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This essay presents a very clear rationale for the adaptations of technique necessary to accomplish intermediate aims and strengthen the therapeutic alliance, on the way toward achieving the long-term aim of intrapsychic structural change. Such carefully thought out adaptations have evolved from a broader model of development influencing our understanding of process and outcome. Child analysis has contributed much, though such adaptations are also central to analytic work with more disturbed adults.
Intermediate aims are tailored according to each child's stage of cognitive and ego development. But also, since few patients have only a clear-cut childhood neurosis, the intermediate aims can address developmental lags and distortions, an admixture of interpretation and ego support known as "developmental help." Two very interesting examples are given of this delicate and sensitive process—with a four-year-old boy who first needed help in feeling safe, and a sexually promiscuous adolescent girl who needed some response to her affectional needs and fragile sense of self. This could then be followed by more thorough interpretation of unconscious conflict and defense.