Insight and the Nature of Therapeutic Action in the Psychoanalysis of 4- and 5-Year-Old Children1

After a discussion of some of the theoretical issues raised in the past about the concept of insight, the authors go on to track changes in the internal representations of two young patients during the course of a session with each of them. Their argument is that in the attention to the detail of these sessions there is evidence of a gradual development of knowledge about internal relationships in the patient, which is reflected in movements in the narrative of the play. The need for congruence between heightened affect in the patient and the analyst conveying understanding is stressed and compared with early mother—infant relationships. They argue that the 5-year-old child can use his developing capacity to mentalise most safely in the context of pretend play and that the analyst's communications should remain as close as possible to that context, typically in displacement. They conclude that their sessions give evidence that children of this age are capable of a form of insight that could be said to be the equivalent of that of adults in analysis, but that their mode of expression and of communication of their self-knowledge through their play is very different.