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THIS PANEL IS A SEQUEL TO AN EARLIER PANEL which centered on diagnosis and pathology.1 It focuses on therapy, studying a case in detail.
The case of eleven-year-old Matthew was presented by Marans. The child was well known to the Hampstead Child-Therapy Clinic. His six-year-old adoptive brother was in analysis, his mother had been analyzed, and he himself was observed by a social worker during his first two years, so an unusual amount of information was available about his early development.
His mother said he was clingy, alternately demanding and withdrawn. She hounded him to do simple tasks. He had no age-appropriate interests. Sometimes mother was provoked to physical violence, which terrified mother and child. Matthew wanted treatment. He felt sad and missed his father who left the family when Matthew was eight, and lived abroad.
Matthew's parents, whose social backgrounds were completely different, married when his mother was in her late thirties and father in his early twenties. Father was delinquent, sporadically employed, and a heavy drinker. Labor and delivery were prolonged and painful. The mother suffered both breast and vaginal infections, but insisted that nursing be Matthew's sole nourishment. The baby slept poorly and cried incessantly for two months, until mother was convinced to add supplemental feedings.
The infant observer reported that despite mother's severe depression, Matthew seemed alert and happy during his first two years, once he was adequately fed. Mother worried, as she worried about herself, that he was defective or might grow fat. At four months Matthew first refused the breast, then fed well. At six months he seemed well,