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This commentary incorporates a lively discussion that took place in our Clinical Research Group at the Anna Freud Centre.
Responding to a clinical session is always a challenge. Processes are clear in hindsight but the session reflects the therapist's attempts to respond ‘on her toes’ to what is taking place in the analytic space. To do this she capitalises on the relationship and course of work that have been established. But these are unknown to the readers in these clinical commentaries. Therefore this kind of summary gives rise to many questions and fantasies in the commentator. These will influence the way we look at the session and I will therefore spell them out.
John presents a discontinuity of experience with regards to himself and to the object. From her reported responses to him, I understand that the therapist has formulated the child's problem in terms of fragmentation and sees him as a child who cannot hold an integrated object in mind. It seems to me that this frame of reference defined her verbal responses in their session. On the other hand, my impression is that the therapist is warm and caring towards this vulnerable child, and that her affective attitude held the session together. I thought the child was responding to this in his non-verbal engagement with her.
Indeed I noted that at 18 months, an important age in terms of the capacity to integrate and symbolise, this child's life fell apart. I wonder how far his internal experience of discontinuity is related to the epilepsy, as a constitutional problem or, perhaps and, reactive to it. With this in mind we could view the child accruing experiences of non-chiming with the object around the epileptic episodes, with the object continuing to behave while he was ‘absent’ from the interaction during the fit. Parallel to a consequent dislocation in his self-other experiences, there could have