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Adam, the little boy whose treatment this paper records, was brought to a child therapy clinic because his mother was concerned by his slow speech development. At two years six months, he had only acquired a few words, and showed little interest in learning more. I embarked on his treatment with the expectation of coming to understand the conflict which impeded his acquisition of speech. However, as the treatment progressed I found myself concerned primarily with responding to the child's expectation that I would meet certain emotional needs. I began to see that some essential needs had not been met by his environment, and that it was this which stood in the way of his development proceeding normally.
A. Freud (1968) wrote, “Not only does every infant have definite needs stemming from his unformed and unstructured state, but these needs also change and vary with ongoing development. At every stage of his growth the child needs help from definite environmental attitudes and suffers harm if this help is not forthcoming”. She went on to warn of the need to distinguish diagnostically between disorders stemming from the frustration of developmental needs, “deficiency illnesses”, and the “neurotic and developmental disorders in which the child's ego plays the central pathogenic role”. She drew attention to the therapeutic problems such cases present, noting that analysis will only affect the “neurotic superstructure which does not cause, (but) merely overlays, the basic damage to the personality”. However, she did suggest that if the child is young and still close in time to the frustration of his needs, treatment may meet his needs.
D.W. Winnicott (1965) wrote more specifically of the techniques needed to help patients with this type of developmental deficiency. The analyst must provide an environment which will “facilitate the maturational process”. He compared the subtle adaption which the analyst makes to the changing needs of his patient to that of the moth