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This paper is a presentation of my work with Rachel, a three year old girl whom I saw four times weekly for two and a half years at an outpatient hospital clinic. The work presented covers the first two years of therapy.
Rachel was brought for assessment by her father and step-mother because of increasing alarm over her behaviour at home. She was described as being agitated, tense and aggressively demanding. During the day she had repeated periods of screaming when she avoided physical holding or comfort. At night her sleep was also disturbed by frequent screaming tantrums.
Three months following Rachel's birth, her mother was diagnosed as having breast cancer. The on-set and subsequent progression of the disease was rapid and she died when Rachel was fourteen months old. Following their mother's death, Rachel and her older brother were looked after by a live-in nanny until their father re-married a year later. Rachel's difficulties began to surface following her father's marriage to her stepmother and escalated during the pregnancy and subsequent birth of a new baby.
I first met Rachel in the waiting room where she had come with her stepmother for her first session. She was reluctant to come with me at first, but soon took my hand and walked quietly with me to the consulting room. Inside the room she stopped still next to my chair, looked around and chewed her fingers. Then she began to look at me and we continued to look at each other for some moments. I felt an immediate liking for her. She stood smiling at me and after what seemed a fairly long exchange of looking at each other I began to speak to her about the toys prepared in a box for her to use whenever she came to see me, who I was and the times of our sessions together. I told her that her mummy and daddy had told me about some of the worries they thought she had been having recently and that her play with me in the therapy room could perhaps help her to sort out some of h