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Wilson, P. (1988). The Psychoanalytic Treatment of a Boy Dominated by Omnipotent Fantasies. J. Child Psychother., 14(1):13-31.

(1988). Journal of Child Psychotherapy, 14(1):13-31

The Psychoanalytic Treatment of a Boy Dominated by Omnipotent Fantasies

Peter Wilson

Introduction

This paper gives an account of the 3½ year analysis of a latency-aged boy whose bizarre and restless behaviour, excessive self-preoccupation, and inability to tolerate the demands of the external world carried many of the hallmarks of a narcissistic disturbance. John's immersion in grandiose fantasy and his imperative demand that I be part of this fantasy were the most striking features of the analysis.

Initially, I focused on the content of his fantasies, with particular reference to primitive anxieties of annihilation and self-dissolution. Later, I learned to pay greater attention to the nuances of the particular kind of relationship he created with me — accepting his implicit requirements that I be part of his experience, yet noting and exploring his consternation and rage in the face of inevitable disappointment and discontinuity.

Kohut's concept of the grandiose self, with its demand for admiration and control, and of the narcissistic mirror transference were of especial relevance in following this case (Kohut, 1968). The provision of an affirming primary experience, the containment of narcissistic rage, and the interpretation of anxiety in terms of John's narcissistic vulnerability were crucial. This paper gives an impression of the therapeutic experience and approach and offers some evaluation of the effectiveness of treatment.

Referral

John was referred for psychoanalytic treatment at the age of 5½. At that time he was on the point of being excluded from his infant school.

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