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Anne Alvarez: Since you changed your approach, he is really bringing you his problems, and so the material is much less perverse; it is much more disturbed. This is a lovely development.
Laura Kleinerman: More recently, perhaps, he is able to show in an expressive way more of the worst of his feelings, like the (narcissistic) injuries from his classmates, and the experience of his unguarded “badness” when he was hitting me the previous Thursday.
Carole Grand: There are important diagnostic considerations; one feels differently in relation to a child in the range of Pervasive Developmental Disorder (PDD), or one who is schizophrenic. Maybe Anne Alvarez would address the dilemma of the different ways of thinking about children—and adults for that matter.
Anne Alvarez: I do want to talk about that, because the work is beautiful; the sensitivity and perception about what is going on is absolutely right. I do think, however, you're still using what you've been taught too much; it is what we've all been taught which is the psychoanalytic level of work with neurotics. Let's go through the session looking at it from that point of view. I think he is not neurotic. There is PDD there, and there is this slightly Asperger-ish quality, but mostly in the earlier phases of treatment, not so much here in this session. Here he is much more like a borderline patient. The psychopathic quality has also receded. It comes back at moments, with all this grandiose raping of the mother's bag, but mostly here he is more disturbed and very borderline. I think there are a number of technical things you could fine tune a little. You can see the developmental level he's at when he says, “I don't know how to get linked up to people like the key with the lock, but I'm beginning to get an idea that you're the thing I want.” The