1st Edition

The Thinking Heart Three levels of psychoanalytic therapy with disturbed children

By Anne Alvarez Copyright 2012
    232 Pages 3 B/W Illustrations
    by Routledge

    232 Pages 3 B/W Illustrations
    by Routledge

    How do we talk about feelings to children who are cut off from feeling? How do we raise hope and a sense of safety in despairing and terrified children without offering false hope? How do we reach the unreachable child and interest the hardened child?

    The Thinking Heart is a natural sequel to Live Company, Anne Alvarez' highly influential and now classic book about working with severely disturbed and damaged children. Building on 50 years experience as a child and adolescent psychotherapist, Alvarez uses detailed and vivid clinical examples of different interactions between therapist and client, and explores the reasons why one type of therapeutic understanding can work rather than another. She also addresses what happens when the therapist gets it wrong.

    In The Thinking Heart, Alvarez identifies three different levels of analytic work and communication:

    • the explanatory level – the "why - because"

    • the descriptive level - the "whatness" of what the child feels

    • the intensified vitalizing level  - gaining access to feeling itself for children with chronic dissociation, despairing apathy or 'undrawn' autism.

    The book offers a structured schema drawing on and updating some of her classic work. It is designed to help the therapist to find the right level of interpretation in work with clients and, provides particular help with the unreachable child. It will be of use to Psychotherapists, Psychoanalysts, Clinical and Educational Psychologists, Child Psychiatrists, Social Workers, Special needs teachers and carers of disturbed children.

    Anne Alvarez is a Consultant Child and Adolescent Psychotherapist and is retired Co-Chair for The Autism Service at the Tavistock Clinic, London. She is currently a visiting teacher and lecturer for the Tavistock Clinic, and a Lecturer on the San Francisco Psychoanalytic Society Child Programme.


    Alvarez, Introduction. Alvarez, Levels of Therapeutic Work and Levels of Pathology: The Work of Calibration. Alvarez, Section 1: Explanatory Level Conditions. Alvarez, Fiurgiule, Some Emotional Conditions for the Development of a Capacity for a Type of Two-Tracked Thinking in Infancy: Thinking in Parenthesis, the Sense of Agency and the Sense of Abundance. Alvarez, Obstructions to and Developments Toward Sequential Thinking: Some Connections Between Phantasy, Thinking and Walking. Alvarez, Making Links and Making Time: Steps Toward the De-Compression of Thoughts and the Establishment of Links Between Thoughts. Alvarez, Section 2: Descriptive Level Conditions. Alvarez, The Equal Role of Delight and Connectedness, Frustration and Separateness in the Development of a Sense of Reality: Technical Implications. Alvarez, States of Torment and Despair: Moral Imperatives and Rectifications in Work with Borderline Children. The Grammar of Wishes or the Grammar of Needs? Alvarez, Motiveless Malignity: Problems in the Psychotherapy of Patients with Psychopathic Features. Alvarez, Issues of Narcissism, Self-Worth, and the Relation to the Object: The Therapist’s Response to Being Seen as Stupid – A Devalued or Unvalued Object? Alvarez, Types of Sexual Transference and Countertransference in Psychotherapeutic Work with Children and Adolescents. Alvarez, Under-Integration and Integrations at the Paranoid-Schizoid Level. Alvarez, Section 3: Intensified Level. Alvarez, Play and the Imagination: Where Pathological Play May Demand a More Intensified Response from the Therapist. Alvarez, Finding the Wavelength: Tools in Communication with Children with Autism. Alvarez, Further Reflections: Transference, Countertransference, the Paranoid and Schizoid Positions, and Some Speculations on Parallels with Neuroscience.


    Anne Alvarez is a consultant child and adolescent psychotherapist and is retired co-chair for the Autism Service at the Tavistock Clinic, London. She is currently a visiting teacher and lecturer for the Tavistock Clinic, and a lecturer on the San Francisco Psychoanalytic Society Child Program.

    "The Thinking Heart would be a useful text for any psychoanalytic scholar, independent psychotherapy practitioner or group of practitioners hoping to deepen their psychoanalytic understanding, particularly in relation to child psychoanalytic sychotherapy... [this book] reminds me why I continue to work with children and why I love it so much, despite the many challenges that go hand in hand with child psychotherapy." - Jenny Perkel, New Therapist, November/December 2012

    "The Thinking Heart is a very full and moving book. It repays the careful responsive mindfulness that Alvarez advocates in clinical practice... In this book's lyrical synthesizing of science and art in examining the process and efficacy of psychotherapy with disturbed children, we can indeed hear her heart beat as we hear her think, as though they were one and the same process." - Sarah Sutton, ACP Bulletin, 2012

    "Alvarez is a great teacher; her knowledge is immeasurable, her writing is brave and her reflections are humble. She claims that her thoughts are ‘only considerations, because the complexity of the human mind... ensures that there can be no manual’ (p86). I believe that the work of Anne Alvarez is the closest we can get to such a manual." - Jeanine Connor, Therapy Today, November 2012