The contributions of pioneering women have shaped the field of child and adolescent mental health. Their ground-breaking research and innovative clinical practices have changed the way we view and treat child and adolescent mental health problems, paving the way for future generations of mental health professionals. For this year’s International Women’s Day, this blog celebrates the achievements of remarkable women in the field: Anna Freud CBE, Professor Mary Ainsworth, and Professor Virginia Axline.
Anna Freud CBE: Pioneer of Child Psychoanalysis
Anna Freud CBE, the youngest daughter of Sigmund Freud, was one of the founders of child psychoanalysis (Triarhou, 2022). Her work laid the foundation for our understanding of child development and mental health. Her double approach emphasised the importance of observing children in their natural environments to gain an accurate insight into their psychological states (Cirasola & Pretorius, 2024; Freud, 1951; Pretorius, 2011).
In 1941, she opened the Hampstead War nurseries, where she cared for children separated from their families by the Second World War (Pretorius, 2011). At the Hampstead nurseries, Anna made key observations on the impact of separation on children, the importance of routine, the unique social dynamics and support systems that children form with each other as well as the resilience and adaptability that children can display despite the traumatic circumstances of the 2nd World War (Midgley, 2007). These findings highlighted the importance of understanding children’s unique psychological needs and paved the way for direct observation as a new therapeutic approach (Cirasola & Pretorius, 2024). Anna Freud’s findings also influenced the public’s understanding of the importance of parenting and provision for children, leading to public policies such as the Sure Start and Head Start programs in the UK and USA respectively (Pretorius, 2011).
In 1967, Anna Freud was awarded the Commander of the British Empire (CBE) for her contributions to the field of psychoanalysis, particularly in child psychology (Young-Bruehl, 2008). Her work and emphasis on the importance of early childhood experiences and the role of the family in a child’s development have influenced countless researchers and practitioners (Sandler, 1980). Her contributions have paved the way for future mental health professionals to ensure that the needs of young minds are met. Anna Freud, the mental health charity named in her honour continues her work and dedication to creating a world where all children and young people can achieve their full potential (Anna Freud, 2025).
(Image from Institute of Psychoanalysis)
Professor Mary Ainsworth: Revolutionising Attachment Theory
Professor Mary Ainsworth‘s work on attachment theory changed our understanding of child-parent relationships (Mesman & Emmen, 2013). Her research provided the Strange Situation Procedure, an attachment measurement tool still in use today (Nivison et al., 2025) and a framework for understanding how early relationships influence children’s social and emotional development by introducing the idea of how children use their mothers as a ‘secure base’ from which to explore (van Rosmalen et al., 2016).
Ainsworth developed the Strange Situation Procedure to observe and classify attachment styles in children and identified three primary attachment styles that are standard in psychiatric practice today: secure, anxious-ambivalent, and anxious-avoidant attachment (Ainsworth & Bell, 1970). The secure attachment style refers to children who are confident that their caregiver will meet their needs (Ainsworth & Bell, 1970; Forslund & Duschinsky, 2021). These children can explore their environment and feel safe. In contrast, children with the anxious-ambivalent attachment style are very dependent on their caregiver, become distressed when they leave and are difficult to comfort upon their caregiver’s return (Ainsworth & Bell, 1970; Forslund & Duschinsky, 2021). These children may alternately resist and seek comfort. Finally, the avoidant attachment style relates to children who tend to ignore or avoid their caregiver (Ainsworth & Bell, 1970; Forslund & Duschinsky, 2021). Little emotion is expressed when their caregiver leaves or returns, and they usually do not seek much comfort or contact (Forslund & Duschinsky, 2021). Children with the anxious-avoidant attachment style seem independent but may be suppressing deep emotional needs (Forslund & Duschinsky, 2021).
The findings of the original Strange Situation Procedure showed the importance of secure attachment between a child and their caregiver for healthy emotional development. The procedure has since been used as a gold-standard way of measuring attachment in young children (Granqvist & Duschinsky, 2021). Professor Mary Ainsworth‘s work has shaped how we approach child mental health by highlighting the critical role of early relationships and emphasising the need for supportive and nurturing caregiving environments.
(Image from The College of New Jersey, Psychology)
Professor Virginia Axline: Innovator of Play Therapy
Professor Virginia Axline innovated within the practice of play therapy, a therapeutic approach that uses play to help children express their feelings and resolve psychological issues (Cattanach, 2003b). Her work and introduction of child-centred play therapy as a treatment impacted the way we deliver therapeutic treatment to children and has had a profound impact on the field of child and adolescent mental health.
