The Hollow Laugh: An Account of the First Six Months of Therapy with a Brain-Damaged Boy

He slumped in a big chair, like a rag doll. In contrast, his smart fashionable clothes seemed somehow incongruous. He raised his head so that he could see me from beneath the wide peak of his cap. His eyes looked in my direction, yet seemed dead. His mouth hung open, revealing irregular teeth.

This was my first meeting with James, an eight-year-old boy who had had a highly malignant brain tumour — a medulloblastoma — removed surgically when he was nearly five years old. The fact of the tumour, and the subsequent ordeals he had been through, were foremost in my mind.

His mother, Mrs E, whom I had already met for two meetings, sat by his side. She looked, as before, bright, well-dressed, and attractive. It was only upon closer contact in those initial meetings that I had sensed a tense, stressed side to her.

This first meeting with James arose as a result of his being referred to the clinic where I worked, for an assessment for psychotherapy. He was referred by the Consultant Child Psychiatrist at the hospital where he had received treatment and where he still attended from time to time for check-ups and further tests, including psychological tests. Mrs E's main anxiety was that her son was not progressing academically: if anything he was doing less well in learning to read and write than some months before. She worried if his school was doing all it could for him. He attended a local special school for physically disabled children. Mrs E's anxiety had led to further remedial teaching input. However, the Consultant Child Psychiatrist wondered if James could be helped emotionally. The referral included a request for help for Mrs E, a single parent, who apparently had coped admirably, but who was possibly in need of regular individual help. She had apparently, up to a point, used the support of a social worker and a community psychiatric nurse since James's illness.

Mrs E's strong wish for James to progress academically, and her hope that the proposed therapy — whic