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Journal of Child Psychotherapy

Vol. 35, No. 1, April 2009, 62–80

Complications in the development of a female sexual identity
Jeanne Magagnaa* and Tara Pepper Goldsmithb

Flat 5, 33 Eton Ave, London, NW3 3EL, UK; b14 Rugby Street,
Flat 3, London, WC1N3QZ, UK

This paper describes the struggle to develop a female sexual identity and the
importance of the roles of the father and mother in this struggle. The clinical
illustration is taken from the psychotherapy of an anorectic adolescent.
Keywords: female sexual identity; role of the father; anorectic; introjective
identification; adolescent development

An anorectic girl’s development of her female sexual identity and the influential role
of the father will be presented in this article. Clinical illustrations will derive from
twice-weekly psychoanalytic psychotherapy with a 17-year-old anorectic Italian girl,
As I look around at eight anorectic girls in a group therapy session, I ask myself:
‘What common problems in developing a psychologically healthy female sexual
identity do these young women have?’ They are high-functioning in their academic
work, while at the same time they remain ‘little girls’ in their emotional lives. They
do not seem to view their emotions with ‘compassionate comprehension’ providing
reflective understanding. I am struck by how, as the group begins, they ‘don’t
remember’ intensely emotional events from the group meeting held only one week
previously. They all agree that ‘not remembering’ is one of the key ways they cope
with ‘difficult moments’, those difficult moments in which conflict, aggression or
psychic pain has been revealed. They often say, ‘‘I just don’t want to talk about it,’’
when referring to some very hurtful event. Turning to anorectic self-harm – that is,
starvation or cutting – seems preferable to crying or feeling sad, hurt or angry. More
than one patient has said, ‘‘I would rather cut than cry . . . crying is too painful!’’
Without exception, the girls find it difficult to differentiate what would ‘be rude’
to say to a person and what would be rightfully expressing a dissenting point of view.
To be a strong, assertive young woman seems a challenge; being a submissive young
woman feels safe.
Although all eight girls share these common problems, they dress very differently.
They might wear the clothes of little girls or the permanently present tracksuits of
latency-age boys or style their hair in pig-tails. Others have sexually developing
bodies, use make-up, wear ‘pop star’ trendy clothing of tight low-cut jeans and short

*Corresponding author. Email:
ISSN 0075-417X print/ISSN 1469-9370 online
Ó 2009 Association of Child Psychotherapists
DOI: 10.1080/00754170902750164

Journal of Child Psychotherapy


t-shirts, and have pierced ears, tongues, noses or belly-buttons. At the beginning of
the group, each girl firmly asserts that if she loses the identity of having anorexia
nervosa her emotional needs will not be met by her teachers, nurses, psychotherapist
and parents. More specifically, there is a certainty that the adults will not recognise
that the academically able adolescent girl is not psychologically ready to be
It is probably true to say that most girls have anxieties about becoming sexually
mature, but each of these anorectic girls is particularly anxious about losing her firm,
straight, latency-age body. Breasts and curved hips are invariably associated with
‘being fat’. They are also perhaps unconsciously associated with being sexually
mature/active; perhaps with being pregnant, for there is a feeling that you get ‘fat’
when you are pregnant; this fear is in addition to the cultural ‘taboos’ against being
fat. Menstruation represents something messy, dirty, the body out of control.
Control is felt to be needed and normal bodily rhythms seem out of each girl’s
control. There is a huge anxiety that the development of increased sexual impulses
and the ability to bear children can lead to the risk of encounter with persecutory
internal objects. Boys are fine as long as they are ‘just friends’, but confusion reigns if
a girl has a sexually and/or emotionally intimate relationship with a boy.
Several of the girls have had adverse experiences which contributed to a devalued
sexual identity. One third of these girls have had sexually abusive experiences
(Palmer et al., 1990). In addition, family therapy sessions have often revealed serious
parental quarrelling, clinical depression in the parents, parental eating disorders,
parental addiction to alcohol or drugs, and emotional and/or physical abuse of the
young people. I am struck by the number of girls born from ‘unplanned
pregnancies’. These family dynamics are symptomatic of a more basic issue: both
the parents and their daughters have difficulties in compassionately comprehending
the girls’ inner emotional lives. In lieu of compassionate comprehension of emotional
experiences, there is an early infantile development of primitive omnipotence (Briggs,
2002). Primitive omnipotence involves avoiding the frustrations of dependence on
the parents. Primitive omnipotence also prevents impingements of others by using
the self as the source of satisfaction. Omnipotence is aptly described in Paul Simon’s
lyrics: ‘I’ve built walls that none may penetrate . . . I have my books, and my poetry,
to protect me. I am shielded in my armour.’ For various reasons, explained more
fully below, each girl feels she must control rather than depend on the parental
couple. Simultaneously, each girl experiences limited depressive concern for the
parental couple; this concern would permit the internal parental couple to exist as a
sexual, nurturing pair who have other children besides herself. While these dynamics
are common to all the eight girls suffering from severe weight loss and anorexia
nervosa, each girl has a unique personality, a particular family narrative, different
responses within herself and different interactions with significant others.
Drawings by anorectic girls, some of which are shown in my chapter on
individual psychotherapy in Anorexia Nervosa in Children (Magagna, 2000) often
reveal a progression of development:

The experience of the self as ‘a very fat and ugly person’
The skinny, starved self caged in by omnipotent control
The self emerging with persecutory anxieties, fears of attack and rape
The wish to be in the middle of the parental couple, splitting them up, rather
than maintaining the generational boundary between parent and child

