Clinical Commentary XVII

[The material was sent ‘blind’ to three clinicians who were asked to comment on the session and on how their way of thinking about the patient would inform their way of working with him. - MB]

John - 10 Years of Age

This session was taken from the middle of John's third term of three times a week psychotherapy. John lives with his parents and is the eldest of three children; they are a middle-class family. There was a previous miscarriage before John's birth. The second child, Mark, was born when John was 18 months old and the third child was born a couple of years later. Mark suffered a life-threatening illness, and the couple managed by dividing their care. Mother looked after Mark whilst John was looked after by his father. John began suffering from severe epilepsy at 18 months, but he has been stable for many years and has not been on medication for some time. John was eventually referred because of his odd and unmanageable behaviour which perplexed both his family and the staff at his special school. John habitually lived in a world of his own leaving him developmentally delayed in all spheres.

The following is a Monday session. There had been some uncertainty about transport, and we had spoken about it in the previous session.

John's dad acknowledged my arrival by looking at John, then up to the heavens in ‘mock’ despair. Meanwhile John was grinning widely, perhaps to himself. When he saw me he literally dropped what he was doing and eagerly joined me. He half spoke to me, mumbling in an excited way whilst flicking his hands ritualistically. Once in the room he calmed and opened his box taking out his telephone. ‘Now, boys and girls, I'm Miss Smith.’ I knew this to be the name of his teacher. He continued in this way and I spoke to him about how it seemed that right now John had gone. I talked then about how hard it was to be John at school, then John at the clinic, to be one place, then the other. John then seemed to leave his Miss Smith chara