Psychotherapy with an E.S.N. Head-hanker

My heart sank as I surveyed the pair in front of me. This was one of my first referrals at a new post; and I was well aware that my growing, decsion to try to work with this child stemmed more from the wish to get on and do something than from any real conviction that I could help. His mother was doing all the talking at me, listing her complaints in a harsh staccato voice which gave the impression that she took time to sharpen each sentence before hurling it forth. Her son, Joe, was never given the chance to say anything for himself. About all lie did manage was, at the end, to stammer out that he would like to come to see me. This clinched it to make a start, and somehow suggested that there was hope after all.

‘The neighbours all get at me because he never stops banging his head. They'd be happy if I got up a petition to have him put away. They all pick on him, and all the kids, too. They say he's a raving loony. The next door comes round and complains because they can hear him banging on the wall’. As she rattled off her accusations, Joe goggled at a point about three feet above my head and shifted about uncomfortably in his seat. If I asked him anything, he looked horrified, and could manage no more than a mumbled ‘yes’ or ‘no’ as a counterpoint to his mother's almost instant interjection.

Joe, it seemed, had begun head-banging just before he was two years old. This had continued unabated up until now when, at the age of thirteen and a half, he was attending the local delicate school. They had requested a psychiatric assessment as it was felt that things were generally going wrong for him. He was bunking off more frequently, which was not surprising as when he did attend he was regularly bullied. When this happened, his mother said, he returned home ‘in a mood’ and banged his head against a wall.

He was finding it hard to get to sleep of late. When he was at home his favourite pastime was playing with his vast collection of toy cars, on which he spent all his pock