A Clinical Study of the Effect of a Failure of the Average Expectable Environment on a Child's Mental Functioning

In order to illustrate a 6-year-old child's comment on his own infancy I offer an example of what may be called a therapeutic consultation.

The therapeutic consultation is a kind of clinical work which psycho-analysis makes possible. It is a diagnostic interview which is at the same time a piece of deep therapy. It is particularly applicable where a child can (for financial or location reasons) only attend once or perhaps three times; but there is also a place for this kind of work in the child psychiatry of private practice, where there is no team to complicate the procedure.

In this work the motto is: How little need be done? Here use is made of the psychiatrist's position as a subjective object of the child. This condition only lasts for a few interviews, after which the child uses the psychiatrist in a complex and essentially changing way, which the psycho-analyst knows as the transference. The psychiatrist is more free to be natural than he or she is in psycho-analysis proper, and indeed countertransference phenomena are not a threat. This matches the absence of transference movement. The psychiatrist finds it easy to be objective in this work of limited scope.

The aim is to 'unhitch' a developmental catch, so that the environmental influences may resume their function of facilitating the process of maturation in the child. When such a result is not reached then the case changes automatically over into one in which psycho-analysis is appropriate, and indeed necessary. This outcome is not to be reckoned a failure. It should be reckoned a failure, however, if a case is handed on to a psycho-analyst which could have been 'unhitched' in one to three interviews by this method that I am describing, in this and a series of similar cases.

The therapeutic consultation is not difficult to conduct, but experience is needed for it, and a knowledge of the theory of all aspects of individual emotional development, including the early stages that are characterized by v