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She defines this object as a 'fusion of self and object representations'. She writes (1961, P*341): the mental representation of the symbiotic object is quite rigidly and permanently fixated to the primitive representation of the self. When in the course of maturational growth the ego is confronted with the incontrovertible fact of separateness, the fused symbiotic representations of self and object do not allow for progress towards individuation. We then see rage-panic reactions .. . I t seems feasible that John's illusion of the 'button', arising in the state when bodily parts were scarcely differentiated, would be formed and maintained by sensations from nipplelike objects in his mouth and other bodily 'holes'.

He then indicated both his shoulders with a semi-circular movement and said, 'I've got a good head on my shoulders. Can't fall off. ) Touching his own mouth he said, 'Nina's got a black hole. She had a prick in her mouth. Button broken! ) He took the plastic tractor which was a toy he had attacked remorselessly. He touched the plastic axle which is not in reality sharp. ' He spat as though spitting something that was repugnant. He then screwed himself up and screamed loudly. ) In his screaming he pushed away flying beaks.

With hindsight, I realized that these nightmare screams expressed infantile anxieties which had been active in relation to the father, the 'red daddy bus' and the button on the cushion-all of which seemed to have been equated. But, as long as the anxieties were scattered in this way, I could not sufficiently understand them to help him to come to grips with them. A session which occurred fifteen months after treatment had begun will now be reported in detail. In this session, anxieties which had been adumbrated in previous sessions were brought together and more clearly represented by means of words and toys.