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In this paper Ekstein discusses the specific countertransferences encountered in therapists working with severely disturbed or psychotic children, and the reflection of these countertransference attitudes in the supervisory situation. He suggests that child psychotherapists usually overidentify with their parents, which makes the therapists natural enemies of the parents. This, however, may not be inherent in the child psychotherapist but, rather, stem from the special technical task. The necessity for active work with the parents—different from the work one does in adult psychotherapy—presents special problems for the child psychotherapist. He deals with the infantile neurosis not as a repetition of the past but as a present reality. He may think of help for the child as a rescue mission, and of himself as a miracle worker. The psychotic child, unlike the mildly disturbed child, has not achieved the capacity for object relationship; there exists a symbiotic or fusion state which is reflected in the autistic position. The psychotic transference configuration, in which mother and therapist are not truly separated in the child's mind, increases the countertransference potential.
Ekstein believes that countertransference, if understood and dealt with, can be taken as a cue and can help us to understand the patient. The child's regressive behavior provokes the therapist's regression to a very early stage in his relationship with his own parents; his special parent-hating syndrome frequently will be reflected in the use he makes of his teachers, administrators, the clinic, or the hospital. Further, the supervisor or administrator in the field of child psychotherapy sometimes brings his own special problems to the treatment situation, problems not unlike those of the parent of the sick child. The powerful countertransference reactions provoked by the psychotic child are expressed in impossible demands on the supervisor for emergency help, for advice, for his play