Prestructural determinants in a case of phobia.

Questions of genesis, dynamics, and treatment techniques, in what is hypothesized as the first developmental layer of agoraphobic or pan-anxious symptoms, are considered. In the patient described it was concluded that this layer of anxiety came from many inadequate ego functions brought about by a mother who could not (for reasons speculated about in her history) tolerate autonomous functioning in this child. This mother-child reality shaped the course of the patient's first four years of therapy. During this period of treatment there was more material that lent itself to reconstruction of her real world as perceived by the developing ego, while there was a paucity of fantasy material available. It is suggested that the symptom state called agoraphobia resulted from continuous stimulation since infancy from a mother making dyadic functioning appear imperative for the patient's emotional equilibrium. In similar cases, the initial phase of therapy should focus on reconstructions and clarifications of past and present dyadic relationships. This, as well as other technical interventions to aid development of attenuated ego functions, appears to be necessary as the initial and crucial aspect of therapy.