From hints the parents gave. Psychoanalytic psychotherapy with an anorectic girl The question posed is. or to modulate them if distressed and hating. Grazia’s traumatised and depressed mother did not pursue him to give any money to the family so they were financially bereft. This more spontaneous drawing of the normal adolescent female body suggests a spontaneous interplay between one’s bodily sensations and feelings and a compassionately comprehending self. a car mechanic. was fleeing from some financial and legal problems encountered in Italy. respectively. Goldsmith (5) Possessive jealousy of primary caregivers’ relationships with siblings (6) More integration of split-off parts of the self (7) Development of a healthy female identity comprised of identification with good parental figures. Her confused. Although underneath uniquely different from all other anorectic girls. Magagna and T. her expressions of pleasure. uncertain mother seemed like Grazia’s daughter. were six and four. with an abundance of curly shoulderlength chestnut hair. for many months they hid the father’s mysterious departure from everyone. and to thoughtfully hand them back to her in recognisable and now tolerable form (Waddell. despite the fact they were very short of money. The children were ashamed that they were without a father and. what each anorectic young girl shares with other anorectic girls is the reality that she is not psychologically ready to grow up and bear anxieties aroused by sexual development. When Grazia was 10 years old.P. Her parents emigrated to the UK from Italy when Grazia was eight years old and her two brothers. Prior to Grazia’s birth. Later it was discovered that the father was living with another woman and wanted absolutely no contact with Grazia. 1998: 31). Brief history Grazia is a 17-year-old brown-eyed Italian girl.64 J. Phase One: The psychotherapy assessment Grazia. Marco and Luca. to receive them. even slight encounters with sexual intimacy and the responsibilities of growing up. the mother had experienced severe clinical . Will twice-weekly psychoanalytic psychotherapy be sufficient to assist a very emotionally deprived and sexually abused anorectic adolescent girl develop a healthy female sexual identity? Can psychoanalytic psychotherapy provide sufficient compassionate comprehension to give meaning to this girl’s emotions and enable her to develop and internalise a good parental couple – the base of a healthy female sexual identity? Compassionate comprehension refers to the capacity of the psychotherapist unconsciously in be touch with the girl’s evacuations or communications of pain. severely emaciated and suffering from anorexia nervosa was accompanied to her first hospital appointment by her 37-year-old mother. the father suddenly disappeared from the family without giving his whereabouts or re-contacting the family who were left without any money. I wondered whether Grazia’s alcoholic father. her two brothers and her mother. to be able to engage with and savour them if calm and loving. for the mother appeared completely under Grazia’s control.

’’ I offered two sessions of psychotherapy per week and mother attended family therapy alone because the father and the two sons refused to join her. Phase Two: Acknowledging the body/self sensations of fat and the presence of omnipotent control If we are to help patients with their hidden heartbreak. food. For many years. I am not a ‘therapy person’. During the first nine months. exam anxiety and conversations about her two brothers’ laziness. ‘‘I’ve taken over dad’s role. severely emaciated 10-year-old latency-age shape.’’ In the assessment. with whom she associated and when she went out. Grazia stated that she was terrified by three things. Her two younger brothers jokingly referred to Grazia as ‘‘the little dictator’’ because she had taken the role of ‘a bossy dad’ in relation to everyone in the family. At 15. Grazia’s mother also felt grateful that her bright young daughter could – and did – take on the leadership role in the family when the father left home. bloated and fat if she ate. ‘‘No. not a ‘drinking person’. dependent.’’ Grazia went on to say. Mother’s depression. I took note of her response to my question about what adverse experiences she considered herself to have had had in her life. I discovered that she had slept with her parents until she was five years old and that currently she. 1986) Initially. ‘‘I want to be 34 kg and have A stars. omnipotent.Journal of Child Psychotherapy 65 depression for which she received medication but no psychotherapeutic assistance. getting take-away meals and cleaning the flat. Grazia trusted only her own common sense and felt she could not rely on her mother. Grazia was ‘a little dictator’ not only in her family. She added. her mother took a full-time cleaning job. When Grazia was 11. we have to make acquaintance with the despairing part of ourselves. (Tustin. I experienced Grazia as physically 10.’’ I said that leaves some other possibilities. Grazia denied any need for nurturance while maintaining a stick-like. but also in relation to the doctors. alcoholism and anxiety over being abandoned may have blinded her to the emotional dangers to Grazia in taking on this parentified role. not a ‘meal person’. her ‘bossy dad’ omnipotent identification now prevented her from acknowledging and developing the more vulnerable. Grazia firmly asserted that she wanted to be slim. Grazia said. feminine parts of herself. she had a lot of friends. ‘bossy dad’ identification felt a developmental necessity for Grazia to survive the anxieties of lacking parents both externally and internally to nurture and support her. Grazia had decided what she did with her time. She said. However. I look after my mother. For seven years she had been paying the bills. her two brothers and her mother still shared the same bedroom. whose attempts to weigh her were continually fought. She weighed 75% weight/height and although only 34 kg she wanted to lose ‘‘a couple of stones’’. Grazia said that she felt sick. she was a perfectionist. but she said. Grazia dominated the sessions with talk about food/dieting talk. In the initial assessment. ‘‘I haven’t been abused by my uncles or any family members. ‘‘I don’t want to get better. the doctor with the scales who had a duty to weigh her and missing school.’’ . Grazia’s sturdy. Nothing else has any meaning. she had stopped menstruating because of her low weight. but psychologically going on 25. she always liked to please people.

