From Interactions to Mental Representations: Psychodynamic Parent — Infant Therapy in a Case of Severe Eating and Sleep Disorders

This paper describes the process of psychodynamic psychotherapy with an infant and his family, during a developmental phase in which the infant's mental organization was in transition from the level of interactions to representations. The treatment of a 23-month-old boy suffering from a severe sleeping and eating disorder was initiated in a parent — child psychotherapeutic setting. The sleep disorder was a consequence of separation anxiety. Additionally, phobic avoidance of new oral experiences led to an eating disorder. These symptoms had developed in the context of dysregulation of the triadic family relationships (mother—father—children), which tended to split into two-plus-one relationships. After one year, the setting was changed to alternating individual and family sessions. Due to his developing symbolic capacities, the boy was able to express his inner concerns and his internalised affect-laden experiences through play and actions. His internal world could now be addressed by interpretations. New psychodynamic theories and research results on early triadic development were taken as the theoretical background for the psychotherapeutic work. We understood the course of the treatment and the development of the transferencel countertransference relationships in terms of processes of triadification (at the level of interpersonal relationships) and triangulation (at the level of intrapsychic representations).