The Development of a Preschool Symbiotic Psychotic Boy

In Malcolm's case, therapy was begun by bringing the child from his withdrawn state into a primitive relationship with the therapist as a need-satisfying object, chiefly through her communication to him of her empathy with his needs and their gratification. At the same time, she became a part of his omnipotent dual unity. Gradually she helped him to organize his experience and to explore reality, in this way fostering the libidinal cathexis of herself. A previously static state in his psychosis, liked to the resting place of Winnicott's transitional experience, and in the mother-child relationship which was

reflected in the therapist-child relationship, was altered and progressive changes ensued. When we first saw him, he was already capable of delaying, of interposing thought and fantasy between instinctual pressure and discharge, and showed some organization of his psychic life, at least in the preoccupation with the "psychotic fetish," which in his case were the edges of inanimate objects. However, there appeared to be a profound disorganization in his instinctual and affective expressions. Gradually, however, his reactions became more differentiated and understandable to observers, when he began to show aggressive responses to frustration and libidinal responses to gratifications from the therapist and mother. There were indications that the human object had become invested, though self and object seemed not yet to be distinguished. Despite this lack of complete differentiation, a coalescence of memory traces of separate object images and a separate self image took place. In this period the child's previously chaotic behavior became better organized and we saw a flowering of life and interest in the "transitional world," which now included the human object, and the appearance of a variety of understandable symptomatic behavior.