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THIS PAPER DESCRIBES THE OFFICE-BASED MENTAL HEALTH treatment of a very frightened 2½-year-old girl who refused to eat solid food. At the start of treatment, she was below the 5th percentile in height and weight. She had been given a diagnosis of Inorganic Failure to Thrive after many doctors had ruled out medical causes for her inability to eat and grow. The doctors had recommended play therapy and the parents reluctantly complied. In infancy, this child had been removed from her birth family due to lack of care and filthy living conditions. She had been placed with this foster family, who hoped to adopt her, and they were quite frustrated with her refusal to eat.
Healing emerged in five stages. In the first stage, starting at age 2 ½, the child was able to use symbolic play to communicate with her mother and the therapist about her intense fear. This work helped the mother to understand the child's lack of compliance as a result of this fear, to provide emotional holding of the fear, and to reassure the child of protection from danger. The mother's increased understanding, holding, and reassurance had two central effects: First, promoting the child's developing an internal representation of a protecting and emotionally holding caregiver so that she could trust the possibility that harm could be prevented and that intense fear could be emotionally held; and second, facilitating her differentiation of current safe relationships from frightening ones rooted in her past traumata, including the abuse by a male relative and neglect of the birth mother who did not feed or protect her.
In the second stage, the child was able to grieve the loss of her birth family and to disengage from internal representations of these frightening and unprotective caregivers. In the third stage, the child was able to use symbolic play to show her mother memories of abuse and neglect. As this play helped the mother to understand the source of her child's refusal to eat, the mo