Reality approximated, external and internal

Some of Heinz Hartmann's theoretical formulations concerning the adaptive functions of the ego are described as they apply to the case of a patient analyzed between the ages of five and eight. This boy, vulnerable because of prematurity, was born at twenty-six weeks weighing 2.7 pounds and remained in the hospital newborn unit for sixty-six days. Difficulties and vulnerabilities resulting from this experience are discussed as they appeared in the analysis.