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In the pages that follow, I will attempt to give an account of a case of nonorganic failure to thrive in infancy that richly demonstrates the ways in which environmental stressors, filtered through the parents, find their way into the intrapsychic life of very young children. Because of the unusual proximity of the traumatic events and their subsequent representation in play, Peter's case is a fascinating study of the complex interplay between inner and outer reality and the active role of the child in constructing both, even at a stage in life when he is otherwise quite helpless and dependent. In addition, the case illustrates a three-pronged approach to treatment, in which the three elements are:
Direct environmental intervention: mental health consultation to medical personnel;
Parent support: an active reconstitution of the parents in the parental role, which had been all but overwhelmed by the medical crisis in the family, and strengthening of the infant-parent relationship;
Traditional individual play therapy, in which the internal representations of the traumatic history were expressed and worked through in play and, to a lesser extent, in language.
Peter was 18 months old when I first saw him. He was sitting on the floor outside his hospital room, across from the nursing station. Although a litter of brightly colored toys lay all around him, he neither touched nor looked at them. He sat bolt upright, arms held rigidly away from his body, with a frozen, panic-stricken grimace on his wizened little face. His lips were so chapped that the skin peeled off in huge flakes. His thumb was ulcerated,