The treatment of children traumatized under the age of 3 years has presented particular challenges. The cognitive immaturity, lack of verbal fluency and uncertain memory capacities of very young children have made it difficult to know how traumatic events are represented internally and how their effects may be alleviated. Addressing these difficulties, this article describes the psychotherapeutic treatment of a 3-year-old boy traumatized at 22 months of age by a medical illness and its associated treatments. The goals of the therapy were to relieve symptoms and help the child integrate the traumatic experience, while promoting the parents’ crucial role in the child’s recovery. The case material illustrates the usefulness of active structuring of the child’s play as a vehicle for understanding the child’s experience of a trauma. It also documents the child’s impressive memory for the medical events and his comprehension of their implications, as well as the influence of the rapid developmental changes occurring in early childhood on the processing of the trauma. Lastly, the case highlights the disruptive impact of traumatically induced anger on children’s development and the importance of facilitating its appropriate expression so that a traumatic experience can be resolved fully.
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