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My experience in this field has been obtained by consultative, group work and counselling undertaken in a residential school for physically disabled children, which I have visited about fortnightly for the past 31/2 years, and by psychotherapy with two disabled childen seen at the Tavistock Clinic. I have also been greatly assisted by a Study Group, the members of which are child psychotherapists working with handicapped or chronically sick children in a number of settings, special day and residential schools, a residential home, clinics, paediatric wards and hospital departments.
My very limited previous experience in this field had led me to suppose that the physical disabilities were so evident and so distressing that no one could bear to think that these children might also have the hidden disabilites of psychic suffering, like any one else, or possibly more so. Despite a gradual increase of referrals of the physically disabled, this preconception has largely been confirmed rather than refuted by closer acquaintance with this field. I have slowly come to realise that the trauma and mental suffering of the physically disabled are difficult to perceive due to a bewilderment of complex defences which are activated both in the physically disabled and in those who work with them.
In this paper I intend to concentrate mainly upon some difficulties which are likely to be experienced in the counter-transference when we are working with children who have experienced external trauma. I shall make particular reference to what may be learnt from some counter-transference phenomena which may be specific to work with the physically disabled.
As we continue to extend the applications of psychotherapy we are increasingly drawn to work with those who have experienced external traumas in addition to the universal psychic trauma. The universal trauma arise from the losses and changes of normal development, especially those which are