Commentary by a Child Psychotherapist and Psycho-Analyst

I found this clinical material both very interesting and particularly relevant to understanding some of the difficulties encountered in the treatment of disturbed adolescents. Paul might be seen as representative of many adolescents who desperately need psychotherapeutic help. Despite obvious risks and difficulties, Paul's frequent missed sessions (mainly before breaks) and his rather provocative and threatening way of relating, this boy seemed to me to be capable of valuing and using his therapy.

Paul seems a very vulnerable adolescent who feels trapped in an impossible situation: he wants his therapist to know about his anxieties, to see how fragmented and mad he feels, to see his anxieties about his sexuality, to tackle his ‘fakedness’, to see how he cannot bear knowledge of his loving feelings without distorting them in a perverse way, while, at the same time, whenever his therapist does try to approach this, it is experienced as an attack. It seems to me that whenever he is confronted with his own psychic reality, he feels threatened and attacked by the therapist who is experienced as containing the projections of his own ‘madness’.

It is worth bearing in mind Paul's need to resort to sado-masochistic actions, such as burning himself, suicidal thoughts and possible suicidal attempts, all of which provide