To Analyze or Not to Analyze: The Treatment of a Severely Disturbed Four-Year-Old Boy

This article summarizes the treatment of a severely disturbed four-year-old boy who represents the widening scope of child analysis—a boy whose exposure to an array of traumas undermined his ego development, distorted his object relations, and interfered with his developmental progression. Earlier generations of analysts would have viewed such a child as possessing too many ego deviations or deficits to be considered analyzable. Such traditional ideas about analyzability are at odds with more recent research, however. Thus, Fonagy's and Target's (1996) research found child analysis to be the optimal treatment for children with severe and complex psychopathology. This article presents analytic material that supports this research and demonstrates (1) that severely disturbed children are analyzable and capable of deep and meaningful change, (2) that early intervention is imperative, (3) that an analytic framework involving four or more sessions per week is essential in containing and regulating affect, (4) how functioning as a developmental object helps build the necessary mental structures to experience conflict, (5) that serving as a developmental object does not have to preclude the development of transference or a psychoanalytic process, and (6) that the analyst's gender can play an important role in promoting development and facilitating treatment.