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It’s always a pleasure to discuss a very complicated and difficult clinical case that was handled well with a lovely outcome. When we first meet Nicola, he is an 8 year old boy whom Dr. Simona Caprilli describes as looking much more like a pre-teen. Nicola almost immediately begins repeating dirty lyrics and swear words from Italian rap songs. She has the feeling that he is letting her know that he is the strong one, both in the consulting room and elsewhere. The origin of the sexualized aggression is a complex matter which I will return to later in the discussion, but first let’s take a look at the most important matter: the treatment process.
From the very beginning there is an acted upon desire on Nicola’s part to dominate both the treatment process and Dr. Caprilli. He lets her know very early on that her games are inadequate, referring to them as boring and childish and he doesn’t want to play with them. Child analysts need to remain open to their own childhood vulnerabilities and are vulnerable themselves to narcissistic injury, to some degree, when a child comes into to their office and tells them that all of the toys and games in their office are inadequate. A lot of thought goes into the types of game and toys that would help the therapeutic process along. The healthy child therapist tolerates the injury just as an adult analyst would do with a patient who has a felt need to verbally attack the analyst in a sadistic manner. This is exactly what Dr. Caprilli does so well. She lets the attack roll off her back and continues to display a desire to find ways to play with Nicola.
Nicola soon brought his Monopoly game to the sessions. As they begin to play Monopoly, Nicola states “I am good, and I always win”. He then proceeds to sadistically criticize her moves. Dr. Caprilli tells us that his play is representative of the way in which his father has been with him: dismissive and critical. Although I agree with her assessment, I would add that, at this stage, Nicol