Aggression and impulse control in the analysis of a young boy.

The analysis of a young boy with aggressive, impulsive problems is reported with an emphasis on technique. The step-by-step analytic work is reported to highlight the gradual emergence of the underlying function, determinants, and developmental context for such difficulties, which helped guide the analytic work. An important focus is on the analyst as a developmental as well as transference object, the use of nonverbal communication until interpretation could be tolerated, and the ways to facilitate the development of reflective function. Needing to address both conflict and developmental interference, the analyst was always guided by the level of mental organization when making interventions. The important work with the parents is also carefully described.INTRODUCTION AND BACKGROUNDMATT, A STURDY-LOOKING, LIGHT-BROWN-HAIRED, BLUE-EYED, ATTRACtive three-and-three-quarter-year-old boy, with a cleft in his chin, has been in analysis exactly two years. Always wearing sneakers that light up as he walks, or stickers with shiny exteriors, he is in constant motion. His clothes are always clean, despite the necklines being soggy from biting down on the neck of his shirts. His language is difficult to understand at times because he speaks so quickly and is unwilling to ever repeat himself. He was referred for having behavior difficulties at school and at home. Often he would be impulsive - spit, hit, kick, and bite with very little provocation. In school, in spite of indicated high potential, he gave up quickly on challenging tasks and shied away from tasks requiring attention and concentration, such as putting puzzles together or drawing. In fact, when the least bit frustrated with them, he would dump puzzle pieces or wildly toss crayons.Family situation: Although Matt comes from an intact family with abundant material resources, each parent in their own way was unable to be consistently emotionally available to him, being short-fused and unreflective people. Matt is the middle child (the only child of the three who was conceived through IVF), having a two-year-older sister and a two-year-younger sister, both of whom are well-behaved and wellrelating children. Matt stands out as difficult and problematic, often attacking his siblings without clear cause. Mother is an overly anxious woman, often overwhelmed by taking care of three young children under the age of six, despite having a good deal of help. She enjoys being a full-time mother and has never worked since she married. She has long-standing anxiety in relation to aggression, was always quite bottled up, putting a premium on "nice" behavior, but prone to sudden raging outbursts. Her own mother was prone to rages and permanently cut off friends or family members ruthlessly after a fight. Furthermore, she has a disturbed younger brother who was quite aggressive. Mother often calls Matt by her brother's name. Father is from a warm, loving family, from whom he has difficulty separating. He is in the family business. Quickly becoming irritable, short-tempered, and unfocused, he has struggled with long-standing learning problems. He was felt to be of little help with Matt because he so preferred his older daughter and also was preoccupied with a lawsuit involving his successful business. Father confessed to his wife early on that he never really felt connected with Matt, since he reminded him so much of his competitive middle brother. Two of Matt's great-grandparents reportedly suffered from bipolar disorder.Developmental history includes the report of normal development throughout Matt's first two years. By the time he turned three, "all hell broke loose." Before that, Mother considered Matt a loving, cuddly, well-endowed child. He did have special sensitivities to smell, touch, and temperature, sometimes leading to disgust reactions to food and to the smells of Mother.The focus of this presentation will be on the analytic work with this young child, who refused to allow verbal interventions and became wilder and more aggressive the more I tried to put his feelings into words. …