The Analysis of a Five-Year-Old Girl: the interrelationship of Low Self-Esteem and a Poor Capacity to Delay Gratification

At the time of referral Emma R was 4 years, 8 months old. Mrs R complained that Emma was becoming ‘uncontrollably angry’ and that every day began with a battle over the clothes she would wear and the food she would eat. She criticized almost everything her mother did and alternated between shouting that she hated mother and that mother hated her. She could not bear to see her older sister, Sara, talking with mother and bitterly insisted that Sara was the favourite and had the best of everything. According to her mother, when Emma was not battling she demanded close physical attention and was only at peace when curled up in her mother's lap, sucking her thumb. Mother was desperate, feeling that there was little she could do to please her daughter.

Emma's toilet training was slow. She achieved bowel control at 2 years and daytime dryness at 3 years. At the time of referral Emma was still wearing nappies at night. She was afraid to go to the toilet on her own, stained her underpants, and peeled wallpaper and paint off the walls at home. She had frequent nightmares.

In contrast to her wilful manipulative behaviour at home, Emma was described as settling in fairly well at school. She was well-mannered, even poised with adults and usually played happily with her peers.

Emma was in four-times-weekly treatment for three years.

Both parents grew up in South America and they moved to this country fifteen years ago. English is the only language spoken in the home and neither parent has had much contact with their family since arriving in England.

Mrs R is an intelligent, articulate woman who came from a successful business family. Her parents died in a car accident shortly before Mr and Mrs R left South America. Mrs R has a degree in English Literature and now works part-time for a small public relations firm. Mrs R had weekly telephone conversations with me and we met once every three months.