I like neither.’’ But Grazia wouldn’t talk about what was troubling her. She began plaintively crying throughout some sessions. ‘‘I might blame people and I am frightened to do that.’’ Fierce rows over eating escalated between Grazia and her mother resulting in her mother’s succumbing to Grazia’s refusal of both eating and hospital appointments. a sense of ‘high crime’ in her neighbourhood. In desperation.’’ Grazia. The worst thing would be for my body to look healthy while I feel in such a state inside. Magagna and T. She started describing large boys. Feeling completely frazzled. At least in this way.’’ As her weight dropped dramatically. she was also isolated and frightened by what was happening. I like to hear my stomach rumbling.’’ After a brief silence Grazia wistfully added. Grazia adamantly said. ‘‘You have such a sensible voice as a psychotherapist. I argued.P. her mother also refused to collaborate with the doctors to challenge Grazia’s decision to avoid inpatient treatment. I enjoy it. asking her to be the psychotherapist while I would be the patient. Then she quietly added. I don’t want to die. Grazia went on to elaborate: ‘‘If I am not dieting my mind gets filled with too much. There is so much unhappiness at home with everyone fighting. While in this role I firmly asserted. I don’t want help from anyone. I reversed roles with her. I will be ill forever. I suggested that she deserved to be understood. what is different when you get into your own mind?’’ Grazia replied. She then refused to come to the therapy. Feeling desperately concerned I made a series of phone calls in which I acknowledged that although Grazia was adamantly dictating one course of action. violent gangs.’’ I then resumed my role as psychotherapist and queried. She complained about ‘feeling numb’. how she ran when she saw boys. Georgia gained 8 kg and began menstruating. both inside and outside are the same. when the contraceptive effects of anorexia nervosa were not working.66 J. the lack of safety. in her role as psychotherapist calmly said. ‘‘My body is dehydrated. Goldsmith During one year of psychotherapy. ‘‘My girlfriends choose either the ‘grunges’ or the sexy. ‘‘You don’t want to go to hospital. I feel strong when I am in control. because her worried psychiatrist intended to continue weighing her when she came to her hospital appointments. Grazia proclaimed. She said. I don’t want to eat or drink except to have enough energy to live. I have such a maladjusted family. tough black boys. When I lose control I feel weak. It was then. it is terrible. a lot is happening. . too upsetting. this isn’t working!’’ In my role as patient. Grazia began crying in the sessions. I really miss my father who at least provided some structure in the home. ‘‘I will either kill myself or immediately run away if I am put into hospital. I like the pain of starvation. ‘‘You need to get some help looking after yourself. that the sexual problems became more obvious. I am starved.’’ Grazia replied authoritatively. I want to do things by myself. Grazia became extremely frightened and withdrawn. but I want to starve. but you need to. ‘‘I will kill myself or run away if I go to hospital. Finally I was able to help Grazia to come to a therapy session. It would feel even worse. during this therapy session. Terrified of putting on weight again.

Fat idiot. which she was bringing to psychotherapy to be healed (Rey. stupidity. Eventually. no structure. She was bringing both a damaged body and destroyed persecutory internal objects in which all goodness was gone. the dreams reflected more than these internal difficulties. the boys. I hate myself. they would both kill her and report her father to the police for ‘his criminal activities’. I hate me. It’s all my fault. no discipline. Dream Two: I cut myself and a boy grabbed my cut arm and swung me around. She then described two dreams: Dream One: I dreamt of a house getting smashed by a group of rough boys. In the dream. A father can draw on his own maternal ability to act as a container for . Grazia agreed that to stay alive she required the daily benevolent authority of doctors and nurses in the inpatient unit. she handed me a sheet of paper which read: I hate myself. Now only I take on that role. I would now like to explore various crucial factors. provided some authority. Subsequently Grazia had many regular discussions with a social worker. I hate.Journal of Child Psychotherapy 67 stopped quarrels between family members. however. which contributed to Grazia’s difficulty in developing a healthy female sexual identity. I hated the couple who didn’t protect me from them. cooked the meals. It was striking that Grazia projected aggression and directed aggression to herself in moments of emotional crisis. I hate myself. from birth. She was afraid to tell her parents about the abuse partly because she feared that her father would kill the men and then end up in prison himself. messiness. Grazia was also describing the state of her internal objects. I hate fat. and perhaps actual boys. seemed to be creating a lot of damage to both her physical body and her psyche. Shortly thereafter. fat and shame were all concretely directed to both her psychological and her bodily self. Grazia’s expressions of hate. I deserve everything I get. representing parts of Grazia’s anorectic and destructive self. Grazia disclosed that during the previous two years she was being raped weekly by two African young men who knew her father and threatened that. Fat and ashamed. 1994). The importance of the father’s role Ideally. As part of a long discussion regarding the contents of the diary sheet and her two dreams. if she gave away their identities. pleasure at the birth of a child is accompanied by feelings of envy and exclusion from the intensity of the early mother–infant relationship. but she refused to identify the young men in order to protect her father. My mother provides no food. In normal development. during the course of this session. There was nothing left but utter desolation. the father is involved with his daughter as a ‘third’ person mitigating the intensity of the mother–infant relationship (Trowell and Etchegoyan. I hate my body. including the sexual abuse. 2002).

