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Tim and Jack are two adolescent boys who I have seen for once a week psychotherapy in a boarding school. Both are physically handicapped. Both were caught in a massive use of protective identification by their fascination for the scenes of cruelty which they phantasised happening inside Mother's body. These two boys felt that the congenital illnesses, which had actually affected them in the womb, and the subsequent damage and anguish they have suffered, were the result of sado-masochistic conflict taking place in the interior of Mother's body.
Tim, who was just fifteen when he started therapy, was referred because it was felt he failed to develop emotionally.
A severe congenital heart defect puts his life in danger. He is able to walk only short distances. His face is cyanosed and when, instead of using his wheelchair, he walks to his sessions, he gasps for breath. An operation to remedy the heart defect when he was four caused a blood clot which resulted in his losing the use of one arm, and having a somewhat limp leg. Six months before Tim's birth, his father underwent dental surgery and died under the anaesthetic. Tim's mother remarried and he has two younger half-siblings who live at home.
The session I will now describe took place after six months of work, and gives a vivid portrait of Tim, in that early phase of his therapy.
Tim had complained the previous week that because of therapy he only attended the first fifteen minutes of the woodcraft lesson. He talked of this lesson as he came in and then, to my dismay, told me how “that girl” in the school office had gathered together all my patients, in order to check the times of their session. “The girl” was actually the school secretary, a mature lady. According to Tim she had asked him whether he was satisfied with the time of his session. He had said he was not and had been told to discuss this with me. Instead he had arranged to swap times with another patient, but he then realized he