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I have always enjoyed the publications from the Cassel (such as Tom Main's ‘The ailment’ and Kennedy et al.'s The Family as Inpatient (1986)). This book edited by Lesley Day and Denis Flynn was no exception. Their title describes their work as ‘collaborative therapeutic care’, which presupposed a question for me about the feasibility of such collaboration between professionals working in different settings from the Cassel. Coombe, in one of the early chapters in the book, speaks of this collaboration as a ‘function of the institution as a container’ and he says, ‘A fundamental and vital feature of the Cassel treatment is the provision of containing structures…. These are multiple, and they extend far beyond the therapist-patient relations. It includes the existence, on a daily basis, of relationships of differing quality with groups and individuals allowing the holding and evolution of conflictual states of mind’ (p. 5).
Coombe's and Dowling's early chapters provide illuminating and thought-provoking accounts about work with different family members in a case of Munchausen syndrome by proxy. Coombe focuses on the way joint supervision with the psychosocial nurse and the mother enabled him to be aware of how he might ‘annihilate the child from his awareness’. Dowling, working with the poisoned girl, supplies the suggestion that one account of this syndrome can be depicted as ‘illnesses and injuries … used by parents, particularly the mother, to get attention for their own distress’ (p. 15).
Day, in her introduction, described their ‘work as a “landmark” case, showing the possibility of personality shifts in a parent with this diagnosis, previously deemed “untreatable”’. Day highlights the paucity of resources available for psychotherapy with adolescents in her introduction and explains that the Cassel provides a ‘last resort’ service at tier 4. This led me to reflect on ways in which clinicians, not at the cutting edge of a ‘last resort service’ but at levels 2 and 3,