Brief Psychotherapy with a Three-Year-Old Girl1: “You Don't Want to Touch That Hole, Do You?”

In child guidance clinics, particularly in areas unfamiliar with child psychotherapy, we are often able to offer only limited or short-term help to a child who might require intensive psychotherapy. This is especially likely to happen when the child's immediate environment is unsettled: parents may be unable to support the treatment; they may move away; the child may be taken into care or sent to boarding school; or similar outside events may terminate therapy prematurely. If, at the referral, we know that time available is limited, we must assess carefully whether to undertake therapy at all. This is true even though the child may unquestionably be in deep psychic pain. We must ask ourselves if the breaking of yet another relationship will do more harm than good, or if, on the contrary, the opportunity to explore feelings and fantasies, including those of sadness, anger, loss and helplessness, will help the child to develop and to cope with new changes.

In this paper, I will discuss a three-year-old girl, Rachel, whom I saw twice weekly for psychotherapy during a period of ten weeks, 19 sessions in all, just before she and her mother moved to another city. Her mother met weekly with a clinic social worker.

I first saw Rachel in September. Her mother (Mrs. G.) had been attending the clinic since March of that year, when she had sought help on behalf of her daughter, who at the time (age 2 years, 7 months) was existing almost entirely on warm milk from a bottle, usually fed by mother (2-4 bottles a day). She was not using the pot or toilet. Rachel was an only child, and Mrs. G., age 30, was separated from her husband, who was not Rachel's father. After several years of a tenuous marriage, she had become pregnant by a married Spanish man, who had no intention of leaving his own family. (Mrs. G. and her husband are English.) Mrs. G. saw her affair primarily as a way of finding out if she could become pregnant and of having a child.

She left her husband during pr