This article discusses three clinical cases involving severe child sexual abuse. Each of the cases is analyzed from three perspectives-cognitive development, object relations and traumatic intrusion into the body of the children. In each case small and large synthetic penises the size of flaccid and erect penises were used as objects of play by the children because of clear and convincing evidence that these children were victimized by an erect penis. The penises were effective vehicles by which the children could reenact and discharge the fright from their traumatic injury when they did not otherwise have the verbal skills to relate their victimization because of developmental arrest and/or significant dissociative process. Therapeutic alliance and the necessity for negative and sometimes hostile transference neurosis in a safe therapeutic setting is emphasized as critical to successful therapy outcome.
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