Making Meaning through Play: Psychoanalytic Intervention in a Pre-School Child with Global Developmental Delay

ABSTRACT

Global developmental delay (GDD) is defined as significant delay in two or more developmental domains, including motor, speech and language, cognition, social/personal and activities of daily living. The prevalence of GDD is estimated to be 1–3% of children below 5 years of age, yet the child psychiatric and psychoanalytic literature is very limited as to effective treatment modalities for pre-school children with severe and/or multiple developmental delays. For these impacted children, the treatments are often highly fragmented with multiple providers typically prioritizing their own objectives with potential results, from the child’s and the parents’ point of view, of uncoordinated, confusing, challenging and anxiety-producing experiences. This case report, describing the first 2 ½ years of the psychoanalytic treatment of a 3 ½ year old girl with global developmental delay, proposes that, in the treatment of such pre-school children, a psychoanalytic play therapy model with multiple visits per week effectively can: (i) focus on and address the child’s developmental and emotional state as a whole; (ii) provide a safe, stable and containing developmental object relationship for the child to use effectively in their developmental process to build internal psychic structure; (iii) significantly decrease anxiety and oppositional or negative behaviors by verbally linking words and co-created meaning to difficult feelings, problems and memories and thereby provide the child with tools to understand and govern their own emotions and behaviors and finally (iv) help the larger system of parents and allied professionals organize the clinical data, prioritize goals and shift technique to consider the child’s mental states.

KEYWORDS:

• Developmental delay
• coordinated care
• psychoanalytic play therapy
• mentalization
• developmental object

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Notes on contributors

Susan L. Donner

Susan Donner, M.D., is a child, adolescent and adult psychiatrist and psychoanalyst in private practice in Woodland Hills, CA. She is a Training and Child, Adolescent and Adult Supervising Analyst, Chair of Child and Adolescent Psychoanalytic Training, and Director of the NCP 0-21 Child and Adolescent Clinic at the New Center for Psychoanalysis in Los Angeles. She is also an Associate Clinical Professor in the Department of Psychiatry and Biobehavioral Sciences at the UCLA Semel Institute of Neuroscience and Human Behavior. She is the 2019 winner of the AACAP Rieger Psychodynamic Psychotherapy Award.