Psychotherapy of a Young in-Patient with Dystonia*

Individual psychotherapy in a hospital in-patient unit differs in some respects from work in Child Guidance or out-patient settings. In particular the staff and other patients in the Unit form a duplicate family background during the period of the child's stay. The therapist therefore is regarded as being more closely linked with this ‘family’ than is usually the case. Frequently the patient appears to feel as if the therapist represents one of the parents, and the Unit the other. His efforts to manipulate them against each other, or his capacity to feel that they are working harmoniously together, can be seen close at hand and clearly. Further it offers an opportunity of inter-relating individual psychotherapeutic work with the temporary home environment, which is specific to this type of setting.

A case is described here of a boy who was admitted to the Department of Psychological Medicine in a Children's Hospital. He was suffering from both somatic and psycho-neurotic disorders, and in this respect was somewhat characteristic of the in-patient population, as also in the fact that while his disability was severe, no definite diagnosis had been made.

Pierre, a pale red-headed boy, was the son of a professional couple. His frame was short and slight with a severe postural deformity, which included sitting and walking bent almost double. The movement of head and neck was strained and not well-controlled. In walking there was a tendency for the right foot to turn outwards at a sharp angle. In addition he had great difficulty in vocalising, so that he spoke little, in a struggling whisper, while breathing in (instead of on exhalation). This sometimes meant that he stuttered over words and was difficult to hear. The diagnosis of dystonia musculorum deformans was considered, and remains a possibility, but since despite extensive investigation no organic basis could be established, it was suggested that there might be some form of conversion hysteria or allied psychogenic e