Commentary by a Tavistock Clinic-Trained Child Psychotherapist

The session is dominated by the theme of transition. Transition between the outside and inside of a session, between one person and another, one place, experience and

state of mind and another. In the session John and his therapist explore John's infancy and his present age, and the transitions between sessions and terms of therapy.

In a general way, the session made me think about the brief history the therapist gives us at the beginning. John might have experienced a confusing and persecuting sense of loss of his mother both during and after her pregnancy with Mark; it seems that the session illustrates his struggle to understand what happened.

Despite John's developmental delay, he is a child with a wish to use his mind to think with, and to acquire a clearer idea of the sequence of important events in his life. He alternates between a more mature aspect of himself, asking questions and wanting to clarify things, and a more regressive baby-like aspect wanting the comfort of a pillow and blanket and playing a peep-bo game. In his communication he uses words and language to try to understand, and at the same time plays games that symbolise his experience of loss (such as the telephone and peep-bo). I was struck by John's inclination to talk rather than play, as if he were holding onto the more mature element in himself in his attempt to make sense of things.

In the waiting-room John's father expresses mock despair. Without knowing the nature of the therapist's relationship with the parents, this expression suggests the father's wish to engage in his own dialogue with the therapist, leaving John outside their interaction. It might indicate the ongoing burden of looking after John, showing how difficult it is for the father to stay in contact with his son. John's grin seems anxious, particularly because of the way he drops everything to engage with the therapist, the anxiety being quickly carried over into the flicking of his hands, as if he is letting go of his fathe