title: Working through conflict with self-destructive preschool children.
abstract: This case history charts the treatment of a preschooler who first presented at the age of three years and ten months with aggressive and self-destructive behaviors. During the initial months of treatment, the therapist focused upon establishing a therapeutic alliance with the child in order to evoke a transference reaction. Compelling evidence of the transference in this case occurred in the ninth month of treatment when the therapist told the child that she would be going on vacation. The child, whose own mother had abandoned him several times, responded with uncharacteristic physical and verbal abuse. Although the child engaged in aggressive and self-destructive play enactments almost from the onset of treatment, these behaviors intensified from the fifth month of treatment onwards, as it became evident that he had entered the working-through phase. Aggressive impulses were shown in his manipulation of toys and other objects, and self-destructive episodes emerged in the child's incessant efforts to jump from chairs and tables, as well as in repeated threats to "shoot" himself with a toy gun. The therapist was sensitive to the child's need to continually repeat and gradually modify these behaviors. She permitted their display without exhibiting shock or alarm, but at the same time, expressed concern for the child's safety and reinforced this concern by setting limits on his unacceptable behavior. Gradually, the child's self-destructive and aggressive tendencies abated. Further evidence that the conflict had been worked through was also seen in the child's ability to express a more realistic assessment of his home environment, one which reconciled the conflict between "good" and "bad" impulses. This advancement in perception was demonstrated by the child's verbal recognition that while his mother was capable of doing "bad" things, she was still his mother and he loved her. Prior to the termination of treatment, both the child's grandmother and teachers reported significant improvement in the child's behavior and linguistic abilities.
authors.affiliation: Cornell University Medical Center, Child and Adolescent Outpatient Department, White Plains, NY 10605.
authors.forename: P V
authors.initials: PV
authors.lastname: Trad
authors.forename: M J
authors.initials: MJ
authors.lastname: Raine
authors.forename: S
authors.initials: S
authors.lastname: Chazan
authors.forename: E
authors.initials: E
authors.lastname: Greenblatt
mesh_terms: D002675:Child, Preschool; D015928:Cognitive Behavioral Therapy; D003220:Conflict, Psychological; D003379:Countertransference; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011613:Psychotherapy; D016728:Self-Injurious Behavior / Q000523:psychology / Q000628:therapy*; D014167:Transference, Psychology