You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Child analysis is clearly the treatment of choice where the infantile neurosis is concerned (A. Freud, 1945; 1968); here interpretative work designed to alter defences, to undo repressions, etc., is called for. Exploration of fantasy material is one of the techniques used to gain insight into the dynamics of both the child and the adult patient's mental functioning. At proper moments, interpretations made in the context of the child's manifest fantasy scenarios can result in further access to unconscious conflictual material, lessen reality distortions secondary to these underlying conflicts, help to resolve conflicts and to modify pathological defenses, decrease the magnitude of neurotic symptoms, and/or provide relief from unpleasant affects such as anxiety.
In recent years in our work with children in the Day Treatment Division of the Child Analytic Study Programme, however, we have become increasingly aware of children with whom interpretative therapeutic techniques have unexpectedly resulted in a heightening of anxiety, further impairment of reality testing, and ego disorganisation. These seemingly paradoxical reactions occurred in cases which, during the outpatient evaluation and even in the early phases of treatment, appeared to be neurotic disorders amenable to traditional analytic psychotherapy. It was only after each case had progressed into treatment and after usually successful analytic techniques repeatedly resulted in little improvement or even in exacerbations of already presented difficulty that the presence of an underlying primary ego deficiency was suspected. Careful re-examination of each child's medical and psychological histories in regard to ego functions and apparatuses revealed evidence of these primary ego deficits. In several cases, the child appeared to demonstrate subtle central nervous system impairments. These were undetectable by the standard techniques for investigation of ‘organicity’, (e.g. psychological testing, neurolo