Therapeutic work with a physically abused preschooler.

This paper explores the impact of early abuse by a parental figure (foster mother) on a child's subsequent development. The child's adoption into a nurturing home at age 3-1/2 allowed for early intervention, and a brief follow-up period of treatment at age ten provides further insight into the impact of early trauma across developmental periods. The paper highlights unique challenges that may arise in treatment with child victims of interpersonal violence. During treatment, the child struggled with profound difficulty tolerating his natural aggressive impulses and distinguishing inner fantasies from external stressors. Significant modifications in treatment format, including encouraging the adoptive mother to be an active participant and using settings outside the consultation room when the child could not tolerate affects associated with the familiar playroom, were helpful in moderating the child's anxiety.