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This case deals with an eight year old child who came into treatment presenting a complex and double sided picture. On the one hand, Tim seemed to be suffering from neurotic conflicts which manifested themselves in the forms of eating difficulties and sleep disturbances. This would imply that he had a relatively strong ego, which, when confronted with conflict at various stages of development, forced symptom formation.
… Symptoms are created in order to remove the ego from a situation of danger. If the symptoms are prevented from being formed the danger does in fact materialize; that is … the ego is helpless in the form of a constantly increasing instinctual demand
However, coupled with this was the problem of his intense aggressive outbursts (directed towards himself and others), which he was unable to control, plus his conscious, horror-filled and violent phantasy life (shown quite clearly in his initial psychiatric and psychological test interviews). This would indicate that his ego was weak, and unable to deal with his overwhelming impulses which were experienced as a continuous threat.
It became apparent very early in treatment that the technical handling of a child with such dual presenting pictures would be on two levels.
Treatment firstly entailed “ego-building”, or ego support, whereby the therapist helped to control overwhelming drives when the child could not. By siding with the child's weak ego, and by helping to contain explosive impulses, the therapist was experienced as a safe, protective object. The external object helped to reinforce the child's inadequate internal structure.
A great deal of Tim's first year of treatment was on this level, as it was essential that a trust with the therapist be established before acknowledgement and interpretations of his violent phantasy world could be made. When these were touched upon too early, Tim reacted with great anxiety, and he needed to protect himself from the dangerous therapist whom he felt as