Therapeutic work with a traumatized toddler

This case report describes the psychotherapeutic treatment of a three- year-old boy. At the age of twenty-one months the child was attacked by a dog in the facial area. Symptoms of posttraumatic stress disorder consistent with patterns seen in older children and adults and significant developmental disruptions had persisted up to the time of the treatment. The therapeutic work illustrates the unique contributions that psychoanalytic approaches can make to the treatment of posttraumatic stress disorders in children. It appears to have contributed significantly to resolution of the overwhelming feelings evoked by the trauma, such that the child's development could resume its normal course. The case material highlights a number of therapeutic principles relevant to work with traumatized children and frames a discussion of several current issues in the field. A conceptual framework that delineates the effects of trauma on children according to seven different levels of impact is presented utilizing a psychoanalytically based developmental perspective.