Self-pathology in childhood: developmental and clinical considerations

The conceptualization of childhood psychopathology is greatly aided when the stability and cohesiveness of the self are used as overriding points of orientation in the organization of clinical data. In children, self-cohesion, which is experienced as vigor, enthusiasm, and pleasure in the body-mind-self, depends on the phase-appropriate responses of the environment to the child's narcissistic developmental needs: mirroring and merger with the idealized selfobject. Since these selfobject responses depend on the empathic capacities of the child's psychological environment (primarily the parents), the development of parental empathy and the vicissitudes of its maintenance have been given special emphasis in this paper. The diagnosis of self-pathology in childhood has far-reaching consequences for the treatment of the child and his psychological environment. Recognizing the parents as selfobjects provides a conceptual bridge between the intrapsychic and the interpersonal in the treatment of children whose self is still in the process of evolving in relationship to their psychological environment. The active involvement of the parents in the treatment of a young child is supported by the now repeatedly made observation that patients who establish selfobject transferences in the course of their analyses are able to utilize the analyst's selfobject functions for belated structure building by the transmuting internalization of these functions. During childhood this structure-building potential can be remobilized within the child's own psychological environment. The clinical vignettes were chosen from the three representative age groups in childhood: preschool, latency, and adolescence. These vignettes were not intended to demonstrate "typical" manifestations of self-pathology at the various developmental phases. Rather, they were intended to demonstrate that the theory of the self as it develops within its psychological (selfobject) environment provides the child therapist with a theoretical tool which facilitates the understanding of those psychological conditions which- on a depth-psychological rather than on a descriptive level-could not readily be categorized either as a neurotic or a psychotic conditions. Since parental empathy is the sine qua non for the execution of parental self-object functions, the remobilization of these functions will depend on the parents' ability to become empathic toward the now symptomatic child. This may require the treatment of one or both parents, since this capacity cannot be "grafted" onto the parents' personalities: these are capacities that have to become the expressions of their own nuclear self. Parental selfobject functions are active functions and have to be differentiated from the processes of identification...