Finding a Way to the Child

I am going to describe some assessment work with the only child, a six year old boy, of a divorced mother.

They had been referred to the clinic by their GP who was asking for psychotherapy for mother, which had previously been recommended at another clinic, and indicating that the child's state of mind and health gave considerable cause for concern.

Mrs. S. had consulted her GP about her persistent headaches and leg pains, and about Alex's hair, which was falling out. Hospital investigations suggested that all their symptoms were fundamentally psychosomatic and not organic. Some months later, mother again expressed worry about Alex, who was speaking of “wanting to die”, saying that he would use a knife, and also sleepwalking. His mother felt he was disturbed by his frequent visits to his father—agreed access was three times weekly.

When this case was first considered, we thought it likely that both mother and son might need individual therapy. The degree of somatisation was worrying, but mother's persistent search for help was also striking. We felt concerned to provide a framework in our initial contact which could help her to distinguish between her personal needs and those of Alex—we had to devise an approach which took account both of her own difficulty and of her parental worry and active concern about Alex.

We decided to offer her an exploratory consultation with a social worker to sort out whether she wanted assessment for Alex, whether a treatment might be feasible practically, and to clarify the legal situation vis-a-vis care and control of the boy. A consultation took place in which it was explained to her that a therapist could be available for her subsequent to an assessment of Alex, and that a decision would be taken jointly with her about what help would be appropriate for him. Our initial work was therefore designed to try to clarify whether there was available a parental framework of responsible concern which would provide a reliable setting for work wit