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This is a vividly presented session of work with a highly complex case, involving emotional and physical violence between mother and child. In a situation of heightened and volatile emotions it is often difficult for the therapist to think, and the behavioural enactments force the therapist to act on the spot. The material raises questions regarding therapeutic frames of reference, the choice of technique in intervention, and the patients' experiences of the therapist in the transference and as a ‘developmental object’.
The referral was made because of Owen's ‘violent and disruptive behaviour’, particularly towards his mother and sister. The background information contextualizes the referral: Owen was exposed to violence in his parents' relationship in his first year, and he and his mother are now engaged in a mutually violent relationship, to which 8-week-old Susan is exposed. Thus we are alerted to the intergenerational repetition of interactions characterized by violence and terror. In infancy such relationships constitute trauma to the developing neuropsychological structures (Schore 2001).
The session contains enactments of all the above elements - violence, terror and trauma. Owen quickly presents this to the therapist through his hurt lip. He may also be expressing the family's hope that this is a place for ‘hurts’. Ms S's explanation of Owen's hurt lip immediately introduces her attributions and recriminations. Mother repudiates the therapist's attempts to explain Owen's behaviour (getting into a state and biting) in terms of mental states (because he was anxious about Susan's injection). She blames her children for her state of depletion (‘worn out’ by the sleepless nights). Owen tries to ‘interrupt’ - stop - his mother's thrusting anger. This is the here-and-now of attack and fear in their relationship. The therapist tries again to modify mother's negative attributions (of aggressive intent) by representing Owen's internal world - linking his wakefulness wit