From command to request: the development of language in the treatment of a symbiotic psychotic child.

A discussion of "Separation-Individuation and Transitional Objects in a Four-Year-Old Psychotic Child" by Stavroula Beratis, M.D., Robert Miller, M.D., and Eleanor Galenson, M.D. The case study of the treatment of a four-year-old symbiotic psychotic child is presented. The child is in therapy at a day treatment program at the Psychological Center of the City University of New York as part of an ongoing research program studying the relationship of cognition and object relations in autistic and psychotic children. The development of the child's language and self-concept in the course of two years of treatment is discussed. His language is regarded as an indicator of the level and quality of self-object differentiation. A distinction is drawn between the pathological symbiotic state and the normal symbiotic stage, and maturation along the lines of separation-individuation is discussed in terms of the development of dialogue.