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An earlier paper described the fluctuating availability of different ego organizations in the above type of child, ranging from psychotic manifestations to advanced achievement appropriate to chronological age. The present paper describes the implications of these observations for psychotherapy.
In the therapy of neurotic children, interpretations are addressed primarily to the more mature ego achievements. Such interpretations often result in panic and the precipitous disruption of contact in the borderline. Or they may succeed in superimposing a pseudo-secondary process upon a shaky foundation as a concession to an outer demand for social adjustment and conformity.
An example is cited where the therapist, mistaking the level of ego organization from which the child's material arose, interpreted a displacement from the transference as with a neurotic child. The resulting breakdown of ego functioning is accounted for as follows: 'In general the mechanism of displacement represents a relatively advanced achievement in the hierarchy of defences. For it is associated with the differentiation of self from the outer world and its efficacy as a defensive manoeuvre can be said in large part to be predicated upon the stable cathexis of ego and object boundaries. For the psychotic child the ability to use displacement as a defence frequently signals a significant progress because it is associated with a growing capacity to maintain object cathexis.'
A second example is cited where the therapist interpreted 'within the regression'; that is, the interpretation rested upon a temporary willingness to assume that the patient's grossly distorted perceptions reflected outer reality, because they accurately reflected his inner psychological reality and the state of his ego, which had temporarily lost the capacity to differentiate inner and outer reality.
'By returning with the child to ego stages where contact is almost disrupted and by reliving early experiences, primitive trans