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Miller, J.M. Norman, J. Guignard, F. (2003). An example from child analysis. Int. J. Psycho-Anal., 84(4):809-816.

(2003). International Journal of Psycho-Analysis, 84(4):809-816

The Analyst at Work

An example from child analysis Related Papers Language Translation

Jill M. Miller, Johan Norman and Florence Guignard


Although Julia was born a healthy baby, her long history of medical complications began early. By the time she was 4 months old she had been hospitalized twice due to a stroke and the development of hydrocephalus. A shunt was implanted to repair the disruption of the free flow of cerebral spinal fluid. The doctors were pessimistic about Julia's future but, to everyone's surprise, she made remarkable progress. By 2 years of age it was thought by all that she was completely recovered.

Julia grew into a happy and bubbly toddler. She displayed no observable difficulties and developmentally was on target. For the next two and a half years she continued to do well until she was confronted with five shunt failures and emergency surgeries in fourteen months. When her parents consulted me, Julia, now 5 years old, was in a state of panic, at times hysterical and inconsolable, could not be left alone and was having nightmares. Suffering from cumulative trauma due to the succession of shunt failures, her caring and psychologically minded parents were no longer able to provide a secure holding environment.

The analysis

When Julia began her analysis she was in a traumatized state, confused and disoriented internally, frightened she was crazy and damaged, as well as terrified of abandonment and aggression. Julia's traumas were in the present and, for a time, remained ongoing. In addition, the more recent traumas recapitulated the earlier ones, which Julia had previously mastered, causing them to become an issue retrospectively.

Julia had called a halt to thinking and feeling, trying to remove herself mentally. The work involved disinhibiting her mind with the aims of promoting developmental progression and preventing retraumatization. Themes of loss were pronounced. Julia had lost a sense of herself and had difficulty retaining an internal image of her objects in their absence, in addition to the reality that she could get lost in her environment.

As Julia opened her mind to the experience of her thoughts and feelings, we could begin to differentiate in a clearer way what was her brain and what was her confusion, helping her separate out the aspect of confusion which served as a defense against intolerable affect.

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