Can I Wash Away My Skin Color? Compulsive Hand-Washing in a Ten-and-a-Half-Year-Old Girl

This is a clinical presentation of two year, twice-a-week therapy sessions with a ten-and-a-half-year-old girl suffering from compulsive hand washing and social isolation. In the background were her father’s business failure and parents’ marital crisis. I suggest that differences in appearance between parent and child, like marked differences in skin color, are experienced as empathic failures, thus interfering with natural experiences of merger, and processes of transmuting internalization and identification. Skin color resemblance or difference may become the source of identification and feelings of belonging or, conversely, of alienation, strangeness, and loneliness. The opportunity to relive these difficulties in therapy enabled the development of an idealizing transference toward the therapist, and thus provided the opportunity for internalizations that softened the girl’s self-attitude. My empathic stance toward her deep need for bodily resemblance, first to her mother and then to me in the transference, proved crucial for meeting her self needs of merger with an idealized parent and of feeling understood and worthy.