Observations on the Psychotherapy of Borderline and Psychotic Children1

In a previous paper (1954) we reported several observations regarding the ego psychology of borderline and psychotic children. We described the fluctuating availability of different ego organizations in these children, ranging from psychotic manifestations to advanced achievement appropriate to chronological age. These observations have various implications for psychotherapy. In this paper we shall attempt to examine some of the technical problems of interpretation which arise in the treatment of these children. Furthermore, since our primary goal is the enrichment of clinical skill, we shall describe some technical modifications which gradually took shape in accommodating to the particular ego attributes of these clinical groups.

We may take the well-known story of Hansel and Gretel as our common point of departure. For the psychoanalyst and the small child, the fairy tale of Hansel and Gretel is a story of conflict which gathers dramatic strength as it moves regressively from one level of ego organization to another. The mother image in the fairy tale appears in at least two successive guises: first, as a stepmother plotting to banish the children and separate them from their loving father, and later as a witch inside a candy house who means to devour them. Thus, the story follows a regressive pathway in developing the theme of the rejecting and vengeful mother figure, and the children's attempt to master this threat. For it retreats from secondary-process thinking, moving from the suspiciousness of the children at the outset to the paranoid projection of the devouring witch. In libidinal terms, the dominant oedipal and phallic elements in the stepmother figure give way increasingly to primitive,