Psychotherapy with a Blind Child
Authors: Bonaccorsi M. T. , Caplan Hyman 
Published: April 2017

We have tried to present enough of the case and the therapeutic process to describe this boy. Mike was born blind and prematurely. In addition, his family was struggling with many tragedies. His mother was depressed, distant, and preoccupied with her own ‘bad’ self and the defective children she produced. She was not readily available for gratification and stimulation.

We had no means of repairing his blindness or rectifying his birth history. We could deal with his denial mechanisms and those of his parents. We could work with Mike's inhibition of affect and inadequate object relationships. He could learn that there were many things he could do as well as things he could not do. We wish to underline that most of the psychotherapy was done with the boy and that the parents could begin to hope and do more for the boy only after he had made sufficient headway to pull them along with him.

The study of this case brings up two basic questions: — 1) What are the indispensable factors for cognitive development? and, 2) What is the relationship between affect development and cognitive development? The recent literature bearing on this subject has been reviewed.

Our tentative formulation is as follows: cognitive development depends essentially on a healthy ego apparatus and a stimulating environment. The stimulus is transmitted through the sensory modalities: as long as there is a sufficient sensory input the ego development will not be handicapped. The stimulus has two qualities: cognitive and affective. An important defect in either area will produce a distortion of the ego development generally. A sufficient sensory input does not necessarily require the intactness of all the sensory modalities: what matters is that enough information could be offered to the brain to allow concept formation and then abstract and creative, thinking. Mike suffered from a sensory deficit and emotional deprivation. In our work with him we acted mainly at the affect level, sensory deficit being irreversible. The result was a removal of symptoms at both the cognitive and the emotional level.

This seems to support the theory that “interpersonal isolation without sensory interference can produce symptoms; sensory deficit by itself, without affective and interpersonal isolation, need not”. To quote G. Klein (1): “The sensory modalities are only carriers of input for high-order, integrative achievement, but they are only carriers, not the indispensable organizers of this input”. A ‘blind child will perhaps develop a different ‘cognitive style’, but “there is very little to support the idea that blindness imposes an upper limit on the potential development of the synthetic function of the ego”.

The more, disabled the child is, the more important his world of people and early object relationships become. His dependency on ‘alter ego’ functioning and on stimulation of residual sensory capacity may have to go on for a much longer time than in the case of a normal child. Maternal care then becomes the crucial factor, mothering being defined as the source of a continual feed-back of reality at both the cognitive and the affective level.