This involves the father ‘staking a claim’ on his child (Campbell. 2005). the three dimensional character of the combined object – mother and father with baby – can create the foundation for the establishment of the infant’s own internal objects and all future object relations (Ermann and Lazar. the infant can risk hating the primary attachment figure. Moreover. however. 1931). leading to a profound sense of loss (Cooper and Magagna. and help his daughter think about her ambivalent ideas about growing up and becoming independent. Goldsmith the mother. 2005). In Grazia’s situation. In the absence of a competent mother. 1995) in order to help her to move from the exclusivity of her relationship with her mother to an inclusive position as part of a pre-Oedipal triad. With a present second parent. The father’s role could have been to modulate Grazia’s possessiveness. 1964). Grazia’s father could have assisted her in navigating a fundamental shift in her relations with the outside world that occurs as she matures physically. both sexual and destructive. and to bear distressing events without being overwhelmed by them. as his wife suffered from postpartum depression and later clinical depression. He could also help her in overcoming another profound loss: that of the loss of childhood and a child’s sexually undeveloped body. Generally. Magagna and T. formed an Oedipal partnership with her father (Ambrosio. Grazia’s father had the task of providing both the nurturing functions of the mother and the limit-setting thoughtful role of the father required to regulate emotional states. and revival of these original feelings is intensified by the dramatic physical changes of puberty. the baby girl finds ways of coming to terms with the loss of this exclusive dyadic relationship. because there is someone else to keep her alive (Winnicott. However. In Grazia’s home. However. Freud recognised the little girl’s attachment to her father as providing a refuge from her first attachment to mother (Freud. her father can excite the young girl’s interest in the outside world. masculine role. Grazia. 2002). the father can gradually develop a more active. As is the case with some single parents. She is faced with the fact that had her father been physically present she would now have the physical and sexual capacity to realise her Oedipal desires with her father. In order to develop. the arrival of this notion of a ‘third’ creates difficulties of its own. Grazia’s father had completely disappeared. 1987). to support her in caring for the newborn at this stage. an exciting and attractive alternative to the child’s regressive wish to return to a fused state with mother.P. Usually the ‘third’ changes the dyadic relationship to the mother and requires the infant to relinquish the idea that she is the sole possessor of the mother. In particular. The quality of this early infantile containment is tested again as Grazia enters adolescence. in the presence of an inadequate mother. In normal circumstances.68 J. He associated this with the introjection of ‘the role of the father’ as opposed to introjection of ‘the nurturing functions of the breast’ and considered that this was crucial in enabling the child to move from the paranoid–schizoid experiences to those of depressive concern for the mother–father relationship. The ‘other parent’ may be able to help the infant tolerate these feelings. Wisdom (1976) described the role of father in helping the child to accept frustrations. jealousy and hate towards the parents. While her mother represents the pre-Oedipal state with all its attendant anxieties. the good-enough father offers a second potentially rich and fulfilling relationship. the father had to take on the roles of the mother. Her longing for her father. as his daughter enters adolescence. her primary attachment was to her reasonably adequate father and her mother was ‘the rival third’ in her relationship with her father (Gluckman. .

By giving Grazia the feeling that she could be an ‘object of desire’. He may feel excluded. a form of creativity that is closed to him. so that she could move towards a more depressive state of mind. It was his task to hold Grazia’s aggression safely. This is a task that begins long before the onset of adolescence. The role of the father is especially crucial to young girls achieving separation and individuation from the mother during adolescence. her father could help solidify Grazia’s feminine identity (Ritvo. the role of Grazia’s father throughout her development became even more crucial. For a man. 1989). An absent. issues surrounding female sexuality and the capacity to bear children. starting long before the birth of a daughter. Grazia’s defensive phantasies of having some qualities of a hard. and involving them in joint endeavours. a mother lacking the emotional and intellectual resources to foster her development. Tessman (1989) found that the fathers were described as stimulating their daughters’ curiosity and independent judgement. Grazia’s mother was not in a good frame of mind – inadequate. Indeed this engagement is with the ghosts in the father’s own nursery. In this situation. Micati Squitieri (1999) has shown how. 1976). with the absence of a penis coming to form the symbolic representation of this for a girl. 1998). However. Grazia’s father had completely abandoned her. In a study of the life histories of women who have developed independent careers and lead a meaningful family life as well. the body too can come to be seen as wounded. fear of loss of her self became heightened as her body underwent dramatic transformation. The father’s denial of the importance of the maternal role may damage the value of the mother’s maternal functions in the young girl’s mind. To compensate for this. Grazia certainly hated having a woman’s body like her damaged and denigrated mother. and may take refuge in the patronising attitude that his wife is no more than an incubator for his child (Fast. needed to feel that her father was attracted and pleased by her attractiveness both physically and emotionally whilst not experiencing the father as being seductive towards her (Laufer. as an adult. he only served to . The father-to-be may feel that this is a mysterious power. 1979). Grazia’s father had indeed denied sexual differences and the importance of the maternal role in choosing a clinically depressed young woman whom he would have to replace in parenting his children. severely depressed and unavailable to her daughter. Grazia was identified with a damaged woman. firm male body were intensified and led to her concretely holding onto a ‘stick male body’ to avoid the soft vulnerability of a feminine identification.Journal of Child Psychotherapy 69 As Grazia developed the physical capacity to take on a sexual role. In Grazia’s adolescence. she could have sought ways of experiencing her new body as gratified. simply a stud for his wife’s pregnancy. like all young girls. when the self is felt to be precarious. Her internal mother with whom she identified was also attacked by Grazia’s Oedipal jealousy and rage about her mother’s inadequacies. Grazia. What are the implications of the absence of the father for Grazia? As an abandoning father. A ‘good enough’ father would have offered Grazia a chance to test out new parts of herself and new emotional possibilities in relations with others (Waddell. loved and appreciated in reality or in phantasy by her father in order to avoid the anxiety that threatened to overwhelm her when she felt unable to achieve this. abandoning father Chiland (1982) has rightly noted that the effects of an absent father on a girl must be considered in relation to the qualities of her particular mother. the pregnancy of his wife may form the stimulus for him to revisit.

