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Ornella Caccia is one of the first Italian child psychotherapists to have trained, almost thirty years ago, at the Tavistock Clinic in London. She now works in private practice and teaches in Rome where she lives. In this paper she introduces a new technical approach in child psychotherapy. The paper addresses an important question; Caccia argues, based on her lengthy clinical practice, that the usual technique of addressing the child's deepest anxieties has not proved helpful in changing the child's cognitive confusion. In her quest for a more appropriate technique, Caccia begins by drawing upon the psychoanalytic concept of the combined object, as the foundation of the capacity of the infant to maintain a good balance between love and hate, so that the desire to know (Bion's K) can prevail. In normal development, the mother represents a combined object, an object who can listen, understand, make links for her infant (maternal function) but also an object that places limits and is not traumatized by her infant's negative emotions (paternal function). When this is not the case, the child will not be able to develop a realistic concept of an object with good and bad qualities, instead excessive splitting will take place, and the child will conceive an object either as all good or all bad. Money-Kyrle links cognitive confusion with failure of integrating an object with good and bad qualities, recognizing that emotional confusion gives rise to cognitive impairment. Caccia provides a good literature review of the combined object from Klein, Bion and Meltzer.
Caccia believes that analysis can become a corrective experience that modifies emotional disturbance. She links the concept of a combined object with Money-Kyrle's preposition, and imagines an analyst who is required to perform, beside the maternal function, what she calls ‘the paternal reality principle’. This is an active technique according to which the analyst is engaged in discussing, with the child, his cogniti