Commentary by the under Fives Counselling Service at the Tavistock Clinic

This description of a 3-year-old boy out of the control of his mother who feels helpless and hopeless is a familiar experience to those who work with parents and children under five. On this occasion there is a single mother with a history of unsatisfactory relationships with violent and now absent men. The small boy seems to take the place of the absent man and provide a relationship which feels like a substitute and a repetition. In this description his mother keeps telling the therapist about his excitement with ‘blood and gore’. There is a need on the mother's part to get the therapist to understand the importance of this and it dominates her communication for some time at the beginning of the session. How can one intervene effectively in this relationship which is so dominating mother and child and where the violence is projected back and forth between them?

The first issue is to engage them and the therapist has succeeded in doing this; this is the second session. It is necessary for the mother to feel supported by the therapist and the structure of the meeting, and it is clear in this second meeting that she does feel helped. She, with the therapist's help, is better able to control Owen, which she acknowledges in this session. An important part of this engagement comes from the mother's feeling that her concerns are listened to and accepted. She repeats several times the descriptions of Owen's excitement in upsetting her and his enjoyment of destructiveness, and it may be that in the earlier part of the session she is not sure whether this is being heard. The therapist is trying to make a link with Owen directly and this seems to cause the mother to become competitive for the therapist's attention. It is difficult at these moments to decide to whom to give the