but he also left them without his paternal/maternal roles of looking after the family. 1960). 1981) This poem bristles with rage and bitterness against her father who died when Plath was 10 years old. However. If Grazia’s father was absent. neglectful father. In his absence. Her very intense hatred of him may be seen in part as a projection of her own rage. Her father could have still fulfilled his role of affirming his daughter in the concrete way that is of vital importance in enabling healthy development as she entered adolescence and developed normal relations with her male peers (Burgner. I tried to die And get back. A similar example of this projected anger and hate is found in Sylvia Plath’s poem. But they pulled me out of the sack. and Grazia’s guilt and anger at his abandonment was split off to gnaw away at her internalised father and her selfesteem in identification with her internalised father. Grazia idealised her absent father and denigrated her depressed mother. her emotional life and her body. . ‘Daddy’: . I thought even bones would do. in Grazia’s situation. the girl can go back and forth.70 J. the picture becomes very black and white. Because her idealised father was absent and her depressed mother was so fragile. 1973). Without the opportunity of testing her phantasies against the reality of a more benign. A man in black with a Meinkampf look (Plath. However. but could come back and think with her. He had become ‘‘fed up doing everything for everyone’’ and both financially and emotionally neglected Grazia and her family. Grazia mainly directly her overt hostility towards her internalised parents. She obliterated thinking about emotions and resorted to ‘omnipotent control’ to feel safe in the face of her terrors. the father not only traumatised the family by abruptly disappearing. back to you. back. Neubauer. Magagna and T. testing her internal world against the reality. the man who bit my pretty red heart in two . her father would have stayed. Goldsmith increase her hostility. . paternal presence. rather than working through such raw emotions. Plath may have attempted to externalise these murderous feelings in order to cope with them in reality. persecution and dread’ (Meltzer. Grazia would have had the possibility of taking in the idea of a helpful. And then I made a model of you. The sexual abuse by men and her absent abandoning father created even more of a ‘bad penis’ filled with her projected anger and hate. present. This was a narcissistic blow to Grazia who felt that if she had been ‘good enough’. This sadistic father is created through rage towards the absent. There are many different kinds of absent father: those who remain in weekly or monthly contact and those. And they stuck me together with glue. With a present father. Studies of the young one-parent child and of adolescent girls in treatment found that absence or non-participation of a father frequently leads to overt overidealisation accompanied by inner phantasy of a terrifying and sadistic father (Leonard. Grazia’s aggressive and sadistic father prevailed internally. 1985). . ‘third’. like Grazia’s father.P. Simultaneously her absent abandoning father was consciously idealised. . who have entirely rejected their family and do not maintain any communication. These attacks created damaged. 1966. persecutory internal parents from which emanated a sense of internal ‘terror. . limit-setting.

she feared her father’s uncontained violence which also contained her own projected and internalised violence. merged with an idealised maternal imago. but also. Grazia’s hatred and profound disappointment in her parents makes them less adequate as internal helpers than her actual parents might have been. His mothering object was perceived as untrustworthy and dangerous. furthermore. the damaged maternal object became identified with the body. because this was equated with her repeated abusive experiences of rape. sexual abuse by another male followed abandonment by the father. Campbell (1995) described the analysis of a pre-suicidal patient. Then. and likewise with Grazia. each is underpinned by the fantasy that a part of the self will live on. and his father as aloof and distant. and the girl-speaker little more than the principle of masochism’ (Lord and Stone. because of her experience that husbands leave wives. for when sexual abuse occurs after a bad. 1981) she wrote in the same poem: ‘I made a model of you/A man in black with a Meinkampf look/And a love of the rack and the screw. With such a patient. abandoning father left Grazia vulnerable not only to the damage done to her self-esteem by the lack of a reassuring paternal presence. The absent. abandoning father has already been internalised. sexual abuse interferes with any introjection of a good father that did take place. Initially Grazia could have no boyfriend. he was abandoned by his father to the mercy of a damaged mother. his leaving his wife created further damage done to her identification with her already damaged internal mother. the anxieties resulting from an early failure to separate from her mother may be revived in adolescence with renewed force. and that this kind of survival was dependent on the destruction of the actual physical body. As was the situation for Grazia. and the fear of being left to starve if he did not.Journal of Child Psychotherapy 71 Of Plath’s own marriage as ‘a model’ of her relationship with her father (Plath. with whom she would identify as a sexually mature woman. and no sex. which reinforced her phantasies of the internalised parental . 1973). for whom separation from his mother and individuation proved too painful. and the presence of a bad man casts a powerful shadow over all psychic reality and all future relationships with men. was not good enough to keep her father. in infancy and then in adolescence. Grazia could not turn to her parents to talk about the traumatising sexual abuse because she had developed an internal image of a useless parental couple.’ In the poem. If the father is not sufficiently present or alert to his daughter’s needs. The patient was then left at the mercy of profound. In addition. She is left lacking the equipment to deal with sexual development and maturity. Grazia’s mother. primitive anxieties: the terror of being engulfed by the maternal object if his wish to merge should succeed. As in Plath’s (1981) poem. his leaving has reinforced in her mind the idea that men leave wives and men are callous and uncaring. ‘The father gradually becomes little more than the principle of sadism. the external father can offer no reassurance to his daughter as she approaches sexual maturity. Campbell (1995) notes that although there are different types of suicide fantasies. The influence of sexual abuse linked with inadequate mother and absent father In Grazia’s situation. It is too painful to explore the new relationships that come with adolescence. It was easy to see how she might come to feel that her own sexual development is almost life-threatening.

1976). the abusing men. Dream Four: I dreamt of being with an English teacher who is rushing around. Grazia made fun of some of her dreams as she described them: Dream Three: I dreamt that I brought my eight-year-old cat to church. Grazia remained afraid.P. already identified with a damaged mother. age-appropriate way. Her image of a bad penis. too busy to eat. Phase Three: Beginning to develop an inner mental space for linking sensations. While in psychotherapy. She desperately clung to the notion that she must count on herself and on her own ‘bright mind’. Goldsmith couple’s intercourse already ravaged by her own hostility towards the couple (Meltzer. abandoning father was Grazia’s denigrated. Thus isolated from establishing relationships with the opposite sex in a normal. also became bad because it was filled with sexual abusers and rapists. Someone leaves a baby with her. ‘The bad penis’ inside Grazia then became externalised and concretised in her unclear involvement with two men who regularly raped and terrorised her. She disliked ‘‘stupid thinking about things’’. coupled with her sexual abuse. . her psychotherapist. masculine self. absent. Grazia moved towards a lonely omnipotent identification with an idealised absent father accompanied by sense of a persecutory bad penis. 1987). 1967). Grazia’s body. So the clock stopped and Grazia became fixated to a regressed state of being ‘a little girl’. Grazia had become ‘the little boss’ at home it was very difficult for her to see any reason not to be in control and to be free to do as she liked. When she entered psychotherapy emotionally immature Grazia had a hard. feelings and thoughts The counterpart to the idealised. alcoholic mother to look after if she directly showed her anger to her mother. made developing sexual attractiveness a treacherous task and her anorexia became a natural outcome. I bravely commented that she had some idea that there was ‘a little girl’ who could be brought to therapy. She created a protective psychic retreat to avoid the pain and terror of working through the damage. an omnipotent self (Rosenfeld. This enabled her to become more involved in trying to think about her inner experiences. Grazia hated but at times concealed and denied her hatred of her mother for not being good enough for her and for her father to stay. She would have only have a more depressed. Magagna and T.72 J. distrustful and competitive with me. Having insecure attachments to disappointing parents. but she doesn’t have time for the baby. As an inpatient. She had no idea of how she might attract someone who might help repair the damage. She did not have such a need to focus upon her anorexia and her academic work. regulate and integrate her emotional experiences. unavailable mother and the inner terrors intensely magnified by the external aggressors. a little girl who lacked good parental care. depressed and inadequate mother (Kestenbaum and Stone. both used as omnipotent defences to survive the failure of damaged internal parental figures to process. I sensed that Grazia was mocking the psychotherapy when she linked therapy with going to church. Grazia was protected from some external traumas to her body and psyche. Now. Since after her father’s departure. which was designed to compensate for the absent father. Initially she was not so interested in the idea that I might help her understand her emotional life.

