Ego Disruption in an Abused Little Girl

This is the story of the treatment of a little girl I shall call Taylor. When I met her she was just 5. She did not know how to pretend, but played mechanically, in a way that was deeply boring. Nothing in her games happened in an order that made sense to me, and Taylor did not seem to notice that sometimes the dolls ate breakfast before they went to sleep or arrived at school before they got into the car. She liked to line up and sort the toys but could not communicated the basis for the categories. Taylor did only what she wanted, but she also wanted to know and perform what would placate the grownups. The puzzle was to understand the meaning and aetiology of this appearance of profound dissociation and to help Taylor achieve integration of her developing ego, so that it might effectively mediate between her impulses and the outside world.

But the outside world had already impinged inappropriately on Taylor. Working with children can be very unlike our frequent predicament with adult patients, who remember or suspect abuse in their past or whose treatment uncovers such a possibility. With Taylor, the facts were clear that her history contained numerous evidences of abuse of different kinds. So at the start we had definite information on the one hand and, on the other, a child who was not functioning adequately. One of the tasks of evaluation and treatment was to understand the connections between Taylor's history and her current functioning. We knew much of what had happened to her, but we did not