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Although it is widely appreciated that the emergence of psychoneurotic symptoms in adult life results from unconscious conflicts deriving from early childhood experiences, little effort has been directed toward primary prevention in this area. A possible approach to early intervention was evaluated by offering intensive psychoanalysis to third trimester foetuses during the two weeks prior to their delivery. Long-term followup was obtained on 46% of the sample (n = 110) at age thirty, via interview and psychometric data. The primary criterion for adequate adult adjustment was an annual gross income exceeding $36, 000.
Factor analysis of the data revealed six therapeutic factors to be correlated with good outcome:
1Appropriate timing of interpretations, i.e. between contractions.
2Analysis conducted with the foetus in the horizontal position. This can be achieved by first determining the alignment of the foetus in the uterus via sonography and then positioning the mother so that the foetus lies flat.
3Thorough working-through of foetal feelings of anticipatory anxiety related to labour and imminent delivery.
4Development of a full-blown transference neurosis wherein the foetus's behaviour toward the analyst reflects earlier experiences with fellow germ cells in the prezygotic stage.
5High forceps extraction, which appeared to enhance the effect of deep interpretations by pressing them into the foetal skull at the time of delivery.
6The necessity that the foetus himself pay for the analytic sessions. Although this was impractical to arrange prior to delivery, it was found equally effective to inform the foetus that he would be billed at the age of 18.
In addition to the above therapeutic manoeuvres, it was found that certain specific aspects of the foetal situation affected the subsequent course of personality development: