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Fraiberg, S. (1962). Technical Aspects of the Analysis of a Child with a Severe Behavior Disorder. J. Amer. Psychoanal. Assn., 10:338-367.
(1962). Journal of the American Psychoanalytic Association, 10:338-367
Technical Aspects of the Analysis of a Child with a Severe Behavior Disorder
The analysis of this behavior disorder reveals in specific ways how the aggressive and destructive behavior was employed in the service of defense.
In tracing the motive for a destructive act we saw very early in the analysis how a fantasy in which the child was in extreme danger was translated into an action in which the content of the fantasy was reproduced and the ego spared itself anxiety through identification with the aggressor and through a shift from passive to active. (As in the first dream reported by Roger, the fear of castration by the faceless man was immediately translated into an action in which the child performed the symbolic destructive act upon objects in the room.) This defense served painful memories as well as fantasies. When primal-scene material emerged in the analysis, the memory of an act perceived as destructive, and as "fighting, " was translated into aggressive acting in which destruction of objects and fighting was re-enacted and that which was passively experienced through observing and overhearing was transformed into action. Ultimately, the great danger against which the ego defended itself was loss of identity. The extreme negativism and obstinacy that characterized another aspect of Roger's behavior disorder was seen as a fear of surrender to the object, the fear of becoming one with the object(2).
The connections between the masturbatory fantasies and impulsive acting provided insights both into certain forms of erratic conduct and the role of isolation of affects in the behavior disorder. Anna Freud(1) has brought our attention to a form of social maladjustment that can be traced back to the complete suppression of phallicmasturbation and the consequent acting out of the masturbation fantasies: "… the masturbation-fantasy is deprived of all bodily outlet, the libidinal and aggressive energy attached to it is completely blocked and dammed up, and eventually is displaced with full force from the realm of the sex-life into the realm of ego-activities." In Roger's analysis it could be demonstrated
that he periodically abandoned phallicmasturbation under pressure of castrationanxiety and in the erratic and apparently unprovoked periods of acting that followed we could trace a masturbatory fantasy.
But Roger also illuminated for me the process that led to abandonment of masturbation at certain times. On many occasions there was no evidence of a conscious struggle against the urge to masturbate. (The child who fights the urge to masturbate reveals the struggle in defense and resistance in analysis. The argument between the urge and the prohibition is seen in moral ambivalence, self-punishment, self-imposed taboos. He reveals the struggle in transference by identifying the analyst with the repudiated temptations and often behaves toward the analysis as if it were a bad habit that must be broken.) Through Roger I came to understand that at certain times when masturbation was apparently given up he lost "the good feelings" in his penis. His own description of this, in a period of the analysis that I have not included in this report, went as follows: "But my penis doesn't feel good when I touch it. It doesn't feel not nice, either. Not good and not bad. Nothing." In other words, anesthesia took place, probably on a hysterical basis, and masturbation could no longer evoke phallic sensations. Masturbation was then given up, not as the result of a struggle, but because of the loss of feeling and the inability to have sensations in the penis. The fantasies which had lost their connections with masturbation were now acted out, following the pattern described by Anna Freud.
One further connection is suggested in the acting out of the masturbationfantasy. In the earlier association of the fantasy with the act of masturbation, the fantsy was "made real" by the accompanying phallic excitations. (Another child once said to me, "The stories are more realer when I'm playing with myself.") I have wondered, then, if one of the elements in the acting out of the masturbatory fantasy is the attempt to make the story real through enactment, to recover the lost excitement, and to animate the fantasy gone dead with the penis. And since the fantasy had once served to excite the penis, is acting out also a magical device to bring back the lost feelings in the penis?
The most important part of the analytic work was that which
dealt with the defenses against affects and it was here that analysis encountered its strongest resistance. The absence of anxiety and guilt which distorted the early picture of the behavior disorder was seen finally as the achievement of the most elaborate defenses against affect. By identifying with the aggressor and by switching from passive to active, the ego escaped both anxiety and self-reproach. The simultaneous acting out of libidinal and aggressive fantasies and the provocation of punishment spared the ego the necessity of experiencing guilt. The isolation of affect which proved to be the most formidable resistance of all, served many purposes in the mental economy. The barely disguised oedipal fantasies and castration fantasies were rendered less dangerous by depriving them of affect, making them "not real." Further, by maintaining guilt and anxiety in isolation, Roger was able to enjoy masturbation and its attendant fantasies. We saw that each time analysis re-established the connections between fantasies and affects the anxiety experienced by the child was nearly intolerable.
The analysis of the transference resistance in the last period of treatment shed further light on both the libidinal and ego aspects of the active-passive conflicts in which the behavior disorder had been rooted. Both the passive longings for the father and the defenses against these wishes were revived along with anal masturbation. The fight with mother over bowel training which had extended well into the fourth year was re-enacted in transference along with castration dread. The negativism which had been one of the primary defenses and one that had served resistance throughout the analysis was seen as a defense against the danger of passive surrender to the mother, the "fear of loss of personality" as Anna Freud put it.
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