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The Child Psychotherapist's main work is with children or adolescents individually. Ideally, one hopes that a colleague will support the individual work by working regularly with parents. Apart from regular reviews, the individual work is kept separate with a clear boundary. The patient's privacy is protected, and so is the setting within which the psychotherapist and the patient can work together on understanding the patient's internal reality.
In the case presented here, circumstances did not allow for such a division of labour. As in many Child Guidance Clinics, the Social Workers were under great pressure. They were made to undertake additional, time-consuming statutory work, and were unable to offer frequent, regular work with parents. A little later on, all of them resigned from the clinic within a short space of time. I, the Child Psychotherapist, was left with a young, very disturbed, adolescent patient in twice-weekly psychotherapy and an acute family crisis which threatened this adopted girl's placement with her family. I found myself undertaking weekly family therapy with them, while continuing to see my original patient for her individual sessions.
In this paper, I intend to describe the family work and its impact on the work with the girl, whom I shall call Louise. I have some thoughts about the experience in relation to some of the technical questions which arise over boundaries and about managing the counter-transference. Further questions are addressed about the difficulties in assessing individual pathology, perhaps particularly in cases of adoption, where there is a deprived, bereaved and traumatised family history.
Louise, who had been adopted at the age of fifteen months, was referred to me by the psychiatrist who had been seeing her since she was five. She had been referred to him by her adoptive parents. They complained that she was impossible at home, and always had been. She would rarely seek affection, and had been constantly