Commentary by a Freudian Child Psychotherapist

I have sympathy and admiration for the therapist in her strenuous attempts to go on working in face of F's difficult and dangerous behaviour and the anger and feelings of abuse that were naturally aroused in her. No differences of view which follow detract from that. It demands the utmost from therapists as professionals and as human beings to process the denigrating behaviour and destructiveness which is directed at them by child patients, concretely not symbolically. In any case I take it that the main purpose of this commentary is to illustrate my own way of thinking about the material.

Immediate Reactions

I would have welcomed a more detailed history including an account of when the behaviour started and whether the parents were being seen - but we often find ourselves wishing we had more information.

The account begins with an impression of instability in F's care situation both in the past and in the present, possibly affecting F's attendance at his session on Friday. Therapy seems to have started in his first year of school. Was this also when the behaviour problems started? Or, as is often the case, did starting at school merely make public a problem which had existed for a long time before that? Loss of a nanny and a new escort - did F have as little warning as his therapist?

F ignores Mrs P. His first reaction to the missed session? Or a habitual beginning? Short sleeves - he strokes his arms and seems to be going to touch Mrs P - this in a boy who exposes himself. It looks as if there may be perverse elements in the transference. In the subsequent verbal abuse and smiling behaviour this impression seems to be confirmed. But it is difficult to evaluate without being there. Is it sadistic or some kind of triumph or what? This scene ‘by the lifts’ is always an awkward one for child psychotherapists. What should be our relationship to the child outside the consulting room? Don recognises that he is still in charge of F.

F's behaviour in the room and hi