underneath the anorexia? What will happen if I let go of my anorexia and my intellectual control. the neglect of the children at home and the sexual abuse. ‘‘I feel fat. We are standing next to three crosses. ‘‘I hate that girl (my patient) who runs faster than me. Grazia revealed her terrors as she described how her mother had recently ‘gone mad’ and tried to strangle her. Grazia reported. on separate occasions. As we approached my two-week holiday. I feel useless and a failure. but instead directed hostile feelings to herself saying. since her father had abandoned the family. Grazia explained.’’ As she became more fully aware of her dependency on the therapy Grazia became ‘hungry to be loved’ and in competition with the other patients to become ‘the illest. who will I be then?’’ she asked. My security in life has been my friends. in identification with ‘unavailable parents’. I am being pushed over by one of the girls. unavailable mother and her abandoning father. ‘‘I have no feelings about my mother. Moreover. . my body has had so much dirty sex that I feel rubbish.’’ I described to Grazia how her hunger for compassionate understanding and care left her feeling greedy. huge. ‘‘I am afraid I will just be a pig. Why does my dad look after another family and not my family? What is underneath my anorexia? I wonder. Her ‘baby self’ remained abandoned as she had for so long kept secret the abandonment by her father. her departing therapist representing depressed. and her desire for a trustworthy relationship with a boy and as she acknowledged that the boys were offering her nothing more than a sexual relationship. her wish for intimacy with me. twice weekly therapy. she had not eaten and actually only considered her intellectual life. greedy. I want to cry. until she was literally dragged to the hospital. her psychotherapist. We also talked about how. She described another dream: Dream Six: I dreamt I was kissing an unknown teacher whom I really liked. horrible.Journal of Child Psychotherapy 73 what I offered to her. most worrying anorectic patient’. Grazia’s rage was linked to me. I talked about the propaganda issued by her omnipotent self that said I didn’t have time for her.’’ She could not tackle her feelings about her mother. Grazia bit her mother to prevent this from happening and later arranged for her to be admitted into a psychiatric unit. Subsequently. she hadn’t been to a doctor or dentist for years. do I have schizophrenia. fat. I described Grazia’s rage and greed as being connected to her wish to possess me completely. but I just feel numb. Subsequently. grotesque. to have me just for herself. I feel out of control. Grazia was consumed with rage: She complained: ‘‘I don’t know what to do with my rage. I hate sharing you with the other girls.’’ She continued bringing dreams: Dream Five: I dreamt I was with three girls. Then she repeated. Grazia felt sad as she realised the way she confused her longing for a good father and mother. I think I should feel sad.. She embarrassedly mentioned that her wish to immediately have someone to be intimate and close to her overtook any judgement about whether or not the boy was to be trusted and about whether or not he cared about her. ugly. Grazia became sexually involved with several boys. a man. seemed so little for the baby in her that needed and wanted so much more.

who only wanted sex with her. Before she returned to therapy to report the dream. The phantasy of an exciting penis. . bad objects. the ‘‘stupid mother-me’’ who encouraged her to fulfil her dream to go to university. I acknowledged her worry about schizophrenia and awareness of something ‘bad and terrifying’ inside. my partner. her friends and teachers she would be hated. my other patients. She screamed at me. or the acting out with a sexual adventure. She also sometimes retreated to anorectic starvation routines because they gave her ‘an endorphin high’.74 J. I added that it was up to us to discover its nature. Subsequently Grazia had a dream. Magagna and T. dangerous and undesirable. compassionately comprehending one’s emotional experience thus creating the psycho-sexual possibility of becoming a mother Grazia began menstruating and gaining weight as well as receiving top marks in her comparative literature university studies. I don’t want to tell anyone. She began meeting up with both old and new friends. I want to give up! I hate it here! I hate everything!’’. I am living with them. Now it was more obvious to Grazia that her own rage led to a feeling of inner damage and persecution. Grazia. She feared that if she didn’t placate me. ‘‘You have got it wrong! Nothing you say is right! I can’t cope! You haven’t helped me at all. already had an inner space filled with bad internalised parents. When she did return. and she feared that showing aggression to me would lead to a concrete repetition of her abusive history. Goldsmith I indicated her wish to get rid of my other interests. Her screaming at me had resulted in her feeling very persecuted and she missed the session. an encounter with concrete. Grazia chose to say yes to boys. external. was at times used by Grazia to deny painful feelings and to avoid the anxiety of fragmentation and dissolution of the self (Meltzer. she called me to say she didn’t feel like talking anymore because she couldn’t trust me. but I awaken and remember the dream. Grazia described the dream: Dream Seven: My horrible bossy aunt and uncle are both screaming at me. I can’t do university level work. 1973). I am holding their baby. Grazia’s fear of schizophrenia was linked with her lifetime history of trying to please adults apart from her mother whom she secretly denigrated as ‘‘a stupid woman with no common sense’’. In these two sessions as Grazia attacked the father and me. At times in this phase of psychotherapy.P. Then she then had two dreams: Dream Eight: There is a couple. the bad persecutory penis/male. I then squish the baby by mistake. Phase Four: The debate: to choose anorectic obliteration of feeling or to choose mothering one’s infantile self. her inner world became a dangerous place in which she was again increasingly persecuted by bad inner objects. Gradually though she brought the whole of her infantile self directly to me: Grazia entered university and had three essays to write for her comparative literature classes. her peers. She also became aware that feeling robust through maintaining a menstrual weight and developing sexually was felt as bad.

