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When I look back over all the years I have worked with psychotic children, I realise how much of what I have learned has come from them and how they have patiently and perseveringly showed me the way to reach them, to understand them, and perhaps to help them. My patients have taught me to be humble: not to interpret but to listen, to have a dialogue where they “know” something I do not, something that I can only know if I approach them in a simple and open-minded manner. Until now I have not come very far along this road to knowledge and understanding. It promises to be long, but others may travel it faster and better than I. Perhaps I can share with them the errors and blind alleys which have blocked the way but which, when examined carefully, have shown themselves to be of inestimable help in understanding the reasons for failure.
Perhaps the first problem we face when dealing with a psychotic child is simply to understand him: he does not use language, or he uses an incomprehensible language, he is not in the habit of playing, he tends to act rather than feel and he seems to have an entirely different conception from ours of time, space and causality categories. This happens to both “shell” children and “entangled” children (Tustin, 1978). Thus it is not rare to experience the session as though it were a mass of bizarre, disconnected and confused acts or an accumulation of apparently unmotivated emotional reactions such as sudden escape, attacks, panic or anger.
Thus the report of a session with one of these patients can seem totally incomprehensible; for example: “…the child hit the plastic rings several times, walked on tiptoe to the window, then hit the window with the palm of his hand and then, after touching all the games laid on the table, went toward the door, shouting something incomprehensible…” How can you understand this sort of material? How can you keep from falling into the trap of understanding what you want to understand? And, most important of all