The Development of Containment in a Three to Five Year Old Boy

When Malcolm J started five times weekly psychoanalytic psychotherapy he was three years old. Two years later treatment was continuing and was likely to be needed for some time to come. Using material from these first two years, I describe how anxieties about separation and containment arose in the treatment.

Firstly I outline the referral and history. I then go on to describe the first few chaotic months of treatment. Malcolm at first attempts to invade and control the therapist using the most concrete means at his disposal: his own excreta and physical attacks. He lives in a state of ceaseless anxiety with several weeks of constant diarrhoea and some hallucinations in the sessions. Then as he gradually becomes aware of the containment provided in the treatment, he begins to symbolise his anxieties more and to keep some of his most extreme feelings in the therapy room and in the transference. He becomes able to attend playgroup, of which he had previously been too frightened. Treatment is now established.

The following year is briefly outlined, with particular reference to the theme of containment.

Finally I give an account of several months in the second year. Malcolm fabricates and talks about a series of containing vehicles for himself; he uses these as alternatives to what he feels to be the hazards of maintaining contact with the therapist as a container. These airborn vehicles move gradually earthwards as Malcolm comes closer to direct emotional contact and to standing on his own feet, outside his object. The secondary containers then recede into the background as Malcolm begins to explore his relationship with the therapist as a primary container. The move earthwards is connected to a number of other changes. Perhaps the most important of these is an increased trust in peoples’ ability to survive his attacks and respond to and contain his feelings. This entails Malcolm beginning to accept the therapist in the transference as a mother fruitfully linked to a fath