You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
“My daughter, far from weeping for her fate, Forgives her father, nay invites me still To bow before the hand that cleaves her heart.”
I shall describe the assessment and psychotherapy of a seven-year-old girl who suffered serious physical abuse prior to being removed from her parents and taken into care. She was returned to her mother only during in-patient treatment at the Cassel Hospital Families Unit, which lasted in all eighteen months. Her psychotherapy was one element in the treatment arrangements offered to the family during their time there. I shall include some other selected elements of the treatment, in particular the nursing work with the family, and the mother's individual psychotherapy, in order to give some idea of the context of the child's individual treatment.
The aims of psychotherapy of abused children are twofold. The first is that which is common to all psychoanalytic psychotherapy, namely to understand the inner life of the child as it becomes revealed in the transference relationship to the psychotherapist. For this one needs to establish a psychoanalytic setting, with regular place and times to see the child. The setting in an in-patient establishment varies from that in an out-patient setting in some respects, which I shall describe shortly, but the commitment to the setting and an understanding of the transference is the same. The second aim is to understand the predicament of the child. By this I mean what has happened to the child, in particular the child's view of the abuse, and changes in the child's closest relationships and attachments, i.e. to the parents. There may also be a further series of disruptions in relationships to others, in particular foster parents and children's home staff, which occasion further upset and disturbance for the child. To understand the predicament of the abused child is also to recognise the effect not just of the abuse but of these crises of change upon the c