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Mittelmann, B. (1957). Motility in the Therapy of Children and Adults. Psychoanal. St. Child, 12:284-319.

(1957). Psychoanalytic Study of the Child, 12:284-319

Motility in the Therapy of Children and Adults

Bela Mittelmann, M.D.


Skeletal motility is a significant means of pleasure seeking and of reality testing and integration throughout life. It is one of the dominant functions in these areas, beginning with the second year of life, for several years. This period is further characterized by increase in self-assertion along with continuation of dependence on the environment, increase in motor aggression, imitative identification, predominantly motor communication with the environment, readiness to translate impulses into action, and certain affectomotor (expressive) patterns. In addition to being a function in its own right, skeletal motility is significantly connected with all other physiological and psychological needs and impulses, particularly with self-evaluation and self-determination. Skeletal motility with its psychological concomitants has its characteristic vicissitudes. Among these are motor anxiety—for example, fear of high places—anxiety and rage in response to restriction, ready inhibition of new skills in response to fear and pain and disapproval and, as a result, fear of motor retribution and abandonment, and guilt and self-injury. Conflict solutions are: incomplete (and primitive symbolic) action, reaction formation, increase or diminution in motility, and regressive action.

Motility is one of the significant areas of function to be systematically explored in therapy, like orality or genitality. Its disturbances may arise either from traumata directed at the motor function directly or through the expression of other motivational conflicts in the motor area. The utilization of motor data, comprising observable manifestations, motor memories, and dreams, contributes to the effectiveness of the treatment of both children and adults. While in children as a rule the observable manifestations predominate, in most adults the predominantly verbal communication and interpretation of these data are effective. With some patients, their motor behavior, gestures, symptoms, motor elements in dreams and fantasies, and motor memories need to be interpreted and carefully worked through

for full therapeutic effectiveness of the analysis. In disturbed schizophrenics the interpretive utilization of symbolic action is indispensable.

The most frequent situations to be dealt with in therapy are: (1) restriction of freedom of motility; (2) awkward motility. Restriction of freedom of motility in infancy may be based on external conditions or considerations of health and may have massive psychological consequences. Restriction in childhood, particularly in boys, may be a result of rivalry with or fear of parents, particularly the father, or may result from (mostly) the mother's anxiety over possible injury to the child. In either case the resultant disturbance may have a strong genital element (castration). Awkward motility usually is a consequence of a mixture of congenital and psychological factors and results in a disturbance of self-evaluation. Motor traumata may have a crucial significance in the development of neurosis and psychosis.

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