The Princess Who Did Not Smile: A Clinical Account of the Development of Primitive Psychic Structure in a 4-Year-Old Child

On the basis of clinical phenomena observed in the treatment of a 4-year-old child, the author attempts to show that the formation of psychic structure at a primitive level of development does occur when certain conditions are fulfilled. Through listening in a specific way, i.e. looking for form in the clinical material, it was possible to recognise key points in the treatment process. Such key points were often heralded by new therapeutic material, which in turn was accompanied by some new quality in the therapeutic relationship. On the basis of some of these key points it was possible to describe a sequence of levels, which could be regarded as levels in the formation of psychic structure. The therapeutic interplay in the phases of treatment that are described occurred mainly through non-verbal affective exchanges in which the analyst contributed to the process by the quality of her presence. The non-verbal interplay between the patient and the analyst took on the quality of an interactive language that seemed necessary in the initial phase of treatment. It is assumed that it was this quality in the therapeutic relationship that led to the formation and development of psychic structure.