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The treatment of children with borderline psychotic features* presents particular problems: their object relationships are especially labile; their perception of reality is uncertain and often confused with fantasy; and the ego is easily overwhelmed by anxiety. Interpretation by the therapist is felt as a serious threat to the brittle and shaky defences. Interpretations seem to make the patient worse; he may feel he is being driven mad by them and they may be re-interpreted in concrete terms or in ways quite different from the therapist's intention, or they may be simply not heard. Yet the patient makes a strong demand on the therapist for help and the therapy is valued. Something else is required of the therapist before interpretative work can take place.
In this paper I am attempting a description of a process whereby, during the first eighteen months of treatment, Peter D, a nine-year old boy with borderline psychotic symptoms, became able to embark on the work of analytic psychotherapy. His modes of relating to the therapist and what took place within that relationship were transformed, by stages, to a point where interpretation was possible. The treatment was undertaken in an out-patient clinic, twice a week for the first year and then three times a week, in all for three and a half years. The events of the first eighteen months have provided me with a model for similar pre-interpretative work with borderline children.
Peter was referred at the age of nine and a half by his mother on the advice of his junior school. He was suffering from nightmares and day “horrors”. The family too were suffering from his hyperactivity and provocative behaviour, compulsive whistling, tapping and outbursts of uncontrollable temper; there had been threats to his mother with a knife. At school he was seriously underachieving, unable to read and subject to unaccountable attacks of panic. Their doctor had prescribed Valium but still Peter was hearing chains dragging i