Working through Conflict with Self-Destructive Preschool Children

This case illustrates the emergence of a transference relationship and the working-through of conflict in a black preschool boy referred because of disruptive behavior. The child’s preoccupation with violence was manifested through aggressive and self destructive impulses. Auditory hallucinations and a diminished attention span were also evident. These symptoms occurred in the context of an abusive home environment and neglecting mother. After approximately two years of treatment, the child’s problematic behavior patterns receded. The therapeutic alliance evoked transference and countertransference phenomena that helped clarify the nature of the patient’s conflict and facilitated the working-through process. The working-through was characterized by numerous repetitions in the form of physical enactment and fantasy. The therapist’s empathic approach provided the child with a new object, different from the rejecting parental object. Finally, sensitivity to the child’s developmental status enabled the therapist to design strategies appropriate to the child’s maturational level.