Gradually Grazia began to develop some notion of a different way of being.’’ She said she had tried to tell herself. At this moment. Grazia subsequently found a way of encouraging each of her divorced parents to meet her separately for an hour or so each week.Journal of Child Psychotherapy 75 Dream Nine: I am trying to get to a class with a psychology teacher who is perceptive. I am so afraid of losing my anorectic identity. She was trying to develop some of the sensitivity and thoughtfulness. and she was obviously going to have to help me understand how to get it right in terms of how she was feeling. Then she grumbled. financial help. Jealousy of another occurs. interested in the work. I understood that sometimes I got it wrong. cutting omnipotent. Grazia said: ‘‘They are who they are and they are my parents. When I meet my mother each week I feel a bit paranoid about what she will feel and say about my wish to tell her what to do. I am afraid to do this. I realised that Grazia was aspiring to become a different kind of person. my wish to have her all to myself. ‘‘I can’t though because there is a rigid ribbon coiling round my brain. She commented. masculine. Also she was aware that she was having to create a life with friends herself and that she had to let me have my life too. concern for her. ‘‘Unwind the rigid ribbon that has become so entwined in your hair that it has become a part of you. This gentler. I guess I will have to let her live her own life the way she wants to live it. I added that on the other hand. Grazia subsequently brought an image of a couple talking together. which she perceived as being present in our relationship. I told Grazia that she did often seem to feel the need to tell me what to think and say. We explored how something destructive interferes with Grazia holding. She then feels guilty and worthless and feels she has ‘missed the boat’ carrying her to a more fruitful life including developing insight in psychotherapy. but appreciated. I want to stay a little girl for fear I won’t get any help from anyone. but a hedgehog hurts me.’’ Grazia complained. caring for and developing from the insights she has gained in therapy. I end up missing the boat and not getting to the class. She also succeeded in helping them become fairly reliable in meeting her. holding it in check. I guess I just have to accept this is who they can be. more sensitive. with the pearls and hairstyle consisting of hair piled on top of her head. intellectual control. About her parents. I became aware that Grazia was attiring herself a bit too old for her age and rather identically to me. Grazia began seeing her parents again with more acceptance of both their disappointing. She did get worried about what I will think of this wish to boss me.’’ As she became further involved in a discussion of her parents with . Later in the dream I discover that one of my brothers has attended the psychology class. She denigrates herself and what she has been given. limited capacities to parent her and their minimal. help from friends. with their children exploring the surroundings. feminine way of being and feeling coupled and modified by thinking together with me was different from Grazia’s taking control of her life by herself with piercing. She started talking about moving forward in her life. magazines around them. therapeutic help.

will he like me. ‘‘I feel flat. ‘little dictator’ omnipotent self. Conclusion I have described how part of the work of psychoanalytic psychotherapy with an anorectic adolescent girl involves retracing and re-working the stages of early emotional development in the transference to the therapist. her mother and brothers returned to Italy to live with the maternal grandparents. I want to have a family. The other part of the work involves learning more about how the omnipotent destructive part of the personality and other parts of the personality attempt to achieve ‘psychic equilibrium’ rather than emotional development of the personality. however. existing both in the girl’s internal world and in the form of external sexual abusers is masked by a masculine. . I have a lot of friends. I talked with her about how there was a little hope which enabled her to think about having a boyfriend. ‘a seductive female’. ‘a studious saint’ or simply as ‘a little girl with a fragile self’. . I need to eat in order to do that. Grazia was able to gain weight: I just sit in Costa Coffee looking at a group of mothers with their babies. father figure or sibling figure and projecting into others one’s feelings of rage. Grazia has found a new psychotherapist in Italy and she is successfully continuing to develop as she pursues her university studies.P. will he just want a fling or will he just drop me because of who I am and what my family is? I don’t want a fling and I don’t want rejection.’’ She was having to mourn the absence of external parents as she grew up. An anorectic girl with ‘a false self’ faces many complications in developing a stable female sexual identity. tired and a bit lost. boys and girls. The masquerades are created through aggressively entering the mother figure. subsequently Grazia. jealousy. Goldsmith me Grazia said. At the end of this period of psychotherapy Grazia. I think. At times the self masquerades as a ‘hard Hitler’.’’ These hopeful thoughts inspire me to eat more normally. love. With my help. In another session Grazia lamented. The ‘haunting monster’. ‘the rapist’. Initially the presence of an attacked and damaged ‘combined parental figure’ and damaged internal babies creates inner terror. ‘‘I want to be a mother. controlling. hate and over-protectiveness. The problem is that when I start thinking of having a real boyfriend I immediately get worried . did find a boyfriend with whom she enjoyed the pleasures of a trustworthy intimacy and interesting cultural experiences. realistically. I want to have a baby.76 J. Magagna and T. but at times the voice of despair settled in and made it difficult to take hopeful steps in her life. She was trying to think about it sensibly. This more realistic view of her parents was assisted by the fact that Grazia’s needy and infantile destructive feelings were more fully accepted and understood in therapy. The therapeutic work in each session is thus complicated by a sense of ‘dissociated identities’ refusing to acknowledge the presence of other parts of the self. hard. When she alone did not have to bear the weight of all her intense feelings. The therapist must constantly use the .

