Kerry Kelly’s report is of the successful psychoanalytic treatment of a 4-1/2–year-old precocious child. Functioning at 2–3 years beyond her chronological age in many areas, she developed sleep difficulties, refused to read or write, and began to wet herself day and night. Her parents were psychologically deeply disturbed individuals unable to gratify each other in their marriage. Instead, focused on their daughter, they got great pleasure from her precocious accomplishments but were unable to nurture her more age-appropriate childish needs. The child’s own self-criticism and high expectations caused feelings of intense inadequacy and poor self-esteem.

The clinical material is divided into four phases: oral, anal, phallic, and terminal. It provides an excellent example of how psychodynamic/ psychoanalytic play psychotherapy works. In the sessions, the child acted out her unconsciously repressed wishes and conflicts and was allowed an opportunity to express her emotions freely. The patient used the therapist to act out different versions of important relationships while the therapist, at times, interpreted different levels of the unconscious meaning of these relationships as well as gratified some of the patient’s basic needs. In this process, the patient found healthier solutions to painful conflicts—no longer needing symptoms to express herself. Of particular interest is a discussion of how psychoanalysis helped this young patient express her childish needs while simultaneously retaining her precocious level of functioning.

Psychotherapy of Children

William Dahlberg’s case report is of the successful treatment of a profoundly gifted 9-year-old boy who entered psychotherapy because he had become suicidal and homicidal. Dahlberg’s approach is a flexible one: Both parents, the patient, and his sister were treated individually. The parents were also seen as a couple.

The issues addressed in the psychotherapy were as follows:

1. Parental misunderstanding of giftedness
2. The patient’s social isolation caused by
   1. Peer rejection
   2. An idiosyncratic, precocious intellect that permitted secretive, spiritual, and magical thinking
   3. An inadequate educational setting
   4. The parentification of the patient and his sister

The goals of the psychotherapy were to help the patient engage in age-appropriate social tasks and to find an appropriate setting for the full expression of his remarkable gifts.

The length of the psychotherapy, although not exactly specified, appears to have been relatively short term. Rather than terminate the psychotherapy, Dahlberg made himself available in an open-ended way so that all members of the family could and did request periodic consultations.