The Foot in the Hole in the Dress: The Development and Use of Symbols in the Psychotherapy of an Eleven Year Old Girl*

Throughout the course of seven years of three times weekly psychotherapy one thing has been without question: Livia, an eleven year old Afro-Caribbean girl, has wanted urgently to communicate the quality of her internal world. It was this urgency that got through to Children's Home staff when she came into care aged three and a half. She and her brother of one and a half had been neglected and, in Livia's case, abused by their schizophrenic mother. They had been received into care several times but finally became subject to Care Orders after neighbours had heard Livia's cries and had seen her head jammed through a broken window. The mother had left the children to go to her evening class in computing. In the Children's Home it was found Livia could neither feed herself, nor play, nor sleep unless first tied down in her cot. She was either in a state of restless activity, or thumb in mouth she clung onto a member of staff. Much affected by her state, they referred her to a Department of Child Psychiatry for help, and a year later she started psychotherapy with me. By that time her legal status had been decided and, as a result of containment and consistency of care in the Children's Home, she was able to play and her language was well developed.

The therapeutic work which then began was characterised by a process which Bion described as the interplay between the container and the contained. His theory of development, and in particular of the development of thinking, derives from the model of the infant/mother relationship. The infant projects into the mother the emotions that he/she is still too immature to have developed any means to process. The infant requires a mother, who, drawing on her own internal object, is capable of receiving and processing the emotions in such a way that the infant is not overwhelmed by them. The mother is offering her baby what Bion calls alpha function. This function can be experienced by the infant as that which Bion called a “thinking