The splintered holding environment and the vulnerable ego. A case study.

This paper describes the developmental dilemmas of children in long-term foster care whose permanent placement is delayed for years. Developmental theory and clinical research postulate the psychological risks to children who face the continuous threat of primary object loss. The detailed account of Matthew's case illustrates the effects of early neglect, abuse, and multiple separations on ego development. Matthew was removed from his birth mother at thirteen months but was not adopted by his foster mother until he was seven years old. He entered therapy when he was four. The clinical material reveals not only his strong will for survival but also his gradual internalization of the fear of primary object loss, his extreme narcissistic vulnerability, and his hypervigilance concerning danger, abandonment, and annihilation. He had great difficulty controlling his impulses. With some technical modifications, treatment enabled Matthew to strengthen his capacity for object relatedness, self-reflection, and learning. The paper demonstrates how important it is for social welfare agencies and the courts to be more cognizant of developmental theory and to recognize the need for earlier permanent placement determinations.