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DISCUSSION: Dr. Manuel Furer saw in Dr. Winestine's work a creative combination of the ideas of Aichhorn, Loewald, and Mahler. However, he disagreed with the position taken by the author. He suggested that the primary trauma was the mother's depression, as well as the various losses and rejections the child was confronting. A central conflict such as this can serve to organize ensuing traumata; thus the accidental fall down the stairs was significant because it fit in with a central conflict. Although the first phase of the therapy was more in line with usual psychoanalytic principles, it nevertheless was colored by the author's bias. This bias is, of course, explicit in the second phase and forms the main thesis of her paper. Dr. Furer was unable to see that a change in technique was indicated and maintained that a consistent and persistent interpretation of the various manifestations of the patient's conflicts remained the best approach.
Dr. Theodore Shapiro asserted that when one writes such a case report, the material is ordered according to what one knows, e.g., according to a set of preconceived cognitive organizations known as theory—the theory in this case being Dr. Mahler's separation-individuation theory. This theory is used by Dr. Winestine in her work to complement the usual classical analytic mode and is especially evident in the phase of the treatment where she attempted to foster the building of structure and the overcoming of developmental arrests. Dr. Charles Brenner's concepts on the difficulties of distinguishing between preoedipal and