Conjoint treatment of a mother and her 16-month-old toddler.

This paper offers a partial account of the ongoing treatment of a 16-month-old toddler who presented with a history of a psychogenic rash; a feeding disorder; bowel retention; an intolerance to physical separation from mother, even in the house; and a marked insomnia, all dating from the time she was 8 months old. I came to understand the infant's constellation of symptoms, interpersonally, as part of a three-generational intercommunication that included toddler, mother, and mother's mother and, intrapsychically, as a failure in the separation-individuation process. A nodal point in the treatment and in symptom relief occurred when the toddler became aware, in her 17th month, of the anatomical difference. This clinical example is presented to support the idea (Roiphe & Galenson 1981) that such early genital awareness may act as a spur to ego development and may further ego organization, allowing the child an opportunity to master partially what had been phase-specifically traumatic during the symbiotic phase.