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This paper is about an adopted boy whose treatment was in progress when his father died suddenly. Howard was just eleven when his father, aged fifty, died from a heart attack. He had had an attack in the previous July but had made an unexpectedly good recovery. Seven years before he had two serious attacks within a year of each other, both involving several months in hospital. His father's heart condition had overshadowed Howard's life since the age of three, although the final attack occurred without warning.
When Howard came into treatment at the age of nine he was seen for a year by a woman therapist on a once a week basis. When he was transferred to me I continued on the same basis for one term but in January I increased his sessions to four times a week. Six months later, two weeks before the summer break, his father died.
The main material which I would like to discuss is drawn from the five sessions which took place within those two weeks. This material can be linked with some of the typical latency reactions to the loss of a parent described in the literature: namely the short sadness span, the inability to mourn, the avoidance of pain through the use of manic defences such as denial, triumph, contempt and control. In Howard's case, however, these defences are not used rigidly to exclude feelings of shock and grief but they are the means by which he holds himself together and protects himself from the full impact of the distress which is present underneath and which at times breaks through momentarily. But before coming to this material I would like to outline his family background and the course of his treatment up to that point.
Howard was four weeks old when he was adopted. His adoptive parents had no children of their own but three years later they also adopted a baby girl. Howard's birth was normal. For the first four weeks he was looked after by a foster-mother and after his adoption by a part-time nanny until he was four. Father was active in the motheri