Psychoanalytic Approaches to Work with Children with Severe Developmental and Biological Disorders

Barry Landau's introduction emphasized the panelists' wish to engage the audience in a discussion of clinical material presented by Steven Ablon and James Herzog. Each of these child analysts would present a detailed account of his work with a child with a severe form of biologically and/or developmentally based psychopathology. The work would then be discussed by Peter Fonagy. Landau anticipated that the panelists' presentations would raise important questions about psychoanalytic techniques, what happens when these techniques are applied to children with severe forms of psychopathology, and the nature of these disorders, including the degree to which they are amenable to psychoanalysis and psychoanalytically oriented modes of treatment.

Ablon presented material from the analysis of Josh, an elevenyear-old boy tormented by terrifying, chaotic impulses that seemed to emerge from raw, unfiltered sexual and aggressive images. Within days of his initial consultation, and again six months later, hospitalization was required. In addition to four-times-weekly psychoanalysis, Josh's treatment plan included medication, regular monthly meetings with the parents, and (at the parents' request) once-weekly cognitivebehavioral therapy.

Throughout the first year of his analysis, Josh battled an overwhelming level of anxiety. At times he seemed to be struggling to maintain his sanity. Detailed process notes from five months, nine