Primary Process Phenomena in the Case of a Borderline Psychotic Child

Although the treatment of Tony, a borderline psychotic boy of eight and a half years, could be conducted over a period of only five months, the circumstances were so propitious1 that certain elusive types of primary process functioning achieved definition. In that the work increasingly became that of translating Tony's disruptive distortions of perceptual impingement back to him, two general questions suggested themselves of which certain of the answers will be presented as psychodynamic formulations. These questions were: "What is it about these children which makes you respond to them as you do?" and "What is the functional meaning of your therapeutic task?" The second question leads to a direct answer. My function for children such as these is to orientate them to themselves at all cognitive and sensory levels, so that their emotional arousals should become increasingly congruent with the actuality of their current experiences. The first question, of which the practical answers had long preceded knowing why I respond to these children in the way I do, will be set out as follows: the parents of such children had been advised:

treat them as if they were small babies, even though they can walk and talk, who can see things, including yourselves, to a degree that they do not fall over them and can even name them with your words. Although your child is clever enough, he is blind to an understanding of himself as a real person and consequently also of you and of almost all else. Think of him as being a stranger from a strange land for whom few of your expectations ever make sense. Handle him, quite literally with your hands as an elderly baby needing to be shown the ways to rely on himself in the environment to which you are accustomed. For example, you must teach him how to distinguish between the physical properties of things, including of yourselves and the bad or good intentions thereof.

I did not realize that this advice was but a symptomatic account of be