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This paper describes the intensive psychotherapy of a severely disturbed boy. The child had a cleft palate and lip. The events surrounding the child's development illustrate a child unable to engage human beings as sources of comfort and well-being. The meaning for his life was obtained from the world of diesel trucks. Significant alterations in therapeutic interventions had to be implemented in order to engage the child in a meaningful relationship. During the course of therapy, the child progressed from being a “wild diesel” to a “diesel mechanic” and finally, to an “executive” of a “diesel company”. Therapy was successful in advancing the child from his pathological identification with diesels to more realistic identification with the therapist
The literature on the psychological implications for children of hospitalisation and surgery describes fears of abandonment, punishment, mutilation, disfigurement and pre-occupation with fantasies of violence and death (Becker, 1972; Bergman & Freud, 1965; Conway, 1975; Erikson, 1972; Jessner, Blom & Waldfogel, 1952). Children with cleft palate and lip experience surgery in their first year of life with follow-up surgery as they develop (Grabb, Rosenstein & Bzoch, 1971; Holdsworth, 1970). Some studies of these children focus primarily on assisting the parents in their attitudes, anxieties and misconceptions through a team approach of medical, dental and speech specialists (Baker, 1955; Lillywhite, 1956; Lowe, 1961; Subtelny, 1955). Tisza et al (1958) comment upon the extreme distortion of the mouth in figure drawings by cleft palate and lip children reflecting their body image perception. Alpert (1959) describes a boy with cleft palate being fixated at the oral stage with a compulsion to repeat injury to his mouth. Irwin and McWilliams (1974) report that the fantasies of these children depict themes of oral aggression, fears of bodily injury and fears of being attacked or killed. Tisza et al (1969) subjected the