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This book is one of a series designed to present aspects of work at the Tavistock Clinic. Gianna Williams is a Consultant Child and Adolescent Psychotherapist drawing on extensive experience in the Adolescent Department and especially in its workshop on eating disorders. She writes with a lucidity that makes her subtle psychoanalytic understanding accessible to the general public as well as illuminating to her colleagues. There is an abundance of case illustrations demonstrating how the child's internal world comes to be constituted as it is and how this can be understood and eventually modified in the child's interaction with the therapist.
Most of the clinical illustrations are of intensive long-term work with very traumatised and deprived adolescents, but Williams illustrates the same processes in detailed observation of mothers and infants and some painful studies of young children in crèches and institutions.
These patients have not been able to establish in their internal worlds ‘an object who loves and protects the self and is loved and protected by the self’ (pp. 123-4). In some of Williams's cases, spoiling and destructive forces within the personality, that begrudge acknowledging a helpful object, prevent the internalisation of such a figure. She traces psychoanalytic awareness of these forces back to the Rat Man and comments on how Freud's exoneration of that patient from moral responsibility for the violence of his unconscious was superseded in Mourning and Melancholia by a recognition of how such unconscious attacks affect our internal objects and our self-esteem.
The main emphasis in this book is, however, not on spoiling and perverse impulses but on environmental factors that have prevented the child from establishing an object capable of what Bion described as containment, the ability to process emotional tumult and make some sense of it: Williams contrasts how we are born equipped with digestive systems in our bodies with the way in which, on the other