Freud's Free Clinics

1922
Hug-Hellmuth has done him a great deal of good,” Freud had written to
Abraham about his charming four-year old grandson Ernst Halberstadt. 28 In
her lectures on early childhood education to Viennese women in private circles
and at worker’s educational societies, Hermine Hug-Hellmuth described
psychoanalysis as a broad-minded approach to child psychology. She used
stories from the Ambulatorium’s child therapy program to help her audience
picture her at work. Recently returned from a teaching assignment at the
Berlin Poliklinik, Hug-Hellmuth believed that a strong attachment to the
therapist is necessary for successful analysis with children. She was an active
member of the Technical Seminar and taught her colleagues to scrutinize selected
clinical features of children’s early dreams and fantasies by using analytical
methods now generally attributed to Melanie Klein. Hug-Hellmuth’s
attention to the needs of two social groups, that of the therapist and that of
the patient, made for an auspicious beginning for the clinical facility she
oversaw with great success until her sudden death in 1924.
The originality of mounting a separate child treatment program within a
clinic devoted overall to the mental health of adults cannot be overestimated.
Karl Abraham had conceived the idea and Hermine Hug-Hellmuth made it
a clinical reality. Children were to be treated as individuals in their own right,
not as miniature versions of adults. Esther Menaker, a trainee from New
York, remembered evaluating a “pathetic little boy of seven who was referred
by the Ambulatorium.” She recalled that he was a bed-wetter, and that his
mother, who was very poor, “was desperate about the laundry problems and
the added work that his symptoms caused her. He was an only child, and his
father was an unskilled worker.” 29 Menaker’s treatment style was more supportive
(like Anna Freud) than interpretive (like Melanie Klein). Though her
work with the young boy focused on his feelings, she could not ignore the
family’s severe social and economic conditions. Children like Menaker’s
young patient were sometimes accompanied to the Ambulatorium by their
parents, but eventually many young people went to the center by themselves.
As Hitschmann reported ten years later, schools and clubs, teachers, school
doctors and personal pediatricians referred children “from all strata of the
necessitous classes” to the clinic. The basis for this was twofold. In 1922 the
state appreciated the need to protect the health and mental health of its
young citizens. At the same time, children born after the war to Vienna’s
young, and often poor, families needed individual help to survive the stressful
climate.
The problem of urban depopulation was answered by one of the new
state’s most controversial institutions, a marriage consultation clinic. Red
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