discourse with the father and who can create/have other babies/ patients. weight. fear of menstruation. lesbianism and infertility all have been shown to have psychological implications linked with envy of the breast and its riches. inadequacy and lack of comprehension of external parents as well as the existence of internal persecutory internal figures. loss of proper neurological functioning and also claustrophobia. The neglect. There is considerable countertransference pressure on the therapist to remain claustrophobically trapped with the young girl in the musings of anorexia nervosa that can control everything . as a wife. When encapsulation of patient and psychotherapist through anorectic conversation occurs there is a starving of the infantile self requiring understanding (Magagna. The development of a female sexual identity is based on the complex interplay between a girl’s perpetually present unconscious internal family relations and her external environment (Laufer. can result in an inability for a girl to aspire. After various regressions to anorectic behaviour and sexual acting out. to become a wife with one’s own husband and a mother of one’s own . allowed the freedom to have intercourse. Grazia had the task of introjecting the compassionate comprehension of internal mother–father roles combining feeling with thinking. Dr Joan Symington (1985) described how the chance of a girl achieving psychic independence without undue guilt and depression depends to a large extent on the parents willingness to allow the girl to become independent and have her sexual identification with the mother. Grazia began to find ways of coming to terms with the love–hate relationship with me. Following my holidays there was a decrease in her need to miss a session as a way of controlling the times for meeting and projecting her rage and her sense of abandonment. gradually through psychotherapy Grazia began to identify with the mother who can love and look after the baby and contain the baby’s anxieties as well as with the mother. fear of breast development. I showed the sense of emotional impoverishment felt underneath this omnipotent intellectual control and anorectic thinking and behaviour. To achieve an appropriate female sexual identity. her jealousy into me. . hatred and separation from the mother. 1981). anal and genital attacks on the internal family members. 2008). jealousy of the mother’s babies and oral. As time progressed. 2000). inadequate mother influenced her in becoming ‘a little boss father’ at home with no compassion for feelings. . shape and feelings. hatred of the male. In the assessment session. Grazia was consumed with the fear of unreliable. During a later phase of psychotherapy Grazia gradually relinquished the role of being ‘a little boss father’ in the sessions.Journal of Child Psychotherapy 77 countertransference to be emotionally present to the anorectic girl’s discordant symphony of competing states of mind (Alvarez. Anorexia nervosa pretends to offer protection but ultimately it provides breakdown of physical health. Initially. Not eating. she has had to traverse emotional paths so different from her early patterns of development. filled with destructive projections. her psychotherapist representing the internal parents. the anorectic obsessional thoughts about fear of fatness and feeling disgusting forcefully occur and strangle the healthy mind. feelings of misunderstanding and the loneliness of existing in a vacuum with certain states of mind. uncomprehending parents as well as the physical and emotional trauma of repeated sexual abuse. When a crisis occurs and there are overwhelmingly intense emotions. because of her emotionally and physically abusive external life and her internal experiences. Grazia’s absent abandoning father coupled with her depressed. Moreover. to identify with mother.

inner and painful taking over of one’s self. AMBROSIO. However. M.P. International Journal of Psycho-Analysis. Grazia at times was able to say. Unpublished draft. social and academic progress can mask the lack of internal development. we have a moral responsibility to provide compassionate comprehension for the immature developing child within the anorectic adolescent . like a parent. The progress in the development of a healthy female sexual identity is further complicated by extreme deprivation and abuse.) (2005) On Incest: Psychoanalytic Perspectives. will reveal the nature of the girl’s female sexual identity.’’ Internal family relationships present in a girl’s dreams. A. London: Karnac. References ALVAREZ. I have highlighted aspects of development in therapy to illustrate some of Melanie Klein’s (1945) ideas regarding early Oedipal anxieties. I am sorry.) (2002) Surviving Space: Papers on Infant Observation. but a moral responsibility to find ways to establish inner development through psychotherapy for: The child. For an adequate female sexual identity to develop it is essential to develop a quiet. the roles of the damaged mother and absent father in influencing the development of a healthy female sexual identity. Compassionately comprehending the young person’s dreams as a reflection of the developing relationship with the psychotherapist as well as giving a picture of external realities of a young anorectic person will assist in noting and predicting difficulties in treatment and noting stages in her sexual development. External physical. 66: 311–20. International Journal of Psycho-Analysis. her love and her hate (Schore. must address the infantile self as well as more mature aspects of the developing personality. Implicit in my work is the understanding that the therapist. Grazia. A. (Gibran. BURGNER. 1999). daily worrying about who one is being with the self and others. 1994). a moral responsibility not only to help an anorectic young girl to regain her physical health by eating. Proceeding to marry and have children while having damaged internal parents often results in repetition of failures of the previous parent–child relationships as is shown in Alan Stein’s (1994) studies of anorectic mothers and their children. to help the young anorectic girl integrate and regulate her emotional life. (2008) ‘Types of sexual transference and countertransference in psychotherapeutic work with adolescence’. abused girls is difficult but essential to modify in psychotherapy. (1985) ‘The Oedipal Experience: Effects On Development Of An Absent Father’. and Dr Anne Alvarez who supervises my clinical work with patients and also to Tara Pepper Goldsmith and Ellen Jaffe who helped with the writing of this paper. . ‘‘thank you for staying connected to me. 1933) Acknowledgement I would like to express my gratitude to the heavily disguised patient. G. (ed. will be responsible for the next generation of children.78 J. Magagna and T. BRIGGS. Goldsmith children. Sadistic revenge (a common problem) in very deprived. (1995) ‘The role of the father in a pre-suicide state’. London: Karnac. In writing this paper. Sometimes I am really nasty. Remorse is essential for reparation of the damaged self (Murray-Cox. . D. 76: 315–23. a child of life’s longing for itself. . CAMPBELL. (ed.

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