Child-centred play therapy, also known as non-directive play therapy, is an approach developed by Axline that allows children to lead the therapy session, using play as a medium to express their emotions and narrate their experiences (Cattanach, 2003a; Garralda, 1990). The effectiveness of this approach was illustrated in her famous case study “Dibs in Search of Self” (Axline, 1966). The book tells the story of Dibs, a young boy who, through child-centred play therapy, overcomes behavioural and emotional challenges (Axline, 1966). Axline showed the transformative power of play therapy in treating children’s mental health issues through the story of Dibs and other case studies, and her approach is still in use almost sixty years after she first introduced it.
Child-centred play therapy is an effective intervention for children with a range of mental health and neurodevelopmental conditions such as anxiety disorders (Hateli, 2022), Attention-deficit Hyperactivity Disorder (ADHD) (Abdollahian et al., 2013) and Autism Spectrum Disorder (ASD) (Francis et al., 2022). The approach has also been effective in children facing a variety of adverse circumstances, such as homelessness (Baggerly, 2004; Baggerly & Jenkins, 2009) and abuse (Gil, 2012). Professor Axline’s work opened a new path of effective treatment for children, changing countless lives of children over the past six decades.
Reflections
The pioneering work of Anna Freud CBE, Professor Mary Ainsworth, and Professor Virginia Axline has not only changed our understanding of child development and mental health but has also paved the way for future generations of mental health students and professionals. Their groundbreaking research and innovative therapeutic approaches have provided immense insight into the unique psychological needs of children and adolescents and has shown us the importance of early childhood experiences, secure attachments, and child-centred therapeutic interventions in fostering healthy emotional development.
International Women’s Day provides an opportune moment to recognise the remarkable contributions of women in the field of child and adolescent mental health. As we reflect on the achievements of the inspiring women mentioned in this blog, it is important to recognise the countless women who dedicate their careers to advancing the field of child and adolescent mental health in research, therapy and clinical practice. In celebrating the legacies of these trailblazing women and all women within the field, we reaffirm our commitment to a future where all children and young people can achieve their full potential.
NB this blog has been peer-reviewed
References
- Ainsworth, M. D. S., & Bell, S. M. (1970). Attachment, Exploration, and Separation: Illustrated by the Behavior of One-Year-Olds in a Strange Situation. Child Development, 41(1), 49–67. https://doi.org/10.2307/1127388
- Anna Freud Charity. (2025). Who we are. https://www.annafreud.org/about/who-we-are
- Axline, V. M. (1966). Dibs in search of self: Personality development in play therapy. Gollancz.
- Freud, A., & The Institute of Psychoanalysis, T. I. (1992). The Ego and the Mechanisms of Defence. Taylor & Francis Group. http://ebookcentral.proquest.com/lib/kcl/detail.action?docID=709572
- Garralda, E. (1990). Play Therapy. By Axline, Virginia M. London: Churchill Livingstone. 1989. 360 pp. The British Journal of Psychiatry, 156(2), 296–296. https://doi.org/10.1192/S0007125000005493
- Mesman, J., & Emmen, R. A. G. (2013). Mary Ainsworth’s legacy: A systematic review of observational instruments measuring parental sensitivity. Attachment & Human Development, 15(5–6), 485–506. https://doi.org/10.1080/14616734.2013.820900
- Sandler, J. (with Kennedy, H., Tyson, R. L., & Freud, A.). (1980). The technique of child psychoanalysis: Discussions with Anna Freud. Hogarth Press and the Institute of Psychoanalysis.
- Sonuga-Barke, E. J. S., Kennedy, M., Kumsta, R., Knights, N., Golm, D., Rutter, M., Maughan, B., Schlotz, W., & Kreppner, J. (2017). Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: The young adult follow-up of the longitudinal English and Romanian Adoptees study. The Lancet, 389(10078), 1539–1548. https://doi.org/10.1016/S0140-6736(17)30045-4
- Takizawa, R., Maughan, B., & Arseneault, L. (2014). Adult Health Outcomes of Childhood Bullying Victimization: Evidence From a Five-Decade Longitudinal British Birth
- Cohort. American Journal of Psychiatry, 171(7), 777–784. https://doi.org/10.1176/appi.ajp.2014.13101401
- Triarhou, L. C. (2022). Anna Freud (1895–1982). In L. C. Triarhou (Ed.), The Brain Masters of Vienna: Psychology and Neuroscience Pioneers around the Secession up to the Anschluss (pp. 125–129). Springer International Publishing. https://doi.org/10.1007/978-3-031-13052-6_25
About the author
Malaika from Kenya is a Research Assistant working on the Atlas of Longitudinal Datasets project as part of the Platforms for Longitudinal Mental Health Data (PALM) at the Social, Genetic & Developmental Psychiatry (SGDP) Centre at King’s College London. Malaika is interested in the politics of medicine, epidemiology, machine learning and expanding the conversation on the impact of racism on mental health through research, podcasts and written works. Malaika joined the SGDP Centre as a research assistant in 2022 after completing a Bachelor of Science in Global Health and Social Medicine – Neuroscience at King’s College London.