Puppet Play of a Psychotic Adolescent Girl in the Psychotherapeutic Process

The play has been considered the royal road to the unconscious conflict of the child. While one may suggest that the neurotic child weaves in his play—as Waelder (1932) phrases it—fantasies around external objects, Ekstein and Friedman (1959) characterize the play of psychotic children as weaving hallucinatory and delusional fantasies around external objects. They stress the child patient's unstable capacity to differentiate objects which serve as play material from internal objects. The psychotic child's play represents the ceaseless struggle between the forces of individuation and identity formation on the one hand, and those which aim toward symbiotic union or symbiotic conflict on the other, a struggle which has been elucidated by Mahler and her coworkers (1952), (1955).

In an earlier paper (Ekstein and Friedman, 1957), it was suggested that the play of children, neurotic, borderline, or psychotic, can be understood in terms of different maturational stages of play activity, along a developmental axis of thinking, the end points of which are impulse release and secondary-process reality-oriented thinking. We referred to Freud's (1911) famous dictum according to which thinking is trial action, and suggested that acting out be considered a form of trial thinking, a form of experimental recollection. We related the different forms of play to action and acting out, to a form of unconscious trial thinking. The attempts to resolve unconscious conflicts can be ordered along the above-mentioned