Intervention and Adaptation in the Third Year: The Mother-Child Dialogue

The following clinical report is based on a short-term, conjoint treatment of a 2¹/₂ to 3 year old boy and his mother. First we will summarise observations gathered during an assessment period at the beginning of treatment. We will discuss our understanding of the developmental significance of this observational material and describe the set of clinical hypotheses which grew out of this understanding and guided the subsequent therapeutic work. The clinical case report proper will illustrate the application of the above issues to the treatment situation and be followed by a discussion of treatment outcomes and our understanding of the causes behind them.

Six months before referral, when Andy was just two, there had been a terrible argument between Mr. and Mrs. Clayton, which took place outside Andy's bedroom. From his crib, Andy could only hear the angry, frightening words, and his father hitting his mother. His father left after the argument and was not seen again. Mr. and Mrs. Clayton were divorced soon afterwards. Mrs. Clayton became severely depressed and gave Andy no explanation of his father's disappearance. There had also not been any words on previous occasions to explain father's violent episodes which had punctuated family life, or his long absence when Andy was 3 to 15 months old. Mr. Clayton had a history of instability, including several short-term psychiatric hospitalisations.

When Andy was 2¹/₂ years, Mrs. Clayton called the Child Development Project at the recommendation of Andy's nursery school. The referral came 2 weeks after he had entered full-time nursery school. Mrs. Clayton reported that the school staff was concerned about his incomprehensible speech, his lack of awareness of danger, his refusal to follow instructions, and his aggression toward other children. Mrs. Clayton wondered if these symptoms meant that Andy had inherited his father's mental illness.

The assessment included a school visit, 4 home visits, and a developmental