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In his article, “To Analyze or not to Analyze: The Treatment of a Severely Disturbed Four-Year-Old Boy,” Scott Boles calls attention to the need of child and adolescent analysts to conceptualize analytically the problems of severely disturbed children, especially those under five years of age, and to devise methods to analytically treat these children.
Dr. Boles is correct to point to the work of Fonagy and Target (1996) as a pivotal article in helping child and adolescent analysts appreciate the power of the analytic method in helping the more disturbed young children. As Boles states, the work of Fonagy and Target helps analysts understand that in severely disturbed children the “early compromise of a child's mental functioning has a cascading and negative impact on future development. Early psychoanalytic intervention, however, provides the child's mental processes with an opportunity to receive the intensive, interactional input necessary to undo them and free up the developmental process.”
The question, of course, remains: How does a child analyst help young children with compromises in their ego functions, or to use the language of modern cognitive-neuroscience, compromises in their executive and other cognitive functions, including their language, inability to delay gratification, attention difficulties, and mood disturbances, including compromised affect regulation.
I am very grateful to Dr. Boles and very fortunate to be able to study this careful analytic work with Sam. The aim of my discussion is to highlight a few aspects of the case to develop hypotheses about which kinds of interventions seem to be helpful and which seem to be less helpful. Can one develop some general clinical hypotheses from this detailed analytic material, including hypotheses about clinical interventions which may be generalizable to other populations, in particular, severely traumatized older children and adults?
I show that this clinical case discussion illustrates two important prin