The little prince: psychotherapy of a boy with borderline personality structure

The author describes the history and treatment of a nine-year-old boy who had presented autistic features of withdrawal and bizarre behavior until the age of four and was later diagnosed as suffering from a minimal brain dysfunction. Treatment was recommended because of enuresis, violent arguments, especially with mother, odd interests, fears, dangerous accident-proneness and inability to tolerate physical closeness, and was continued for two years. The therapy dealt initially with apparently typical oedipal conflicts, but interpretations were followed by rage reactions and the emergence of primitive defenses: projection, grandiosity, idealization and depreciation. The therapist was forced into physically controlling the patient's rage, challenging the narcissistic reality distortion and vigorously interpreting the negative transference. Support of the family was secured by monthly joint therapy sessions. Psychotherapy helped the family to resolve a deadlock created by the patient's rages, and helped the patient to progress from a borderline personality organization, with predominance of narcissism and primitive defenses, into a more advanced organization, centered upon masculine identification.