How Many Biscuits Will Jonathan Steal Today?

Jonathan was a 7-year-old boy with a history of painful medical interventions associated with a chronic illness from which he had suffered since birth. At the time of referral he was described as intolerant of nearly every restriction—even those entirely unrelated to his illness—or discplinary measure imposed on him by his objects. His behaviour became increasingly like that of a demanding and controlling toddler. When at his worst he either shouted verbal abuse at anyone who frustrated his desires or erupted into tantrums until he was given what he wanted. Jonathan's analytic material revealed that his behaviour was a passive to active response to the ongoing medical procedures used to treat his illness, which made him feel controlled and dominated by his objects and underscored the long-standing narcissistic wound and feelings of helplessness that the illness engendered.

At every available opportunity during the early months of treatment, and at times extending even beyond this initial period, Jonathan persistently resisted my endeavours to help him understand the unconscious motivations which gave rise to his need to control others. It was only when I found interventions that provided Jonathan with a desire to observe his behaviour more closely, and to try to make sense of it, that we were able to move forward.

The following vignette is an example of a piece of work which I think illustrates this kind of intervention; it focusses on Jonathan's tendency to externalize his superego and my efforts to facilitate his recognition of this defence.

Once Jonathan's bids to control and dominate his objects entered and dominated the transference, he began to insist on using the adult library in the Clinic for his treatment sessions. While attempting to analyse the reasons that lay behind this preference, I allowed him to use it during those sessions which were arranged in the early morning. On other days of the week when afternoon sessions were scheduled, the library was unava