Assessment of a Latency Boy With Obsessional Symptoms

Michel was 11 when he was referred to the Anna Freud Centre by his mother, Mrs S. About two years previously he had developed great anxiety about going to sleep at night. He would often be awake until late and spend some time in a variety of rituals. Mrs S had already approached two other agencies to get help for Michel. The first, the child psychiatric department of her local hospital, had prescribed night-time tranquillizers which had been of little benefit and had made Michel rather drowsy the next day. The second, the local child guidance centre, had suggested that Michel had been sexually abused and should be sent away to boarding school. Mrs S had disagreed both with the diagnosis and prescription from this agency and had come to us for a further assessment.

The possibility that Michel had been sexually abused had arisen out of the fact that it had been discovered three years previously that his sister Joan, four years younger than himself, had been sexually abused by mother's younger brother. At that time the child guidance centre had had a disclosure interview with Joan and subsequently there had been a number of family therapy sessions. Mrs S said that in these sessions the social worker and the psychiatrist were very explicit about what had occurred during the abuse. Apparently this had included penetration into every orifice. Michel had refused to talk, so it was not known either whether he was abused or had been witness to the abuse. Mother was at a loss to know how the abuse had occurred, as although Alex, her brother, had been a frequent visitor to the house, she could not see how he might have had the opportunity. Joan was 8 at the time of Michel's referral and the abuse had occurred roughly between the ages of 2 and 4. This had been ascertained retrospectively, since during those years Joan had had constant vaginal thrush and cystitis as well as loose bowel movements. At the time, the cause of this had not been suspected and the abuse only came to lig