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A lucid and detailed account of successful work with a severely disturbed four-year-old girl is used to illustrate clinical and theoretical aspects of the treatment method called COR (Corrective Object Relations). It is a psychoanalytically oriented approach to prelatency children with ego disturbances arising from severe oral deprivation due to the mother's pathology, absence, or death. These children were inaccessible to conventional psychotherapy or analysis since they could not establish an object relationship without direct gratification and could not communicate adequately. They are to be differentiated from children with severe ego defects based on organic damage, schizophrenia, or autism.
As the name implies, the technique seeks to provide a corrective experience based on systematic restitution by a constant object (therapist) symbolizing the good mother. An exclusive need-satisfying relationship is set up, regression to the traumatic phase promoted, and then direct gratification of regressive needs provided along with verbal accompaniment designed to facilitate mastery and reality testing. Progressive tendencies are supported as they appear. The regression is confined to the therapeutic situation and is self-limiting. The entire course of treatment is designed to last from seven to nine months, with sessions of one hour a day, four or five days a week. The parents are treated on a less intensive basis.
It is hypothesized that the need-satisfying relationship produces a regression to the oral introjective phase resembling the identification with the primary object and that the libidinal relationship with the restitutive person promotes therapeutic change by facilitating drive fusion, neutralization, greater ego integration, and more favorable ego drive balance.
One of the goals of COR is to prepare the child for more exploratory and analytic types of psychotherapy.