A Five-Year Old Child and Her Grandmother -Therapeutic Encounters in General Practice

When there is an opportunity in general practice to bring psycho-analytic ways of understanding to bear on the puzzled distress of the man-in-the-street or the family in the waiting room, the impact is deeply felt on both sides.

The setting provides direct access to people who know nothing about psychotherapy, as well as to those who have sought referral to a clinic, and been rejected, or have grown weary of waiting, or have been offered an inadequate therapy.

Asked by a patient in general practice, a woman in her fifties, to provide a sedative for her five-year old grand-daughter, the only child of her daughter who had died a month ago, I found that she was mildly surprised at my suggestion that she present the child. She explained that Sally's mother had died after many months in hospital, of a wasting illness. Her father's grief had given him the appearance of coldness towards his daughter, he had scandalised the family by consulting his diary and finding a previous engagement that would prevent him from visiting her at his mother-in-law's house. So they were planning to adopt her, and their one-bedroomed flat would have to be exchanged for a larger one. In the meantime Sally seemed to have taken the loss well, did not refer to the matter, and the family were careful not to show grief in her presence.

There was just one difficulty, Sally was refusing to go to bed at night, and would not go to her new school.

I suggested that it was most likely that she was after all suffering from the effects of her loss, but grandmother reasoned against this, repeating that the mother had been ill for a long time, and away from home, that they were all careful to shield Sally, and besides the idea of death was not new to her, a favourite uncle on the father's side had died six months earlier.

Sally and her parents were unknown to me, but I knew the grandparents to be affectionate, unpretentious, homespun, saddened by this cruel death, not accustomed by culture to express more than th