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Maintaining neutrality while preserving an empathic, observing, clarifying, confronting and interpretive stance that enables ongoing self expression, is critical for child therapists. Doing so in the face of aggressive, domineering and occasionally even explosive behavior is a far more difficult and demanding therapeutic task. This paper is an attempt to clarify the problem with a case illustration. DESCRIPTION OF THE CHILDSally, age 5, was referred primarily because she began to act out pregnancy fantasies at home and in school. Her mother, Ms. R., described her as pretending she was pregnant, putting a doll under her blouse, then taking the "baby" out of her blouse, wrapping her in a blanket, cradling her and pretending to breast feed her. This behavior occurred with great frequency shortly after her father had a baby with his second wife. While this was the precipitating factor in the mother seeking treatment, there were other issues that were essentially unacknowledged. There was a history of ongoing power struggles between the mother and Sally regarding such routines as sleeping, weaning, eating habits, and in general compliance with the mother's This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

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Multiple regression analysis of a wide range of variables for a sample of 58 women obtaining elective abortion identified psychodynamic factors as the only statistically significant explanations for seeking abortion at later gestational ages. Delay among these women was associated with greater disturbance in the basic sense of self as noted in indications of gender/sexual conflict on their drawings of a human figure, and lower achievement orientation ('striving') as expressed by lower levels of striving attributed to parents or other primary (early) caretakers. These findings are discussed as an active taking charge of an unintended pregnancy for women who present early for abortion; for those who delay, attempts to affirm a deficient feminine identification and/or reunite psychologically with the early caretaker are discussed as underlying dynamics.

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