**6. Child analytic case**

Now I want to describe a vignette from an analysis of a 3 ½ year old boy, whom I call Patrick1 :

Patrick's parents came to see me first as a family in a parent-infant psychotherapy for 5 sessions. It was clear that Patrick needed a longer therapy so the parents agreed to an analysis for him. He had nightmares and they had to wake him up to help him stop crying. He had fits of rage, and was an outsider in his playgroup. In the transference to his analyst the same patterns that he has towards his parents are developing. Patrick's parents had not described any unusual experiences with their child although he woke up almost every night screaming and in panic. With Patrick it was his kindergarten teacher who drew the parents' attention to his emotional difficulties.

In the first assessment Patrick showed me his chaotic inner world, turning the playroom with cruel destructiveness and sadistic pleasure into a messy world in which he had no hope of making himself understood. For me, the analyst, it felt like a massive attack and I could hardly believe what I saw when he destroyed the brand new colored pencils. He deliberately and violently broke off the tips of the pencils, then throwing them around the room, then stamping on them. I tried to transform his projections of beta-elements into words, to show him how desperate he was and that he wanted to push these unbearable sensations into me. I suggested to him that he wanted to show me how easy it was to make useless broken pencils out of the beautiful new pencils and that he perhaps felt broken himself. When he continued I told him that he was convinced that I would turn away from him and he would not be allowed to come back. Then he stopped. As if accidently, he touched my legs with his body by standing close to me, leaned trustingly on my leg. I told him that this was his way of showing me that he felt touched by my words. He looked into my eyes so that I added, "Now you feel understood" and told him that he could come three times a week and he nodded.

Now I shall describe a session at the beginning of Patrick's second year of analysis, where the fine structure concealed behind his apparently unmotivated destructivity and the special quality of Patrick's relationship to his father became visible. Here some vignettes from a therapy session:

*First, we were two fishermen with fishing rods fishing small fish. Then he became aggressive demanding that I shout at him: "Dirty Patrick, he makes his pants dirty". When he was unable to do something, he said "crap"; when he gets excited, he quickly had to use the toilet. Later he played to be the little baby who needs his pants to be changed; he wanted me to be the father who did it. With enthusiasm he was the little baby, lying down (wanted to pull down his trousers what I stopped) I should say: "Lift your bottom", what he did pretending to put some paper towel under him as if it was a diaper. Then I should put him to bed as his father did. When I asked: "Where is the mother", he answered: "She is dead". After a few moments – in the middle of the night he climbed out of the bed. I was told as his father I should find him, shout furiously at him and beat him. This game was very intense. Patrick was not contend with my simulation of beating with without touching him. He became excited, took my hand and showed me how to do it saying: "You have to hit me hard, much harder!" Since I did not do this, instead expressing verbally how I (as his father) was furious with him, he began to hit himself with his own hand. "That's how to do it," he said.*

<sup>1</sup> The case of Patrick is described in full in my book *The Early Years of Life* [22].

#### *Is the Death Instinct Silent or Clinically Relevant? From Freud's Concept of a Silent Death… DOI: http://dx.doi.org/10.5772/intechopen.94444*

In his play Patrick shows the persecutory quality of his paranoid-schizoid feelings. He put me in the position of the sadistic father who clearly wants this punishment and denigration of his son. The pleasure of both of them was clear. Both of them are stuck in these intense sado-masochistic struggles. He wants to repeat them again and again. For the analyst, it is difficult and shocking to feel these feelings in him/her in the countertransference – but as Bion said: "If you cannot bear the heat, refrain from the kitchen." ([23], p. 40). In many sessions, Patrick demonstrated how successfully he upset both himself and his father, drawing his father into his cruel fights. He is part of a couple consisting of a man and a by – a homosexual couple - who were bound together in a pleasurable yet intimately cruel way. The child was in control: Patrick knew he could provoke his father into a state of extreme rage and complete helplessness. That was very satisfactory for him. My aim was to make him aware that he was the active agent in this. Or Patrick could provoke his father by doing the opposite of what his father wanted him to do, or pretended not to hear him. In a role play, he showed me how he could do this. He wanted me – as the child - to come and told me I had to pretend not to hear him. Then he as his father got furious and screamed "Don't you hear me?". I could feel the power to provoke him to get so furious. Sometimes he sat in the car ready to drive off, and I as the child was supposed to hesitate to get into the car. Then he really seemed about to drive away to threaten me as the child. I then had to scream in horror and run after him in panic. He showed he enjoyed this power game even to the extent of manipulating his father into acts of violence.

In the following discussion with the parents, the father said to me that he had asked his wife to take care of all disciplinary questions with their son. Patrick now loved to build houses with his sister, including the father in the role either of mailman or policeman. The parents were impressed by all the changes in Patrick, fits of rage had completely vanished; in kindergarten, in his play he showed more ideas and fantasies than the other children. It was important to allow him to continue his analysis to stabilize his inner development. He now loved to go to the playgroup. Visibly moved, Patrick's mother described how he could talk about his feelings. She also could discuss and explain what decisions she and his father had made. Once Patrick came to her, put his arms around her neck and said, "Mommy, I love you"; that was the first time this had happened. He could also part from her without crying.

In these brief vignettes, I tried to show how useful Bion's concept of containercontained is. Elements of destructiveness and jealousy emerged continually with Patrick, where he spat on me, tried to kick me or to tear the spectacles from my face in a fury and wanted to break them. I always had to be on guard to protect him and myself. However, he gained more control over his aggressive impulses. When I could understand his changing moods and connect them with his experience, he got softer and more sensitive; he even put his head in my lap as if he wanted to go back into mother's belly. As a very distressed child he showed his inner conflict in a concrete way, often wanting me actually to perform the same cruel punishment and mockery as he provoked his father into doing. Patrick learned from emotionally experiencing his analyst able to take in his projections, suffer their impact, and put them into words. Pursuing the emotional truth even in very disturbing areas – as clinically visible expression of the death instinct – enabled him to acquire a knowledge that enriched his personality.

The advantage of working with children as young like Patrick is that they still show their aggression in a concrete and obvious way and show by their reactions whether they take in the interpretation of the analyst – stopping the destruction as soon as they feel understood. Then, it is not any longer necessary to show their aggression in this way and we can explore the deeper anxiety behind it. With adult

#### *Psychoanalysis - A New Overview*

patients the aggressive wishes are mostly covered by a strong defense system. Now I shall show how an adult patient struggled to accept his aggressive and murderous wishes which were so vividly manifested in his dreams. In the session we observe the same struggle against understanding in the inner world of the patient, who attempts this with all means- mainly by massive projective identification, pushing these feelings into another person, his ex-wife or his analyst. In one dream he shows his aggressive side which is envious of his new baby.
