Limit setting and projective identification in work with a provocative child and his parents: a revisiting of Winnicott's "Hate in the Countertransference.
Dealing with children who have disruptive behavior disorders can evoke feelings of frustration and anger in their therapists. D.W. Winnicott discussed the complexities in the treatment of enraging patients in his article "Hate in the Countertransference" (1949). In the following paper, I will depict the relationship between limit setting, projective identification dynamics, and enraging behavior in the treatment of a provocative latency-aged boy. I will argue that poor limit setting caused by powerful projective identification dynamics were central to the pathology of the boy and his family. These dynamics partially repeated in the boy's treatment--an outcome of which Winnicott had warned. The repetition contributed to the boy becoming physically out of control in my office and led to a disruption in his treatment. The establishment of solid limits by addressing projective identification forces was necessary for the improvement in the disruptive behavior of the child.
Henry
Charles A
CA
Department of Psychiatry and Pediatrics, Massachusetts General Hospital, 1 Brookline Place, Suite 426, Brookline, MA 02445, USA. charles_henry@hms.harvard.edu
D019958:Attention Deficit and Disruptive Behavior Disorders / Q000523:psychology / Q000628:therapy*; D002648:Child; D003379:Countertransference; D006252:Hate; D049673:History, 20th Century; D006801:Humans; D010287:Parent-Child Relations; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D011584:Psychology / Q000266:history*; D011613:Psychotherapy / Q000266:history*; D014481:United States