The Psychoanalytic Study of the Child. An Annual 9, 1954: Rudolph Ekstein, Ph.D., and Judith Wallerstein, M.S.W. (Topeka). 'Observations on the Psychology of Borderline and Psychotic Children. Report from a Current Psychotherapy Research Project at Southard School.' Pp. 344–369.

This type of child is subject to marked fluctuations of ego states. Dramatic shifts can occur in treatment in which neurotic defences crumble and psychotic defences erupt into view without perceptible cause. What causes these shifts and what purpose do the fluctuations fulfil in the psychic economy? Three determinants are suggested: (i) they occur autistically and bear no relation to external stimuli; (ii) they reflect changes in the transference; (iii) they occur in response to inner feelings which may be related to changing introjects as yet unexpressed in the therapeutic context.

Fluctuations of ego state in response to transference reactions appear to serve the purpose of maintaining contact as well as indicating an inability to do so. 'Both the regressed mode of relationship and the communication content from the regressive ego state can be conceived as aimed at revealing to the therapist the ways in which the conflict is experienced in the depths of the child's personality by its most primitive and most cathected organization.' The child's underlying conception of the conflict as absolute and insoluble remains constant.

These fluctuations occur in the main outside conscious control. What is the nature of the mechanism of control which in contrast is available to the neurotic? 'The degree of conscious control which the ego exerts over it shifting states may be a function of ego structure and the relationship between the stages of (ego) development achieved. Thus where the different developmental levels are closely connected, as in the neurotic patient, we may think of the ego as having relatively full control over its fluctuations; whereas in our patients the lines of communication between the different ego states are tenuous and easily disrupted, and the ability to go back and forth at will is seriously impaired.'

Is there a relationship between the content of the conflict and the ego state in evidence? In this case it would be theoretically possible to