Milk and Tears: A Very Difficult Beginning: The Assessment and Treatment of a Young Boy with Atypical Presentation

Abstract

This article describes the assessment and treatment of Leo, a young boy who was seen in twice weekly psychotherapy for three years. The first part of the article presents the material obtained during the assessment process organized by following the framework of the 2001 version of the Provisional Diagnostic Profile (Davids et al., 2001). The second part addresses the main themes arising from the boy's treatment and reflects back on the initial diagnostic impressions following the assessment phase. We seek to illustrate the value of a thorough and detailed diagnostic framework in contrast to the limitations presented by the sole use of descriptive diagnostic criteria based on symptomatology.

Voices from the Anna Freud Centre

“…This special journal issue presents the historical backdrop as well as references contemporary research and newer theoretical integrations which stimulated and supported the substantive changes to the original profile and its application to clinical work. We also present a detailed clinical case (Melandri, 2017) illustrating the application of the profile within the context of an extensive treatment of a young boy with atypical development, and substantive commentary on both the case and the theoretical issues raised by the numerous articles (Altman, 2017;Kalas Reeves, 2017).…”

“…Providing historical background, including an article replete with rich memoirs of early psychoanalysts who worked with Anna Freud in the Hampstead War Nurseries (Ludwig-Körner, 2017), we can once again appreciate the extent to which Anna Freud's approach to observation and clinical formulation is foundational to many observational, diagnostic, and treatment approaches of today, even beyond the traditional psychoanalytic. The application of the revised profile to a detailed clinical case (Melandri, 2017) provides the reader with a window into the thought processes of a gifted contemporary child analyst as she considers the clinical material, uses her own responses to the child to facilitate her understanding, and intervenes. Accompanying the clinical case, two significant commentaries discuss the analytic work while considering the implication of shifts in theoretical formulation that are reflected in both Melandri's work and this newer profile.…”

Commentary on Federica Melandri’s “Milk and Tears”

“…"Milk and Tears" describes 5-year-old Leo's poignant psychoanalytic journey with Dr. Melandri (Melandri, 2017). Queried for autism and global developmental delays, Leo comes to treatment overwhelmed by the demands of nursery for which he is scarcely prepared, given the sorrowful atmosphere of his first few years.…”

The Proof is in the Pudding: Commentary on Papers Updating Anna Freud’s Diagnostic Profile

“…In Melandri's (2017) fine clinical case, 5-year-old Leo is preoccupied with road signs. We, the readers, come to understand that faced with an overwhelming reality, full of what Bion (1963Bion ( /1984 would call "beta elements," Leo struggles for a sense of orientation and direction.…”