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The present paper concerns the treatment of certain severe personality disorders in children most often labelled as ego disturbed, deviational, or borderline. These terms indicate a heterogeneous diagnostic group situated between the neuroses and the adjacent psychoses, psychopathies, and mental deficiencies. The general clinical picture is characterized by disturbed personality traits and interpersonal relations, often with excessive anxiety and neurotic symptomatology. In these disorders unfavorable interactions of constitution and environment cause developmental arrests and aberrations. The ego pathology gradually consolidates and intertwines with internal conflicts on a preoedipal, and partly an oedipal level. Ego disorders emerge in early childhood or latency—usually evolving into the chronic personality disorders, borderline conditions or, less often, the overt psychoses of adulthood (Beres, 1956; Pine, 1974; Weil, 1953a,b).
Ego disturbed children present clinicians with perplexing problems of treatment choice and technique. They are not usually good candidates for classical psychoanalysis since they do not possess the tolerance of frustration and anxiety, the sublimation potential, or the motivation prerequisite for psychoanalytic cure. Even in those cases which do profit from psychoanalysis, the improvement may result from subsidiary, noninterpretive elements in the total treatment relationship. (A. Freud, 1965, 1974). Certain ego disturbed children require a supportive or educational therapy that does not uncover unconscious conflicts. Supportive techniques can stabilize and strengthen the ego by sharpening reality testing, reinforcing defenses, promoting socialization, etc. With very young children educational