Interactions in the Treatment of a Child and her Mother: Extract from a Child Guidance Case

Child Guidance Clinics are perpetually faced with the difficulty of dealing with too many serious problems in too little time and with insufficient staff. It is rarely possible to offer more than once-weekly treatment, and even this to only a minority of cases. Consequently various techniques of limited therapeutic intervention with the child and/or parents have been devised. These techniques have been found to work when a child can be “caught” at the crucial moment before a disturbance becomes consolidated, so that the process of normal development can be set going again with relatively little intervention, (e.g. Winnicott 1966; Hood 1964; Harris and Carr 1966). Longstanding disturbances, where a neurosis is already established, are rarely amenable to brief interventions. Even here, however, experience shows that in suitable cases once-weekly treatment by analytically trained workers can alleviate problems to a greater extent than the mere giving of “first aid” or the making of environmental compromises. To illustrate this we present a selective extract from the first year of treatment of a mother-child couple who were becoming increasingly enmeshed in a pathological relationship, serious enough to make the workers concerned wonder at times whether anything short of simultaneous analysis could resolve it.

The Referral

Mrs. Thomas sought the Clinic's advice because Jean, aged eight, was demanding and clinging, suffered from disturbed sleep and had anxieties in regard to school.

Both parents came to the Social History interview and from their descriptions it seemed that the father, a thin, weary-looking man, was authoritarian in manner towards Jean, unable to demonstrate his affection and subject to outbursts of temper. He had had a heart attack when Jean was in her third year.

The mother, a pleasant-looking, middle-aged woman, saw herself as the peacemaker in the household. She was clearly anxious and depressed but seemed intelligent and warm. Her childhood