The Mother as Therapist, in a Case of Obsessional Neurosis

This is a description of the case of a boy of four and a half years, suffering from a fairly severe obsessional state. It has been selected because it presents interesting features from the technical, theoretical and clinical points of view. Although the mode of treatment was not one of choice but arose out of necessity, yet the results are so good that it invites consideration, in its own right.

Unlike the majority of mothers who attend child guidance clinics, this child's mother was free of any marked neurotic disturbance. For these reasons, and because there was no early vacancy on our treatment waiting list, it was decided to use her as a therapeutic intermediary between myself and her son. The work was conducted at the East London Child Guidance Clinic. Since the War, it has been reopened as a department of a hospital, namely the London Jewish. As all hospitals are now the property of the State, this case chances to be the first recorded of nationally provided psychoanalytic therapy. Our Clinic's psychiatric and therapeutic personnel is all psychoanalytically trained, and it is still the only hospital staff to be so. In contradistinction there are a few other child guidance clinics which are psychoanalytically orientated, but they do not form part of the medical services of a general hospital. Among these are the three clinics founded by the late Dr. Kate Friedlander.

The type of work described in this article is atypical for our clinic since most of the suitable cases receive treatment at the hands of the therapists. This is either of an "intensive" or "short" nature; i.e., four or else one session weekly, depending on the circumstances. It is also customary with us for the same therapist to interview the mother of the child as often as she considers necessary. Owing to the pressure of clinic work it was not normally possible to see this mother more often than fortnightly except during "crisis" phases of the treatment, when she was seen weekly. Duri