol; involve parents and, where indicated, CAMHS crisis services; agree safety steps with the family, including securing medicines and other means at home.
Parents want to be told the child's content, or one parent opposes treatment [synthesis informed by NSPCC]: restate the confidentiality agreement; check who holds parental responsibility and whether both consents are needed under your service's policy; for older young people, assess competence to consent for themselves.
Pressure to analyse a relative, friend's child or your own child [source: Niwa 2014 for Hug-Hellmuth's warning; Austria-Forum/German Wikipedia for the nephew history]: decline and refer. This dual role is the single best-documented harm in this history.
Child in care or with multiple carers [synthesis]: clarify who consents, who attends parent meetings and how information flows to the social worker; plan for placement moves, which can end treatment abruptly.
Adapting for a non-intensive service [synthesis]: where only weekly sessions are possible, keep the preparatory phase, parent work, firm frame and developmental assessment; reduce depth of transference interpretation; set clearer review points.
Working outside your competence [synthesis]: if you are not a trained child psychotherapist, use the developmental and parent-work ideas for consultation and refer to an ACP-registered child and adolescent psychotherapist (UK) or a nationally recognised equivalent for intensive analytic work.

Sources

Sources:

Books and papers cited (details as given in the sources above):

Hug-Hellmuth, H. (1921). Zur Technik der Kinderanalyse. Internationale Zeitschrift für Psychoanalyse (Hague congress paper, 1920); English: On the technique of child-analysis (1921). Republished as chapter 2, "Child analysis", pp. 13–83, in Influential Papers from the 1920s (Routledge, 2020) [uncertain: editors].
Freud, A. (1927). Einführung in die Technik der Kinderanalyse. English (1928): Introduction to the Technic of Child Analysis, Nervous and Mental Disease Monograph Series no. 48, New York (reprinted Arno Press, 1975).
Freud, A. (1936). Das Ich und die Abwehrmechanismen (English 1937, The Ego and the Mechanisms of Defence).
Freud, A. (1965). Normality and Pathology in Childhood: Assessments of Development. New York: International Universities Press (The Writings of Anna Freud, vol. 6).
Freud, A., & Burlingham, D. (1942, 1943). Young Children in Wartime; Infants Without Families; War and Children.
Sandler, J., Kennedy, H., & Tyson, R. L. (1980). The Technique of Child Psychoanalysis: Discussions with Anna Freud. Harvard University Press.
Graf-Nold, A. (1988). Der Fall Hermine Hug-Hellmuth.

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