Psychoanalytic Conceptualizations of the Internal Object in an ADHD Child

Abstract

Several factors contribute to the dearth of psychoanalytic treatments and conceptualizations of attention-deficit hyperactivity disorder (ADHD). The author argues that psychoanalysis can contribute to standard treatments of such children. The prerequisites are the child's interest in change and the analyst's insight as to the legitimate aims of such treatments: to help the child discover his inner world and the connections between emotions, thought processes, and symptoms. The patient's reception of interventions varies. Sometimes, he is open to the verbal content of words. Other times, he reacts mainly to nonverbal aspects of the analyst's communication such as tone of voice, dress, or demeanor. The motor behind these vacillations is the present state of the child's internal object. When it is harsh, unyielding, and ridiculing, interventions are taken as assaults that must be defended at. Only in moments when it is welcoming and benevolent can the child use the intervention for building up his ego. The child's so-called semiotic capacity is related to the shifting state of the internal object. This has repercussions on both transference and countertransference. The discussion is illustrated by a six-and-a-half-year-old boy in child psychoanalysis while being in remedial and pharmacological treatment.

ACKNOWLEDGMENTS

I wish to thank Nic's parents for giving me permission to submit the clinical material in a de-identified form. The article was supported by grants from the Ax:son Johnson, Engkvist, Groschinsky, Kempe-Carlgren, Mayflower Charity, and the Wennborg Foundations.