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This paper is principally intended as an account of the main events in a psychotic girl's psychotherapy. I saw her twice-weekly for eighteen months starting from the age of ten and a half years and finishing a few days after her twelfth birthday, when she reached the upper age limit of the hospital and had to leave. From the material I will describe certain ‘rules' which governed the girl's experience of life. The nature of these sometimes led her to seek refuge by withdrawing from the outside world; at other times they left her too unsafe to be able to learn or have the freedom to develop or change her ideas. These ‘rules' were manifested in her use of various items such as her body and its sensations, sticks, paper models and also in her variable ability to feel safe in having any form of relationship with me. The ‘rules' changed and what I wish to present here are some of the ways these changes showed themselves. The most comprehensive and helpful material from the literature in formulating this account were those of Meltzer et al (1975) and Tustin (1981).
A second issue, which I address more briefly is the contribution psychotherapy can make where there have been problems of diagnosis. In a description of the institution in which the child presented here was being treated, G. Stroh (1974) give five diagnostic categories for the children admitted to the hospital. These are: childhood autism, organic with autistic features, schizophrenia, traumatic psychosis, ESN psychosis. His use of the first three categories is identical with the description in “The International Classification of Diseases (1978)”, but he defines the latter two within his own frame of reference. They share with the other groups severe pervasive developmental disturbance, bizarre symptomatology and grossly impaired relationships but are differentiated on the basis of history and progress in treatment. The characteristics of the traumatic psychosis group is that their disturbance is as