Middle-Class Waifs. The Psychodynamic Treatment of Affectively Disturbed Children: By Elaine V. Siegel. Hillsdale, NJ/London: The Analytic Press, 1991. 263 pp.

This book is an impassioned treatise on the psychodynamic treatment of children. Siegel focuses on children she calls "middle-class waifs"—middle-class children referred because of inability to learn in school, grossly disordered behavior, and stark unhappiness. She presents twelve cases, organizing the presentations into five groups—Children Who Don't Accept Their Gender, Children Who Have Been Exposed to Adult Sexual Play, Children Who Have Been Beaten, Children Who Have Suffered Sexual Abuse, and Children Who Live Behind and Emotional Mask. Siegel has chosen an interesting subject, which she presents in generous clinical detail. I admire her dedication in working effectively with children others have written off as hopeless. I also have some questions to raise about her view of therapeutic process with children.

Siegel intersperses her clinical accounts with references to relevant literature, primarily psychoanalytic, but also psychiatric and pediatric. Freud influences her in a complicated way. She invokes Freud's theory of stage-specific conflicts inherent in development, as well as the inevitable identificatory conflicts inherent in bisexuality. In light of her patients' histories and symptoms, Siegel is also quite interested in Freud's idea of a stimulus barrier and the serious psychological consequences of excessive stimulation, both sexual and aggressive. She cites Shengold's account of his work with adults who suffered similar experiences, again with a focus on the sequelae of overstimulation. She reviews some of the literature on the incidence of sexual and physical abuse of children, and she also